Who needs a VA 22-5495 form?
This form is used in the Department of Veteran Affairs. It is completed by the veteran’s dependent or survivor who wants to change a program or place of training under a specific benefit program, either educational or vocational.
What is the purpose of the VA 22-5495 form?
This request provides information about the veteran’s dependent or survivor and the details of benefits and education or training which should be changed. The Department of Veteran Affairs uses this information to make certain changes to the benefit program.
What other documents must accompany the VA 22-5495 form?
As a rule, there is no need to attach other documents to this request. The applicant may include the voided personal check if needed.
When is the VA 22-5495 form due?
The request must be completed when the applicant decides to change the benefit program or place of training. The estimated time for completing the form is 15 minutes.
What information should be provided in the VA 22-5495 form?
The form consists of V parts which the applicant is to complete:
- Part I — Information about the applicant (name, Social Security Number, VA file number, sex, date of birth, phone number, email address, direct deposit, account type, information about the contact person)
- Part II — Qualifying individual information (information about the person on whose account benefits are being claimed)
- Part III — Information about the applicant’s military service (date of entering and separating; branch of service; character of discharge)
- Part IV — Benefit and type of education or training (basic information about the program)
- Part V — Remarks and certification
The applicant also must sign and date the request.
What do I do with the VA 22-5495 form after its completion?
The completed form is forwarded to the local office of the Department of Veteran Affairs for further consideration.
