Form VA Form 28-1905c VA Form 28-1905c Monthly Record of Training and Wages

OMB Approved No. 2900-0176
Respondent Burden: 15 minutes

MONTHLY RECORD OF TRAINING AND WAGES
INFORMATION: This form is provided by VA for use at training establishments where similar records of progress in training are not ordinarily
maintained. Additional information and instructions are furnished on the reverse side. This form is used in both the training of disabled veterans
under chapter 31 of title 38 U.S.C. and the training of eligible dependents under chapter 35 of title 38 U.S.C.
NAME OF TRAINEE (First-Middle-Last)

VA FILE NUMBER

TYPE OF VA BENEFIT

NAME OF ESTABLISHMENT

REPORT FOR (Month and year)

VOCATIONAL REHABILITATION
(Chapter 31)
DEPENDENTS EDUCATIONAL
ASSISTANCE (Chapter 35)

INSTRUCTIONS TO TRAINEE: In Item 1 below, please list the work processes (job skills) in which you will be trained during the month.
At the end of each month, you should enter the number of hours you received instruction in your training program, sign and date this
record in Item 7, and submit this record to your trainer for review and endorsement.
INSTRUCTIONS TO TRAINER: Complete "Trainers Rating," Item 4 below for each unit of instruction on which the trainee spent time during the
report period. You may use Symbols: O=Outstanding, S=Satisfactory, U=Unsatisfactory. Also complete Items 5 and 6 the first time you complete
this form for a trainee and for any month in which the trainee's rate of pay changes. Do not consider overtime pay as a change in pay rate.
Following your review of this record, sign and date it in Item 8 below. Please refer to the reverse side for more instructions.
MONTHLY TRAINING RECORD

1. TYPE OF INSTRUCTION AS LISTED IN YOUR VA TRAINING AGREEMENT

2. CUMULATIVE TOTAL
NUMBER OF HOURS
COMPLETED BY END OF
LAST MONTH

3. TOTAL NUMBER

4. TRAINER'S
RATING
(O, S OR U)

RELATED INSTRUCTION (Specify type)
HOURS ABSENT FROM TRAINING THIS MONTH
5A. TRAINEE HOURLY OR MONTHLY RATE OF PAY

5B. TOTAL WAGES PAID THIS MONTH

$

$

PER

5C. DATE THE WAGE RATE IN ITEM 5A BEGAN

6. REASON FOR ENTRIES IN ITEM 5 (Check one)
START OF TRAINING

INCREASE IN WAGE RATE

OTHER (Specify)

7A. SIGNATURE OF TRAINEE

7B. DATE SIGNED

8A. SIGNATURE OF TRAINER

8B. DATE SIGNED

VA FORM
JAN 2005

28-1905c

EXISTING STOCK OF VA FORM 28-1905c, AUG 2000,
WILL BE USED.

INFORMATION AND INSTRUCTIONS
VOCATIONAL TRAINING TO DISABLED VETERANS (CHAPTER 31)
Instructions For Trainer
The original form should be submitted to VA not later than the 10th day after the end
of each month.
The copy of the form should be given to the trainee for his or her record.

APPRENTICESHIP OR OTHER ON-JOB TRAINING PROGRAMS FOR ELIGIBLE DEPENDENTS
(CHAPTER 35)
Instructions For Trainer
The original copy of this form must be retained at the training establishment until 3 years after the trainee completes or
terminates training. This form should not be sent to VA. Instead, the trainee will give you a separate card each month for
reporting his or her monthly hours of employment to VA.
The copy of the form should be given to the trainee for his or her records.
PRIVACY ACT INFORMATION:
The law requires that adequate records be maintained to show the progress made by each veteran or other eligible person
toward the completion of his or her training program (38 U.S.C. 1777). Records of progress must be made available for
examination by duly authorized representatives of the Department of Veterans Affairs. Responses may be disclosed outside
VA only if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of
records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal Register.
VA may use computer matching programs with other agencies to verify the information you enter on the form. VA may also
use the information for debt collection purposes.
RESPONDENT BURDEN:
We need this information in order to track the type and hours of training as well as the rating of trainee performance (38 U.S.
C. 5107 (a)). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average
of 15 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 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.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments
or suggestions about this form.