Va Form 22-6553d-1 - Monthly Certification Of On-The-Job And Apprenticeship Training

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OMB Approved No. 2900-0178
Respondent Burden: 10 Minutes
Expiration Date: 3/31/2018
REGIONAL PROCESSING OFFICE (RPO) NAME AND ADDRESS OR FAX NUMBER
(See RPO listing on reverse)
MONTHLY CERTIFICATION OF ON-THE-JOB
AND APPRENTICESHIP TRAINING
VA FILE NUMBER
PAYEE
TRAINEE'S NAME AND ADDRESS
IMPORTANT: Read the instructions carefully. You and the
employer should complete, date, and sign this form on or after the
last day of the last month shown in Item 1. Call 1-888-GI-BILL-1
(1-888-442-4551), if you have questions. If you use the
Telecommunications Device for the Deaf (TDD) call the Federal
Relay number is 711.
INSTRUCTIONS TO TRAINEE
ITEMS 1 AND 2 - Enter the number of hours worked for each month/year shown (include any hours of related training given during working hours).
ITEM 3 - Check the appropriate box, and if training has been terminated, complete Items 4 and 5. If you have attained the complete job skills for
your job (a "journeyman" knowledge and skills), show this information in Item 5.
ITEMS 6A, 6B, AND 6C - Check the appropriate box. If you received a wage increase (or decrease) not in accordance with your training agreement,
show your new wage rate and the effective date of that wage rate (when you first received this wage rate).
ITEM 7 - Use Item 7, Remarks, to show any additional information concerning your wage rate. Also, if you are receiving additional educational
allowance for dependents use this item to report any change in the number of your dependents.
ITEMS 8A and 8B - Sign and date the form. After signing and dating the form give it to your employer/certifying official or an authorized official of
your training establishment for verification.
CHANGE OF ADDRESS - If you are changing your address permanently, neatly line out the preprinted address shown above. Then, print or type
your new address in the remaining space. Be sure to include your ZIP Code.
INSTRUCTIONS TO EMPLOYER/CERTIFYING OFFICIAL
Please verify the number of hours worked and other information reported by the trainee in Items 1 through 6 with the payroll and training records.
Please report any differences in Items 6 and/or 7.
Also use Item 7 if the trainee's conduct or progress is unsatisfactory or if the trainee has attained the complete job skills for the job (a "journeyman"
knowledge and skills).
ITEMS 9A and 9B - Sign and date the form and return it to the VA office shown above.
If you have any questions, call VA toll-free at 1-888-GI Bill (1-888-442-4551).
3. WAS TRAINEE ENROLLED IN AND
2. NUMBER OF HOURS
PURSUING THE APPROVED PROGRAM
4. DATE TERMINATED
WORKED
1. MONTH(S)/YEAR TO BE CERTIFIED
FOR THE MONTH(S) SHOWN IN ITEM 1?
(Month, day, year)
FOR EACH MONTH SHOWN IN
ITEM 1
YES
NO
(If "No," complete Items 4 and 5)
5. REASON FOR TERMINATION
6A. IS WAGE RATE IN ACCORDANCE
6B. RATE
6C. EFFECTIVE DATE
WITH TRAINING AGREEMENT?
YES
NO
(If "No," complete Items 6B and 6C)
7. REMARKS
I CERTIFY THAT the previous statements are true and correct to the best of my knowledge and belief.
PENALTY - Willful false reports concerning benefits payable by VA may result in fines or imprisonment or both.
8A. SIGNATURE OF TRAINEE
8B. DATE SIGNED
9B. DATE SIGNED
9A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL
VA FORM
22-6553d-1
Page 1
SUPERSEDES VA FORM 22-6553d-1, MAR 2015,
DEC 2016
WHICH WILL NOT BE USED.

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