Fillable Va Form 22-5281 - Application For Refund Of Educational Contributions printable pdf download

Form Approved: OMB No. 2900-0261

Respondent Burden: 10 minutes

APPLICATION FOR REFUND OF EDUCATIONAL CONTRIBUTIONS

(VEAP, Chapter 32, Title 38, U.S.C.)

IMPORTANT INSTRUCTIONS - Before completing this form, remember you may be eligible for education benefits under VEAP if you served between the dates of

January 1,1977 through June 30, 1985 and contributed to the fund. If you accept a refund of your contributions, you will forfeit any entitlement you may have earned

under VEAP. To get information about eligibility for VEAP, or for assistance in completing this form, contact your local VA regional processing office (RPO). See the

reverse side of this form for the address of your RPO. If you want a refund, complete and send this form to your RPO at the address shown. If you need additional

information click on Ask a Question and Find Answers, or call toll-free to 1-888-442-4551. This refund is not available to Montgomery GI Bill, 903, and Chapter 32

participants. Partial refunds cannot be made from your fund balance.

PART I - IDENTIFICATION DATA

(If applicable)

1. NAME OF APPLICANT

2. SOCIAL SECURITY NO.

3. BRANCH OF SERVICE

4. VA FILE NO.

5a. MAILING ADDRESS OF APPLICANT

5b. PHONE NUMBER

5c. EMAIL ADDRESS

(Include Area Code)

PART II - NOTICE OF DISENROLLMENT AND APPLICATION FOR REFUND

I request to be disenrolled from the POST-VIETNAM ERA VETERANS EDUCATIONAL ASSISTANCE PROGRAM. I further

request a refund of my remaining contributions. I realize that a refund of my contributions will result in forfeiture of my entitlement to

receive educational benefits under this program. However while on active duty, I may enroll again in this program by establishing a

payroll deduction and/or making a lump sum contribution(s) not to exceed a total of $2700, thereby reestablishing entitlement to

educational benefits.

6. REASON FOR DISENROLLMENT

(Specify)

PERSONAL HARDSHIP

EDUCATION COMPLETED

VOCATION OBTAINED

OTHER

NOTE: The following signature block is to be completed only by applicants on active duty. Signature of Service Approving Official is

required only upon disenrollment prior to completion of at least 12 monthly contributions to this program.

7. SIGNATURE OF APPLICANT

8. DATE SIGNED

9. SIGNATURE AND TITLE OF SERVICE APPROVING

10. DATE SIGNED

OFFICIAL

FOR

APPLICANTS

ACTIVE

DUTY

(Month, year)

11. LAST ALLOTMENT

12. SIGNATURE OF INSTALLATION FINANCE OFFICER

13. DATE SIGNED

NOTE: The following signature block is to be completed only by applicants not on active duty, and must either be notarized by a

Notary Public or certified by a VA official upon the applicants personal appearance and presentation of valid identification at any VA

regional office.

14. SIGNATURE OF APPLICANT

15. DATE SIGNED

16. SIGNATURE AND TITLE OF VA CERTIFYING OFFICIAL

17. DATE SIGNED

FOR

18. DATE OF DISCHARGE (AS SHOWN ON YOUR DD FORM 214)

APPLICANTS

NOT

day

Sworn to and subscribed before me this

ACTIVE

DUTY

Notary Public

[SEAL]

My commission expires

PART III - CERTIFICATION (FOR VA USE ONLY)

I CERTIFY that I have reviewed this document and that payment of refund is proper.

19. SIGNATURE OF VA REGIONAL OFFICE FINANCE OFFICER

20. DATE SIGNED

VA FORM

22-5281

SUPERSEDES VA FORM 22-5281, OCT 2010,

JUL 2012

WHICH WILL NOT BE USED.

Va Form 22-5281 - Application For Refund Of Educational Contributions

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