(The items that are considered self-explanatory are not included in these instructions)
ITEM 3. If you (or the veteran or serviceperson) were previously assigned an 8-digit file number, enter this number.
ITEM 6. If you have not previously applied for VA education benefits, go to www.benefits.va.gov/gibill/, and click on "Apply for
Benefits". See the top of this form for the education benefits that permit reimbursement of Licensing or Certification tests.
ITEM 7. Write the complete name of the test.
ITEM 8. Write the complete name and complete mailing address (including ZIP Code) of the organization issuing the license or
certificate (not necessarily the organization that administered the test).
ITEM 9. Show the date you took the test and attach a copy of your test results. (If you do not have any test results but have a copy of
your license or certification and a payment receipt for your test, attach these documents.) Reimbursement of the test fee can't be paid
until this information is received. Provide this information for each test you want to receive reimbursement.
ITEM 10. Enter the cost of the test you took, including any required fees. (We can only reimburse you for required test fees.) We
have no authority to reimburse you for any optional costs related to the test process. Test fees that VA will reimburse include
"registration fees," fees for specialized tests, and administrative fees such as a proctoring fee. Fees that VA has no authority to
reimburse include fees to take pre-tests (such as Kaplan exams), fees to receive scores quickly, or other costs or fees for optional items
that are not required to take an approved test.
ITEMS 12 and 13. Sign and date the form.
Additional Information: You may provide additional information that you think will help VA process your claim. Attach additional
sheets of paper to this application if necessary. Additional information should be properly labeled (such as: Item 1, if the additional
information supports Item 1 on the form).
MORE HELP: If you need 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 education Internet site: www.benefits.va.gov/gibill/.
HOW TO FILE YOUR CLAIM. Send the completed application to the Regional Processing Office in the region of your home
address. Use the addresses below.
RESPONDENT BURDEN: We need this information to determine your eligibility for reimbursement of licensing and certification test fees. We cannot pay you any
education benefits for this reimbursement until we receive this information (38 U.S.C. 5101). 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 1-888-GI-BILL-1 (1-800-442-4551) to get information on where to send comments or
suggestions about this form. If you are hearing impaired, call 1-888-829-4833.
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., 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) VA obtains further information as may be necessary from
the school for 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 benefits (licensing and certification test reimbursement). While you do not have to respond, VA cannot reimburse you any
licensing and certification test fees until we receive this information (38 U.S.C. 3452(b) and 3501(a)). Your responses are confidential (38 U.S.C. 5701). Information
submitted is subject to verification through computer matching programs with other agencies.
VA FORM 22-0803, AUG 2020
VA Regional Office
P. O. Box 4616
Buffalo, NY 14240-4616
US Virgin Islands
VA Regional Office
P. O. Box 8888
MUSKOGEE, OK 74402-8888