Homepage Fill Out Your Va 28 8872 Form
Article Structure

The VA Form 28-8872 serves as a critical tool in the vocational rehabilitation process for veterans seeking to improve their employability. This form outlines a rehabilitation plan tailored to the individual needs of a veteran, highlighting essential information such as the veteran's name, claim number, and Social Security number. It requires detailed documentation of the program plan, including the type of rehabilitation strategy and specific goals to be achieved. Each objective within the plan is supported by anticipated completion dates, services provided, and evaluation criteria, ensuring a comprehensive approach to the veteran's rehabilitation journey. Stakeholders, such as the counseling psychologist and vocational rehabilitation specialist, must sign to confirm their involvement and commitment to the development of the plan. Moreover, the form mandates a closure statement, promoting transparency and indicating the veteran's understanding of their responsibilities within the program. Annual reviews, as stipulated in the form, allow for reassessment and adjustments to the rehabilitation strategies, ensuring that they remain effective and relevant to the veteran's evolving needs. A crucial part of the process is a privacy notice, which assures veterans that their personal information will be handled according to federal regulations. Overall, the VA Form 28-8872 provides structure and clarity, facilitating the vocational rehabilitation process while empowering veterans in their journey toward successful employment.

Va 28 8872 Example

 

 

 

REHABILITATION PLAN

1. DATE

 

2. FIRST - MIDDLE - LAST NAME OF VETERAN

3. CLAIM NUMBER

4. SOCIAL SECURITY NUMBER

 

C-

 

5. PROGRAM PLAN

 

 

6A. TYPE OF PLAN

6B. AMENDMENT NO. TO IWRP

6C. DATE OF IWRP

7. PROGRAM GOAL

NOTE: INTERMEDIATE OBJECTIVES TO ACHIEVE PLANNED GOAL COVERED IN ITEMS 8 THRU 11.

8A. OBJECTIVE ONE (Description)

 

8B. ANTICIPATED COMPLETION DATE

 

 

 

 

8C. SERVICES PROVIDED

 

8D. DURATION OF SERVICES

 

 

FROM (Mo., Yr.)

 

TO (Mo., Yr.)

 

 

 

 

 

8E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES

8F. PERSON TO CONTACT (If institution)

 

 

 

 

 

8G. TELEPHONE NO. (Include Area Code)

 

 

 

 

 

 

8H. EVALUATION CRITERIA

 

 

 

 

 

 

 

 

 

8I. EVALUATION PROCEDURE

 

 

 

 

 

 

 

 

 

8J. EVALUATION SCHEDULE

 

 

 

 

 

 

 

 

 

8K. PROGRESS NOTES

 

 

 

 

 

 

 

9A. OBJECTIVE TWO (Description)

 

9B. ANTICIPATED COMPLETION DATE

 

 

 

9C. SERVICES PROVIDED

 

9D. DURATION OF SERVICES

 

 

FROM (Mo., Yr.)

 

TO (Mo., Yr.)

 

 

 

 

 

9E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES

9F. PERSON TO CONTACT (If institution)

 

 

 

 

 

9G. TELEPHONE NO. (Include Area Code)

 

 

 

 

 

 

9H. EVALUATION CRITERIA

 

 

 

 

VA FORM

28-8872

SUPERSEDES VA FORM 28-8872, SEP 1989, WHICH

JUL 2010

WILL NOT BE USED.

Continued on Reverse

ITEM 9 (CONTINUED)

 

 

 

 

9I. EVALUATION PROCEDURE

 

 

 

 

 

 

 

 

 

9J. EVALUATION SCHEDULE

 

 

 

 

 

 

 

 

 

9K. PROGRESS NOTES

 

 

 

 

 

 

 

 

10A. OBJECTIVE THREE (Description)

 

10B. ANTICIPATED COMPLETION DATE

 

 

 

 

10C. SERVICES PROVIDED

 

10D. DURATION OF SERVICES

 

 

FROM (Mo., Yr.)

 

TO (Mo., Yr.)

 

 

 

 

 

10E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES

10F. PERSON TO CONTACT (If institution)

 

 

 

 

 

10G. TELEPHONE NO. (Include Area Code)

 

 

 

 

 

 

10H. EVALUATION CRITERIA

 

 

 

 

 

 

 

 

 

10I. EVALUATION PROCEDURE

 

 

 

 

 

 

 

 

 

10J. EVALUATION SCHEDULE

 

 

 

 

 

 

 

 

 

10K. PROGRESS NOTES

 

 

 

 

 

 

 

 

 

11. CLOSURE STATEMENT

 

 

 

 

I CERTIFY THAT I have participated in the development of this program plan. I understand it is my responsibility to cooperate in the program and make reasonable efforts on my behalf. There will be periodic and/or an annual review of the plan, at which time the VA staff members and I will have a chance to jointly redevelop it.

