Claimant information and Section I
The claimant's name, the last four digits of the VA file number and the VRC's name, then the verified address, email address, phone number and marital status.
28-1902w
Information for Veteran Readiness and Employment Entitlement Determination
- Agency
- VA
- Revision
- November 2024
- Fillable fields
- 128
- Pages
- 8
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 28-1902w: Information for VR&E Entitlement Determination
VA Form 28-1902w is the U.S. Department of Veterans Affairs Information for Veteran Readiness and Employment Entitlement Determination. The form says it is used during the comprehensive initial evaluation to gather information for an entitlement determination for Chapter 31 benefits, the Veteran Readiness and Employment (VR&E) program.
VA's form page says to use it if you're a Veteran or service member with a service-connected disability and you're eligible for VR&E benefits, and that the information helps your Vocational Rehabilitation Counselor (VRC) determine your specific employment and training needs. The instructions say the VRC reviews the form with the claimant during the initial evaluation to obtain additional or missing information.
The form is eight pages in nine sections: contact details, civilian and military employment history, legal and substance abuse history, education and training, service-connected and non-service-connected disabilities, other information and comments. It ends with the counselor's name and the date. 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 28-1902w
Section II: civilian employment history
Items 1 to 3 ask whether the claimant is employed, how long they have been unemployed and what they did in that time. Items 4 to 8 hold up to five jobs with title, employer, dates, full or part time, average gross monthly salary, duties, whether the duties aggravate service-connected disabilities and the reason for leaving. Item 9 covers difficulties due to service-connected disabilities, such as job performance or missed time at work.
Section III: military employment history
Items 10 to 13 list enlistment history, job title or military occupational specialty, and the branch of service, dates of service and rank, with a second block for another term or branch.
Sections IV and V: legal and substance abuse history
Item 14 lists bankruptcy in the last seven years, misdemeanor, felony, probation, parole or other. Item 15 lists alcohol, illegal drugs, prescription drugs or other. Each has a Not applicable box and space to describe, and a last box asks about treatment progress with dates and locations.
Sections VI and VII: education and disabilities
Items 16 to 18 ask the highest level of education, the field of study and any certifications or licenses. Items 19 to 23 list service-connected disabilities, any Individual Unemployability or TDIU claim, a valid driver's license, treatment facilities and how often the claimant is seen.
Sections VIII and IX: other information and comments
Items 24 to 27 ask about registration with a local VA medical center and MyHealtheVet, a referral for HUDVASH or a homeless program, and other benefits received or applied for. The form says this part is not relevant to the entitlement determination but can help with referrals and resources. Item 28 holds comments.
How VA Form 28-1902w is completed
- 1
Note the records provided
Sections II, III and VI each have boxes to mark whether the claimant provided a resume, a DD-214 or military records, or transcripts, certifications or licenses. The form says information already on them need not be duplicated.
- 2
Verify contact details
The counselor confirms the claimant's address, email, phone number and marital status in Section I.
- 3
Review the employment history
The form says the civilian and military employment history is reviewed and discussed to identify any difficulties with job duties, obtaining and maintaining employment, salary, and reasons for leaving.
- 4
Discuss disabilities and needs
Section VII asks the counselor to discuss how the claimant's disabilities affect their ability to obtain and maintain employment. A note at Item 20 says the VRC reviews the severity of service-connected disabilities, feasibility and potential independent living needs.
- 5
Add comments, name and date
Item 28 holds other relevant information from the initial evaluation. The counselor enters their name in Item 29 and the date in Item 30.
Why fill Form 28-1902w 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 it is used and getting help
Where it is used
The form is completed during the comprehensive initial evaluation with the VRC. Neither the form nor VA's page prints a mailing address.
Questions
The form points to https://ask.va.gov and the toll-free number 1-800-827-1000, and says the Federal relay number for Telecommunications Device for the Deaf (TDD) users is 711.
Privacy and burden
The form says the responses are considered confidential under 38 U.S.C. 5701 and estimates a burden of 45 minutes per respondent.
Edition
The November 2024 edition supersedes the July 2024 edition, which will not be used. It carries OMB Control No. 2900-0092, which expires 11/30/2027.
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Questions about Form 28-1902w
What is VA Form 28-1902w used for?
The form says it is used during the comprehensive initial evaluation to gather information for an entitlement determination for Chapter 31 benefits, the Veteran Readiness and Employment program.
Who fills in VA Form 28-1902w?
The instructions say the Vocational Rehabilitation Counselor reviews the form with the claimant during the initial evaluation. The counselor's name and the date go in Items 29 and 30, and the form has no claimant signature line.
Does a resume replace the employment section?
The form says that if the claimant provides a resume it is not necessary to duplicate the information in Items 1 to 9, but the civilian employment history is still reviewed and discussed.
Does Section VIII affect the entitlement determination?
The form says the Section VIII information is not relevant to the entitlement determination, but the questions can assist with referrals, resources and addressing the claimant's needs.
How is changed contact information handled?
Section I says that if the claimant's contact information or marital status has changed, the counselor advises the claimant to update it on their VA.gov profile.
Who can I contact with questions?
The form lists https://ask.va.gov and the toll-free number 1-800-827-1000, with the Federal relay number 711 for TDD users.