28-10281 Request for Restoration of Entitlement due to Facility C

OMB Control No. 2900-NEW
Respondent Burden: 10 minutes
Expiration Date: XXXXXXXX

REQUEST FOR RESTORATION OF ENTITLEMENT DUE TO FACILITY CLOSURE, PROGRAM OF
TRAINING OR COURSE DISAPPROVAL
(Chapter 31 - Veteran Readiness and Employment)
Before completing this form, read the Privacy Act and Respondent Burden on Page 2. Use this form to submit a request for Chapter 31 restoration of
entitlement due to facility closure, program of training or course disapproval. For more information, contact us at https://www.va.gov/contact-us, or call us
toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711. VA forms are available at
www.va.gov/vaforms.

PART I - APPLICANT IDENTIFICATION AND PERSONAL INFORMATION
NOTE: You may complete the form online or by hand. If completing by hand, print neatly and legibly in ink, and completely fill in each applicable circle to
help expedite processing of the form.
1. NAME OF CLAIMANT (First-Middle-Last)

2. VA FILE NUMBER (Last 4)
3. CURRENT MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code and Country)

No. &
Street
Apt./Unit Number

City

State/Province

Country

4.TELEPHONE NUMBER (Include Area Code)

ZIP Code/Postal Code
5. E-MAIL ADDRESS

I agree to receive electronic correspondence from
VA in regards to my claim.

Enter International Phone Number (If applicable)

PART II - INFORMATION NEEDED TO REVIEW FOR RESTORATION OF ENTITLEMENT
6. PROVIDE THE NAME AND ADDRESS OF THE FACILITY THAT WAS CLOSED OR COURSE DISAPPROVED (If more space is needed, use Item 12 Remarks)
Name

No. &
Street
City

State/Province

Country

ZIP Code/Postal Code
OR Course Disapproved

7A. DID YOU COMPLETE A PROGRAM OF TRAINING OR COURSE THAT 7B. DID YOU RECEIVE CREDIT FOR THE ENROLLED HOURS BEING
ATTEMPTED AT THE TIME OF THE CLOSURE OR DISAPPROVAL?
WAS DISAPPROVED OR THE FACILITY CLOSED?
YES

NO

YES

NO

7C. WERE YOU STILL ENROLLED IN THE PROGRAM OF TRAINING OR A 7D. WERE YOU ON AN APPROVED LEAVE OF ABSENCE WHEN THE
COURSE WHEN THE FACILITY CLOSED OR A PROGRAM OF
FACILITY WAS CLOSED OR DISAPPROVED?
TRAINING OR COURSE WAS DISAPPROVED?
YES

NO

YES

NO

8A. DID YOU WITHDRAW FROM THE FACILITY PRIOR TO THE FACILITY 8B. PROVIDE THE DATE OF WITHDRAWAL FROM THE FACILITY
(MM/DD/YYYY)
CLOSING?
DATE
YES
VA FORM
XXXX

NO

(If "Yes," complete Item 8B)

28-10281

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PART II - INFORMATION NEEDED TO REVIEW FOR RESTORATION OF ENTITLEMENT (Continued)
9A. ARE YOU ENROLLED IN A PROGRAM OF TRAINING OR COURSE AT A NEW FACILITY?

YES

NO

(If "Yes," complete Item 9B)

9B. PROVIDE THE FULL NAME OF YOUR NEW FACILITY AND PROGRAM OF TRAINING OR COURSE

9C. IF YOU ARE ATTENDING A NEW FACILITY, DID THEY GRANT 12 OR MORE CREDIT HOURS FOR COURSE(S) TAKEN FROM THE CLOSED
OR DISAPPROVED FACILITY?
YES

NO

(If "Yes," please attach degree audit after "No" checkbox)

10. IF YOU ATTENDED A NON-COLLEGE DEGREE (NCD) FACILITY THAT WAS CLOSED, OR WAS DISAPPROVED, DID THAT FACILITY
TRANSFER ANY HOURS OR CREDITS?
YES

NO

(If "Yes," please attach degree audit after "No" checkbox)
11. WHAT WAS YOUR LAST DATE OF ATTENDANCE AT THE CLOSED OR DISAPPROVED FACILITY?
DATE
(If "Yes," please attach degree audit after "No" checkbox)
12. REMARKS (If any)

PART III - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
13A. SIGNATURE OF APPLICANT

13B. DATE SIGNED (MM/DD/YYYY)

PENALTY: The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material fact you
know to be false, or for fraudulent receipt of any document you are not entitled to.
PRIVACY ACT INFORMATION: The responses you submit are considered confidential (38 U.S.C. 5701). Your obligation to respond is required in order to obtain benefits. 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 (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United
States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and
personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Veterans Readiness and Employment Records - VA,
published in the Federal Register. Information that you furnish may be utilized in computer matching programs with other Federal or State agencies for the purpose of
determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered
by the Department of Veterans Affairs.
RESPONDANT BURDEN: This form is used to determine restoration of entitlement to Chapter 31 benefits when certain criteria are met (38 USC 3699(c)(2)). 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. Valid OMB 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 28-10281, XXXX

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INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
REQUEST FOR RESTORATION OF ENTITLEMENT DUE TO FACILITY CLOSURE,
PROGRAM OF TRAINING OR COURSE DISAPPROVAL
(Chapter 31-Veteran Readiness and Employment)
(VA FORM 28-10281)
HOW TO USE THIS FORM
Use this form to apply for a request for restoration of entitlement for Department of Veterans Affairs Veterans
Readiness and Employment (VR&E) benefits used at a facility that has closed or program of training or course has
been disapproved. Please respond to all required questions regardless of the type of facility you were attending and
provide the requested documentation.
With limited exception, the VA can restore entitlement only for the period of enrollment in which you did not receive
credit (or in which you lost training time). Generally, this means that entitlement can only be restored for the single term
you were enrolled in when your program of training or course was disapproved, or the facility closed.
Effective August 1, 2021 through September 30, 2023, VA is able to restore entitlement for the entire program of
education, not just the last term, quarter, or semester if you were not able to transfer at least 12 credits to a new school
and your last enrollment period was within 120 days of the facility closure or disapproval. Claims for this temporary
provision must be received after enrollment at the new school and on or before September 30, 2023.
PART I
In this section, complete your name, last four of VA file number, mailing address, telephone number and email address.
PART 2
In this section, respond to all applicable questions regarding the facility closure, program of training or course
disapproval.
PART 3
In this section, sign and date prior to submission of completed form.
HOW TO FILE YOUR CLAIM
After completing this form, if returning by mail to:
Department of Veterans Affairs, Veteran Readiness and Employment (VR&E) Intake Center
P.O. Box 5210, Janesville, WI, 53547-5210.

VA FORM 28-10281, XXXX

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