12. SIGNATURE OF VETERAN

13. SIGNATURE OF COUNSELING PSYCHOLOGIST

 

 

14. SIGNATURE OF VOCATIONAL REHABILITATION SPECIALIST

15. ANNUAL REVIEW DATE

 

 

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for the purpose of educational and vocational planning and to help you make the best use of your rehabilitation benefits. This information will not be released outside VA unless you authorize its release in writing or the disclosure is authorized under the Privacy Act, including the routine use identified in VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

VA FORM 28-8872, JUL 2010

Form Characteristics

Fact Name Description
Purpose of Form The VA Form 28-8872 is used for creating a Rehabilitation Plan for veterans, outlining their program goals and objectives.
Components Key sections include personal information, program type, specific objectives, and the evaluation criteria for the rehabilitation plan.
Governing Laws The form is administered under the authority of Title 38 of the United States Code, which governs veterans’ benefits and rehabilitation services.
Review Process Periodic reviews are mandated to assess the veteran's progress and adjust the plan as needed, ensuring ongoing support and engagement.
Privacy Protection Information collected on this form is protected under the Privacy Act of 1974, ensuring confidentiality in handling personal data.

Guidelines on Utilizing Va 28 8872

Filling out the VA Form 28-8872 is an important step in creating a rehabilitation plan tailored to assist a veteran. Once you have gathered the necessary information and materials, you’ll be ready to proceed with completing the form. Each section requires careful attention to detail to ensure that all relevant information is accurately represented. Here’s a step-by-step guide to help you navigate this process.

  1. Date: Write the current date in the designated space.
  2. Veteran's Name: Fill in the first, middle, and last name of the veteran.
  3. Claim Number: Enter the veteran's claim number.
  4. Social Security Number: Provide the veteran's Social Security Number.
  5. Program Plan: Indicate the type of program being developed.
  6. Type of Plan: Mark the appropriate type of plan from the options provided.
  7. Amendment No.: If applicable, indicate the amendment number to the Individualized Written Rehabilitation Plan (IWRP).
  8. Date of IWRP: Write the date that the IWRP was established.
  9. Program Goal: Clearly state the main goal of the rehabilitation program.
  10. Objectives: For each objective (1-3), provide the following information:
    • Description: Briefly describe each objective.
    • Anticipated Completion Date: Provide the expected date of completion for each objective.
    • Services Provided: List the services that will help achieve each objective.
    • Duration of Services: Specify the time period for the services (from month/year to month/year).
    • Name & Address: Include the name and address of the person or institution providing the services.
    • Contact Person: If applicable, provide the name of a contact person in the institution.
    • Telephone Number: Include the area code with the phone number.
    • Evaluation Criteria: Define criteria that will be used for evaluation.
    • Evaluation Procedure: Describe how the evaluation will take place.
    • Evaluation Schedule: Indicate when evaluations will be conducted.
    • Progress Notes: Maintain a section for recording progress notes for each objective.
  11. Closure Statement: Read and verify the closure statement, which reaffirms participation in the development of the program plan.
  12. Signatures: Collect required signatures from the veteran, the counseling psychologist, and the vocational rehabilitation specialist.
  13. Annual Review Date: Enter the date for the next annual review of the plan.

Once completed, make sure to review each section for accuracy. Double-check that all necessary signatures are collected, and retain a copy for your records. Submitting this form will lead to further discussions and actions regarding the rehabilitation plan, so stay engaged through the process.

What You Should Know About This Form

What is the VA Form 28 8872?

The VA Form 28 8872, also known as the Rehabilitation Plan, serves as a critical document for veterans seeking vocational rehabilitation and employment services. This form outlines a structured plan that includes the goals, objectives, and services tailored to assist a veteran in achieving rehabilitation and gaining employment. By completing this form, veterans engage in a collaborative process with VA staff to develop and implement their individual rehabilitation plans.

Who should fill out the VA Form 28 8872?

This form should be completed by veterans who are enrolled in the Vocational Rehabilitation and Employment (VR&E) program under the Department of Veterans Affairs. A vocational rehabilitation specialist, alongside the veteran, will work on this form to ensure that the rehabilitation plan accurately reflects the veteran’s needs and aspirations. It is essential that the veteran actively participate to create a plan that is both realistic and achievable.

What information is required on the form?

The VA Form 28 8872 requires various pieces of information, including personal details such as the veteran's name, claim number, and Social Security number. The form also emphasizes setting clear program goals with intermediate objectives. Sections dedicated to specific objectives detail the services provided, anticipated completion dates, evaluation criteria, and progress notes, ensuring that every aspect of the rehabilitation process is well-documented.

