VA Certifying Official Procedures for On-the-Job Training and Apprenticeship Programs

Business, Industry, and Government Employers.

MISSOURI STATE APPROVING AGENCY

JAMES HENLEY, DIRECTOR January, 2019

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Handy Reference Guide

My State Approving Agency (SAA) Representative is:

Jefferson City 573-522-2061, Kansas City, 816-241-1705; or St. Louis, 314-416-2124.

My Facility Name as approved is:

My Facility Code is:

The VA St. Louis Regional Processing Office (RPO) P O Box 32432 St. Louis, MO 63166-6869 Fax: 314-253-4140

Use this contact information to submit forms.

Veterans Benefits: 888-442-4515 Veterans should call this number to determine if they are eligible for educational benefits. Veterans, as well as the son, daughter or spouse of a disabled or deceased veteran, may be eligible for benefits in this training program, provided the disability or death is related to the period of active duty. Once it has been determined that they are eligible, they can find the applications online at https://www.vets.gov/education/apply/ This site enables veterans to apply for benefits using the Internet.

This handbook applies only to GI Bill Educational Benefits for Registered On-the-Job and Apprenticeship programs.

For assistance and information regarding approval of academic institutions, and other schools please contact 573-751-2571.

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Responsibilities of the GI

Table of Contents

Handy Reference Guide...................................................................2

Enroll Eligible Veteran in Your Training Program...... ……………….4

Maintain a Quality Training Program …………….……..………….…8

Glossary and Abbreviations ………………………….…………….…11

Certify Monthly Training Hours ………………….……………………..5

Report Changes in Training Program...............................................6

Maintain Proper Training Records..……………….…….………….....9

Participate in Compliance Surveys ……………….…………………..9

Appendix …………………………………........................................ 13

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Once you have been approved as a GI Bill® Training Facility, you wi l l receive the letter of approval from the director of Veterans Education and Training and from the Veterans Administration. The letter form the Veterans Administration will include your Facility Code which will be used on virtually all forms. At that point, you can begin enrolling eligible veterans in your approved training program(s).

Upon receipt of the letter we encourage you to include “Approved for the “GI Bill ® GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA).” with any announcements regarding openings for positions that have been approved. You must use the entire statement whenever it is used. This informs veterans about their eligibility for benefits as an On the Job Training facility. “Approved for the GI Bill ®” is a registered trademark of the Veterans Administration and can only be used with positions approved for training.

This guide will help you maintain your approval as GI Bill Training Facility and carry out these tasks:

1. Enroll Eligible Veteran in Your Training Program

A. ELIGIBILITY – If the veteran isn’t sure if they are eligible for benefits or if they have used all their benefits, they should call 888-442-4551 for verification of their eligibility.

If the veteran has not applied for benefits, the veteran can apply online using VA’s website https://www.vets.gov/education/apply. Use of website online application by the veteran is strongly encouraged. If the veteran is not able to use the website they can call 888-442-4551. They can also contact the Veterans Representative at the local Workforce Development office for assistance in completing the application and other veteran issues. A list of offices can be found at https://jobs.mo.gov/career-centers

The Certifying Official should NOT counsel on GI Bill eligibility or selection of benefits. If the veteran desires assistance, the VA provides eligibility assistance and a benefits comparison tool at www.gibill.va.gov and phone assistance at 888-442-4551.

NOTE: Sometimes VA eligible trainees pursue benefits well after the completion of training. In cases where VA benefits are pursued retroactively, VA will honor claims up to one year from the date they receive an application or other verifiable claim, such as a training agreement bearing the veteran’s signature. Retroactive payment of benefits will include only those months of training during the past 12 months. Time prior to that must be accounted for as prior credit.

B. ENROLLMENT - The following forms must be completed for certification:

1. For On-the-Job training complete the VE-1A, for Apprenticeship training complete the VE-11 (Veteran Training Agreement)

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This form is completed and signed by the certifying official and the veteran. Name of Training Establishment is the facility name listed on the Application for Approval. The claim number is generally the social security number of the veteran. Trade or Craft is the name of the training program. Length of Training Period is number of months of the program (e.g. 18 months, 24 months etc.) established during the approval process. The Effective Date is the date the claimant began the training program.

Prior Credit: If the veteran has worked in the occupation prior to beginning their training, discuss with the State Approving Agency (SAA) representative if some months need to be subtracted from the standard training time. If it is agreed that time should be reduced list the months to be subtracted in the Credit given for experience prior to effective date of this Agreement area of the form. Report the total prior credit in terms of months. Subtract prior credit given from length of training program and record the remaining time in Training Period Remaining After Effective Date area.

2. VA Form 22-1999 side B (VA Enrollment Certification) Contact the State Approving Agency (SAA) for additional copies.

If the veteran has a copy of the Certificate of Eligibility or a VA 1990 (Application for VA Education Benefits) we encourage you to submit it with the other two forms.

Ensure that the veteran signs and receives a copy.

Make a copy and then send all forms to Veterans Administration Regional Office Box 32432, St. Louis, MO 63132-0832.

You may submit the required forms for several veterans at one time.

The Certifying Official needs to ensure that any forms sent to the SAA office or the VA contain the veteran’s claim number/SSN, which is the control number used by the VA to pay benefits

Keep a copy of all training forms and correspondence in the employee file.

C. APPROVAL - When the VA approves the enrollment, the veteran will receive written confirmation from VA.

2. Certify Monthly Training Hours

To receive a full monthly payment, the veteran must work and be paid for at least 120 hours in the month. The veteran’s monthly benefit will be reduced proportionately if the veteran works less than 120 hours a month.

• Include all hours worked during the month as one total. Overtime hours do not need to be designated or separated in anyway.

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• Vacation and other paid leave hours do not count as work hours and must not be included.

• Classroom instruction hours (if any) for which the participant is paid are counted as work hours.

• Unpaid related instruction hours are not counted as work hours.

Hours should be submitted soon after the end of each month to assure the veteran receives their benefits in a timely fashion

If the trainee does not have any training hours in a month, do not submit any documents for that month.

VA Once is an efficient way to submit these monthly hours and is fully automated. To utilize the system your company must complete a Memorandum of Understanding and submit it to the VA for approval. See the appendix for a sample of the Memorandum of understanding. To complete the Memorandum go to https://www.benefits.va.gov/GIBILL/resources/education_resources/mou.html . Your SAA representative can provide this link to you via email if that is more convenient.

