Form 5490 DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS

OMB Approved No. 2900-0098
Respondent Burden: 25 minutes
Expiration Date: XXXXXXXXX

DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS
(Under Provisions of chapters 33 and 35, of title 38, U.S.C.)
INTERNET VERSION AVAILABLE - You may complete and submit your application online at: www.va.gov.

PART I - APPLICANT INFORMATION
3. DATE OF BIRTH

2. GENDER

1. SOCIAL SECURITY NUMBER

4. NAME (First name, middle initial, last name)

(MM/DD/YYYY)
FEMALE

MALE

5. CURRENT MAILING ADDRESS (Number and street or rural route, P.O., or City, State and ZIP Code)

6. TELEPHONE NUMBER(S) (Including Area Code)
MOBILE

HOME

7. EMAIL ADDRESS (If applicable)

8. DIRECT DEPOSIT (Attach a voided personal check or deposit slip and provide the information below. See Instructions for additional information.)
ROUTING OR TRANSIT NUMBER

ACCOUNT TYPE

(Routing number must be 9 digits)

CHECKING

ACCOUNT NUMBER

SAVINGS

PART II - QUALIFYING INDIVIDUAL INFORMATION (See instructions for #13)
9. NAME OF QUALIFYING INDIVIDUAL (PARENT OR SPOUSE) ON WHOSE ACCOUNT BENEFITS ARE BEING CLAIMED (First name, middle initial, last name)

10. SOCIAL SECURITY NUMBER OR VA FILE NUMBER

12. DATE OF BIRTH (MM/DD/YYYY)

11. BRANCH OF SERVICE

13A. DID PARENT OR SPOUSE DIE WHILE SERVING ON ACTIVE DUTY OR WHILE ON DUTY OTHER THAN
ACTIVE DUTY AS A MEMBER OF THE ARMED FORCES?
YES

NO

(If "Yes," is checked complete
Item 13D)

(If "No," is checked then you do not
qualify for the Fry Scholarship)

13C. DID PARENT OR SPOUSE DIE FROM A SERVICE CONNECTED DISABILITY WHILE A MEMBER OF THE
SELECTED RESERVE?
YES

NO

(If "Yes," is checked complete
Item 13D)

13D. DATE OF DEATH (MM/DD/YYYY)

(If "No," is checked then you do not
qualify for the Fry Scholarship)

14. IS QUALIFYING INDIVIDUAL (PARENT OR SPOUSE) CURRENTLY ON
ACTIVE DUTY?
YES

13B. DATE LISTED AS MISSING IN ACTION OR
P.O.W. (MM/DD/YYYY) (If applicable)

NO

15. DO YOU (APPLICANT) OR THE QUALIFYING INDIVIDUAL (PARENT OR SPOUSE)
HAVE AN OUTSTANDING FELONY AND/OR WARRANT?
YES

NO

PART III - RELATIONSHIP AND BENEFIT INFORMATION
16. YOUR RELATIONSHIP TO QUALIFYING INDIVIDUAL (Check only one)
SPOUSE

BIOLOGICAL CHILD

STEPCHILD

ADOPTED CHILD

(After marking your selection, please also complete Section I or Section II on page 2 and then proceed to complete Part IV.)

SECTION I - SPOUSE/SURVIVING SPOUSE
17A. DATE OF MARRIAGE TO THE QUALIFYING INDIVIDUAL? (NOTE: Date will be verified against information

entered on VA Form 21-686c, Application Request to Add and/or Remove Dependents)

17B. IS A DIVORCE OR ANNULMENT PENDING
TO THE QUALIFYING INDIVIDUAL?
YES

(MM/DD/YYYY)

NO

18. IF YOU ARE THE SURVIVING SPOUSE, HAVE YOU REMARRIED?
YES

NO

(If "Yes," please provide date of remarriage)(MM/DD/YYYY)
VA FORM
XXXXXX

22-5490

SUPERSEDES VA FORM 22-5490, JAN 2022,
WHICH WILL NOT BE USED.

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SOCIAL SECURITY NUMBER OF APPLICANT
SECTION I - SPOUSE/SURVIVING SPOUSE (Continued)
19. SPOUSE/SURVIVING SPOUSE SELECT THE BENEFIT THAT YOU ARE APPLYING FOR BELOW:

IMPORTANT ►
A.