How does the evaluation process work on the form?

The evaluation process on the VA Form 28 8872 is integral to tracking the progress of the rehabilitation plan. For each objective outlined in the plan, veterans and their counselors will identify evaluation criteria and procedures to measure success. This includes setting a timeline for evaluations, which allows for regular assessments of progress made towards achieving each objective. These evaluations facilitate necessary adjustments to the plan, ensuring it remains relevant and effective.

What happens after filling out the form?

Once the VA Form 28 8872 is completed and signed by both the veteran and the necessary VA staff, the program plan is put into action. The plan includes a scheduled annual review with VA staff, where the veteran’s progress will be jointly assessed. This ongoing collaboration allows for updates or changes to the plan, enhancing the likelihood of success in achieving the set rehabilitation goals.

Is my personal information safe on the VA Form 28 8872?

Yes, your personal information is protected under the Privacy Act of 1974. The VA will only disclose information collected from this form to authorized personnel for purposes related to educational and vocational planning. Your Social Security Number and other personal details are treated with care, and the form emphasizes that refusal to provide certain information will not automatically result in denial of benefits. Your privacy and data security are taken seriously in this process.

Common mistakes

Filling out the VA 28-8872 form can be a complex task, and mistakes can lead to delays or complications in processing your rehabilitation plan. Here are eight common errors that individuals make when completing this form.

One frequent mistake is the omission of essential personal details. Many forget to include their full name, claim number, or social security number. Providing this basic information is crucial as it helps the VA link the application to the correct account.

Another common error involves incorrect dates. Veterans often miswrite the anticipated completion dates or service duration, which can confuse the planning process. Accurate timelines are essential for ensuring that the rehabilitation goals are realistic and achievable.

Additionally, some individuals fail to detail the services provided. It is necessary to describe precisely what services will be included in the program plan. A vague description might result in the VA questioning whether the proposed plan will meet the veteran's needs.

People often skip evaluation criteria and procedures, which is a significant oversight. This omission can raise concerns during reviews, as the VA needs to assess how progress will be measured and when evaluations will happen.

Incorrectly filling out contact information is another issue. It’s important to provide accurate names, addresses, and telephone numbers for any institutions or persons involved in providing services. Providing incomplete or inaccurate information can create hurdles in communication.

Many also overlook the closure statement section, which requires a signature from the veteran. Skipping this part can lead to automatic denials of the application. It's a straightforward step, but essential for validation.

Furthermore, failing to keep copies of submitted forms can be problematic. Many individuals do not retain a copy of their completed VA 28-8872, making it challenging to track what was submitted. Keeping a record offers peace of mind and can aid in resolving any discrepancies later on.

Finally, misunderstanding the importance of the Privacy Act notice can lead individuals to feel hesitant about providing their social security number. While it is essential to provide this information, veterans should know that the VA will not disclose it without proper authorization. Understanding this can ease concerns and encourage accurate completion of the form.

Documents used along the form

The VA Form 28-8872 is a vital document for creating a rehabilitation plan for veterans. Along with this form, several other documents may enhance the planning and implementation process of vocational rehabilitation services. Here’s a brief overview of these forms and documents commonly used in conjunction with the VA 28-8872.

  • VA Form 28-1900: This document is known as the Application for Vocational Rehabilitation and Employment. It initiates the process for veterans seeking vocational training and benefits and provides important information about the veteran's service and goals.
  • VA Form 28-8870: This form is the Counseling Record - Narrative Report. It contains a summary of the veteran’s history, challenges, and strengths, serving as a foundation for the rehabilitation plan outlined in the VA 28-8872.
  • VA Form 21-526EZ: This is the Application for Disability Compensation and Related Compensation Benefits form. While not directly related to rehabilitation, it can be used to establish eligibility for benefits that may support vocational training.
  • VA Form 21-4138: This form is known as the Statement in Support of Claim. It allows veterans to provide additional information or evidence to support their claims for benefits, which may enhance the success of their rehabilitation efforts.
  • VA Form 28-1990: This form is the Application for Veterans Educational Assistance. It is specifically for veterans who wish to apply for educational benefits to support their rehabilitation and training goals.

These documents work together to create a comprehensive approach to vocational rehabilitation for veterans. Taking the time to complete and submit these forms can significantly impact the support and benefits received throughout the rehabilitation process.

