VA Form 22-6553b-1 Certification of Lessons Completed

OMB Control No. 2900-0353
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/20XX
STUDENT'S NAME (First, Middle Initial, Last)

CERTIFICATE OF LESSONS
COMPLETED

STUDENT'S MAILING ADDRESS

FOR VA USE ONLY
VA FILE NUMBER

STUDENT'S EMAIL ADDRESS (Optional)

FACILITY CODE

PAYEE

TYPE TRAINING

NUMBER LESSONS AUTHORIZED

IMPORTANT
1. Read all instructions before completing this form.
2. If this form is damaged or lost, ask VA for another form
by clicking this link: Find A VA Form Veterans Affairs

NOTE - PLEASE READ THE PRIVACY ACT INFORMATION AND RESPONDENT BURDEN ON PAGE 2 BEFORE COMPLETING THIS FORM.

INSTRUCTIONS TO STUDENT
IF YOU ARE ENROLLED AND STILL PURSUING YOUR COURSE - COMPLETE THIS FORM ONLY if you are due
payment for one or more lessons completed and sent to the school through the last date shown in Item 2. (We will send you a new
form at the end of the next quarter.) To receive payment, check BOX A in ITEM 1. Then enter in Item 4A the total number of lessons
completed and sent to the school since you started this course. VA bases payments on the number of lessons completed by you and
serviced by the school. If you have completed additional lessons, but your school has not yet serviced these additional lessons, VA
will pay for those lessons at the end of the quarter in which your school serviced those lessons.
IF YOU ARE NO LONGER ENROLLED - Check the applicable box, B or C, in Item 1 if you completed or terminated your
course. Then, enter in Item 4A the total number of lessons that you have completed and sent to the school.
BEFORE SENDING THE FORM TO YOUR SCHOOL - Sign and date this form in Items 8A and 8B. Place your telephone
number in Item 8C. If the school has furnished you with an identification number, place that ID number in Item 4B.
WHERE TO SEND THE FORM - Send the completed form promptly to the school for their certification. Your payment will be
issued after receipt of the school's certification.
ADDRESS CHANGE - If you are changing your address permanently, neatly line out your address and print your new address in the
remaining space. Be sure to show your ZIP Code.
INSTRUCTIONS TO SCHOOL
IF STUDENT IS STILL ENROLLED AND PURSUING THE COURSE - Check the "YES" block in Item 3. In Item 6, enter the
total number of lessons serviced from the date the student started this course through the ending date to be certified in Item 2.
IF STUDENT IS NO LONGER ENROLLED - Check "NO" block in Item 3. Enter the date the last lesson was serviced in Item 5.
In Item 6, enter the total number of lessons you have serviced through the date shown in Item 5.
REMARKS - Report any exception to the student's certification in Item 7, Remarks.
BEFORE SENDING THE FORM TO VA - Sign and date the certification in Items 9A and 9B. Send the completed form to the VA
office shown on page 2.

VA FORM
XXX XXXX

22-6553b-1

SUPERSEDES VA FORM 22-6553b-1, APR 2022,
WHICH WILL NOT BE USED.

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INSTRUCTIONS: Complete Items 1 through 9B and return completed form to the appropriate VA office shown in the table below.
3. IS STUDENT STILL ENROLLED

2. PERIOD TO BE CERTIFIED

1. COURSE PARTICIPATION (Check applicable box)
A.

I WAS PURSUING THE COURSE APPROVED BY VA
FOR THE PERIOD SHOWN IN ITEM 2

YES

B.

I COMPLETED MY COURSE C.

NO (If "No," complete Item 5)

I TERMINATED MY COURSE
4B. SCHOOL IDENTIFICATION
NUMBER

4A. TOTAL NUMBER OF LESSONS
COMPLETED TO DATE

5. IF TERMINATED OR COMPLETED ENTER
DATE LAST LESSON SERVED

6. TOTAL NUMBER OF LESSONS
SERVICED TO DATE

7. REMARKS

I CERTIFY THAT the above entries are true and, if applicable, the 85-15% ratio requirements were met for this student's course of study.
PENALTY - Willful false reports concerning benefits payable by VA may result in fines or imprisonment or both.
8B. DATE SIGNED

8A. SIGNATURE OF STUDENT (Sign in ink)

8C. APPLICANT'S TELEPHONE NUMBER (Including Area Code)
MOBILE (include area code)

HOME (include area code)
9B. DATE SIGNED

9A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL (Sign in ink)

Eastern Region:
VA Regional Office
P. O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES
CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO/FPO AA

FOREIGN
SCHOOLS

U.S. VIRGIN ISLANDS

Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888

SERVES THE FOLLOWING STATES
AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO/FPO AP

GUAM

PHILIPPINES

AMERICAN SAMOA

MARIANA ISLANDS

PRIVACY ACT INFORMATION: 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., 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) 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 response is required to obtain or retain benefits. VA cannot determine your
eligibility for further educational benefits and the proper rate payable unless this form is completed and filed as required by existing law and regulation
(38 U.S.C. 3680). While you are not required to respond, we cannot pay you any further education benefits until we receive this information. Your
responses are confidential (38 U.S.C. 5701). The information you send may be verified through computer matching programs with other agencies.
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 2900-0353, and it expires XX/XX/20XX. Public
reporting burden for this collection of information is estimated to average 10 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. 2900-0353 in any correspondence. Do
not send your completed VA Form 22-6553b-1 to this email address.
VA FORM 22-6553b-1, XXX XXXX

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