PLEASE CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 4, ITEM 19 BEFORE SELECTING BOX "A"
OR "B" BELOW REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING. THE INFORMATION AND INSTRUCTIONS
ON PAGE 6 PROVIDE LINKS TO VA WEBSITES WHERE YOU WILL BE ABLE TO COMPARE "DEA" AND "FRY
SCHOLARSHIP" BENEFITS. YOU WILL ALSO FIND OTHER ELIGIBILITY RELATED INFORMATION THERE.

AS A SPOUSE OR SURVIVING SPOUSE BASED ON 100%
PERMANENT AND TOTAL DISABILITY, SERVICE CONNECTED OR
LINE OF DUTY DEATH, I AM APPLYING FOR CHAPTER 35 - DEA
BENEFITS.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

AS A SURVIVING SPOUSE BASED ON EITHER "IN THE LINE OF DUTY"
DEATH WHILE ON ACTIVE DUTY OR DUTY OTHER THAN ACTIVE
DUTY WHILE A MEMBER OF THE ARMED FORCES, OR A SERVICE
CONNECTED DEATH WHILE SERVING AS A MEMBER OF THE
SELECTED RESERVE AFTER SEPTEMBER 10, 2001. I AM APPLYING
FOR CHAPTER 33 FRY SCHOLARSHIP BENEFITS.

B.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

SECTION II - BIOLOGICAL CHILD/STEPCHILD/ADOPTED CHILD
20. BIOLGICAL CHILD/STEPCHILD/ADOPTED CHILD SELECT THE BENEFIT THAT YOU ARE APPLYING FOR BELOW:

IMPORTANT ►
A.

PLEASE CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 5, ITEM 20 BEFORE SELECTING BOX "A"
OR "B" BELOW REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING. THE INFORMATION AND INSTRUCTIONS ON
PAGE 5 PROVIDE LINKS TO VA WEBSITES WHERE YOU WILL BE ABLE TO COMPARE "DEA" AND "FRY" BENEFITS. YOU
WILL ALSO FIND OTHER ELIGIBILITY RELATED INFORMATION THERE.

I AM APPLYING FOR CHAPTER 35 - DEA BENEFITS.

B.

I AM APPLYING FOR CHAPTER 33 - FRY SCHOLARSHIP BENEFITS.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

Important - If your parent died in the line of duty prior to August 1, 2011, you may
apply for both DEA and Fry Scholarship benefits.
If you are eligible for both Chapter 35 (DEA) and Chapter 33 (Fry Scholarship)
benefits and you would like to use the Chapter 35 benefit first, check the box below.

Important - If your parent died in the line of duty prior to August 1, 2011, you
may apply for both DEA and Fry Scholarship benefits.
If you are eligible for both Chapter 35 (DEA) and Chapter 33 (Fry Scholarship)
benefits and you would like to use the Chapter 33 benefit first, check the box below.

CHAPTER 35 - DEA

CHAPTER 33 - FRY SCHOLARSHIP

IMPORTANT: If you are over the age of 18 once you receive either the DEA or FRY SCHOLARSHIP benefits, you will no longer receive payments of Dependency
and Indemnity Compensation (DIC) or Pension and you may no longer be claimed as a dependent in a Compensation claim. If you are under the age of 18, on your 18th
birthday you will lose eligibility for DIC or Pension payments and you will no longer be claimed as a dependent in a Compensation claim.
CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 5, ITEM 21 BEFORE COMPLETING THE ELECTION BOX FOR
QUESTION 21 BELOW. YOU ARE STRONGLY ENCOURAGED TO DISCUSS YOUR ELECTION WITH A VA COUNSELOR.
21. I CERTIFY THAT I UNDERSTAND THE EFFECTS THAT THIS ELECTION TO RECEIVE DEA OR FRY SCHOLARSHIP BENEFITS WILL HAVE ON MY ELIGIBILITY
TO RECEIVE DIC OR PENSION BENEFITS (Please read the Information and Instructions for ITEM 21 on Page 5 for additional information)
YES

NO

PART IV - AGE AND HIGH SCHOOL INFORMATION
22A. ARE YOU A CHILD UNDER AGE 18?
YES

NO (If "Yes," please refer to Question 23)

22B. ARE YOU A SPOUSE UNDER AGE 18?
YES

NO (If "Yes," please refer to Question 23)

23. IF THE APPLICANT IS UNDER AGE 18, HAS THE APPLICANT GRADUATED HIGH SCHOOL OR RECEIVED A GED?
YES

(If "Yes," please provide the date of graduation or the date you received GED)

MM/DD/YYYY

NO

(If "No," please provide the expected date of graduation or GED)