A company can also choose to use the VA website. http://benefits.va.gov/gibill/ “Submit a Question” tab to submit the monthly hours. See appendix for an instructional page.

Discuss these options with your SAA representative so you have a clear plan on how to submit the monthly hours.

3. Report Changes in Training Program If there are changes to the training program, notify the SAA and/or the VA Regional office as is noted below.

A. Change in Certifying Official

• Any changes in Certifying Official(s) must be entered on VA Form 22-8794 (See Appendix) and submitted to Veterans Administration Regional Office Box 32432, St. Louis, MO 63132-0832. Be sure and list ALL the individuals who are certifying officials on the form.

• Only an authorized Certifying Official may sign, and thus certify, GI Bill paperwork to verify a veteran’s enrollment, monthly work/training hours, change in status, and any other circumstances that affect the amount or duration of GI Bill educational benefits.

• The Certifying Official must have access to the training file, including payroll records.

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• The Designating Official must also be listed as a Certifying Official to sign GI Bill paperwork.

B. Change in Wage Schedule. Company name, address, phone number etc.

Submit the VE-2 (Amendment to Approval) to the SAA at MO. Dept. of Elementary & Secondary Education, Veterans Education, PO Box 480, Jefferson City, MO 65102.

C. New training position

Notify your SAA if you wish to add new training programs. The SAA will work closely with you and/or your training coordinator through the approval process.

D. Termination or early completion

Any time the trainee is terminated from the training program or completes the program earlier than anticipated, it must be reported to the VA within 30 days by completing the VE-1999b.

E. Call To Active Duty

When the training of a GI Bill enrollee is interrupted due to call to active duty, the Certifying Official ensures educational benefits are properly stopped. Notify the VA immediately by changing the status in VA Once or by completing the VE-1999b. The contract will remain active, but temporarily unassigned, during active duty. Send to Veterans Administration Regional Office Box 32432, St. Louis, MO 63132-0832.

F. Return From Active Duty

When active duty tour is completed and veteran returns to the same employment in an unfinished training program with you, GI Bill enrollment can resume. Notify your SAA immediately by completing a VE-1A showing their new start date.

Upon notice from your SAA that the contract or agreement is again in active status, the Certifying Official changes the status in VA Once or completes VA enrollment form 22-1999, retains a copy, then faxes or mails to the SAA.

G. Veteran Benefits are Exhausted, Ended or Changed

The Veteran, not the Certifying Official or the SAA, is responsible for the proper selection and application for benefits. There may be times during an active training enrollment when those benefits change due to eligibility issues or the veteran's choice. Those changes may require a new enrollment or other paperwork to be submitted. In nearly all cases, the VA instructs the veteran which forms to submit or process. Your role, as Certifying Official, is to respond to guidance from the VA (directly or through the veteran's

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documents) or the SAA. You are not expected to be an expert in VA benefits, forms or procedures

H. Veteran Has Questions on Benefits or Process

Refer the veteran to the VA experts. Do not answer questions that are the purview of VA. Benefits: 1-888-442-4551 or GI Bill comparison tool: http://www.benefits.va.gov/gibill/comparison_tool.asp

Process or Forms: Ask to see any instructional written notices the veteran has received. Make a copy of that notice and place in the veterans file. If that doesn't describe the needed process or form, contact your SAA for guidance.

Veteran hasn’t received a response after online application: Suggest vet logon to confirm submission. It is common for Vet to complete the online application and fail to click the "submit" button. An application that is initiated, but not submitted, will sit in unfinished status for six months.

3. Maintain a Quality Training Program

A GI Bill Training Facility must provide the training outlined in the training agreement. This includes;

• having adequate space, equipment, instructional material, and qualified personnel to provide satisfactory training.

• adhere to the established Training Outline and Training Agreements. Remember that a veteran has chosen to use GI Bill education benefits within your training program in lieu of college or other options.

• any change to the training plan must be approved prior to implementing those changes.

• training programs for new or different jobs must be approved by the SAA prior to a veteran beginning those jobs.

4. Maintain Proper Training Records The GI Bill Training Facility’s Certifying Official must maintain records that allow VA and SAA to confirm that training provided meets GI Bill requirements and that benefits were properly paid. ALL RECORDS MUST BE MAINTAINED FOR THREE YEARS FROM THE LAST DATE OF VETERANS PARTICIPATION IN TRAINING.

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Retain the following in a training file;

• Documentation of hours worked. Vacation and sick leave hours must be clearly documented. Reminder, vacation and sick leave hours don’t count toward the 120 hours required for the veteran to receive their full monthly stipend.

• A copy of the official wage records,

• Progress records must be maintained. Form VE-7 (See appendix) or an approved company progress document must be completed on a monthly basis. This form is to be retained in the trainee’s file and does not need to be submitted to the VA. Be sure to record hours worked and have training officials initial the form.

• Work and training evaluations, including grades from related instruction.

• A copy of all GI Bill-related forms and letters, including the VA Certificate of Eligibility.

• All veteran records must be retained for at least three years following the veteran’s completion or cancellation of the training program.

5. Participate in Compliance Visits SAA, as the State Approving Agency (SAA), and/or the U.S. Department of Veterans Affairs (VA) will periodically visit the sponsor to monitor the records of the apprentices/trainees. This visit generally occurs annually and is designed to provide technical assistance and ensure that GI Bill benefits paid were paid properly.

Required records are subject to onsite inspection by authorized representatives of the Dept. of Veteran Affairs (VA) and the SAA. A standardized form is used to guide the compliance visit and is provided to the Training Facility.

What kinds of records will be reviewed?

Official payroll records or check stubs to reflect the actual wage paid must be available for review.

• Timecards/Payroll Records/Time & Leave Records, so that the person conducting the compliance survey can verify:

o That the begin date certified was the actual first date of training. o That the hours certified to VA each month match the payroll or time/leave

records of the employee's hours worked. Hours certified must not include vacation, medical leave, layoffs or other paid leave. Hours certified can include paid related instruction hours.

o That wages paid during the training meet the contract/agreement requirements.

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• The employee file contains a current training training agreement for the veteran.

• Training Progress Records so that the person conducting the survey can verify: o Actual progress toward the training objective. o That a progress record is maintained and is current. o That the individual is being properly training as specified in the contract,

• Records to support any credit for prior training or experience awarded, and documentation is available to confirm the VA was properly notified of the credit.

• Copies of VA forms and correspondence.

