VA Form 22-5281 "Application for Refund of Educational Contributions (Veap, Chapter 32, Title 38, U.s.c.)"

What Is VA Form 22-5281?

This is a legal form that was released by the U.S. Department of Veterans Affairs on January 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest available edition released by the U.S. Department of Veterans Affairs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of VA Form 22-5281 by clicking the link below or browse more documents and templates provided by the U.S. Department of Veterans Affairs.

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Download VA Form 22-5281 "Application for Refund of Educational Contributions (Veap, Chapter 32, Title 38, U.s.c.)"

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OMB Control No.: 2900-0261
Respondent Burden: 10 minutes
Expiration Date: 01/31/2020
APPLICATION FOR REFUND OF EDUCATIONAL CONTRIBUTIONS
(VEAP, Chapter 32, Title 38, U.S.C.)
IMPORTANT INSTRUCTIONS - Before completing this form, remember you may be eligible for education benefits under VEAP if you served between the dates of
January 1,1977 through June 30, 1985 and contributed to the fund. If you accept a refund of your contributions, you will forfeit any entitlement you may have earned
under VEAP. To get information about eligibility for VEAP, or for assistance in completing this form, contact your local VA regional processing office (RPO). See the
reverse side of this form for the address of your RPO. If you want a refund, complete and send this form to your RPO at the address shown. If you need additional
information click on Submit a Question at
www.benefits.va.gov/gibill/
or call toll-free to 1-888-442-4551. This refund is not available to Montgomery GI Bill, 903, and
Chapter 32 participants. Partial refunds cannot be made from your fund balance.
PART I - IDENTIFICATION DATA
(If applicable)
1. NAME OF APPLICANT
2. SOCIAL SECURITY NO.
3. BRANCH OF SERVICE
4. VA FILE NO.
5A. MAILING ADDRESS OF APPLICANT
5C. EMAIL ADDRESS
5B. PHONE NUMBER
(Include Area Code)
PART II - NOTICE OF DISENROLLMENT AND APPLICATION FOR REFUND
I request to be disenrolled from the POST-VIETNAM ERA VETERANS EDUCATIONAL ASSISTANCE PROGRAM. I further request a refund of
my remaining contributions. I realize that a refund of my contributions will result in forfeiture of my entitlement to receive educational benefits under
this program. However while on active duty, I may enroll again in this program by establishing a payroll deduction and/or making a lump sum
contribution(s) not to exceed a total of $2700, thereby reestablishing entitlement to educational benefits.
6. REASON FOR DISENROLLMENT
(Specify)
A.
PERSONAL HARDSHIP
B.
EDUCATION COMPLETED
C.
VOCATION OBTAINED
D.
OTHER
NOTE: The following signature block is to be completed only by applicants on active duty. Signature of Service Approving Official
is required only upon disenrollment prior to completion of at least 12 monthly contributions to this program.
9. SIGNATURE AND TITLE OF SERVICE APPROVING
10. DATE SIGNED
7. SIGNATURE OF APPLICANT
8. DATE SIGNED
OFFICIAL
FOR
APPLICANTS
ON
ACTIVE
DUTY
(Month, year)
11. LAST ALLOTMENT
12. SIGNATURE OF INSTALLATION FINANCE OFFICER
13. DATE SIGNED
NOTE: The following signature block is to be completed only by applicants not on active duty, and must either be notarized by a
Notary Public or certified by a VA official upon the applicants personal appearance and presentation of valid identification at any
VA regional office.
14. SIGNATURE OF APPLICANT
15. DATE SIGNED
16. SIGNATURE AND TITLE OF VA CERTIFYING OFFICIAL
17. DATE SIGNED
FOR
18. DATE OF DISCHARGE (AS SHOWN ON YOUR DD FORM 214)
APPLICANTS
NOT
ON
Sworn to and subscribed before me this
day
,
ACTIVE
DUTY
Notary Public
[SEAL]
My commission expires
PART III - CERTIFICATION (FOR VA USE ONLY)
I CERTIFY that I have reviewed this document and that payment of refund is proper.
19. SIGNATURE OF VA REGIONAL OFFICE FINANCE OFFICER
20. DATE SIGNED
VA FORM
22-5281
SUPERSEDES VA FORM 22-5281, JAN 2014,
JAN 2017
WHICH WILL NOT BE USED.
OMB Control No.: 2900-0261
Respondent Burden: 10 minutes
Expiration Date: 01/31/2020
APPLICATION FOR REFUND OF EDUCATIONAL CONTRIBUTIONS
(VEAP, Chapter 32, Title 38, U.S.C.)
IMPORTANT INSTRUCTIONS - Before completing this form, remember you may be eligible for education benefits under VEAP if you served between the dates of
January 1,1977 through June 30, 1985 and contributed to the fund. If you accept a refund of your contributions, you will forfeit any entitlement you may have earned