MM/DD/YYYY

24. WOULD YOU LIKE TO RECEIVE VOCATIONAL AND EDUCATIONAL COUNSELING? (Please read the Information and Instructions for ITEM 24 on Page 5 for
additional information regarding vocational and educational counseling)
YES

NO

25A. [DEA ONLY] DO YOU HAVE A MENTAL OR PHYSICAL DISABILITY FOR WHICH
YOU ARE SEEKING SPECIAL RESTORATIVE TRAINING? (Please read the
Information and Instructions for ITEM 25 Page 5 for additional information
regarding special restorative training)
YES

NO

VA FORM 22-5490, XXXX

25B. [DEA ONLY] DO YOU HAVE A MENTAL OR PHYSICAL DISABILITY
FOR WHICH YOU ARE SEEKING SPECIAL VOCATIONAL
TRAINING? (Please read the Information and Instructions for
ITEM 25 Page 5 for additional information regarding special
vocational training)
YES

NO

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SOCIAL SECURITY NUMBER OF APPLICANT

PART V - APPLICATION HISTORY
26. PRIOR TO THIS APPLICATION, HAVE YOU EVER APPLIED FOR OR RECEIVED ANY OF THE FOLLOWING VA BENEFITS? (Check all appropriate boxes)
A. DISABILITY COMPENSATION OR PENSION
B. DEPENDENTS' INDEMNITY COMPENSATION (DIC)
C. VETERAN READINESS AND EMPLOYMENT BENEFITS (Chapter 31)
D. VETERANS EDUCATION ASSISTANCE BASED ON YOUR OWN SERVICE (Specify benefit(s)):
E. VETERANS EDUCATION ASSISTANCE BASED ON SOMEONE ELSE'S SERVICE
F. OTHER (Specify benefit(s)):

IMPORTANT: Complete Items 27 and 28 only if you checked the box for Item 26E above.
27. NAME OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS (First, Middle, Last)
28A. SOCIAL SECURITY NUMBER OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS
28B. DATE OF BIRTH OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY
CLAIMED BENEFITS

28C. DATE OF DEATH OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY
CLAIMED BENEFITS OR THE DATE HE/SHE WAS LISTED AS MISSING IN ACTION
OR PRISONER OF WAR

MM/DD/YYYY

MM/DD/YYYY

28D. IS THE INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED
BENEFITS CURRENTLY ON ACTIVE DUTY?
YES

28E. PLEASE PROVIDE THE BRANCH OF SERVICE OF THE INDIVIDUAL ON
WHOSE ACCOUNT YOU ARE CLAIMING BENEFITS

NO

PART VI - APPLICANT'S MILITARY SERVICE INFORMATION
(NOTE: Chapter 35 benefits are not payable while an eligible person is on active duty)
29. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (If "No," skip to Part VII)
YES

NO
30. INFORMATION ABOUT YOUR PERIOD(S) OF ACTIVE DUTY

A. DATE ENTERED ACTIVE
DUTY (MM/DD/YYYY)

B. DATE SEPARATED FROM
ACTIVE DUTY (MM/DD/YYYY)

C. BRANCH OF SERVICE OR
RESERVE OR GUARD COMPONENT

D. CHARACTER OF DISCHARGE

NOTE: The most current information on VA Education Benefits is available online at www.va.gov.

PART VII - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
31. SIGNATURE OF APPLICANT (DO NOT PRINT) (You must be at least 18 years of age to legally sign this form. If

32. DATE SIGNED (MM/DD/YYYY)

under 18, your parent, guardian or custodian must complete and sign in Part VIII).

PENALTY: Willfully false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture
of these or other benefits and in criminal penalties.
PART VIII - SIGNATURE OF PARENT, GUARDIAN OR CUSTODIAN
(This section must be completed by the parent, guardian, or custodian if the applicant is a minor)
33. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (First, Middle Initial, Last) (Type or print)
34A. MAILING ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN
Number and Street
Apartment or Unit Number (If applicable)

City, State, ZIP Code

34B. TELEPHONE NUMBER(S) OF PARENT, GUARDIAN, OR CUSTODIAN (Include Area Code)
MOBILE:

HOME:

34C. EMAIL ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN (If applicable)
35A. SIGNATURE OF:
PARENT/GUARDIAN/CUSTODIAN (check if child is under

35B. DATE SIGNED (MM/DD/YYYY)

age 18)