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GLOSSARY AND ABBREVIATIONS

Accrediting AgencyA nationally recognized agency or association which the U.S. Secretary of Education determines to be a reliable authority as to the quality of training offered by an educational institution. The Secretary publishes a list of these agencies and associations which the state approving agencies utilize for establishing that a program of instruction may be approved under the provisions of 38 USC 3675 as an accredited program.

Active Duty Active duty is full-time duty in the Armed Forces. This also includes full-time duty performed by commissioned officers of the Public Health Service and National Oceanic and Atmospheric Administration (not including active duty for training).

Already Qualified A student is considered “already qualified” if he or she has previously completed a program at the same level and in the same field of study for which application is now being made. A person will be considered already qualified if he or she was previously employed in a job for which the course now being requested is designed to qualify the individual who completes it. For example, if the applicant is employed as a welder, he or she is already qualified and not eligible for enrollment in a general welding course. VA benefits are not payable for pursuit of any program for which the student is already qualified. This includes courses required for relicensing or a continuation of licensing in a professional field.

Award Letter The official written notice from the Department of Veterans Affairs to a student of his or her monthly rate of payment, the inclusive dates of payment, and remaining entitlement at the end of the award period. An award letter is sent to a VA student whenever VA awards or changes the student’s education benefit. The award letter is a good source of information for financial aid purposes.

Certificate of Eligibility (COE) Letter issued to an applicant showing approval to pursue a stated program of education at a particular institution, the remaining entitlement of the student, and the ending date of the student's eligibility.

Certifying Official The person(s) designated to sign enrollment certifications and other documents relating to VA benefits. The designation is made on VA Form 22-8794, Designation of Certifying Official(s).

Change of Program A change of program is a change in a student’s program and curriculum. This includes any change that results in pursuing a different position.

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DD Form 214 The Certificate of Release or Discharge from Active Duty that is prepared at the time an individual completes a period of active duty in one of the Armed Forces. Former members of the Public Health Service (PHS) and of the National Oceanic and Atmospheric Administration (NOAA) do not receive a DD Form 214, but they do receive comparable documents that provide necessary information concerning their active duty service. Veterans should be advised to submit Member-4 copy of their DD Form 214 with a claim for VA benefits. A certified copy may also be submitted. A DD 214 can be requested from the National Archives website (http://www.archives.gov/Veterans/military-service-records/ ).

ELR (Education Liaison Representative)

The individual at a VA Regional Office or Regional Processing Office responsible for education liaison and program approval functions. Among other things, the ELR is responsible for promptly informing schools of changes in policies and procedures.

Entitlement The number of months the student will be eligible for VA education benefits. This is usually expressed in the numbers of months and days the student will be eligible for full-time benefits, or the equivalent in part-time training, but also may be expressed in a dollar amount. Entitlement will vary depending on the education law the individual qualifies under. In no event will entitlement exceed 48 months under any combination of laws

Facility Code The numerical code assigned by VA to an institution specifically identifying it or one of its subdivisions.

File Number A seven, eight or nine-digit number assigned by VA to identify a claimant's records. The Social Security Number (SSN) is the VA file number for most Veterans. If a veteran was assigned an old seven or eight digit file number, the veteran’s SSN will cross reference the seven or eight digit file number. VA assigns a suffix to the veteran’s file number (“10” or “W”, spouse or surviving spouse, “41” or “A”, first child to apply, “42” or “B”, second child to apply, “43” or “C” third child . . .) to identify the records of an individual eligible for Chapter 35 benefits. A dependent’s SSN will not cross-reference a veteran’s record in BDN. To access a dependent’s record in BDN, the file number of the veteran must be provided. The dependent’s SSN is put in TIMS, but the TIMS record isn’t created until the dependent applies for Chapter 35.

REPS Restored Entitlement Program for Survivors. Certain survivors of deceased Veterans who died on active duty, or of service-connected causes incurred or aggravated prior to August 13, 1981, are eligible for benefits. The benefits are similar to the benefits for students and surviving spouses with children between ages 16 and 18 that were eliminated from the Social Security Act. The benefits are payable in addition to any other benefits to which the family may also be entitled. The amount of benefits is SAAed on information from the Social Security Administration.

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Selected Reserve The term means, with respect to the Armed Forces, the Army Reserve, the Naval Reserve, the Marine Corps Reserve, the Air Force Reserve, the Coast Guard Reserve, the Army National Guard of the United States, and the Air National Guard of the United States. The Public Health Service and the National Oceanic and Atmospheric Administration do not have Selected Reserve units.

State Approving Agency (SAA) An agency appointed by the Chief Executive of a state to approve institutional programs of education and training for payment of benefits under the various laws administered by VA.

VA-ONCE

Internet based p o r t a l used to submit enrollment certifications and notices of change in student status. Information about VA-ONCE is available at http://www.gibill.va.gov/school-certifying-officials/VA-ONCE-faq/index.html.

WEAMS WEAMS (Web Enabled Approval Management System) is the central application VA uses to store school, organization, and program approval information. Education Liaison Representatives (ELRs) and VACO personnel enter the approval information. VA personnel use the approval information to verify schools and programs are approved.

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APPENDIX

VE-1A – Training Agreement for On-the-Job training programs

Example of VE-1A

VE-11 – Training Agreement for Apprenticeship programs

Example of VE-11

VE-2 – Amendment to Approval

VE-7 – Progress Record

VA 22-1990 – Application for VA Education Benefits -For veteran to complete. Can also complete application on the internet -https://www.vets.gov/education/apply/

VA 22-6553d-1-Monthly Certification of Training hours

22-8794- Designation of Certifying Officials

Submit a Question Instruction Page

VA Once Memorandum of Understanding Instruction Pages

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MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION VETERANS' EDUCATIONANDTRAININGSECTION P.O.BOX 480, JEFFERSON CITY, MISSOURI 65102-0480 VETERAN TRAINING AGREEMENT

VE-1A

INSTRUCTIONS COMPLETETHE ORIGINAL ANDTHREE COPIESOFTHIS AGREEMENT. DISTRIBUTE THEM AS FOLLOWS:

ORIGINAL ·Department of Veterans' Affairs Regional Office, P.O. Box 32432, St. Louis, Missouri 63132. (attach to completed VA ENROLLMENT CERTIFICATION)

COPY • Director of Veterans' Education andTraining Section, P.O. Box 48Ci, Jefferson City, Missouri 65102 COPY • Trainee. COPY • TrainingEstablishment file.

