Form 28-1905h Trainee Request for Leave - Chapter 31, Title 38 U.S.C.

OMB Control No. 2900-0034
Respondent Burden: 15 Minutes

TRAINEE REQUEST FOR LEAVE - CHAPTER 31, TITLE 38 U.S.C.
INSTRUCTION TO TRAINEE: (Read carefully before completing form.) Complete and sign Section I. Have your trainer or authorized school official complete and
sign Section II. Give the form to your VA Representative or send it to the Department of Veterans Affairs office having jurisdiction over your training.
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 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. Completion of this form is required to obtain or retain benefits. The
responses you submit are considered confidential (38 U.S.C. 5701).
RESPONDENT BURDEN: The form is used by the veteran and the trainer to provide sufficient information to justify a leave of absence. Veterans on approved leave
of absence continue receiving subsistence allowance. The information on the form prevents abuse of paid leave. The information collected is required by existing law
(38 U.S.C. 1510). 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 number is displayed. Valid OMB control numbers can be located on the OMB Internet Page at
www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

SECTION I (To be completed by trainee)
NAME AND ADDRESS OF VETERAN

CLAIM NO.

NAME AND ADDRESS OF TRAINING ESTABLISHMENT
OR SCHOOL

CDATES
OF
LEAVE

FIRST DAY (Mo., Day, Yr.)

IF REQUEST IS FOR ILLNESS OR INJURY, STATE NATURE OF ILLNESS OR INJURY

LAST DAY (Mo., Day, Yr.)

SIGNATURE OF VETERAN

DATE

SECTION II (To be completed by trainer or authorized school official)
ABSENCE OF ABOVE-NAMED VETERAN ON DATES INDICATED WILL
(OR DID) NOT MATERIALLY INTERFERE WITH PROGRESS IN THE
COURSE. I RECOMMEND APPROVAL OF THIS REQUEST

ABSENCE OF ABOVE-NAMED VETERAN ON DATES INDICATED WILL
(OR DID) MATERIALLY INTERFERE WITH PROGRESS IN THE COURSE.
I DO NOT RECOMMEND APPROVAL OF THIS REQUEST.

REMARKS

SIGNATURE OF TRAINER OR AUTHORIZED SCHOOL OFFICIAL

TITLE

DATE

SECTION III (To be completed by VA case manager)
ACTION TAKEN
APPROVED
VA FORM
FEB 2012

DATE VETERAN NOTIFIED

SIGNATURE OF CASE MANAGER

DISAPPROVED

28-1905h

EXISTING STOCKS OF VA FORM 28-1905H, AUG 2005,
WILL BE USED.

DATE