Form 22-0810 Application for Reimbursement of National Exam Fee

OMB Control No. 2900-0706
Respondent Burden: 15 minutes
Expiration Date: XX/XX/20XX

REQUEST FOR REIMBURSEMENT OF NATIONAL EXAM FEE
(See General Information on Reverse)

Please read the Privacy Act and Respondent Burden information on the reverse before completing the form.
IMPORTANT: Complete this application to apply for reimbursement of a national exam fee (one exam per form). You must apply separately for VA benefits if you
have not already done so. (SEE REVERSE FOR INFORMATION AND INSTRUCTIONS BEFORE COMPLETING THIS FORM)

PART I - IDENTIFICATION INFORMATION

1. APPLICANT'S NAME (First, Middle Initial, Last Name)

2A. APPLICANT'S ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code)

2B. APPLICANT'S EMAIL ADDRESS
3. TELEPHONE NUMBER (Include Area Code) (Indicate hours you can be reached)
DAYTIME:

4. SOCIAL SECURITY NUMBER OF APPLICANT

EVENING:

5. VA FILE NUMBER (For chapter 35, enter the veteran's file number and include your suffix indicator. For chapter 30 dependent's case, enter the file number of the

person who transferred entitlement to you.)

6. VA EDUCATION INFORMATION
A. HAVE YOU PREVIOUSLY APPLIED FOR VA EDUCATION BENEFITS?
YES (If "Yes," show the specific benefit you previously applied for in Item 6B)
NO (If "No," you must also complete an Application for VA Education Benefits, VA Form 22-1990)
B. WHAT EDUCATION BENEFIT HAVE YOU APPLIED FOR PREVIOUSLY?

C. UNDER WHAT EDUCATION BENEFIT ARE YOU NOW APPLYING FOR EXAM FEE REIMBURSEMENT?
Post-9/11 GI Bill (Chapter 33)
Montgomery GI Bill - Active Duty Educational Assistance Program (MGIB) (Chapter 30)
Post-Vietnam Era Veterans Educational Program (VEAP) (Chapter 32)
Survivors' and Dependents' Educational Assistance Program (DEA) (Chapter 35)
Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR) (Chapter 1606)
National Call to Service (NCS)

PART II - EXAM INFORMATION (Specify each item for this exam)

10. ITEMIZE EXAM COST INCLUDING FEES (Attach exam receipt)

7. NAME OF EXAM
8. ORGANIZATION GIVING EXAM (Indicate if taken online)
9. DATE EXAM TAKEN (MM/DD/YYYY) (Attach a copy of exam results)
11. REMARKS (Optional)

PART III - CERTIFICATION AND SIGNATURE OF APPLICANT

I CERTIFY THAT the information above is true and correct to the best of my knowledge and belief.
PENALTY - Willfully false statements as to a material fact in a claim for education benefits payable by VA may result in a fine, imprisonment, or both.
12. SIGNATURE OF APPLICANT (Sign in ink)

13. DATE SIGNED (MM/DD/YYYY)

IMPORTANT - Please return this form to the VA Regional Processing Office that handles your area (see the VA Regional
Processing Office addresses on page 2 of this form.). You must submit a copy of the exam receipt and the exam results. Please visit
https://benefits.va.gov/gibill/national_testing.asp for more information.
VA FORM
XXX 20XX

22-0810

SUPERSEDES VA FORM 22-0810, DEC 2023,
WHICH WILL NOT BE USED.

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INFORMATION AND INSTRUCTIONS
(The items that are considered self-explanatory are not included in these instructions)
ITEM 5. If you (or the veteran or service person) were previously assigned an 8-digit file number, enter this number.
ITEM 6A. If you have not previously applied for VA education benefits, go to www.benefits.va.gov/gibill, the "Education and Training" page will
appear and then click on "Apply for Benefits."
ITEM 7. Write the complete name of the exam that you took. Show exam information for only one exam on any one application.
ITEM 8. Write the complete name of the organization that administered the national exam you took.
ITEM 9. Show the date you took the national exam. You must also attach a copy of exam results.
ITEM 10. Enter the cost of the exam you took, including any required fees. You must attach a copy of exam receipt. (We can only reimburse you
for required exam fees.) We have no authority to reimburse you for any optional costs related to the examination process. Exam fees that VA will
reimburse include "registration fees," fees for specialized exams, and administrative fees such as a proctoring fee. Fees that VA has no authority to
reimburse include fees to take pre-exams (such as Kaplan exams), fees to receive scores quickly, or other costs or fees for optional items that are not
required to take an approved exam.
ITEM 11. Use the space in this item to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer to
other item numbers on this form to help us match your answers to the correct questions. If more space is needed, please attach separate sheets of
paper. Be sure to place your name and VA file number or social security number on each additional page.
ITEM 12 AND 13. Sign and date the form.
MORE HELP: Our education internet site (www.benefits.va.gov/gibill) is available to help you, even after normal business hours. If you need help in
completing this application, call VA TOLL-FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you use the Telecommunications Device for the Deaf
(TDD), the Federal Relay number is 711.
HOW TO FILE YOUR CLAIM. Send the completed application to the Regional Processing Office in the region of your home address. Use the
addresses shown below.

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

US 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

AMERICAN SAMOA

PHILIPPINES

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, section 1.576 for routine uses (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) 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. While you do not have to respond, VA cannot process your claim for reimbursement of national test fees unless the information is furnished as
required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients,
and others may be subject to verification 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 2900-0706, 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. 2900-0706 in any correspondence. Do not send your completed VA Form 22-0810 to this email address.
VA FORM 22-0810, XXX 20XX

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