VA FORM 22-5490, XXXX

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(Please retain these Information and Instructions Pages for future reference)
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS (VA FORM 22-5490)
Do not use this form to apply for Veterans' education assistance based on your own service (chapters 30, 32, 33, or 1606) or Veterans Readiness and
Employment benefits (chapter 31). To apply for Veterans' education assistance based on your own service, use VA Form 22-1990. To apply for Veteran
Readiness and Employment benefits, use VA Form 28-1900. VA forms are available at www.va.gov/vaforms.
NOTE: The numbers on these pages match the item numbers on this application. Items not mentioned are self-explanatory.
ITEM 8. The Department of the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit.
To enroll in direct deposit, please attach a voided personal check or deposit slip, and provide the information requested in Item 8. If you do not have a
bank account, please visit https://www.benefits.va.gov/benefits/banking.asp. This website provides information about the Veterans Benefits Banking
Program (VBBP), and a link to banks and credit unions that may fit your needs. The Veterans Benefits Banking Program (VBBP) will work with you to
set up an account, or help you qualify for an account, so you can use direct deposit. To get started, call one of the participating banks or credit unions
listed on the VBBP website. Be sure to mention the Veterans Benefits Banking Program.
NOTE: Federal regulation, found in 31 C.F.R. § 208.3 provides that, subject to section 208.4, "all Federal payments made by an agency shall be made
by electronic funds transfer" (EFT).
ITEM 13A. Please check Yes or No for this box if you are a child or spouse of an active duty service member or a member of the Selected Reserve and
the member died in the line of duty while serving. Note: Determination of 'died in the line of duty while serving on duty other than active duty' will be
determined by the Department of Defense and the VA.
ITEM 13C. Please check Yes or No for this box if you are a child or spouse of a member of the Selected Reserve and the member died after September
10, 2001 from a service connected disability as determined by VA.
ITEM 15. You will not be eligible to receive benefits for any period for which you or the qualifying individual on whose account you are claiming
benefits has an outstanding felony or warrant. Any benefits paid to you for such period will result in an overpayment and be subject to collection.
ITEM 17A. If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or
your spouse resided at the time of marriage or where you and/or your spouse resided when you filed your claim (or a later date when you became
eligible for benefits) (38 U.S.C.§ 103(3)). Additional guidance on when VA recognizes marriages is available at http://www.va.gov/opa/marriage/.
ITEM 19. IMPORTANT - PLEASE READ THE INFORMATION BELOW BEFORE MAKING YOUR SELECTION IN ITEM 19A OR 19B
REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING.
• To qualify for Survivor's and Dependents' Educational Assistance (DEA) you must be either:
(1) The spouse of a veteran who is permanently and totally disabled as a result of a service-connected disability, OR
(2) The spouse of an individual on active duty who has been listed as missing in action, captured in the line of duty by hostile force, forcibly
detained or interned in the line of duty by hostile force, or forcibly detained or interned in the line of duty by a foreign government or
power for more than 90 days, OR
(3) The surviving spouse or child of a veteran who died of a service-connected disability or who dies while a service-connected disability
was rated permanent and total in nature, OR
(4) The surviving spouse of an individual on active duty for which the evidence shows that the individual is hospitalized for receiving
outpatient medical care services or treatment; has a total disability permanent in nature incurred or aggravated in the line of duty in the
active military, naval, or air service; and the service member is likely to be discharged or released from such service for such disability.
• To qualify for the Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship, you must be the surviving spouse of a member who
died in the line of duty while serving on active duty or while serving on duty other than active duty while a member of the Selected Reserve or
from a service connected disability while a member of the Selected Reserve. The death must have occurred after September 10, 2001.
NOTE: If you are eligible for both Chapter 35 DEA and Chapter 33 Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship
(Fry Scholarship) benefits, you must relinquish/give up entitlement to one or the other benefit for which you are eligible, even if entitlement
arises from separate events. In other words, you must forfeit eligibility to the other benefit even if your eligibility is due to:
• A separate Period of Service (POS) other than the one for which the death of the spouse is associated; OR
• A separate POS other than the one for which your spouse has a total disability permanent in nature resulting from a service-connected disability,
death due to service connected disability; OR
• A separate POS based on any other criteria as listed in 38 U.S.C. § 3501(a)(1); OR
• Death of any other individual identified in Item 9 of this application.
IMPORTANT: You cannot retain eligibility for both programs simultaneously. Therefore, by checking either box "A" or box "B" in Item 19, you agree
and understand that you are making an irrevocable election to receive the selected benefit and your election may not be changed.
IMPORTANT: Eligibility for DEA will be terminated in the event that VA determines that the individual on whose account benefits are claimed is no
longer totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained.
VA FORM 22-5490, XXXX

