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Get VA 22-6553d-1 2019-2024

8A. SIGNATURE OF TRAINEE 8B. DATE SIGNED 9A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL VA FORM JUL 2012 22-6553d-1 EXISTING STOCKS OF VA FORM 22-6553d-1 JAN 2009 WILL NOT BE USED. OMB Approved No* 2900-0178 Respondent Burden 10 Minutes MONTHLY CERTIFICATION OF ON-THE-JOB AND APPRENTICESHIP TRAINING VA FILE NUMBER FOR VA USE ONLY PAYEE TYPE TRAINING FACILITY CODE 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 1-800-GI-BILL-1 1-888-442-4551 if you have questions. Call 711 Federal Relay if you use the Telecommunications Device for the Deaf TDD. INSTRUCTIONS TO TRAINEE ITEMS 1 AND 2 - Enter the number of hours worked for each month shown* Include any hours of related training 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 for your 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. If you are receiving additional educational allowance for dependents also use this item to report any change in the number of your dependents. ITEMS 8A and 8B - Sign and date the form* Then give the form to your employer or an authorized official of your training establishment for verification* CHANGE OF ADDRESS - If you are changing your address permanently neatly line out the preprinted address shown above. Then print your new address in the remaining space. Be sure to include your ZIP Code. NOTE - If an OJT trainee is receiving the journeyman wage the trainee is no longer entitled to VA educational benefits. You must immediately notify VA. An apprenticeship trainee is not normally entitled to receive educational benefits after reaching the journeyman wage. However there are some exceptions such as training on a Davis-Bacon job or a job in a geographic location that has a different wage scale. If you have any questions call VA toll-free at 1-888-GI-BILL 1-888-442-4551. If you use the Telecommunications Device for the Deaf TDD the Federal Relay number is 711. 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. 1. MONTH S TO BE CERTIFIED 6A. IS WAGE RATE IN ACCORDANCE WITH TRAINING AGREEMENT YES 7. REMARKS NO 4. DATE TERMINATED Mo. day yr. 6B. RATE 6C. EFFECTIVE DATE If No complete Items 6B and 6C 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.

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