VA Form 28-1900 Disabled Veterans Application for Vocational Rehabilitation

What Is VA Form 28-1900?

VA Form 28-1900, Disabled Veterans Application for Vocational Rehabilitation - also known as the VA vocational rehabilitation form - is an official form issued by the Department of Veterans Affairs (VA) to enable veterans to apply for vocational rehabilitation benefits. Veterans who apply for this kind of program may have difficulties in keeping or finding a job because of service-connected disabilities. Filing this form helps them join the rehabilitation program and get the training necessary for a new job or find a way to keep their current job.

The latest VA Form 28-1900 fillable version was released by the VA in September 2014 and is available for digital filing and download below.

The Vocational Rehabilitation and Employment (VR&E) program helps military personnel and veterans with service-related disabilities to prepare, obtain and maintain suitable employment. The program offers employment assistance, short or long-term training, purchase of required supplies and equipment, and on-the-job training. Services generally last up to 48 months, but they can be extended in certain circumstances.

To be eligible to receive the benefits a veteran has to meet one of the following criteria:

  • The veteran must have a service-connected disability (or SCD) which has a rating of 20 percent or higher and an employment handicap;
  • The veteran must have a combined SCD rating of 10 percent and a serious employment handicap;
  • The applicant must be awaiting discharge due to a medical condition caused by a serious injury or illness from active duty;
  • The applicant must be a servicemember awaiting discharge with a VA memorandum rating of 20 percent or more and expects to receive an honorable discharge upon separation from active duty.

The VR&E program is a personal choice for the veteran. There are five options that can be chosen by the veteran with the help of a counselor:

