Chapter 31 Request for Assistance (VA Form 28-10212)

OMB 2900-0882

VA Form 28-10212 will be used by claimants to request specific services, supplies, and equipment to participate in their rehabilitation program under the provisions of 38 U.S.C. 3100.

The latest form for Chapter 31 Request for Assistance (VA Form 28-10212) expires 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form VA Form 28-10212 Chapter 31 Request for Assistance (VA Form 28-10212) Form
2020-26566.pdf Supplementary Document
SupportStatement(2900-0882) (1).docx Supporting Statement A
2020-20650.pdf Supplementary Document
Chapter 31 Request for Assistance (VA Form 28-10212) Form

All Historical Document Collections

202009-2900-003	Extension without change of a currently approved collection	2020-12-30
202007-2900-018 Approved without change	New collection (Request for a new OMB Control Number)	2020-07-27