DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS - Under Provisions of Chapters 33 and 35, Title 38, U.S.C.

Sep 14, 2026

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Dependents' application form for U.S. Department of Veterans Affairs education benefits under Title 38, U.S.C., chapters 33 and 35. Collects applicant identity details, contact information, and direct deposit data including routing and account numbers. Captures qualifying individual (parent or spouse) information and service/death eligibility questions with relevant dates. Also records the applicant’s relationship type and marriage or remarrying status, then selects the requested benefit option for Chapter 35-DEA or Chapter 33-Fry Scholarship.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

PART I - APPLICANT INFORMATION

Social security, sex, birth date, name

Address, telephone, email

Direct deposit details

PART II - QUALIFYING INDIVIDUAL INFORMATION

Parent or spouse identity and service/death eligibility

Missing status and active duty status

PART III - RELATIONSHIP AND BENEFIT INFORMATION

Relationship to qualifying individual

SECTION I - SPOUSE / SURVIVING SPOUSE

Marriage date and divorce/remarriage questions

Benefit selection: Chapter 35-DEA or Chapter 33-Fry Scholarship

SECTION II - BIOLOGICAL CHILD / STEPCHILD / ADOPTED CHILD

Benefit selection: Chapter 35-DEA or Chapter 33-Fry Scholarship

OMB Approved No.2900-0098 Respondent Burden:25minutes Expiration Date:01/31/2028 Department of Veterans Affairs | DEPENDENTS'APPLICATION FOR VA EDUCATION BENEFITS
(Under Provisions of chapters 33 and 35,of title 38,U.S.C.) | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | INTERNET VERSION AVAILABLE-You may complete and submit your application online at:www.va.gov. | | | | | | | | | | PARTI-APPLICANT INFORMATION | | | | | | | | | | 1.SOCIAL SECURITY NUMBER | 2.SEX
□FEMALE □MALE | | 3.DATE OF BIRTH
(MM/DD/YYYY) | | 4.NAME(First name,middle initial,last name) | | | | | 5.CURRENT MAILING ADDRESS (Number and street or rural route,P.O.Box,City,State and ZIP Code) | | | | | | | | | | 6.TELEPHONENUMBER(S)(Inchuding Area Code) | | | | | | | | | | A.MOBILE | | | | B.HOME | | | | | | 7.EMAIL ADDRESS (If applicable) | | | | | | | | | | 8.DIRECT DEPOSIT (Provide the information requested below.See Instructions for additional information.)
ROUTING OR TRANSIT NUMBER
ACCOUNT NUMBER
ACCOUNT TYPE
(Routing number must be 9 digits)
□SAVINGS
□CHECKING | | | | | | | | | | PARTIⅡ-QUALIFYING INDIVIDUAL INFORMATION (See instructions for Items 13A,13B and 13C) | | | | | | | | | | 9.NAME OF QUALIFYING INDIVIDUAL(PARENT OR SPOUSE)ON WHOSE ACCOUNT BENEFITS ARE BEING CLAIMED(First name,middle initial,last name) | | | | | | | | | | 10.SOCIAL SECURITY NUMBER OR VA FILE NUMBER | | 11.BRANCH OF SERVICE | | | | | | 12.DATE OF BIRTH(MM/DD/YYYY) | | 13A.DID PARENT OR SPOUSE DIE FROM SERVICE-CONNECTED DISABILITY WITHIN 120 DAYS FOLLOWING DISCHARGE OR RELEASE FROM DUTY ASA
MEMBER OF THE ARMED FORCES(without regard to whether such duty was active duty)
□YES□NO (If"Yes,"is checked complete lItem 13D | | | | | | | | | | 13B.DID PARENT OR SPOUSE DIE WHILE SERVING ON ACTIVE DUTY OR WHILE ON OTHER THANACTIVE DUTY ASA
MEMBER OF THE ARMED FORCES?
□YES□NO(f"Yes,"is checked complete ltem 13D | | | | | | | | | | 13C.DID PARENTOR SPOUSE DIE FROM ASERVICE-CONNECTED DISABILITY AFTER SEPTEMBER 10,2001,WHILEA
MEMBER OF THE SELECTED RESERVE?
□YES□NO (If"Yes,"is checked complete Item 13D) | | | | | | | | 13D.DATE OF DEATH (MM/DD/YYYY) | | 14.IS QUALIFYING INDIVIDUAL(PARENT OR SPOUSE)CURRENTLY ON ACTIVE DUTY?
□YES□NO | | | | | | 15.DATE LISTED AS MISSING INACTION OR P.OW.(MM/DD/YYYY)
(If applicable) | | | | PARTⅢ-RELATIONSHIP AND BENEFIT INFORMATION | | | | | | | | | | 16.YOUR RELATIONSHIP TO QUALIFYING INDIVIDUAL(Check only one)
STEPCHILD
□SPOUSE
ADOPTED CHILD
BIOLOGICAL CHILD
(NOTE:Afier making your selection,also complete Section Ior Section ll on page 2 and then proceed to complete Pant IV) | | | | | | | | | | SECTIONI-SPOUSE/SURVIVING SPOUSE | | | | | | | | | | 17A.DATE OF MARRIAGE TO THE QUALIFYING INDIVIDUAL?(NOTE:Date will be verified against information
entered on VAForm 21-686c,Application Request to Add and/or Remove Dependents)
(MMDD/YYYY) | | | | | | | 17B.IS ADIVORCE OR ANNULMENT PENDING
TO THE QUALIFYING INDIVIDUAL?
YES NO | | | 18.IF YOU ARE THE SURVIVING SPOUSE,HAVE YOU REMARRIED?
YES NO
(1f"Yes,"please provide date of remarriage)(MM/DD/YYYY) | | | | | | | | | SUPERSEDES VA FORM 22-5490,JAN 2024, VAFORM 22-5490 Page 1 JAN 2025WHICH WILL NOT BE USED. | SECTIONI-SPOUSE/SURVIVING SPOUSE(Continued) | | | | | --- | --- | --- | --- | | 19.SPOUSE/SURVIVING SPOUSE SELECT THE BENEFIT THAT YOU ARE APPLYING FOR BELOW: | | | | | IMPORTANT | PLEASE CAREFULLY READ THE INFORMATIONAND INSTRUCTIONS ONPAGE4,ITEM19BEFORE SELECTING BOX"A"
OR"B"BELOW REGARDINGTHE BENEFITFOR WHICHYOU ARE APPLYING.THE INFORMATIONAND INSTRUCTIONS
ON PAGE6 PROVIDE LINKS TO VAWEBSI

FAQs

What information is required from the applicant?

The form requests the applicant’s Social Security number, sex, date of birth, full name, mailing address, phone numbers, and email (if applicable). It also requires direct deposit information including routing number, account number, and account type.

What qualifying individual details must be provided?

It asks for the qualifying individual’s name and Social Security number or VA file number, plus branch of service and date of birth. It also includes eligibility questions about service-connected disability and the timing of death, when applicable.

How does the form determine which benefit to apply for?

After the relationship and eligibility details, the applicant selects the benefit option by checking the relevant box for Chapter 35-DEA or Chapter 33-Fry Scholarship, with notes that the election is irrevocable.

Sep 14, 2026

Upload by Aurelia