THIS AGREEMENT entered into between -(NAME OF TRAINING ESTABLISHMENT)

____________________________________________________________________________________ _________________________________________________________________

(ADDRESS) (TELEPHONE NUMBER)

_____________________________________________________________________________________ C or SS-___________________ (NAME OF VETERAN) (CLAIM OR SOCIAL SECURITY NUMBER)

APPROVED WAGE SCHEDULE If your Current Wage Schedule is different from the Approved Wage Schedule, submit an Amended Wage Schedule (VE Form 2) to the Director ofVeterans' Education andTraining Section.

HOUR WEEK MONTH NORMAL WORK-WEEK__________ HOURS

BEGINNING WAGE $ END OF MONTHS $

END OF MONTHS $ ENDOF MONTHS $

END OF MONTHS $ END OF MONTHS $

WITNESS, that the TRAINING ESTABLISHMENT agrees to train and the VETERAN agrees to perform the work diligently and faithfully duringthe term of training, inaccordance with the terms andconditions of theTraining Program (includingthe training outline and wage schedule) as approved by the Missouri State Approving Agency.

JOBOBJECTIVETITLE LENGTHOFTRAININGPERIOD

EFFECTIVEDATE OFTHISAGREEMENT (THIS DATECANNOT BEPRIORTOTHE EFFECTIVE DATEOFTHE APPROVAL OFTHETRAINING PROGRAM)

CREDIT GIVEN FOR EXPERIENCE PRIORTOTHE EFFECTIVEDATEOFTHIS AGREEMENT

TRAINING PERIOD REMAININGAFTER THE EFFECTIVE DATEOFTHIS AGREEMENT

SIGNATURE OF AUTHORIZED OFFICIAL OF THE TRAINING ESTABLISHMENT TITLE

SIGNATURE OFVETERAN DATE

MO 500-1201 (3·03)

Y��(;,- -- K?J�

, .... , MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION VETERANS' EDUCATION AND TRAINING SECTION

•e P.O. BOX 480, JEFFERSON CITY, MISSOURI 65102-0480 VETERAN TRAINING AGREEMENT V(;•1A

INSTRUCTIONS ► COMPLETE THE ORIGINAL AND THREE COPIES OF THIS AGREEMENT. DISTRIBUTE THEM AS FOLLOWS:

0 ORIGINAL• Department of Veterans' Affairs Regional Office, P.O. Box 32432,eSt. Louis,eMissouri 63132. (attach to completed VA ENROLLMENT CERTIFICATION)

0 COPY• Director of Veterans' Education and Training Section, P.O. Box 480, Jefferson City, Missouri 65102·0480. 0 COPY • Trainee. D COPY - Training Establishment file.

ACME ANVIL Company THIS AGREEMENT entered Into between • __________________________ _

(NAME OF TRAINING ESTABUSHMENT)

10 Roadrunner Avenue, Hillsboro, MO 636-789-0000 (ADDRESS) (TE:lE:PHONE NlJMBER)

J. R. Runner xxx-xx-xxxxC or SSw (NAME OF VETERAN) (CLAIM OR SOCIAl SECURITY NUM0ER)

APPROVED WAGE SCHEDULE

If your Cwrent Wage Schedule Is different from \he Approved Wage Schedule, submit an Amended Wage Schedule (VE Form 2) \o the Director of Veterans' Eduoa\lon and Tralt)lng ·section.

□ HOURe □ WEEKe x:[] MONTH NORMAL WORK-WEEK 40 HOURS

BEGINNING WAGE $2,500 END OF 24 MONTHS $2,800

END OF 6 MONTHS $2,600 END OF MONTHS $

END OF 18 MONTHS $2,700 END OF MONTHS $

WITNESS, that the TRAINING ESTABLISHMENT agrees lo train <ind the VETERAN agrees to perform the work diligently and falthfully during the term of training, In accordanCB with the terms and conditions of lhe Training Program (Including lhe training outllne and wage schedule) as approved by the Missouri Slate Approving Agency.

JOB OAJF.CTIVE TITLE LENGTH OF TR AINING PERIOD

24 months Production Coordinator

EFFECTIVE DATE OF THIS AGREEMENT (THIS DATE CANNOT BE PRIOR TO THE EFFECTIVE DATE OF THE APPROVAL OF THE TRAINING PROGRAM)

CREDIT GIVEN FOR EXPERIENCE PRIOR TO THE EFFECTIVE DATE OF THIS AGREEMENT

None

TRAINING PERIOD REMAINING AFTER THE EFFECTIVE DATE Of' THIS AGflE(;MENT

24 months

SIGNATURE OF AUTHORIZED OFFICIAL OF THE TRAINING ESTABLISHMENT TITLE

Plant Manager

DATE

9-2-18

MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

V ETERANS' EDUCATION AND TRAINING SECTION

P.O. BOX 480, JEFFERSON CITY, MISSOURI 65102-0480

VETERAN TRAINING AGREEMENT VE-11

INSTRUCTIONS ...- COMPLETE THE ORIGINAL AND THREE COPIES OF THIS AGREEMENT.

DISTRIBUTE THEM AS FOLLOWS:

D ORIGINAL - Department of Veterans' Affairs Regional Office, P.O. Box 32432 St. Louis, Missouri 6313 2. (attach to completed VA ENROLLMENT CERTIFICATION)

D COPY - Director of Veterans' Education and Training Section, P.O. Box 480, Jefferson City, Missouri 65102-0480.

D COPY - Apprentice. D COPY -Training Establishment file.

THIS AGREEMENT entered into between � --------------------------(NAME OF FIRM OR JOINT-A PPRENTICESHIP COMMITTEE)

(A DDRESS) (CITY) (TELEPHONE NUMBER)

hereinafter referred to as the TRAINING ESTABLISHMENT and -

C or SS-(NAME OF VETERAN) (CLAIM OR SOCIAL SECURITY NUMBER)

hereinafter referred to as the APPRENTICE.

WITNESS , that the TRAINING ESTABLISHMENT agrees to train and the APPRENTICE agrees to perform the work of the trade or craft

diligently and faithfully during the term of training, in accordance with the terms and conditions of the Apprentice Program (including the

training outline and wage schedule) as approved by the Missouri State Approving Agency.

