Va Form 22-8692a - Extended Student Work-Study Agreement

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OMB Control No. 2900-0209

Respondent Burden: 3 minutes

EXTENDED STUDENT WORK-STUDY AGREEMENT

VA FILE NUMBER

AGREEMENT NUMBER

PRIVACY ACT INFORMATION: VA will not disclose information collected by this information collection to any source other than what has been

authorized by the Privacy Act of 1974 or Title 38 Code of Federal Regulations 1.576 for routine uses as identified in VA's system of records,

58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation Records - VA as published in the Federal Register at

An example of a routine use allows VA to send 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 VA to

obtain further information as may be necessary from the school for VA to properly process the veteran's education claim or to monitor his or her

progress during training. Your obligation to respond is "required to obtain or retain benefits". We cannot take any action to extend your work-study

contract until we receive this information (38 U.S.C. 3485). Your responses are 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 an extension of your work-study contract shown on this

information collection. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 3 minutes to

review the instructions, find the information and complete the 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 1-888-GI-BILL-1

(1-888-442-4551) to get information on where to send comments or suggestions about this information collection.

NOTE: VA will complete the hourly rate item below with the federal minimum wage or your State minimum wage rate, whichever is

greater. If you have any questions concerning this hourly rate, contact your nearest VA office at 1-800-827-1000.

(student), wish to extend my work-study agreement with the Department

of Veterans Affairs (VA). I agree to perform

hours of service for VA during the period starting

on or about

and ending no later than

VA agrees to pay me at the rate of $

per hour for a total extended work-study allowance of

. I agree to abide by the conditions set forth in my initial agreement. I also understand that I