Va Form 22-1990e - Application For Family Member To Use Transferred Benefits Page 2

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Eastern Region:

VA Regional Office

P.O. Box 4616

Buffalo, NY 14240-4616

Serves the following states:

US Virgin Islands

Foreign Schools

APO/FPO AA

Central Region:

VA Regional Office

P.O. Box 32432

St. Louis, MO 63132-0832

Serves the following states:

Western Region:

VA Regional Office

P.O. Box 8888

Muskogee, OK 74402-8888

Serves the following states:

APO/FPO AP

Guam

Philippines

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.

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

If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions

about this form.

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VA FORM 22-1990E, DEC 2016