Va Form 10-5392 - Occasional Volunteer Time Sheet

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OCCASIONAL VOLUNTEER TIME SHEET

As an Occasional Volunteer, I agree, for an indefinite period, with the following statement: I hereby waive all claims to monetary benefits for services rendered as a volunteer worker on

a “without compensation” basis. I understand that this waiver applies only to remuneration (compensation) for specific services rendered in a VA Voluntary Service (VAVS) Program

and is not related to any other VA services or benefits to which I am entitled. (NOTE: VA has entered into this agreement by the authority of 38 U.S.C. 7405(a)(1)(D). This agreement

may be cancelled by either party upon written notice.

INDIVIDUAL NAME

DATE(S) OF

SIGNATURE

ORGANIZATION NAME

VA SERVICE ASSIGNMENT

HOURS

(Please print)

SERVICE

VA FORM

10-5392

JUNE 2016