Form VA Form 22-5281 VA Form 22-5281 Application for Refund of Educational Contributions

OMB Control No.: 2900-0261
Respondent Burden: 10 minutes
Expiration Date: XX/XX/XXXX

APPLICATION FOR REFUND OF EDUCATIONAL CONTRIBUTIONS
(VEAP, Chapter 32, Title 38, U.S.C.)
IMPORTANT INSTRUCTIONS - Before completing this form, remember you may be eligible for education benefits under VEAP if you served between the dates of
January 1,1977 through June 30, 1985 and contributed to the fund. If you accept a refund of your contributions, you will forfeit any entitlement you may have earned
under VEAP. To get information about eligibility for VEAP, or for assistance in completing this form, contact your local VA regional processing office (RPO). See the
reverse side of this form for the address of your RPO. If you want a refund, complete and send this form to your RPO at the address shown. If you need additional
information click on Submit a Question at www.benefits.va.gov/gibill/ or call toll-free to 1-888-442-4551. This refund is not available to Montgomery GI Bill, 903, and
Chapter 32 participants. Partial refunds cannot be made from your fund balance.

PART I - IDENTIFICATION DATA
1. NAME OF APPLICANT

2. SOCIAL SECURITY NO.

5A. MAILING ADDRESS OF APPLICANT

3. BRANCH OF SERVICE

4. VA FILE NO. (If applicable)

5B. PHONE NUMBER

5C. EMAIL ADDRESS (If

applicable)

(Include Area Code)

PART II - NOTICE OF DISENROLLMENT AND APPLICATION FOR REFUND
I request to be dis-enrolled from the POST-VIETNAM ERA VETERANS EDUCATIONAL ASSISTANCE PROGRAM. I further request a refund
of my remaining contributions. I realize that a refund of my contributions will result in forfeiture of my entitlement to receive educational benefits
under this program. However while on active duty, I may enroll again in this program by establishing a payroll deduction and/or making a lump sum
contribution(s) not to exceed a total of $2700, thereby reestablishing entitlement to educational benefits.
6. REASON FOR DISENROLLMENT
A.

PERSONAL HARDSHIP

B.

EDUCATION COMPLETED

C.

VOCATION OBTAINED

D.

OTHER (Specify)

NOTE: The following signature block is to be completed only by applicants on active duty. Signature of Service Approving Official
is required only upon dis-enrollment prior to completion of at least 12 monthly contributions to this program.
FOR
APPLICANTS
ON
ACTIVE
DUTY

FOR
APPLICANTS
NOT
ON
ACTIVE
DUTY

9. SIGNATURE AND TITLE OF SERVICE APPROVING
OFFICIAL

7. SIGNATURE OF APPLICANT

8. DATE SIGNED

11. LAST ALLOTMENT (Month, year)

12. SIGNATURE OF INSTALLATION FINANCE OFFICER

10. DATE SIGNED

13. DATE SIGNED

NOTE: The following signature block is to be completed only by applicants not on active duty, and must be certified by a VA
official upon the applicants personal appearance.
14. SIGNATURE OF APPLICANT

15. DATE SIGNED

16. SIGNATURE AND TITLE OF VA CERTIFYING OFFICIAL

17. DATE SIGNED

18. DATE OF DISCHARGE (AS SHOWN ON YOUR DD FORM 214)

PART III - CERTIFICATION (FOR VA USE ONLY)
I CERTIFY that I have reviewed this document and that payment of refund is proper.
19. SIGNATURE OF VA REGIONAL OFFICE FINANCE OFFICER

20. DATE SIGNED

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 such as, contacting an employer only to help facilitate the processing of your refund, 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 response is voluntary. Giving us your SSN account information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101. 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. Information submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to properly identify and refund the amount currently being held in the Post-Vietnam Era Veterans Education
Account. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 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.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.
VA FORM
XXX XXXX

22-5281

SUPERSEDES VA FORM 22-5281, JAN 2017,
WHICH WILL NOT BE USED.

To determine the mailing address on where to send this completed form, you should first find your state in the following Regional jurisdiction
tables. Then, mail your completed form to the post office box address for the VA regional office having jurisdiction for that region.

Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES

CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO / FPO AA

US VIRGIN ISLANDS

FOREIGN SCHOOLS
Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
SERVES THE FOLLOWING STATES

AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO / FPO AP

GUAM

PHILIPPINES