Form VA Form 22-8690 VA Form 22-8690 Time Record (Work-Study Program)

OMB Approval No. 2900-0379
Respondent Burden: 5 minutes

TIME RECORD (WORK-STUDY PROGRAM)
3. FILE NUMBER (If Ch. 35, include prefix)

1. AGREEMENT CONTROL NUMBER 2. NAME OF STUDENT

5. TOTAL NO. OF HOURS TO BE WORKED

4. APPROVED PERIOD OF EMPLOYMENT (Month, day, year)
A. FROM

B. TO

INSTRUCTIONS: Use Item 8, Remarks, to show changes in Items 6A and 6B. Include effective dates.
6A. PLACE OF EMPLOYMENT

6B. NAME OF SUPERVISOR

6C. MAILING ADDRESS OF SUPERVISOR

6D. TELEPHONE NO. OF SUPERVISOR
(Include Area Code)

(

)

7. SCHEDULE OF HOURS WORKED
DATE

NO. OF
HOURS

CUMULATIVE
TO DATE

INITIALS
STUDENT

SUPV.

DATE

NO. OF
HOURS

CUMULATIVE
TO DATE

INITIALS
STUDENT

SUPV.

8. REMARKS

CERTIFICATION
By signing below, I certify that this schedule of hours worked is true and accurate to the best of my ability. If this work-study student was pursuing a
program of work-study services at a non-VA site under my supervision, I also certify that this individual performed only appropriate work-study
duties as outlined in the approved position description and that he or she performed these duties in a satisfactory manner.
9A. SIGNATURE OF WORK-STUDY SUPERVISOR

VA FORM
JAN 2007

22-8690

9B. DATE SIGNED

EXISTING STOCKS OF VA FORM 22-8690, MAR 2004,
WILL BE USED.

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been
authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses as identified in the VA
system of records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal
Register. An example of a routine use (e.g., VA sends 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 education benefits." While you do not have to
respond, VA cannot pay the work-study student any further work-study benefits (payment for hours completed in a work-study
program) until we receive this information. The responses you submit are considered 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 the student’s continued eligibility for work-study benefits and the
proper amount payable. (38 U.S.C. section 3485). Title 38, United States Code, allows us to ask for this information. We estimate
that you will need an average of 5 minutes to review the instructions, find the information, and complete this 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
www.whitehouse.gov/omb/library/OMBINV.EPA.html#VA. 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 form.

VA FORM 22-8690 JAN 2007