Statement of Assurance of Compliance with 85 Percent Enrollment Ratios

Statement of Assurance of Compliance with 85 Percent Enrollment Ratios (VA Form 22-10215), 85 Percent Enrollment Calculation Continuation Sheet (VA Form 22-10215a)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0897 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 22-10215 Statement of Assurance of Compliance with 85 Percent Enrollment Ratios Form and Instruction
VA Form 22-10215 Statement of Assurance of Compliance with 85 Percent Enr 22-10215(10-26-21).pdf www.va.gov/vaforms Form and Instruction
VA Form 22-10215a Statement of Assurance of Compliance with 85 Percent Enr 22-10215a(10-26-21).pdf www.va.gov/vaforms Form and Instruction

Information Collection (IC) Details

IC Title:	Statement of Assurance of Compliance with 85 Percent Enrollment Ratios	Agency IC Tracking Number:	202103-2900-029

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.4201

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 22-10215	Statement of Assurance of Compliance with 85 Percent Enrollment Ratios	22-10215(10-26-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form and Instruction	VA Form 22-10215a	Statement of Assurance of Compliance with 85 Percent Enrollment Ratios	22-10215a(10-26-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title: 58VA 21/22/28, COMPENSATION, PENSION, EDUCATION AND VETERAN READINESS AND EMPLOYMENT-VA (58VA21/22/28)	FR Citation: 86 FR 55683

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	40,000	40,000
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.