Form FL22-909 Dependents' Educational Assistance (DEA) Election Reques

DEPARTMENT OF VETERANS AFFAIRS

.

In Reply Refer To:

Based on our review of your application and other information in your file, we recommend
as your beginning date because
.
If you choose a different date, please give chosen date below and explain on the reverse.
You may FAX this letter rather than mailing it to the above address. Use the FAX number
. Or, you can call us at 1-888-GIBILL-1 (1-888-442-4551).
Sincerely,

Department of Veterans Affairs
Enclosure(s)
OMB Control No. 2900-0703
Respondent Burden: 15 Mins.

DEPENDENTS’ EDUCATIONAL ASSISTANCE (DEA)
ELECTION REQUEST
CLAIMANT’S NAME

CLAIMANT’S FILE NUMBER

C-

IMPORTANT - If you choose to change your Beginning Date, please insert your Requested
Beginning Date below. Sign and date this form. If you choose to make this change, give explanation
on reverse.

BEGINNING DATE ELECTION
I choose _____________________________ as the beginning date for my DEA benefits.
SIGNATURE OF CLAIMANT

DATE SIGNED

FL 22-909
OCT 2010(RS)

EXPLANATION FOR DATE CHANGE

PRIVACY ACT NOTICE: 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 (i.e., benefits with VA)
as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and
Employment Records - VA, published in the Federal Register. Your obligation to respond is "voluntary." Your obligation to
respond is not required but may result in a less than desirable beginning date for your benefits.
RESPONDENT BURDEN: We need this information to determine when your beginning date of eligibility will start. (38 U.S.C.
section 3512(a) & (b)). 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 if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at
http://www.reginfo.gov/public/do/PRAMain . 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.
FL 22-909, OCT 2010(RS)