Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.)

Dependent's Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) (VA Form 22-5495)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0099 can be found here:

Documents and Forms

Document Name Document Type
Form 22-5495 Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) Form
22-5495 Dependent's Request for Change of Program or Place of Tr VA Form 22-5495 (7-27-20).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.4234

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	22-5495	Dependent's Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.)	VA Form 22-5495 (7-27-20).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Compensation, Pension, Education and Vocational Rehabilitation and Employment Records – VA (58VA21/22/28)	FR Citation: 75 FR 22187

Number of Respondents: 109,760	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Previously Approved
Annual Number of Responses for this IC	109,760	109,760
Annual IC Time Burden (Hours)	27,440	27,440
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.