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APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS (Maryville University)

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APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS
22-1990E
VA FORM
DEC 2016
Use this form to apply for Transfer of Entitlement (TOE) to basic educational assistance under chapters 30 and 33 of title 38, U.S. Code
and chapters 1606 and 1607 of title 10, U.S. Code. Use this form only if you are a dependent of an individual eligible to transfer benefits
to his or her dependents. The service member's military branch must have approved the request to transfer benefits. The eligible service
member must have designated you by name, the number of months transferred, and the period for which the transfer is effective.
Do not use this form to apply for benefits based upon your own military service. To apply for benefits based on your own service use,
VA Form 22-1990. That form can be downloaded at www.va.gov/vaforms, completed on-line and submitted electronically at
www.benefits.va.gov/gibill (click "Apply On Line" and select the "Education" option). It can also be obtained from the nearest VA
regional office, and it may also be available where you received this application.
INFORMATION AND INSTRUCTIONS
FOR COMPLETING THE APPLICATION FOR VA EDUCATION BENEFITS TOE PROGRAM
VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE - If you need help planning your individual
educational and career goals, VA offers a wide range of counseling services to help you make these decisions. Services include
educational and vocational guidance and such testing as necessary for you to develop a greater understanding of your skills, talents, and
interests. For further information on VA counseling, call VA toll-free at 1-888-GI-BILL-1 (1-888-442-4551) or TDD at the Federal
Relay number 711.
NOTE: The numbers on the instructions match the item numbers on the application. Items not mentioned are self-explanatory.
Part II
ITEM 7. The Department of Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called
direct deposit. Please attach a voided personal check or deposit slip or provide the information requested below to enroll in direct
deposit. If you do not have a bank account, you must receive your payment through Direct Express Debit MasterCard. To request a
Direct Express Debit Mastercard, you must apply at www.usdirectexpress.com or by telephone at 1-800-333-1795. If you elect not to
enroll, you must contact representatives handling waiver requests for the Department of Treasury at 1-888-224-2950. They will address
any questions or concerns you may have and encourage your participation in EFT.
ITEM 9A. Select the benefit transferred to you.
ITEM 9B. Self explanatory, except for the following items:
"Vocational Flight Training." You must already have a private pilot's license. If you are taking an Airline Transport Pilot course, you
must have a valid first-class medical certificate on the date that you enter training. For all other flight courses, you must have a valid
second-class medical certificate on the date that you enter training.
"National Test Reimbursement." You can be reimbursed for the cost of approved tests for admission to or credit at institutions of higher
learning.
"Licensing or Certification Test Reimbursement." A licensing test is a test offered by a state, local, or federal agency which is required by
law to practice an occupation. A certification test is a test designed to provide affirmation of an individual's qualifications in a specific
occupation. Examples include EMT, CPA, MCSE, CCNP, etc.
ADDITIONAL HELP
If you need more help in completing this application, call VA TOLL FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you use the
Telecommunications Device for the Deaf (TDD), the Federal Relay number is 711. You can also get education assistance after normal
business hours at our VA Education Internet site www.benefits.va.gov/gibill.
HOW TO FILE YOUR CLAIM
Be sure to do the following:
(A) If you have selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of that school's physical address. See page 2
for the addresses of these 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 send your enrollment information using VA Form 22-1999, Enrollment Certification, or its electronic version.
Step 3: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.
(B) If you haven't selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of your home address. See page 2 for the
addresses of these 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.
SUPERSEDES VA FORM 22-1990E, JUN 2013,
WHICH WILL NOT BE USED.
Page 1
AK
CA
ID
NV
SC
Guam
AL
FL
LA
OK
TX
Philippines
Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
Central Region:
VA Regional Office
P.O. Box 32432
St. Louis, MO 63132-0832
Serves the following states:
IN
MN
ND
WV
AZ
HI
NM
PR
CO
KS
MO
OH
WI
IA
KY
MT
SD
WY
Privacy Act Notice: The 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, section 1.576 for routine uses (e.g., VA sends educational forms or letters with a veteran's identifying
information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to obtain further
information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her progress during
training) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment
Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain 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. The 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 enacted before January 1, 1975, and still in effect.