Page 4

INFORMATION AND INSTRUCTIONS (Continued)
Note: Before making your election selection, you can compare the differences between DEA and Fry, and the benefits each provide in order
to help you make the best choice that suits your needs. This benefit comparison information can be found on the VA website at:
https://www.va.gov/search/?query=FRY&t=false. You can also find additional information about each program by visiting the
GI Bill website at: https://benefits.va.gov/gibill/ and using the comparison tool.
ITEM 20. IMPORTANT - PLEASE READ THE INFORMATION BELOW BEFORE MAKING YOUR SELECTION IN ITEM 20A OR 20B
REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING.
• To qualify for Survivor's and Dependents' Educational Assistance (DEA) you must be either:
(1) The child of a veteran who is permanently and totally disabled as a result of a service-connected disability; OR
(2) The child of an individual on active duty who has been listed as missing in action, captured in the line of duty by hostile force,
forcibly detained or interned in the line of duty by hostile force, or forcibly detained or interned in the line of duty by a foreign
government or power for more than 90 days, OR
(3) The child of a veteran who died of a service-connected disability or who dies while a service-connected disability was rated
permanent and total in nature, OR
(4) The child of an individual on active duty for which the evidence shows that the individual is hospitalized for receiving outpatient
medical care services or treatment; has a total disability permanent in nature incurred or aggravated in the line of duty in the active
military, naval, or air service; and the service member is likely to be discharged or released from such service for such disability.
• To qualify for the Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship, you must be the dependent child of a member who
died in the line of duty while serving on active duty or while serving on duty other than active duty while a member of the Selected Reserve or
died from a service connected disability while a member of the Selected Reserve. The death must have occurred after September 10, 2001.
NOTE: Children of a member of the Selected Reserve who died while on duty other than active duty DO NOT qualify for DEA. Therefore, you can
only apply for the Fry Scholarship.
PARENT'S DEATH PRIOR TO AUGUST 1, 2011 • The election you choose in Item 20 does not eliminate your eligibility for the alternate benefit (either DEA and the Chapter 33 Post-9/11 GI BillFry Scholarship based on the same event (i.e., your parent's line of duty death that occurred prior to August 1, 2011).
PARENT'S DEATH ON OR AFTER AUGUST 1, 2011 • The election you choose in Item 20 does eliminate your eligibility for the alternate education benefit (either DEA and the Chapter 33 Post-9/11
GI Bill-Fry Scholarship based on the same event (i.e., your parent's line of duty death that occurred on or after August 1, 2011). Therefore, you
must relinquish/give up eligibility entitlement to the benefit that you are not applying for but only with regard to the entitlement arising from
the same event (i.e., your parent's line of duty death that occurred on or after August 1, 2011). By checking either box "A" or box "B" in Item
20, you agree and understand that you are making an irrevocable election to receive the selected benefit and your election may not be changed.
IMPORTANT: Unlike spouses, children may be able to retain eligibility for both programs simultaneously if they qualify under different events and
individuals (i.e., a separate parent's line of duty death that occurred on or after August 1, 2011).
IMPORTANT: Eligibility for (DEA) will be terminated in the event that VA determines that the individual on whose account benefits are claimed is
no longer totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained.
NOTE: Before making your election selection, you can compare the differences between DEA and Fry, and the benefits each provide in order to
help you make the best choice that suits your needs. This benefit comparison information can be found on the VA website at:
https://www.va.gov/search/?query=FRY&t=false. You can also find additional information about each program by visiting the GI Bill website at https://
benefits.va.gov/gibill/, and using the comparison tool.
ITEM 21. Your election to receive Survivors' and Dependents' Education Assistance (DEA) or Chapter 33 Post-9/11 GI Bill Marine Gunnery Sergeant
John David Fry Scholarship (Fry Scholarship) in lieu of payments of compensation, pension, and Dependents' Indemnity Compensation (DIC) is final
and cannot be changed. This means that if you are 18 or older, payments of compensation, pension, and Dependents' Indemnity Compensation (DIC)
will be terminated upon issuance of a DEA or Fry Scholarship benefit payment. If you are under the age of 18, these benefits will be terminated on your
18th birthday. If you are planning to pursue a program of education for more than 36 months, you should consider deferring receipt of DEA for Fry
Scholarship benefits. We strongly recommend that you discuss your education or training plans with a VA counselor before making a decision.
ITEM 24. VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE: VA offers a wide range of services to assist you in
planning your educational and/or career goals. Services include educational vocational guidance and testing to develop a greater understanding of your
skills, talents and interests. For more information on VA counseling, call VA toll-free at 1-800-827-1000 or if you use the Telecommunications Device
for the Deaf (TDD), the Federal Relay number is 711.
ITEM 25. Any individual eligible under the DEA program may receive Special Restorative Training or Specialized Vocational Training if a VA
counselor determines that a specialized program is needed to overcome the effects of a physical or mental handicap. To be eligible for receipt of
specialized training, the disability must prevent you from pursuing an educational program. Examples of Special Restorative Training include speech
and voice correction, language retraining, lip reading, and Braille reading and writing. Specialized Vocational Training consists of specialized courses
leading to a suitable vocational objective.
VA FORM 22-5490, XXXX