Trade or Craft (Job Objective T itle) -----------------------------

Length of Training Period�--------------------------------

Effective Date of this Agreement for this Apprentice------------------------(THIS DATE CANNOT BE PRIOR TO THE EFFECTIVE DATE OF APPROVAL

OF THE A PPRENTICE PROGRAM)

Credit Given for Experience Prior to the E;ffective Date of this Agreement _________________

Training Period Remaining After the Effective Date of this Agreement------------------

TITLESIGNATURE OF AUTHORIZED OFFICI AL OF THE TRAINING ESTABLISHMENT

SIGNATURE OF VETE RAN DATE

MO 500-1209 (3-03)

___ _ _ _

MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

VETERANS' EDUCATION AND TRAINING SECTION P.O. BOX 480, JEFFERSON CITY, MISSOURI 65102-0480

VETERAN TRAINING AGREEMENT VE-11

INSTRUCTIONS ► COMPLETE THE ORIGINAL AND THREE COPIES OF THIS AGREEMENT.

DISTRIBUTE THEM AS FOLLOWS:

D ORIGINAL - Department of Veterans' Affairs Regional Office, P.O. Box 32432, St Louis , Mlssouri63132

(attach to completed VA ENROLLMENT CERTIFICATION)

D COPY• Director of Veterans' Education and Training Section, P.O. Box 480, Jefferson City, Missouri 65102-0480,

D COPY - Apprentice,

D COPY - Training Establishment file.

. Bayor inc. (Must be same as on app.'JTHIS AGREEMENT entered Into between - -----------:--c--:-:--:-:---,-:-:,--

(NAME OF FIRM OR JOINT-APPRENTICESHIP COMMITTEE)

1157 W. Palmdale Trenton 816-657-2415 (ADDRESS) (CITY) (TELEPHONE NUMBER)

hereinafter referred to as the TRAINING ES TABLISHMENT and -

Sally Ride c or SS- 123-45-6789

(NAME OF VETERAN) (CL'l M OR SOCIAL SECURITY NUMBER)

hereinafter referred to as the APPRENTICE.

WITNESS, that the TRAINING ESTABLISHMENT agrees to train and the APPRENTICE agrees to perform the work of the trade or craft diligently and faithfully during the term of training, in accordance with the terms and conditions of the Apprentice Program (including the training outline and wage schedule) as approved by the Missouri State Approving Agency.

Welder (must be same as on app.)Trade or Craft (Job Objective T itle)

24 months {must be same as on app.)Length of Training Period�-------------------------------

8-1-2018 Effective Date of this Agreement for this Apprentice _ _____ _ __________

(THIS DATE CANNOT BE PRIOR TO THE EFFECTIVE DATE OF APPROVAL OF THE APPRENTICE PROGRAM)

. 6mo (discuss w/ SAA) Credit Given for Experience Prior to the E;ffective Date of this Agreement

18 months Training Period Remaining After the Effective Date of this Agreement _________________

F ,t,JJTHORIZE',Q OFFICIAL OF THE TRAINING ESTABLISHMENT

�J-TITLE

HR Adm. Asst. DATE

10-12-18

"

MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION VETERANS’ EDUCATION AND TRAINING SECTION P.O. BOX 480, JEFFERSON CITY, MISSOURI 65102-0480 VE-7 PROGRESS RECORD ON-THE-JOB TRAINING

VETERAN’S NAME JOB OBJECTIVE

INSTRUCTIONS : Enter months of training and grade all areas EACH MONTH according to the following scale: S – SATISFACTORY U-UNSATISFACTORY 0 – No-Training This record is to be kept in the employer’s file, available for inspection by representatives of the Veterans Affairs and the Veterans’ Education and Training Section.

TRAINING OUTLINE LIST THE MAJOR AREAS OR TASKS THAT ARE TO BE PERFORMED AS LISTED ON THE APPROVED TRAINING OUTLINE.

MONTHS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

A

B

C

D

E

F

G

H

I

J

K

L

M

HOURS WORKED DURING MONTH

INSTRUCTOR’S INITIALS

IMO 500 1205 (4 03)

OMB Control No. 2900-0154 Respondent Burden: 15 minutes

APPLICATION FOR VA EDUCATION BENEFITS (See attached Information and Instructions)

PART II - EDUCATION BENEFIT BEING APPLIED FOR See instructions for benefit eligibility criteria

INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at: www.gibill.va.gov

1. SOCIAL SECURITY NUMBER OF APPLICANT

MALE FEMALE

 4. NAME (First, Middle Initial, Last)

Account Number

Savings

VA DATE STAMP (Do Not Write In This Space)

City, State, ZIP Code

5. APPLICANT'S ADDRESS

2. SEX OF APPLICANT 3. APPLICANT'S DATE OF BIRTH

8. PLEASE PROVIDE THE NAME, ADDRESS, AND PHONE NUMBER OF SOMEONE WHO WILL ALWAYS KNOW WHERE YOU CAN BE REACHED

Primary:

Routing or Transit Number

Checking

Account Type 7. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. Direct Deposit is not available for VEAP)

PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING

YearDay

Apt./Unit Number

Secondary:

Number and Street

 10A. TYPE OF EDUCATION OR TRAINING (See instructions for additional information)

9A. Chapter 33 - Post-9/11 GI Bill (Complete 9F if you are eligible for chapter 30, chapter 1606, or chapter 1607) 9B. Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

9C. Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)

B. ADDRESS C. PHONE NUMBER A. NAME

9D. Chapter 1607 - Reserve Educational Assistance Program (REAP)

PART I - APPLICANT INFORMATION

 6B. APPLICANT'S E-MAIL ADDRESS (If applicable)

LICENSING OR CERTIFICATION TEST REIMBURSEMENT (MCSE, CCNA, EMT, NCLEX, ETC.)

CORRESPONDENCE

COLLEGE OR OTHER SCHOOL (Including on-line courses)

TUITION ASSISTANCE TOP-UP (Chapter 30 & 33 only)

NATIONAL TEST REIMBURSEMENT (SAT, CLEP, ETC.)

VOCATIONAL FLIGHT TRAINING

APPRENTICESHIP OR ON-THE-JOB

 6A. APPLICANT'S TELEPHONE NUMBERS (Include Area Code)

Month

9E. Chapter 32 or Section 903 - Post-Vietnam Era Veterans' Educational Assistance Program (VEAP)

9F. Chapter 33 Election (Complete only if this is your first request for chapter 33 and you are eligible for one of the benefits listed below)

I elect to receive chapter 33 education benefits in lieu of the education benefit checked below, effective . I understand that my election is irrevocable and may not be changed. (Check only one)

Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

By electing Chapter 33, I acknowledge that I understand the following: • I may not receive more than a total of 48 months of benefits under two or more programs. • If electing chapter 33 in lieu of chapter 30, my months of entitlement under chapter 33 will be limited to the number

of months of entitlement remaining under chapter 30 on the effective date of my election. However, if I completely exhaust my entitlement under chapter 30 before the effective date of my chapter 33 election, I may receive up to 12 additional months of benefits under chapter 33.