The requested information is considered relevant and necessary to determine the maximum benefits under the law. While you do not have to respond, VA
cannot process your claim for education assistance unless the information is furnished as required by existing law (38 U.S.C. 3471). The responses you
submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others may be subject to verification through
computer matching programs with other agencies.
IL
MI
NE
TN
CT
MD
NJ
VA
DE
ME
NY
VT
MA
NH
RI
Foreign Schools
DC
NC
PA
US Virgin Islands
Serves the following states:
AR
GA
MS
OR
Serves the following states:
APO/FPO AA
APO/FPO AP
VA FORM 22-1990E, DEC 2016
Respondent Burden: We need this information to determine your eligibility for education benefits (38 U.S.C. 3471). Title 38, United States Code, allows
us to ask for this information. We estimate that you will need an average of 15 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 1-800-827-1000 to get information on where to send comments or suggestions
about this form.
WAUT
Page 2
22-1990E
APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS
PART II - BENEFIT TRANSFERRED AND TYPE AND PROGRAM OF EDUCATION OR TRAINING
INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at: www.benefits.va.gov/gibill.
VA FORM
DEC 2016
1. SOCIAL SECURITY NUMBER OF APPLICANT
MALE
OMB Control No. 2900-0154
Respondent Burden: 15 minutes
Expiration Date: 12/31/2019
FEMALE
4. NAME
(First, Middle Initial, Last)
Account Number
VA DATE STAMP
(Do Not Write In This Space)
City, State, ZIP Code
5. APPLICANT'S ADDRESS
2. SEX OF APPLICANT 3. APPLICANT'S DATE OF BIRTH
Primary:
Routing or Transit Number
7. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. See instructions for additional Direct Deposit information.)
YearMonth Day
Apt./Unit Number
Secondary:
Number and Street
9D. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN
(e.g. Bachelor of Arts in Accounting,
welding certificate, police officer, etc.)
PART I - APPLICANT INFORMATION
6B. APPLICANT'S E-MAIL ADDRESS (If applicable)
LICENSING OR CERTIFICATION TEST REIMBURSEMENT
(MCSE, CCNA, EMT, NCLEX, ETC.)
CORRESPONDENCE
COLLEGE OR OTHER SCHOOL
(Including on-line courses)
TUITION ASSISTANCE TOP-UP
NATIONAL TEST REIMBURSEMENT
(SAT, CLEP, ETC.)
VOCATIONAL FLIGHT TRAINING
APPRENTICESHIP OR ON-THE-JOB
9B. TYPE OF EDUCATION OR TRAINING
(See instructions for additional information)
8B. DID YOU RECEIVE A HIGH SCHOOL DIPLOMA OR HIGH SCHOOL EQUIVALENCY CERTIFICATE?
(If "Yes," provide date)
9C. FULL NAME AND ADDRESS OF SCHOOL, IF KNOWN
8A. RELATIONSHIP TO SERVICE MEMBER
DATE:
SPOUSE CHILD
NOYES
6A. APPLICANT'S TELEPHONE NUMBERS
(Include Area Code)
SUPERSEDES VA FORM 22-1990E, JUN 2013,
WHICH WILL NOT BE USED.
9A. BENEFIT TRANSFERRED TO YOU (Select one box)
CHAPTER 33 - POST-9/11 GI BILL
CHAPTER 30 - MONTGOMERY GI BILL EDUCATIONAL
ASSISTANCE PROGRAM (MGIB)
CHAPTER 1606 - MONTGOMERY GI BILL-SELECTED
RESERVE EDUCATIONAL ASSISTANCE PROGRAM (MGIB-SR)
CHAPTER 1607 - RESERVE EDUCATIONAL ASSISTANCE
PROGRAM (REAP)
Account Type
SavingsChecking
Page 3
PART IV - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE
16B. DATE SIGNED
TO
YES
NAME AND LOCATION OF
COLLEGE OR OTHER
TRAINING PROVIDER
DATES OF TRAINING
JOB 2 SINCE HIGH SCHOOL
NO
PRINCIPAL OCCUPATION NUMBER OF MONTHS WORKEDEMPLOYMENT
MAJOR FIELD OR
COURSE OF STUDY
11A. FOR APPLICANTS ON ACTIVE DUTY ONLY: Are you receiving or do you anticipate receiving any money
(including but not limited to Federal Tuition Assistance) from the Armed Forces or Public Health Service
for the course for which you have applied to the VA for education benefits?
PART III - EDUCATION AND EMPLOYMENT INFORMATION
11B. FOR APPLICANTS WHO ARE CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY:
Are you receiving or do you anticipate receiving any money
(including but not limited to the Government
Employees Training Act)
from your Agency for the same period for which you have applied to the VA for
education benefits? If you will receive such benefits during any part of your training, check "YES."
10C. EMPLOYMENT
(Only complete if you held a license or journeyman rating to practice a profession)
JOB 1 SINCE HIGH SCHOOL
10A. DO YOU HOLD ANY FAA FLIGHT CERTIFICATES?
(If "Yes," specify below)
PART VI - CERTIFICATION AND SIGNATURE OF APPLICANT
NOYES
NOYES
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify that I
have consulted with an Education Service Officer (ESO) regarding my education program.
PART V - SERVICE MEMBER INFORMATION
PENALTY - Willful 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.
16A. SIGNATURE OF APPLICANT (DO NOT PRINT)
FROM
LICENSE OR RATING
NUMBER AND
TYPE OF HOURS
(Semester, Quarter
or Clock)
DEGREE, DIPLOMA, OR
CERTIFICATE RECEIVED
10B. EDUCATION AFTER HIGH SCHOOL
(Including apprenticeship, on-the-job training, and flight training)
13. SERVICE MEMBER'S BRANCH OF SERVICE
14. SERVICE MEMBER'S NAME
(First, Middle Initial, Last)
12. SERVICE MEMBER'S SOCIAL SECURITY NUMBER
15. SERVICE MEMBER'S ADDRESS
VA FORM 22-1990E, DEC 2016
City, State, ZIP Code
Apt./Unit Number
Number and Street
Page 4
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APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS (Maryville University)

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Completed 16 August 2020

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