Form VA Form 28-8832 VA Form 28-8832 Application for Counseling

OMB Approved No. 2900-0265
Respondent Burden: 30 minutes

APPLICATION FOR COUNSELING
PRIVACY ACT INFORMATION: The 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 identified in the VA system of records, 58VA21/22, Compensation, Pension, Education
and Rehabilitation Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account
information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 (c) (1). The VA will not deny an individual benefits for refusing to
provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested
information is considered relevant and necessary to determine maximum benefits under the law. 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 if the veteran and other beneficiaries are eligible for counseling services that VR&E services
provide. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 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.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.
INTERNET VERSION AVAILABLE -You may download this application form at www.va.gov/vaforms
PART I - APPLICANT INFORMATION
1A. NAME OF APPLICANT (FIRST-MIDDLE-LAST)

1B. SOCIAL SECURITY NUMBER OF APPLICANT

1C. VA FILE NUMBER (If known)

2A. SEX OF APPLICANT

2B. APPLICANT’S E-MAIL ADDRESS

2C. DATE OF BIRTH

MALE
FEMALE
3A. RELATIONSHIP OF APPLICANT TO VETERAN

3B. APPLICANT’S TELEPHONE NUMBER (Including Area Code)
PRIMARY PHONE NUMBER (Where a message
OTHER PHONE NUMBER
can be left)

SELF

SURVIVING SPOUSE

CHILD

SPOUSE

STEPCHILD

ADOPTED CHILD

(

)

(

)

3C. MAILING ADDRESS OF APPLICANT (Number and street or rural route, city or P.O., State and ZIP Code)

4A. ARE YOU A HANDICAPPED CHILD, 14 YEARS OR
OLDER, SPOUSE, OR SURVIVING SPOUSE SEEKING
SPECIAL RESTORATIVE TRAINING? (See Instructions)

4B. ARE YOU A HANDICAPPED CHILD,SPOUSE,
OR SURVIVING SPOUSE SEEKING SPECIAL
VOCATIONAL TRAINING? (See Instructions)

NO

YES

YES

VA DATE STAMP
(For VA Use Only)

5. HAVE YOU RECEIVED AN INFORMATION PAMPHLET
EXPLAINING SURVIVORS’ AND DEPENDENTS’
EDUCATIONAL ASSISTANCE BENEFITS?

NO

YES

NO

PART II - INFORMATION CONCERNING DISABLED OR DECEASED VETERAN OR INDIVIDUAL ON ACTIVE DUTY
6A. NAME OF VETERAN OR INDIVIDUAL ON ACTIVE DUTY ON WHOSE ACCOUNT BENEFITS ARE CLAIMED (FIRST- MIDDLE -LAST)

6B. SOCIAL SECURITY NUMBER

7. DATE OF BIRTH

6C. VA FILE NUMBER (If known)

8. BRANCH OF SERVICE

9. SERVICE NUMBER

10. DATE OF DEATH OR DATE LISTED
AS MISSING IN ACTION OR P.O.W.

PART III - SPECIAL INFORMATION CONCERNING APPLICANT
11. IF YOU ARE THE SPOUSE OF A DISABLED VETERAN, IS A DIVORCE OR ANNULMENT PENDING?
YES
NO
12A. IF YOU ARE THE SURVIVING SPOUSE OF A DECEASED VETERAN, HAVE YOU
REMARRIED SINCE HIS OR HER DEATH ?

12B. SURVIVING SPOUSE’S AGE AT TIME OF REMARRIAGE

YES
NO
13. HAVE YOU EVER APPLIED FOR ANY OF THE FOLLOWING VA BENEFITS? (Check applicable box(es)
A.

VOCATIONAL REHABILITATION BENEFITS (Chapter 31)

B.

VETERANS’ EDUCATION ASSISTANCE BASED ON YOUR OWN SERVICE (Specify benefit)

C.

DEPENDENTS’ EDUCATIONAL ASSISTANCE (Chapter 35)

D.

SURVIVORS’ AND DEPENDENTS EDUCATIONAL ASSISTANCE (Complete Items 14A and 14B) on reverse)

E.

OTHER (Specify)

F.

NONE

VA FORM
JAN 2007

28-8832

SUPERSEDES VA FORM 28-8832, FEB 2006,
WHICH WILL NOT BE USED.