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HOW TO FILE YOUR CLAIM
You may complete and submit your application online at www.va.gov which when filed electronically renders a faster eligibility determination or be
sure to do the following:
(A) If you have selected a school or training establishment:
Step 1: If you are not submitting electronically, please mail the completed application to the VA Regional Processing Office for the region of
that school's physical address. See below for addresses of the VA Regional Processing Offices.
Step 2: Tell the Veterans Certifying Official at your school or training establishment that you have applied for VA education benefits. Ask him
or her to submit your VA Form 22-1999, Enrollment Certification, electronically through the new Enrollment Manager.
Step 3: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.
(B) If you have not selected a school or training establishment:
Step 1: If you are not submitting your application electronically through https://www.va.gov/education/apply-for-education-benefits/
application/5490/introduction, please mail the completed application to the VA Regional Processing Office for the region of your home address.
Please check below for addresses of the VA Regional Processing Offices.
Step 2: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.

ADDITIONAL HELP COMPLETING APPLICATION
If you need additional help completing this application, call VA toll-free at 1-888-GIBILL-1. If you use the Telecommunications Device for the Deaf
(TDD), the Federal Relay number is 711. You can also get more information about education assistance at www.va.gov.

CONTACT VA FROM OVERSEAS
Students and School Certifying Officials calling from outside the United States can contact VA by phone at: 001-918-781-5678 during business hours, 7
a.m. - 6 p.m. CST, Monday - Friday. This is not a toll-free number but the caller will be routed to the next available customer service representative.
Non-overseas customers should call the toll-free number shown in "Additional Help Completing Application" above.

Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES
CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO/FPO AA

FOREIGN SCHOOLS

US VIRGIN ISLANDS

Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
SERVES THE FOLLOWING STATES
AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO/FPO AP

VA FORM 22-5490, XXXX

GUAM

AMERICAN SAMOA

PHILIPPINES

MARIANA ISLANDS

Page 6

REQUEST TO OPT OUT OF INFORMATION SHARING WITH EDUCATIONAL INSTITUTIONS
The Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public Law 115-48), also known as the "Forever GI Bill," requires the Department
of Veterans Affairs (VA) to make available to educational institutions information about the amount of educational assistance to which a veteran or other
eligible individual is entitled. If you are eligible for the Post-9/11 GI Bill (Chapter 33), Montgomery GI Bill-Active Duty (Chapter 30), Montgomery GI
Bill - Selected Reserve (Chapter 1606), or the Survivors' and Dependents Educational Assistance Program (DEA) (Chapter 35), you may elect to "optout" of these disclosures and have VA withhold this information instead. To request an opt-out, or for information about how to opt-out, please refer to
our website at https://www.va.gov/education/opt-out-information-sharing/, or click https://www.va.gov/find-forms/ to complete the VA Form 22-0993,
Request to Opt-Out of Information Sharing with Educational Institutions.
PRIVACY ACT INFORMATION: 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., awards of benefits) 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. Your obligation to respond is required to obtain education
benefits. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. VA will not deny an
individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still
in effect. The requested information is considered relevant and necessary to determine the maximum benefits allowable under the law. While you do not have to respond,
VA cannot process your claim for benefits unless the information is furnished as required by existing law (38 U.S.C. 3513). The responses you submit are considered
confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your eligibility for education benefits (38 U.S.C. 3513 and Public Law 116-315 Section 1002). Title
38 U.S.C. allows us to ask for this information. We estimate that you will need an average of 25 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. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at http://www.reginfo.gov/public/do/PRAMain. If
desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about this form.

VA FORM 22-5490, XXXX

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