VA Form 28-10290 Labor Market Information-Veteran Readiness & Employment

OMB Approved No. 2900-0098
Respondent Burden: 15 minutes
Expiration Date: XX/XX/20XX

VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)

LABOR MARKET INFORMATION-VETERAN READINESS & EMPLOYMENT
INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 3. Use this form to submit
Labor Market Information (i.e., Labor Market trends, salaries, physical requirements, required education or skills, etc.) For more
information, you can contact us online through Ask VA: https://ask.va.gov/. Ask us a question online or call us toll-free at
1-800-827-1000 (TTY: 711). VA forms are available at www.va.gov/vaforms. After completing the form, electronically email it to
the assigned Veteran Readiness & Employment Case Manager or mail to: Department of Veterans Affairs, Evidence Intake Center,
P.O. Box 4444, Janesville, WI, 53547-4444.

SECTION I: VETERAN READINESS & EMPLOYMENT (VR&E) LABOR MARKET INFORMATION (LMI)
NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter per box, and completely fill in
each applicable check circles to help expedite processing of the form.
1. VETERAN'S NAME (First, Middle Initial, Last)

2. COMPLETED BY STATE WORKFORCE (PROVIDE NAME & TITLE)

3. VETERAN ID

4. DATE REFFERRED
Month

Day

5. DATE COMPLETED
Year

Month

Day

Year

6. APPROVED OCCUPATION(S)

7. DISTANCE WILLING TO TRAVEL

8. VR&E CASE MANAGER

SECTION II: LABOR MARKET INFORMATION
(Document the appropriate individual labor market information in both columns below)
9. JOB DESCRIPTION/DUTIES/ACTIVITIES

12. WORK ENVIRONMENT (SEDENTARY/PHYSICAL)

11. WORK ENVIRONMENT (SEDENTARY/PHYSICAL)

10. JOB DESCRIPTION/DUTIES/ACTIVITIES

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28-10290

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SECTION II: LABOR MARKET INFORMATION (CONTINUED)
(Document the appropriate individual labor market information in both columns below)
13. CAREERS REQUIRING SIMILAR SKILLS

14. CAREERS REQUIRING SIMILAR SKILLS

15. TRAINING/EDUCATION/APPRENTICESHIP REQUIRED

16. TRAINING/EDUCATION/APPRENTICESHIP REQUIRED

17. SALARY RANGE/BENEFITS:

18. SALARY RANGE/BENEFITS:

19. EMPLOYMENT OUTLOOK

20. EMPLOYMENT OUTLOOK

21. ANNUAL JOB OPENINGS

22. ANNUAL JOB OPENINGS

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23. CAREER PERCENT GROWTH

24. CAREER PERCENT GROWTH

25. ADDITIONAL NOTES/COMMENTS

SECTION III: CERTIFICATION AND SIGNATURE
I CERTIFY THAT I have completed this statement and that its information is true and correct to the best of my knowledge and belief.
26. STATE WORKFORCE REPRESENTATIVE

27. DATE SIGNED
Month

Day

Year

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 NOTICE: 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
Feder al 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 Veteran Readiness and Employment Records - VA,
published in the Federal Register. Your obligation to respond is voluntary.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. The OMB control number for this project is 2900-XXXX, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 15
minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the
burden, to VA Reports Clearance Officer at VACOPaperworkReduAct@va.gov. Please refer to OMB Control No. 2900-XXXX in any correspondence. Do not send your completed VA
Form 28-10290 to this email address.

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