NOTE: COMPLETE ITEMS 14A AND 14B ONLY IF YOU CHECKED ITEM 13D
14A. NAME OF VETERAN ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS

14B. VETERANS FILE NUMBER OR SOCIAL SECURITY NUMBER

PART IV - APPLICANT’S MILITARY SERVICE
15. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (Including an initial period of active duty for training for a period of 3 months or more
OR subsequent periods of active duty for training of 6 months or more) (If "NO," skip this part and continue to Part V)
YES

NO

16. SERVICE INFORMATION
(Enter the following information for each period of active duty. Attach a copy of your DD214.
If you have already sent VA a DD214, do not send one with this application)
A. DATE ENTERED
ACTIVE DUTY

B. DATE SEPARATED
FROM ACTIVE DUTY

C. BRANCH OF SERVICE OR RESERVE
OR GUARD COMPONENT

D. CHARACTER OF
DISCHARGE

17. REMARKS (Use this space to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer to the item numbers
on this form to help us match your answers to the correct questions. If more space is needed, please attach separate sheets of paper. Be sure to place your
name and Social Security Number on each additional page)

PART V - CERTIFICATION AND SIGNATURE OF APPLICANT
(All Applicants Must Complete This Part)
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
PENALTY: Willfully false statements as to a material fact in a claim for counseling benefits is a punishable offense and may result
in the forfeiture of these or other benefits and in criminal penalties.
18A. SIGNATURE OF APPLICANT (Do NOT Print)

18B. DATE SIGNED

SIGN HERE
IN INK

PART VI - SIGNATURE OF PARENT, GUARDIAN, OR CUSTODIAN
(This section must be completed if you are a minor child)
19A. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (Type or print)

19B. TELEPHONE NUMBER AND MAIL ADDRESS OF PARENT, GUARDIAN,
OR CUSTODIAN (Include Area Code),

20A. SIGNATURE OF (Check one) (DO NOT PRINT)

20B. DATE SIGNED

(
PARENT
SIGN HERE
IN INK

GUARDIAN

CUSTODIAN

)
20C. DATE REFERRED TO VR & E

APPLICATION FOR COUNSELING
Information And Instructions For Completing This Application
(Please keep these instructions for future reference)
This VA form 28-8832 is also available on the Internet at www.va.gov/vaforms.
VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP IS AVAILABLE FREE OF CHARGE if you meet
one of the following conditions:
1. You are a veteran or dependent eligible for educational benefits under a program that VA administers;
2. You were discharged or released from active duty under honorable conditions not more than 1 year ago;
3. You are on active duty and 6 months or less remain before your scheduled release or discharge from service.
You may get counseling about any matter, including personal problems, related to:

. Career choice and career preparation
. School or job training
. Job selection and job search
What is discussed in counseling depends on you, your situation and needs. You can learn more about yourself; career
opportunities and requirements; training possibilities; sources of financial aid; and how to carry through on plans that you
make.
HOW TO GET COUNSELING
Complete this application and send it to the nearest United States Department of Veterans Affairs office. To get the
address of the local VA office call 1-800-827-1000 toll-free. If you have received a DD214, you should attach a copy of
it, unless you are still on active duty or if you are applying as a dependent of a veteran. VA will arrange for a counselor
to meet with you. There is no charge for counseling, but you will have to pay your own travel. (Please note: counseling
is not available in foreign countries except the Republic of the Philippines)
APPLICATION INSTRUCTIONS
Please complete only those areas which are applicable to you. The number on the instructions matches the item numbers
on the application. Items not mentioned are self-explanatory. If you have a question please phone 1-800-827-1000 and
request help.
Item 2C. VA may have assigned the veteran or individual an eight-digit file number. If you know the number, write it in
the space provided.
Item 3A. "Child" includes adopted children and step children who are members of the veteran’s or individual’s
household. Married children are eligible.
Item 13F. Check this box if you have never applied for VA educational benefits.
Item 14A and B. If you have previously applied for benefits as the dependent child or spouse of a veteran who is
permanently and totally disabled due to service-connected disabilities or who died on active duty, write the name of the
person (parent or spouse) under whom you received these benefits in Item 14A and the file number or social
security number in 14B.
This form is an application for counseling only. Do not use this form to apply for VOCATIONAL REHABILITATION
AND EMPLOYMENT BENEFITS (Chapter 31) (use the VA form 28-1900, Disabled Veterans Application For
Vocational Rehabilitation) or VETERAN’S EDUCATION ASSISTANCE (Chapter 30, 32, 1606 or 1607) (use the VA
Form 22-1990, Application For VA Education Benefits). These forms are available on the Internet at
www.va.gov/vaforms .
VA FORM
JAN 2007

28-8832

SUPERSEDES VA FORM 28-8832, JUN 2006,
WHICH WILL NOT BE USED.