Name and address of institution
A box for the school's name and address, below the Privacy Act and respondent burden notices at the top of the form.
22-1919
Conflicting Interests Certification for Proprietary Schools (Fillable)
- Agency
- VA
- Revision
- March 2024
- Fillable fields
- 11
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 22-1919: Conflicting Interests Certification for Proprietary Schools
VA Form 22-1919 is the U.S. Department of Veterans Affairs Conflicting Interests Certification for Proprietary Schools. It is a school's form, not an application by a Veteran. VA's form page says for-profit schools use it to provide information about people with a financial interest in the school or people enrolled there, and that VA uses it to determine if there's a conflict of interest.
The form says it informs individuals that the law has restrictions concerning any potential conflict of interest. It is one page: the institution's name and address, two certification lists, and the signature of the school's president or chief administrative official.
VA's page says the form can also be submitted online. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 22-1919
Certification (1): profit schools only
Cites 38 U.S.C. 3683, which the form says bars VA and SAA employees from owning any interest in a for-profit school or receiving wages, salary, dividends, profits or gifts from one, and bars VA employees from receiving its services.
Certification (2): all proprietary schools
Cites 38 C.F.R. 21.4202(c), 21.5200(c), 21.7122(e)(6) and 21.7622(f)(4)(iv). The school lists name and title, VA file number and dates of enrollment for officials, owners or officers receiving VA educational assistance there.
Certification and signature
The official certifies the entries are true and correct and agrees to immediately notify VA of any potential violations, then gives name, signature, title and date signed.
Privacy and burden notices
The Privacy Act notice and a respondent burden of 10 minutes per respondent, per year, under OMB Control No. 2900-0657.
How to complete VA Form 22-1919
- 1
Enter the institution
Fill in the name and address of the institution at the top of the form.
- 2
Complete certification (1)
For a proprietary profit school, list the VA and SAA employees known to the school who may have a potential conflict of interest. The form says to enter the word none if there are none.
- 3
Complete certification (2)
List certifying officials, owners or officers receiving VA educational assistance based on an enrollment at the school, with VA file numbers and enrollment dates, or enter none.
- 4
Sign as the school's head
The president or chief administrative official signs, adds a title and enters the date signed in MM/DD/YYYY format.
- 5
Submit it
VA's page says the form can be submitted online instead of sending the paper form. The form says not to send it to the VA Reports Clearance Officer email address.
Why fill Form 22-1919 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it
Online
VA's form page says you can submit your form online instead of sending the paper form.
Not to the burden email
The form says comments on the burden estimate go to [email protected], and not to send the completed VA Form 22-1919 to that address.
No mailing address on the PDF
The one-page PDF does not print a mailing address for the completed form.
Edition
The PDF is dated MAR 2024 and supersedes VA Form 22-1919, MAR 2021, which will not be used. OMB Control No. 2900-0657 expires March 31, 2027.
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Who uses VA Form 22-1919?
The form and VA's page describe it as a school's report to VA.
Official sources and the blank
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Questions about Form 22-1919
Who fills out VA Form 22-1919?
VA's form page says for-profit schools use it. The form is signed by the president or chief administrative official of the school.
What if no one at the school fits either description?
Both certification lists say that if there are none, enter the word none.
Can the form be submitted online?
Yes. VA's form page says you can submit your form online instead of sending the paper form.
Does certification (2) apply to public schools?
Certification (2) is headed All Proprietary Schools and says it excludes public schools.
Can the restrictions on VA and SAA employees be waived?
The form says these provisions may be waived if VA determines that no detriment will result to the government, or to veterans or eligible persons.
Which edition is current?
The PDF is dated MAR 2024 and says it supersedes the MAR 2021 edition. VA's form page lists a form revision date of March 2026.