• My election is irrevocable and may not be changed.

Chapter 1607 - Reserve Educational Assistance Program (REAP) Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)

(date)

 

 

 

VA FORM SUPERSEDES VA FORM 22-1990, DEC 2008,22-1990 PAGE 1 OF 4MAY 2009 WHICH WILL NOT BE USED.

SOCIAL SECURITY NUMBER OF APPLICANT

10B. PROVIDE THE FULL NAME AND ADDRESS OF THE SCHOOL, IF KNOWN (Skip this item if you are only applying for National Test Reimbursement, Licensingand Certification Test Reimbursement, or Tuition Assistance Top-Up)

 10C. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN (e.g. Bachelor of Arts in Accounting, welding certificate, police officer, etc.)

PART IV - SERVICE INFORMATION NOTE: It will help VA process your claim if you send a copy of the following:

DD Form 214 (Member 4) for all periods of active duty service (excluding active duty for training) DD Form 2384, Notice of Basic Eligibility (NOBE) if applying for Chapter 1606 Copies of orders if activated from the guard/reserves

11. ARE YOU NOW ON ACTIVE DUTY? (Do not check "Yes" if you are currently on drilling status in the the Selected Reserve, or if youare on active duty for training)

YES NO 12. ARE YOU NOW ON TERMINAL LEAVE JUST BEFORE DISCHARGE?

YES NO (Please provide a copy of your DD Form 214 (Member 4) when issued) 13. PLEASE COMPLETE THE FOLLOWING FOR EACH PERIOD OF MILITARY SERVICE

A. DATE ENTERED B. DATE SEPARATED C. SERVICE COMPONENT (USN,USAF, USAR, ARNG, ETC.)

D. SERVICE STATUS (Active duty,drilling reservist, IRR, etc.)

E. WERE YOU INVOLUNTARILY CALLED TO ACTIVE DUTY FOR THIS PERIOD?

9/26/2000 9/24/2004 (EXAMUSMC PLE) ACTIVE DUTY NO

1/18/2005 8/14/2007 USMCR DRILLING N/A

8/15/2007 Present USMC ACTIVE DUTY YES

PART V - EDUCATION AND EMPLOYMENT INFORMATION 14A. DID YOU RECEIVE A HIGH SCHOOL DIPLOMA OR HIGH SCHOOL

EQUIVALENCY CERTIFICATE? (If "Yes" provide date)

YES DATE: NO

14B. DO YOU HOLD ANY FAA FLIGHT CERTIFICATES? (If "Yes," specify eachcertificate in Part IX, Remarks)

YES NO

14C. EDUCATION AFTER HIGH SCHOOL (Including apprenticeship, on-the-job training, and flight training)

NAME AND LOCATION OF COLLEGE OR OTHER TRAINING PROVIDER

DATES OF TRAINING NUMBER AND TYPE OF HOURS (Semester, Quarter, or Clock)

DEGREE, DIPLOMA, OR CERTIFICATE

RECEIVED MAJOR FIELD OR COURSE OF STUDY

FROM TO

VA FORM 22-1990, MAY 2009 PAGE 2 OF 4

SOCIAL SECURITY NUMBER OF APPLICANT

14D. EMPLOYMENT (Only complete if you held a license or journeyman rating to practice a profession)

EMPLOYMENT PRINCIPAL OCCUPATION NUMBERS OF MONTHS WORKED LICENSE OR RATING

BEFORE MILITARY SERVICE

AFTER MILITARY SERVICE

PART VI - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE 15. DID YOU MAKE ADDITIONAL CONTRIBUTIONS (UP TO $600.00) TO INCREASE THE AMOUNT OF YOUR MONTHLY

BENEFITS? IF "YES," IT WILL HELP VA PROCESS YOUR CLAIM IF YOU SUBMIT ANY EVIDENCE YOU HAVE TO SUPPORT YOUR CLAIM (e.g., cash collection voucher, leave and earnings statement(s), receipt voucher, etc.)

YES NO

16. DO YOU QUALIFY FOR A KICKER (sometimes called a "College Fund") BASED ON YOUR MILITARY SERVICE? (Kickers are additional amounts contributed by DOD to an education fund). If you qualify for a kicker, it will help VA process your claim if you submit a copy of the kicker contract. Reserve kicker contracts must include the amount and effective date.

ACTIVE DUTY KICKER

YES NO

RESERVE KICKER YES NO

17. IF YOU GRADUATED FROM A MILITARY SERVICE ACADEMY, SPECIFY THE YEAR YOU GRADUATED AND RECEIVED YOUR COMMISSION.

Graduation Year

18. WERE YOU COMMISSIONED AS THE RESULT OF A SENIOR ROTC (Reserve Officers Training Corps) SCHOLARSHIP? If you received your commission through a non-scholarship program, check "No." If "Yes," provide the date of your commission and the amount of your scholarship for each school year you were in the Senior ROTC program. Don't report your monthly subsistence allowance (stipend).

Scholarship Amounts:

Year: Amount:

Year: Amount:

Year: Amount:

Year: Amount:

Year: Amount:

YES NO

Date of Commission

19. ARE YOU CURRENTLY PARTICIPATING IN A SENIOR ROTC SCHOLARSHIP PROGRAM THAT PAYS FOR YOUR TUITION, FEES, BOOKS AND SUPPLIES UNDER SECTION 2107 OF TITLE 10, U.S. CODE?

YES NO

20. IF YOU HAD A PERIOD OF ACTIVE DUTY THAT THE DEPARTMENT OF DEFENSE COUNTS FOR PURPOSES OF REPAYING AN EDUCATION LOAN, CHECK "YES". SHOW THE PERIOD OF ACTIVE DUTY THAT THE MILITARY CONSIDERS AS BEING USED FOR THE PURPOSES OF REPAYING THIS EDUCATION LOAN IN PART IX "REMARKS".