  • Re-employment;
  • Self-employment;
  • Employment via long-term service and training;
  • Independent Living services - an option for veterans who have such a severe employment handicap that they first need help to establish a healthy, independent life style before managing to find a new job.
ADVERTISEMENT
OMB Approved No. 2900-0009
Respondent Burden: 15 minutes
Expiration Date: 09/30/2017
DISABLED VETERANS APPLICATION FOR VOCATIONAL REHABILITATION
(Chapter 31, Title 38, U.S.C.)
PURPOSE OF VOCATIONAL REHABILITATION: Vocational Rehabilitation provides services and assistance to certain veterans with
disabilities to get and keep a suitable job. If employment is not reasonably feasible, vocational rehabilitation may be able to provide services to
support veterans with disabilities to achieve maximum independence in their daily living activities.
IMPORTANT: To see if you should fill out this form, please read the information on back.
If different, from Item 2)
1. FIRST, MIDDLE, LAST NAME OF VETERAN
2. SOCIAL SECURITY NO.
3. VA FILE NO. (
4. DATE OF BIRTH
(Month, Day, Year)
(No. and street or rural route, City, State and
5A. MAILING ADDRESS
6. DAYTIME TELEPHONE NO.
8. VA OFFICE WHERE RECORDS ARE
ZIP Code)
(Include Area Code)
LOCATED
7. EVENING TELEPHONE NO.
9. NUMBER OF YEARS OF EDUCATION
(Include Area Code)
(If, available)
5B. E-MAIL ADDRESS OF VETERAN
10. IF YOU ARE MOVING WITHIN THE NEXT 30 DAYS,
11. LIST ANY PREVIOUS VOCATIONAL REHABILITATION
DO NOT WRITE IN THIS SPACE
PROGRAMS YOU HAVE BEEN IN AND GIVE THE
GIVE US YOUR NEW ADDRESS
(VA DATE STAMP)
Include both VA and non-VA programs)
DATES (
PROGRAM
DATE
12. SERVICE INFORMATION (Enter the following information for each period of active duty. Show ALL active duty)
DATE ENTERED
DATE LEFT
TYPE OF SEPARATION
SERVICE NUMBER
(Prefix and suffix)
BRANCH OF SERVICE
ACTIVE DUTY
ACTIVE DUTY
OR DISCHARGE
(A)
(B)
(C)
(D)
(E)
13. IF YOU ARE NOW WORKING (Enter the following information for your current job)
A. NAME AND ADDRESS OF EMPLOYER
B. DUTIES OF YOUR JOB
C. MONTHLY SALARY OR WAGES
14. IF YOU ARE NOW HOSPITALIZED, WHAT IS THE NAME AND ADDRESS OF YOUR HOSPITAL?
15B. WHAT IS THE NATURE OF YOUR DISABILITY (DISABILITIES)?
15A. WHAT IS YOUR DISABILITY RATING?
(Check appropriate box(es))
16. DID YOU SERVE IN:
17. DISABLED TRANSITION
GULF WAR
ASSISTANCE PROGRAM
WORLD WAR II
POST KOREAN CONFLICT
(DTAP)?
OPERATION ENDURING FREEDOM
POST WORLD WAR II ERA
VIETNAM
KOREAN CONFLICT
OPERATION IRAQI FREEDOM
YES
NO
POST VIETNAM
I HEREBY CERTIFY THAT the information I have entered on this form is true and complete to the best of my knowledge and belief.
I realize that making willful false statements concerning a material fact in a claim of vocational rehabilitation benefits is a punishable
offense that may result in fine or imprisonment or both.
(Do not print) (Sign in ink)
18B. DATE SIGNED
18A. SIGNATURE OF APPLICANT
VA FORM
28-1900
SUPERSEDES VA FORM 28-1900, JUN 2011,
PAGE 1
SEP 2014
WHICH WILL NOT BE USED.
OMB Approved No. 2900-0009
Respondent Burden: 15 minutes
Expiration Date: 09/30/2017
DISABLED VETERANS APPLICATION FOR VOCATIONAL REHABILITATION
(Chapter 31, Title 38, U.S.C.)
PURPOSE OF VOCATIONAL REHABILITATION: Vocational Rehabilitation provides services and assistance to certain veterans with
disabilities to get and keep a suitable job. If employment is not reasonably feasible, vocational rehabilitation may be able to provide services to
support veterans with disabilities to achieve maximum independence in their daily living activities.
IMPORTANT: To see if you should fill out this form, please read the information on back.
If different, from Item 2)
1. FIRST, MIDDLE, LAST NAME OF VETERAN
2. SOCIAL SECURITY NO.
3. VA FILE NO. (
4. DATE OF BIRTH
(Month, Day, Year)
(No. and street or rural route, City, State and
5A. MAILING ADDRESS
6. DAYTIME TELEPHONE NO.
8. VA OFFICE WHERE RECORDS ARE
ZIP Code)
(Include Area Code)
LOCATED
7. EVENING TELEPHONE NO.
9. NUMBER OF YEARS OF EDUCATION
(Include Area Code)
(If, available)
5B. E-MAIL ADDRESS OF VETERAN
10. IF YOU ARE MOVING WITHIN THE NEXT 30 DAYS,
11. LIST ANY PREVIOUS VOCATIONAL REHABILITATION
DO NOT WRITE IN THIS SPACE
PROGRAMS YOU HAVE BEEN IN AND GIVE THE
GIVE US YOUR NEW ADDRESS
(VA DATE STAMP)
Include both VA and non-VA programs)
DATES (
PROGRAM
DATE
12. SERVICE INFORMATION (Enter the following information for each period of active duty. Show ALL active duty)
DATE ENTERED
DATE LEFT
TYPE OF SEPARATION
SERVICE NUMBER
(Prefix and suffix)
BRANCH OF SERVICE
ACTIVE DUTY
ACTIVE DUTY
OR DISCHARGE
(A)
(B)
(C)
(D)
(E)
13. IF YOU ARE NOW WORKING (Enter the following information for your current job)
A. NAME AND ADDRESS OF EMPLOYER
B. DUTIES OF YOUR JOB
C. MONTHLY SALARY OR WAGES
14. IF YOU ARE NOW HOSPITALIZED, WHAT IS THE NAME AND ADDRESS OF YOUR HOSPITAL?
15B. WHAT IS THE NATURE OF YOUR DISABILITY (DISABILITIES)?
15A. WHAT IS YOUR DISABILITY RATING?
(Check appropriate box(es))
16. DID YOU SERVE IN:
17. DISABLED TRANSITION
GULF WAR
ASSISTANCE PROGRAM
WORLD WAR II
POST KOREAN CONFLICT
(DTAP)?
OPERATION ENDURING FREEDOM
POST WORLD WAR II ERA
VIETNAM
KOREAN CONFLICT
OPERATION IRAQI FREEDOM
YES
NO
POST VIETNAM
I HEREBY CERTIFY THAT the information I have entered on this form is true and complete to the best of my knowledge and belief.
