28-1905c Certification of Training Hours, Wages, and Progress

OMB Approved No. 2900-0176
Respondent Burden: 20 minutes
Expiration Date: 7/31/2024

CERTIFICATION OF TRAINING HOURS,
WAGES, AND PROGRESS
INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 4.
This form will be completed by the Certifying Official when Enrollment Manager is not an option to certify
training attendance under chapter 31 of title 38 U.S.C. and the training of eligible dependents under chapter
35 of title 38 U.S.C. This is also used for reporting a claimant's wages paid and monthly progress. The
Trainer must complete and sign this form and must be submitted to the Department of Veterans Affairs (VA)
no later than the 10th day of the month immediately following the month for which wages were paid.
Example: Wage statement for January is due no later than February 10th. For more information, you can
contact us online through Ask VA: https://ask.va.gov/, Ask us a question online or call us toll-free at
1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is
711. VA forms are available at www.va.gov/vaforms. After completing the form, if returning by mail, mail
to: Veteran Readiness and Employment (VR&E) Intake Center, Department of Veterans Affairs, P.O. Box
5210, Janesville, WI, 53547-5210.

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

SECTION I: CLAIMANT'S IDENTIFICATION INFORMATION
NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one
letter per box, and completely fill in each applicable check circles to help expedite processing of the form.
1. CLAIMANT'S NAME (First, Middle Initial, Last)
2. VA FILE NUMBER (If applicable)

SECTION II: TRAINING PROGRAM INFORMATION
3. NAME OF TRAINING FACILITY

4. ADDRESS OF TRAINING FACILITY (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
City

State/Province

Country

ZIP Code/Postal Code
5. NAME OF TRAINING PROGRAM

6. FACILITY CODE

SECTION III: TYPE OF TRAINING
7. SELECT APPROPRIATE TYPE OF TRAINING AND SPECIFIC PROGRAM.
ACADEMIC/VOCATIONAL PROGRAM (Specify below)
SPECIAL TRAINING
CERTIFICATION
NON-COLLEGE DEGREE PROGRAM

OTHER SPECIALIZED PROGRAM (Specify below)
ADULT BASIC EDUCATION
COMMUNITY BASED WORK EXPERIENCE
COOPERATIVE COURSE
FARM COOPERATIVE COURSE

APPRENTICESHIP

INDEPENDENT INSTRUCTOR COURSE
INDEPENDENT STUDY COURSES

NON-PAID WORK EXPERIENCE
ON-JOB-TRAINING (OJT)

REHABILITATION FACILITY TRAINING
TRAINING AT HOME
VOCATIONAL COURSE IN A REHABILITATION FACILITY
WORK HARDENING

VA FORM
XXXX

28-1905c

SUPERSEDES VA FORM 28-1905c, JUL 2021,
WHICH WILL NOT BE USED.

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SECTION IV: TRAINING ENROLLMENT
This section is to be completed by the Certifying Official. This section certifies that the claimant named in Item #1 began or resumed the type of
program specified in Item #7. The claimant continues to be pursuing or enrolled in that program.
8. ATTENDANCE IN ALL TRAINING PROGRAMS
8A. TERM

BEGIN DATE
(MM/DD/YYYY)

END DATE
(MM/DD/YYYY)

8B. TYPE AND
NUMBER OF HOURS

8C. TRAINING
TIME

8D. STANDARD CLASS
SESSION PER WEEK

S - SEMESTER
Q - QUARTER
D - DEFICIENCY
R - RESIDENCE
C - CLOCK/SHOP

F = FULL-TIME
3/4 = TIME
1/2 = TIME
L = LESS THAN
1/2 TIME

ONLY IF LESS THAN THE
TERM HOURS CERTIFIED
OR IF THE TERM IS
OF NON-STANDARD
LENGTH

9B. TYPE AND
NUMBER OF HOURS

9C. TRAINING
TIME

9D. STANDARD CLASS
SESSION PER WEEK

S - SEMESTER
Q - QUARTER
D - DEFICIENCY
R - RESIDENCE
C - CLOCK/SHOP

F = FULL-TIME
3/4 = TIME
1/2 = TIME
L = LESS THAN
1/2 TIME

ONLY IF LESS THAN THE
TERM HOURS CERTIFIED
OR IF THE TERM IS
OF NON-STANDARD
LENGTH

9. REDUCTION IN TRAINING HOURS
9A. TERM

BEGIN DATE
(MM/DD/YYYY)

END DATE
(MM/DD/YYYY)

10. TERMINATION OR COMPLETE WITHDRAWAL FROM TRAINING
10B. REASON FOR TERMINATION OR COMPLETE WITHDRAWAL
10A. DATE OF LAST ATTENDANCE
(MM/DD/YYYY)

