Form VA Form 22-10216 VA Form 22-10216 35% Exemption Request From 85-15 Reporting Requirement

35% EXEMPTION REQUEST FROM 85/15 REPORTING REQUIREMENT
GENERAL INFORMATION
Use this form VA Form 10216 to request exemption of the routine reporting requirements of the 85/15 Rule as required by Title 38
United States Code (U.S.C.) 3680A(d) and 38 Code of Federal Regulations (CFR) 21.4201.
To request the 35% Exemption, a copy of this form and a completed VA FORM 22-10215 (STATEMENT OF ASSURANCE OF
COMPLIANCE WITH 85 PERCENT ENROLLMENT RATIOS) for the corresponding term must be submitted to the Education
Liaison Representative of jurisdiction via email. (Vocational Flight Schools should use VA Form 22-10217 versus VA Form
22-10215).
Note: This exemption applies only to the submission of routine reports. Your Educational & Training Institution remains obligated to
maintain compliance with the provisions of the 85/15 Rule for all programs approved to receive GI Bill® benefits and must provide
85/15 calculations for any term requested by a VA employee or State Approving Agency representative.
In order to be eligible for this exemption, your Educational & Training Institution's number of VA beneficiary students in all
programs approved for GI Bill must not exceed 35% of the total enrollment at the educational institution (computed separately for
the main campus and any separately approved branch campuses of the institution).
VA Beneficiary. Any student who is receiving any amount of payments from the VA for their training (such as through GI Bill
benefits or Veteran Readiness and Employment benefits).
For additional guidance on the 85/15 Rule see the School Certifying Official Handbook.
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE 35% EXEMPTION REQUEST
VA EDUCATION SERVICE HELP AVAILABLE - If you need help calculating your facility's potential eligibility for the 35%
Exemption, or have questions concerning the 85/15 Rule, contact the Education Liaison Representative of jurisdiction.
NOTE: The numbers on the instructions match the item numbers on the form. Items not shown are self-explanatory.
ITEM 1. Provide the full name of your institution as listed on the Web Enabled Approval Management System (WEAMS) report (VA
FORM 22-1998).
ITEM 2. Provide your institution's VA assigned facility code. Do not provide any spaces or hyphens in this section.
Note: Separate exemption requests (and calculations) are required for the main campus and any branch campuses with separate
administrative capability seeking the 35% Exemption. Branches and extensions without separate administrative capability are part
of the main or branch campus under which that extension is approved.
ITEM 4C - VA Beneficiary Student Percentage. The result of students provided in the “Total Number of VA Beneficiary Students”
column divided by the “Total Number of Students” column.
ITEM 4D - Date of Calculation. Provide the date that 85/15 calculation was completed. This must be within 30 days of the term
start date.
35% CALCULATION EXAMPLE:
Total number of students enrolled at your school:
Total number of VA beneficiaries enrolled at your school:

1,000
250

To calculate the percentage for 35% Exemption:
Divide the number of VA beneficiaries (250) by the total number of enrolled students (1,000).
250 ÷ 1,000 = .25
To convert the quotient to a percentage, move the decimal point two spaces to the right and add the % sign after the last digit:
.25 = 25%
VA FORM 22-10216 XXX XXXX

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OMB Control No. XXXX XXXX
Respondent Burden: 30 minutes
Expiration Date: XX/XX/XXXX

35% EXEMPTION REQUEST FROM 85/15 REPORTING REQUIREMENT
INSTRUCTIONS: Read the Privacy Act and Respondent Burden on this page before completing the form.
1. INSTITUTION NAME

2. FACILITY CODE

3. TERM START DATE

4. 35% EXEMPTION CALCULATION

The total number of beneficiaries receiving assistance under all chapters of Title 38 and chapter 1606 of Title 10, U.S. Code at
this institution is equal to or less than 35 percent of our total student enrollment, as identified in the calculation provided below.
NOTE: For the purpose of the 35% Exemption, determine the percentage of VA Beneficiary students of the ETI total student
population. When calculating 85/15 compliance, please refer to the specific instructions noted on STATEMENT OF
ASSURANCE OF COMPLIANCE WITH 85 PERCENT ENROLLMENT RATIOS, VA Form 22-10215.
A. VA BENEFICIARY STUDENTS

B. TOTAL NUMBER OF STUDENTS C. VA BENEFICIARY STUDENTS PERCENTAGE

D. DATE OF CALCULATION

VA Form 22-10215, Statement of Assurance of Compliance with 85 Percent Enrollment Ratios is attached. (Check box)

I HEREBY CERTIFY THAT the calculations listed above are true and correct in content and policy.
5. SCHOOL OFFICIAL PRINTED NAME

6. SCHOOL OFFICIAL TITLE

7. SIGNATURE OF SCHOOL OFFICIAL

8. DATE SIGNED (MM/DD/YYYY)

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 Federal Regulations 1.576 for routine uses as identified in the VA
system of records, 58VA21/22/28, Compensation, Pension, Education, Veteran Readiness and Employment Records - VA,
published in the Federal Register. An example of a routine use (e.g., VA sends educational forms or letters with a Veteran's
identifying information to the Veteran's school or training establishment to (1) assist the Veteran in the completion of claims forms
or (2) for VA to obtain further information as may be necessary from the school for VA to properly process the Veteran's education
claim or to monitor his or her progress during training). Your obligation to respond is required to obtain or retain education
benefits. The responses you provide are considered confidential (38 U.S.C. 5701). Any information provided by applicants,
recipients, and others is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to ensure your school is properly reporting pursuit of training for Veterans
and other eligible persons (38 U.S.C. 3684). Title 38, United States Code, allows us to ask for this information. We estimate you
will need an average of 30 minutes to review the instructions, find the information, and complete the 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
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22-10216

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