I realize that making willful false statements concerning a material fact in a claim of vocational rehabilitation benefits is a punishable
offense that may result in fine or imprisonment or both.
(Do not print) (Sign in ink)
18B. DATE SIGNED
18A. SIGNATURE OF APPLICANT
VA FORM
28-1900
SUPERSEDES VA FORM 28-1900, JUN 2011,
PAGE 1
SEP 2014
WHICH WILL NOT BE USED.
VOCATIONAL REHABILITATION FOR SERVICE-DISABLED VETERANS
TO APPLY OR RECEIVE INFORMATION AND ASSISTANCE:
• To apply, submit this completed application to the nearest VA office.
• You may obtain information and assistance from any VA office or on line at http://www.vba.va.gov/bln/vre/index.htm.
• Local representative of veteran's service organizations and the American Red Cross also have information and forms
available.
EVALUATION : If you have a VA combined service-connected disability rating of 10 percent or more and you apply
for vocational rehabilitation, we will provide you a comprehensive evaluation. During this evaluation, a VA
counselor will work with you to answer a variety of questions. Such as:
1. Do you meet the basic entitlement requirements?
2. Are you within the time limit for receiving this benefit? (This is generally 12 years from the date VA notified you
that you had at least a 10% service-connected disability.)
PLANNING AND COUNSELING: Your counselor must first determine that you meet the entitlement requirements and an
employment or independent living goal is reasonably feasible. Then your counselor will help you develop a plan of services
and assistance to assist you to reach your employment goal. Counseling will be available throughout your program to help
you with problems that may arise.
REHABILITATION SERVICES: Not all vocational rehabilitation programs involve training. You may only need employment
services to help you get a suitable job. If a VA counselor determines that you need training to reach your vocational goal,
your VA counselor will also determine the number of months of training you need. You may train in a vocational school, a
special rehabilitation facility, an apprenticeship program, other on-job training position, a college, or a university.
If training is appropriate, VA will provide medical and dental care treatment, employment assistance to get and keep a
suitable job, and other services you may need. If a vocational goal is not currently feasible for you, VA may provide services
and assistance to improve your capacity for living independently.
SUPPORT: VA may pay for tuition, fees, books, equipment, tools, or other supplies you need to succeed in your program.
During your program, you may qualify for a monthly subsistence allowance to help you meet your living expenses. The
allowance you receive depends on your type of training, rate of attendance, and number of dependents. You will receive
this allowance in addition to any VA compensation or military retired pay you may receive.
PRIVACY ACT: 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 1.576 for routine uses (i.e. VA needs the
information this form requests to help determine your eligibility to the benefit) 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 benefits. Giving us your Social Security Number
(SSN) information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 (c) (1). 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 in effect prior to January 1, 1975, and still in effect.
RESPONDENT BURDEN: We need this information in order for veterans with compensable service-connected disabilities to
apply for vocational rehabilitation under title 38, U.S.C. chapter 31. 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
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.
PAGE 2
VA FORM 28-1900, SEP 2014

Download VA Form 28-1900 Disabled Veterans Application for Vocational Rehabilitation

1005 times
Rate
4.8(4.8 / 5) 50 votes
ADVERTISEMENT

VA Form 28-1900 Instructions

The processing time of the application is from four to six weeks. After completing the application for the VR&E and proving eligibility, an applicant has to make an appointment with a vocational rehabilitation counselor. The main purpose of the meeting is to prove that the veteran is faced with an employment handicap. An employment handicap is the inability to garner or retain suitable employment that falls within the veteran's abilities and interests.

How to Fill Out VA Form 28-1900?

The form contains two pages in total: a fillable part for the applicant to file and an additional page with general information about vocational rehabilitation for service-disabled veterans.

The first page requires the following information:

  • The name and address of the applicant;
  • The number of the VA file and a telephone number;
  • A specification of the applicant's education (the number of years);
  • A list of any previous vocational rehabilitation the applicant may have participated in;
  • Information about their military service;
  • A description of their current job along with the name and address of the employer, the list of the job duties and monthly income;
  • A description of the disability.

Where to Send VA Form 28-1900?

The quickest way is to apply for benefits online through eBenefits website's vocational rehabilitation and employment page. The completed form can be also mailed to a local VA office or out-based office.

Page of 2