YES NO

21. FOR ACTIVE DUTY CLAIMANTS ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE RECEIVING, ANY MONEY (INCLUDING BUT NOT LIMITED TO FEDERAL TUITION ASSISTANCE) FROM THE ARMED FORCES OR PUBLIC HEALTH SERVICE FOR THE COURSE FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION BENEFITS? IF YOU RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES." NOTE: IF YOU ARE ONLY APPLYING FOR TUITION ASSISTANCE TOP-UP, CHECK NO IN THIS ITEM.

YES NO

22. FOR CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE RECEIVING, ANY MONEY (INCLUDING, BUT NOT LIMITED TO, THE GOVERNMENT EMPLOYEES TRAINING ACT) FROM YOUR AGENCY FOR THE SAME PERIOD FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION BENEFITS? IF YOU WILL RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES."

YES NO

VA FORM 22-1990, MAY 2009 PAGE 3 OF 4

SOCIAL SECURITY NUMBER OF APPLICANT

PART VII - INFORMATION ON VA EDUCATION BENEFITS NOTE: The most current information on VA education benefits is available online at www.gibill.va.gov If you would like to receive a printed pamphlet check here.

PART VIII - MARITAL AND DEPENDENCY STATUS NOTE : Only complete this section if you have military service before January 1, 1977 (or delayed entry before January 2, 1978). See instructions. 22. ARE YOU MARRIED?

YES NO 23. DO YOU HAVE ANY CHILDREN WHO ARE UNDER AGE 18, OR OVER 18 BUT UNDER AGE 23, NOT MARRIED AND ATTENDING SCHOOL, OR OF

ANY AGE PERMANENTLY HELPLESS FOR MENTAL OR PHYSICAL REASONS?

YES NO 24. DO YOU HAVE A PARENT WHO IS DEPENDENT UPON YOU FOR FINANCIAL SUPPORT?

YES NO

PART IX - REMARKS (If more space is needed, please attach a separate sheet of paper. Be sure to include your name and social security number on each sheet)

APPLICATION SUBMISSION REMINDERS

Did you remember to ........

Write your social security number on each page?Write your complete mailing address?Attach all supporting documents (e.g. voided check, orders, DD214, kicker contract, NOBE, cashcollection voucher, etc.)?

IF SO, PLEASE SIGN AND DATE THE APPLICATION BELOW

PART X - CERTIFICATION AND SIGNATURE OF APPLICANT I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify that I have consulted with an Education Service Officer (ESO) regarding my education program.

PENALTY - Willful false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other benefits and in criminal penalties. 25A. SIGNATURE OF APPLICANT (DO NOT PRINT) 25B. DATE SIGNED

VA FORM 22-1990, MAY 2009 PAGE 4 OF 4

OMB Approved No. 2900-0178Respondent Burden: 10 MinutesExpiration Date: 3/31/2018

REGIONAL PROCESSING OFFICE (RPO) NAME AND ADDRESS OR FAX NUMBER(See RPO listing on reverse)

MONTHLY CERTIFICATION OF ON-THE-JOB AND APPRENTICESHIP TRAINING

VA FILE NUMBER PAYEE

TRAINEE'S NAME AND ADDRESS IMPORTANT: Read the instructions carefully. You and the employer should complete, date, and sign this form on or after the last day of the last month shown in Item 1. Call 1-888-GI-BILL-1 (1-888-442-4551), if you have questions. If you use the Telecommunications Device for the Deaf (TDD) call the Federal Relay number is 711.

INSTRUCTIONS TO TRAINEE ITEMS 1 AND 2 - Enter the number of hours worked for each month/year shown (include any hours of related training given during working hours).

ITEM 3 - Check the appropriate box, and if training has been terminated, complete Items 4 and 5. If you have attained the complete job skills foryour job (a "journeyman" knowledge and skills), show this information in Item 5.

ITEMS 6A, 6B, AND 6C - Check the appropriate box. If you received a wage increase (or decrease) not in accordance with your training agreement,show your new wage rate and the effective date of that wage rate (when you first received this wage rate).

ITEM 7 - Use Item 7, Remarks, to show any additional information concerning your wage rate. Also, if you are receiving additional educationalallowance for dependents use this item to report any change in the number of your dependents.

ITEMS 8A and 8B - Sign and date the form. After signing and dating the form give it to your employer/certifying official or an authorized official ofyour training establishment for verification.

CHANGE OF ADDRESS - If you are changing your address permanently, neatly line out the preprinted address shown above. Then, print or typeyour new address in the remaining space. Be sure to include your ZIP Code.

INSTRUCTIONS TO EMPLOYER/CERTIFYING OFFICIAL

Please verify the number of hours worked and other information reported by the trainee in Items 1 through 6 with the payroll and training records.Please report any differences in Items 6 and/or 7.

Also use Item 7 if the trainee's conduct or progress is unsatisfactory or if the trainee has attained the complete job skills for the job (a "journeyman"knowledge and skills).

ITEMS 9A and 9B - Sign and date the form and return it to the VA office shown above.

If you have any questions, call VA toll-free at 1-888-GI Bill (1-888-442-4551).

1. MONTH(S)/YEAR TO BE CERTIFIED 2. NUMBER OF HOURS

WORKED FOR EACH MONTH SHOWN IN

ITEM 1

3. WAS TRAINEE ENROLLED IN AND PURSUING THE APPROVED PROGRAM FOR THE MONTH(S) SHOWN IN ITEM 1?

4. DATE TERMINATED (Month, day, year)

YES

NO (If "No," complete Items 4 and 5)

5. REASON FOR TERMINATION

6A. IS WAGE RATE IN ACCORDANCE WITH TRAINING AGREEMENT?

YES

NO (If "No," complete Items 6B and 6C)

6B. RATE 6C. EFFECTIVE DATE

7. REMARKS

I CERTIFY THAT the previous statements are true and correct to the best of my knowledge and belief.

PENALTY - Willful false reports concerning benefits payable by VA may result in fines or imprisonment or both. 8A. SIGNATURE OF TRAINEE (Please sign in ink) 8B. DATE SIGNED

9A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL (Please sign in ink) 9B. FACILITY CODE 9C. DATE SIGNED

FILE N

UM

BE

R:

VA FORM SUPERSEDES VA FORM 22-6553d-1, MAR 2015, Page 122-6553d-1JUL 2016 WHICH WILL NOT BE USED.

Submitting Monthly Certifications

The Certifying Officials can submit certifications through our Submit a Question email box on the VA website. http://benefits.va.gov/gibill/

Certifying Officials will have to set up an account on this site. On the right hand side of the web page above, you will see a tab that says Submit a Question.

