Monthly Certification Of On-The-Job And Apprenticeship Trainin

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OMB Approved No. 2900-0 I 78
MONTHLY CERTIFICATION
OF ON.THE.JOB
AND APPRENTICESHIP
TRAINING
FOR VA USE ONLY
IMPORTANT
R e a d t h e I n s t r u c t i o n s c a r e f u l l y . Y o L r a n d t h e e r n p l o y e r s h o u l d c o m p l e t e ,
d a t e . a n d s r g n t h i s f o n x o n o r a f t e r t h e l a s t d a y o f t h e l a s t m o n t h s h o w n i n
I t e r n L C a l l l - 8 0 0 - C I - B I L L - I ( I - 8 8 8 - 4 4 2 - 4 5 5
I ) , i f y o u h a v e q u e s t i o n s .
C a l l l - 8 0 0 . 8 2 9 - 4 8 3 3 , i f y o u a r e h e a r i n g i m p a i r e d .
INSTRUCTIONS
TO TRAINEE
ITEMS 1 AND 2 - Enter the number of hours worked for each month shown. (lnclude any hours of related training during working hours.)
ITEM 3 - Check the appropriate box, and if training has been terminated, complete ltems 4 and 5. lf you have attained the complete job skills for
your job (a'Journeyman"
knowledge and skills), show this information in ltem 5.
ITEMS 64, 68, AND 6C - Check the appropriate box. lf 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 Jirst received this wage rate).
ITE[/ 7 - Use ltem 7, Remarks, to show any additional information concerning your wage. lf you are receiving additional educational allowance for
dependents, also use this item to reporl any change in the number of your dependents.
ITEMS 8A and 88 - Sign and date the form. Then, give the form to your employer or an authorized ofiicial of your training establishment
for
verificatron.
CHANGE OF ADDRESS - lf you are changrng your address permanently,
neatly line out the preprinted address shown above. Then, print your new
address in the remaining space. Be sure to include your ZIP Code.
INSTRUCTIONS
TO EMPLOYER
NOTE - lf an OJT trainee is receiving the journeyman wage, the trainee is no longer entitled to VA educational benefits. You must immediately notify
VA. An apprenticeship
trainee is not normally entitled to receive educational benefits afler reaching the journeyman wage. However, lhere are some
exceptions, such as training on a Davis-Bacon job, or a job in a geographic location that has a different wage scale. lf you have any questions, call
VA toll-free at 1-888-Gl-BILL
(1-888-442-4551)
lf you are heanng impaired, call us toll-free at 1-800-829-4833.
Please verify the number of hours worked and other information reported by the trainee in ltems 1 through 6 with the payroll and training records.
Please report any drfferences in ltems 6 andlor 7.
Also use ltem 7 if the trarnee'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 98 - Sign and date the form. Then, return it to the VA office shown above.
1 . M O N T H ( S ) T O B E C E R T I F I E D
2 . N O . O F H O U R S W O R K E D
FOR EACH IVIONTH SHOWN IN
I T E M 1
3 . W A S T R A I N E E E N R O L L E D I N A N D
P U R S U I N G T H E A P P R O V E D P R O G R A I V ]
F O R T H E M O N T H T S )
S H O W N I N I T E M 1 ?
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4. DATE TERMINATED (Mo., day, yr.)
5 . R E A S O N F O R T E R M I N A T I O N
T R A I N I N G A G R E E I \ 4 E N T ?
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(lf "M,t ',' utntltlcrc ltctttr 6l)
E F F E C T I V E D A T E
I C E R T I F Y T H A T t h e D r e v i o l r s s t a t e r n e n t s
a r e t r u e a n d c o n e c t t o t h e b e s t o f m y k n g w l e d e e a n d b e l i e f
P E N A L T Y - W i l l f ' u l f a l s e r e
b e n e f l t s o a v a b l e b v V A r n a v r e s u l t r n f i n e s o r i r n o r i s o n m e n t
o r b o t h
I 0 M i n u t e s
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VA FORM
JAN 2OO9
EXISTING STOCKS OF VA FORM 22-6553d.1, SEP 2OO5
W I L L B E U S E D .
22

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