SECTION V: TRAINING PROGRESS
This section is to be completed by the Trainer or Certifying Official to reflect the claimant's training progress.
11. APPRENTICESHIP, PAID OJT, AND NON-PAID WORK EXPERIENCE
11A. PROVIDE THE JOB
OBJECTIVES LISTED IN THE
TRAINING AGREEMENT

VA FORM 28-1905c, XXXX

11B. REPORT FOR THE MONTH OF

11C. TOTAL NUMBER OF
HOURS COMPLETED FOR
THIS MONTH

11D. TOTAL NUMBER
OF HOURS
COMPLETED IN
PROGRAM
(For apprenticeship only)

11E. RATING

O - OUTSTANDING
S - SATISFACTORY
U - UNSATISFACTORY

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SECTION V: TRAINING PROGRESS (Continued)
11A. PROVIDE THE JOB
OBJECTIVES LISTED IN THE
TRAINING AGREEMENT

11B. REPORT FOR THE MONTH OF

11C. TOTAL NUMBER OF
HOURS COMPLETED FOR
THIS MONTH

11D. TOTAL NUMBER
OF HOURS
COMPLETED IN
PROGRAM
(For apprenticeship only)

11E. RATING

O - OUTSTANDING
S - SATISFACTORY
U - UNSATISFACTORY

COMPLETE THE FOLLOWING BELOW FOR THE INITIAL TRAINEE'S HOURLY OR MONTHLY RATE OF PAY AND THEN UPDATE THIS SECTION
FOR ANY CHANGES IN TRAINEE'S RATE OF PAY (Do not consider overtime pay as a change in pay rate.) (Wages for Apprenticeship and OJT only)

.

12B. JOURNEYMAN HOURLY OR MONTHLY RATE OF PAY

12A. TRAINEE HOURLY OR MONTHLY RATE OF PAY
$

PER

HOURLY

MONTHLY

$

12C. BEGIN DATE OF RATE OF PAY LISTED IN ITEM #12A (MM/DD/YYYY)
12D. REASON FOR ENTRIES IN ITEM SPECIFIED ABOVE:

START OF TRAINING

.

PER

HOURLY

INCREASE IN RATE OF PAY

MONTHLY

OTHER (Specify):

12E. PROVIDE THE NUMBER OF HOURS THAT CONSIST OF A STANDARD FULL TIME WORKWEEK FOR YOUR PARTICULAR ESTABLISHMENT.

13. SUMMARY OF TRAINING PROGRESS OF SKILL DEVELOPMENT
NOTE: (The Trainer must document a summary of training progress and skill development below to include information related to the trainee's progress, attendance,
punctuality, ability to accept supervision and instruction, cooperation with co-workers, ability to perform assigned duties, any issues related to training, or changes in
the trainee's status.)

SECTION VI: VOCATIONAL REHABILITATION COUNSELOR CONTACT INFORMATION
14. NAME OF VR&E COUNSELOR

VA FORM 28-1905c, XXXX

15. EMAIL ADDRESS OF VR&E COUNSELOR 16. VR&E COUNSELOR TELEPHONE NUMBER

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SECTION VII: CERTIFICATION AND SIGNATURE
17. NAME OF CERTIFYING OFFICIAL

18. EMAIL ADDRESS OF CERTIFYING OFFICIAL

19. NAME OF TRAINER

18. EMAIL ADDRESS OF TRAINER

I CERTIFY THAT this statement and its information is true and correct to the best of my knowledge and belief.

PENALTY: The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material
fact you know to be false, or for fraudulent receipt of any document you are not entitled to.
21A. SIGNATURE OF TRAINER OR CERTIFYING OFFICIAL

21B. DATE SIGNED (MM/DD/YYYY)

PRIVACY ACT NOTICE: The responses you submit are considered confidential (38 U.S.C. 5701). Your obligation to respond is required in order
to obtain benefits. VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of
1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications,
epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an
interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as
identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Veteran Readiness and Employment Records - VA,
published in the Federal Register. Information that you furnish may be utilized in computer matching programs with other Federal or State agencies
for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your
participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: Use this form to maintain adequate records to certify hours of attendance, wages and progress towards the completion
of the training program (U.S.C. 3677). Title 38, United States Code allows us to ask for this information. We estimate that you will need an average
of 20 minutes to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of information
unless a valid OMB control number is displayed. VA cannot conduct or sponsor a collection unless a valid OMB control number is displayed. You
are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers are located on the OMB
Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.

VA FORM 28-1905c, XXXX

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