under VEAP. To get information about eligibility for VEAP, or for assistance in completing this form, contact your local VA regional processing office (RPO). See the
reverse side of this form for the address of your RPO. If you want a refund, complete and send this form to your RPO at the address shown. If you need additional
information click on Submit a Question at
www.benefits.va.gov/gibill/
or call toll-free to 1-888-442-4551. This refund is not available to Montgomery GI Bill, 903, and
Chapter 32 participants. Partial refunds cannot be made from your fund balance.
PART I - IDENTIFICATION DATA
(If applicable)
1. NAME OF APPLICANT
2. SOCIAL SECURITY NO.
3. BRANCH OF SERVICE
4. VA FILE NO.
5A. MAILING ADDRESS OF APPLICANT
5C. EMAIL ADDRESS
5B. PHONE NUMBER
(Include Area Code)
PART II - NOTICE OF DISENROLLMENT AND APPLICATION FOR REFUND
I request to be disenrolled from the POST-VIETNAM ERA VETERANS EDUCATIONAL ASSISTANCE PROGRAM. I further request a refund of
my remaining contributions. I realize that a refund of my contributions will result in forfeiture of my entitlement to receive educational benefits under
this program. However while on active duty, I may enroll again in this program by establishing a payroll deduction and/or making a lump sum
contribution(s) not to exceed a total of $2700, thereby reestablishing entitlement to educational benefits.
6. REASON FOR DISENROLLMENT
(Specify)
A.
PERSONAL HARDSHIP
B.
EDUCATION COMPLETED
C.
VOCATION OBTAINED
D.
OTHER
NOTE: The following signature block is to be completed only by applicants on active duty. Signature of Service Approving Official
is required only upon disenrollment prior to completion of at least 12 monthly contributions to this program.
9. SIGNATURE AND TITLE OF SERVICE APPROVING
10. DATE SIGNED
7. SIGNATURE OF APPLICANT
8. DATE SIGNED
OFFICIAL
FOR
APPLICANTS
ON
ACTIVE
DUTY
(Month, year)
11. LAST ALLOTMENT
12. SIGNATURE OF INSTALLATION FINANCE OFFICER
13. DATE SIGNED
NOTE: The following signature block is to be completed only by applicants not on active duty, and must either be notarized by a
Notary Public or certified by a VA official upon the applicants personal appearance and presentation of valid identification at any
VA regional office.
14. SIGNATURE OF APPLICANT
15. DATE SIGNED
16. SIGNATURE AND TITLE OF VA CERTIFYING OFFICIAL
17. DATE SIGNED
FOR
18. DATE OF DISCHARGE (AS SHOWN ON YOUR DD FORM 214)
APPLICANTS
NOT
ON
Sworn to and subscribed before me this
day
,
ACTIVE
DUTY
Notary Public
[SEAL]
My commission expires
PART III - CERTIFICATION (FOR VA USE ONLY)
I CERTIFY that I have reviewed this document and that payment of refund is proper.
19. SIGNATURE OF VA REGIONAL OFFICE FINANCE OFFICER
20. DATE SIGNED
VA FORM
22-5281
SUPERSEDES VA FORM 22-5281, JAN 2014,
JAN 2017
WHICH WILL NOT BE USED.
To determine the mailing address on where to send this completed form, you should first find your state in the following Regional jurisdiction
tables. Then, mail your completed form to the post office box address for the VA regional office having jurisdiction for that region.
Eastern Region:
Western Region:
VA Regional Office
VA Regional Office
P.O. Box 4616
P.O. Box 8888
Buffalo, NY 14240-4616
Muskogee, OK 74402-8888
SERVES THE FOLLOWING STATES
SERVES THE FOLLOWING STATES
CT
DE
DC
ME
AK
AL
AR
AZ
MD
MA
NC
NH
CA
FL
GA
HI
NJ
NY
PA
RI
ID
LA
MS
NM
US Virgin
Foreign
VA
VT
NV
OK
OR
PR
Islands
Schools
APO/FPO AA
SC
TX
UT
WA
Central Region:
Guam
Philippines
APO/FPO AP
VA Regional Office
P.O. Box 32432
St. Louis, MO 63132-0832
SERVES THE FOLLOWING STATES
CO
IA
IL
IN
KS
KY
MI
MN
MO
MT
NE
ND
OH
SD
TN
WV
WY
WI
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., contacting an employer only to help facilitate the processing of your refund, 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 voluntary. Giving us your SSN account information is mandatory. Applicants are required to provide their SSN under Title 38
USC 5101. 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. Information submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to properly identify and refund the amount currently being held in the Post-Vietnam Era Veterans Education
Account. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 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
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 22-5281, JAN 2017
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