Form VA Form 22-0810 VA Form 22-0810 Application For Reimbursement Of National Exam Fee

OMB Approved No. 2900-0706
Respondent Burden: 15 minutes

APPLICATION FOR REIMBURSEMENT OF NATIONAL EXAM
FEE
Please read the Privacy Act and Respondent Burden information on the reverse before completing the form.

IMPORTANT: Complete this application to apply for reimbursement of a national exam fee (one exam per form). You must apply
separately for VA benefits if you have not already done so. You can receive reimbursement of a national exam fee if you qualify for
VA benefits under one of the following programs:

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Montgomery GI Bill - Active Duty Educational Assistance Program (MGIB) (Chapter 30)
Post-Vietnam Era Veterans Era Educational Program (VEAP) (Chapter 32)
Survivors’ and Dependents’ Educational Assistance Program (DEA) (Chapter 35)
Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR) (Chapter 1606)
Reserve Educational Assistance Program (REAP) (Chapter 1607)
National Call to Service (NCS)
(SEE REVERSE FOR INFORMATION AND INSTRUCTIONS BEFORE COMPLETING THIS FORM)

Part I - IDENTIFICATION INFORMATION
1. APPLICANT’S NAME (First, Middle Initial, Last Name)

2. APPLICANT’S ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code)

4. SOCIAL SECURITY NUMBER OF APPLICANT

3. TELEPHONE NUMBER (Include Area Code) (Indicate hours you can be reached)
DAYTIME

EVENING

5. VA FILE NUMBER (For chapter 35, enter the veteran’s file number and include your suffix indicator. For chapter 30 dependent’s case, enter the file number
of the person who transferred entitlement to you.

6. VA EDUCATION INFORMATION
A. HAVE YOU PREVIOUSLY APPLIED FOR VA EDUCATION BENEFITS?

YES

If "Yes," show the specific benefit you previously applied for in Item 6B)

NO

If "No," you must also complete an Application for VA Education Benefits, VA Form 22-1990)

B. WHAT EDUCATION BENEFIT HAVE YOU APPLIED FOR PREVIOUSLY?

C. UNDER WHAT EDUCATION BENEFIT ARE YOU NOW APPLYING FOR EXAM FEE REIMBURSEMENT?

CH 30

CH 32

CH 35

CH 1606

CH 1607

NCS

Part II - EXAM INFORMATION (Specify each item for this exam)
7. NAME OF EXAM

10. ITEMIZE EXAM COST INCLUDING FEES (Attach receipt)

8. ORGANIZATION GIVING EXAM (Indicate if taken online)

9. DATE EXAM TAKEN

11. REMARKS (Optional)

Part III - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT the information above is true and correct to the best of my knowledge and belief.
PENALTY - Willfully false statements as to a material fact in a claim for education benefits payable by VA may result in a fine, imprisonment, or both.
13. DATE SIGNED

12. SIGNATURE OF APPLICANT (Do NOT print)

IMPORTANT - Please return this form and a copy of the receipt for exam fees to the VA Office that handles your area. See the VA
Regional Office addresses on the reverse of this form. VA will request a copy of your exam results only if needed.
VA FORM
OCT 2010

22-0810

SUPERSEDES VA FORM 22-0810, AUG 2007,
WHICH WILL NOT BE USED.

INFORMATION AND INSTRUCTIONS
(The items that are considered self-explanatory are not included in these instructions)
ITEM 5. If you (or the veteran or serviceperson) were previously assigned an 8-digit file number, enter this number.
ITEM 6A. If you have not previously applied for VA education benefits, go to www.gibill.va.gov and click on "Education Benefits" then
click on "How to Apply for Benefits."
ITEM 6C. See the top of this form for the education benefit programs that permit reimbursement of national exam fees.
ITEM 7. Write the complete name of the exam that you took. (Show exam information for only one exam on any one application).
ITEM 8. Write the complete name of the organization that administered the national exam you took.
ITEM 9. Show the date you took the national exam.
ITEM 10. Enter the cost of the exam you took, including any required fees. (We can only reimburse you for required exam fees.) We
have no authority to reimburse you for any optional costs related to the examination process. Exam fees that VA will reimburse include
"registration fees," fees for specialized exams, and administrative fees such as a proctoring fee. Fees that VA has no authority to
reimburse include fees to take pre-exams (such as Kaplan exams), fees to receive scores quickly, or other costs or fees for optional
items that are not required to take an approved exam.
ITEM 11. Use the space in this item to provide information that does not fit elsewhere on this form or that will help VA to process your
claim. Refer to other 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 VA file number or social security number on each additional page.
ITEM 12 AND 13. Sign and date the form.
MORE HELP: Our education internet site (www.gibill.va.gov) is available to help you, even after normal business hours. If you need help
in completing this application, call VA TOLL-FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you are hearing impaired, call us TOLL FREE at 1-800-829-4388.
HOW TO FILE YOUR CLAIM. Send the completed application to the Regional Processing Office in the region of your home address.
Use the addresses shown below.

EASTERN REGION:
VA Regional Office
P. O. Box 4616
Buffalo, NY 14240-4616

CT
MD
NY
VT

Serves the following states:
DE
DC
MA
NH
OH
PA
VA
WV

CENTRAL REGION:
VA Regional Office
P. O. Box 66830
ST. LOUIS, MO 63166-6830

ME
NJ
RI
Foreign Schools

CO
KS
MO
SD

WESTERN REGION:
VA Regional Office
P. O. Box 8888
Muskogee, OK 74402-8888

AK
CA
MS
OR
Philippines

Serves the following states:
AL
AR
HI
ID
NM
NV
TX
UT
Guam

Serves the following states:
IA
IL
KY
MI
MT
NE
TN
WI

IN
MN
ND
WY

SOUTHERN REGION:
VA Regional Office
P. O. Box 100022
Decatur, GA 30031-7022

AZ
LA
OK
WA

FL
PR

Serves the following states:
GA
NC
US Virgin Islands

SC

APO/FPO AP

APO/FPO AP

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, section 1.576 for routine uses (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) as identified in VA’s 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. While you do not
have to respond, VA cannot process your claim for reimbursement of national test fees unless the information is furnished as required by existing law (38 U.S.C. 3471). 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 your eligibility for reimbursement of national test fees. We cannot reimburse you for any test fees until we
receive this information (38 U.S.C. 5101). 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
information collection.