Click on that tab, then register for an account. DO NOT enter your social security number. Once your account is set up contact Barry Walser the VA Education Liaison at 314-253-4100 ext .1029 so he can go in and mark your account as a Certifying Official.

After your account has been designated as a certifying official account, you can then go in, click on Submit a Question and attach the monthly certification to the email. The certification must be in PDF format and include the signature of the Certifying Official.

In the subject line, enter Monthly Certifications

In the Question section, enter “Submitting Monthly Certification for OJT” or something similar.

Category: choose “School Officials Only”

State of Residence: choose Missouri

State of School: choose Missouri

SSN/Claim #: enter your Facility Code.

Create a separate document for each individuals certification form, DO NOT mix/combine individuals into one scan. Then attach each certification document for that month.

Fax 314-253-4140 can still be utilized. However, this new way of submitting the documents is faster and more direct than fax.

https://www.benefits.va.gov/GIBILL/resources/education_resources/mou.html

MEMORANDUM OF UNDERSTANDING

BETWEEN

THE DEPARTMENT OF VETERANS AFFAIRS

AND

VA-ONCE (VA ONline Certification of Enrollment)

Electronic Transfer of Enrollment Information by Educational Institutions to the Department of Veterans Affairs

I. PURPOSE

This is an agreement between the Department of Veterans Affairs, hereinafter referred to as VA, and Insert Name of Institution Here

, hereinafter referred to as the institution. The purpose of this agreement is to establish an alternative procedure for the institution to use to make certifications to VA of enrollments and changes in enrollments of students of the institution who seek to receive benefits under educational assistance programs administered by VA.

Under current procedures, a majority of institutions use the VACERT program to electronically transmit enrollment information to VA. The other institutions prepare such certifications in written form, the institution's certifying official signs them, and presents them to VA in that form. The alternative procedure authorized under this agreement permits the institution to use an Internet program known as VA-ONCE, to submit the certifications solely by electronic means.

II. AGREEMENTS BY VA

VA agrees to accept, instead of certifications made on printed forms prescribed by VA for that purpose or certifications generated by the VACERT program, certifications created by the institution using the VA-ONCE program in the form of electronic certification documents or written computer-generated documents signed by the institution's certifying official(s). VA also agrees to maintain the history file of enrollment activity on its VA-ONCE server.

III. OBLIGATIONS AND AGREEMENTS OF INSTITUTION

The institution, by executing this agreement and in consideration of the agreement of VA to accept the alternative VA-ONCE generated written or electronic documents submitted by the institution, agrees to comply with all applicable laws, regulations, and VA requirements pertaining to certifications of enrollments and notices of change in student status, even though the provisions of those laws, regulations, or requirements do not appear on the certifications created by the VA-ONCE program.

The institution acknowledges that by using the VA-ONCE program it is subject to all the duties and liabilities pertaining to educational institutions found in 38 U.S.C. sections 3684 and 3685; 38 CFR sections 21.4203, 21.4209, 21.7156, 21.7307, 21.7656, 21.7807, and 21.5200; all certifications applicable to the institution certifying on comparably prescribed VA forms otherwise in use at the time of the certifications; and any other provisions of law or regulations that apply.

The institution certifies that it has appropriate resources, including hardware, software, and staff, to effectively use the VA-ONCE program instead of traditional certification procedures. The institution must provide an appropriate web browser which can be obtained free from several vendors.

The institution agrees to take reasonable precautions to safeguard against unauthorized access to VA-ONCE, and to prevent improper use or disclosure of passwords. The institution also agrees to notify VA immediately upon learning of any unauthorized access,

Insert Name of Institution Here

unauthorized use, or disclosure of a password. The institution further agrees to notify VA immediately if any authorized certifying official leaves that position so that VA can suspend the certifying official's user ID and password.

To the maximum extent permitted by the law applicable to the institution, the institution hereby agrees to hold harmless the Department of Veterans Affairs from any claim for damages based on use of the VA-ONCE program.

IV. ACTION

Upon receipt of the signed agreement from the institution, and executed by VA, VA will furnish each designated certifying official with his or her own user ID and password that will be necessary to access the Internet-based program.

V. OVERSIGHT

If the institution electronically sends files to the regional processing office, VA will continually monitor the quality and timeliness of the information. VA will notify the institution of problems detected during the receipt and processing of these files.

The institution agrees to inform VA of any problems found with the VA-ONCE program that could jeopardize the accuracy, integrity or confidentiality of the information contained in files electronically sent to the regional processing office.

VI. WITHDRAWAL

The institution may withdraw from this Memorandum of Understanding (MOU) at any time by notifying VA in writing 60 days beforehand. After withdrawing from this MOU, the institution is required to timely submit certifications using VA Form 22-1999, Enrollment Certification.

VII. REVIEW/CHANGES

VA will conduct periodic reviews of this Memorandum of Understanding as deemed necessary. Changes of this Memorandum of Understanding shall be in writing and approved by the signatories or their successors.

VIII. SECURITY

Data for VA-ONCE is stored behind the Veterans Benefits Administration (VBA) firewall and thus falls under its approved data protection storage procedures. When the institution sends data over the Internet it will be encrypted using Secure Sockets Layer (SSL) technology, an accepted industry standard. Access to the data will be protected and controlled by unique user names and passwords. Passwords will follow the VBA standard of strong passwords.

Insert Name of Institution HereExecuted by the

1 st January 2015this day of , .

By: ____________________________________________

Insert Name and Title of Designating Official (An official with contract authority for the institution.)

Phone Number: E-mail Address:

Executed by the Department of Veterans Affairs

this ________ day of __________________, __________.

By: ____________________________________________

Select Regional Processing Office

School Name:

School Address:

Facility Code:

Certifying Official's Name:

Phone Number:

E-mail Address:

Leave blank.

Your company name and address.

If you are a new program, leave this blank.

Please list all certifying officials. If you would like to add or change your certifying officials you will need to

complete an additional form. Please contact us at 573.522.2061.

Certifying Official's Name:

Phone Number:

E-mail Address:

Certifying Official's Name:

Phone Number:

E-mail Address:

Certifying Official's Name:

Phone Number:

E-mail Address:

Certifying Official's Name:

Phone Number:

E-mail Address:

Once completed send the form to VA Regional Office, PO Box 32432, St. Louis, MO 63132-0832. Or you can email it to barry.walser@va.gov. You will receive your log in information from the VA. Feel free to contact me if you need assistance.