Similar forms

  • VA Form 28-1900 (Application for VA Vocational Rehabilitation and Employment): Similar to the VA Form 28-8872, this application form is used by veterans to apply for vocational rehabilitation benefits. It helps establish eligibility and outlines the services available to assist veterans in becoming employable. Both forms focus on the veteran's rehabilitation journey and goals.
  • VA Form 28-8832 (Employment Adjustment Report): This document is used to report changes in a veteran's employment status after they have received rehabilitation services. Like the VA Form 28-8872, it includes evaluations and services provided towards achieving occupational goals, emphasizing the veteran's ongoing journey toward self-sufficiency.
  • VA Form 28-8890 (Application for Dependents' Educational Assistance): This form is for veterans to apply for educational benefits for their dependents. It is similar in that both forms require detailed personal and service-related information. Both aim to enhance the quality of life for veterans and their families, focusing on education and rehabilitation.
  • VA Form 22-1990 (Application for VA Education Benefits): This application allows veterans to apply for educational benefits through the GI Bill. Like the VA Form 28-8872, it requires personal data and outlines the specific goals and plans graduates should expect. Both forms prioritize the veteran's development and access to necessary resources.

Dos and Don'ts

When filling out the VA Form 28-8872, it’s essential to navigate the process with care. Below is a list of suggestions that can help you complete this form accurately and effectively.

  • Do double-check your personal information for accuracy.
  • Don’t leave any required fields blank; incomplete forms can lead to delays.
  • Do ensure you provide detailed descriptions for each objective.
  • Don’t use abbreviations or jargon that may be unclear to the reviewer.
  • Do keep a copy of the completed form for your records.
  • Don’t assume that previous forms are sufficient; each submission should be thorough.
  • Do pay attention to deadlines for submissions to avoid complications.
  • Don’t hesitate to ask for help from a veteran’s assistance officer if you have questions.
  • Do sign and date the form where indicated.
  • Don’t neglect the importance of including all necessary evaluations and progress notes.

Taking the time to follow these recommendations can greatly enhance your experience and facilitate a smoother application process. Each step matters in securing your vocational rehabilitation benefits.

Misconceptions

The VA Form 28-8872, often referred to as the Rehabilitation Plan, plays a crucial role in the vocational rehabilitation process for veterans. However, several misconceptions about this form can lead to confusion. Understanding these myths can demystify the process and empower veterans in their journey.

  • Myth 1: The VA Form 28-8872 is only for veterans with serious disabilities.
  • Many believe that only those with significant disabilities are eligible to utilize this form. In reality, veterans with a variety of challenges can benefit from vocational rehabilitation services, making this form applicable to a broader audience.

  • Myth 2: Submitting the form guarantees immediate benefits.
  • Some veterans think that by simply submitting the 28-8872 form, they will instantly receive benefits. However, the process involves multiple evaluations and deliberations to determine eligibility and tailor services appropriately.

  • Myth 3: The form is just a formality and lacks importance.
  • While it may seem like a bureaucratic requirement, the information collected on this form is vital for creating an effective rehabilitation plan. It details the veteran’s needs and goals, ensuring that the right services are provided.

  • Myth 4: The plan is set in stone once submitted.
  • Contrary to popular belief, the VA recognizes that circumstances may change. The rehabilitation plan can be reviewed and amended through periodic evaluations, allowing for adjustments to better meet the veteran's evolving needs.

  • Myth 5: All services provided are free of charge.
  • Although many services under the VA’s vocational rehabilitation program are covered, some might require cost-sharing, depending on the veteran's financial situation. It’s essential to clarify any potential costs with the VA.

  • Myth 6: Only a counseling psychologist needs to sign the form.
  • In fact, the signatures of both the veteran and the vocational rehabilitation specialist are also required on the 28-8872. This multifaceted approach ensures collective agreement and accountability in the rehabilitation process.

  • Myth 7: The form ensures job placement.
  • While the plan focuses on preparing veterans for employment, it does not guarantee job placement. Instead, it outlines the necessary steps and services to help veterans enhance their skills and maximize their opportunities in the job market.

By clearing up these misconceptions, veterans can approach the rehabilitation process with a better understanding of what to expect. Knowledge empowers individuals, leading to successful participation in their rehabilitation journey.

Key takeaways

Filling out the VA Form 28-8872 is essential for veterans seeking assistance in their rehabilitation plans. Here are some key takeaways about this important document:

  • Complete Identification: Fill in your full name, including first, middle, and last name, as well as your claim number and social security number.
  • Program Plan: Clearly outline your program plan under the appropriate sections for easy understanding.
  • Set Objectives: Use items 8 through 10 to define clear objectives that align with your overall program goal.
  • Service Details: Provide detailed information on the services you will receive, including the provider's name and contact details.
  • Evaluation Criteria: Outline how your progress will be evaluated to ensure accountability throughout your rehabilitation.
  • Periodic Review: Acknowledge that your plan will undergo periodic reviews and updates in collaboration with VA staff.
  • Signatures Required: Ensure that the document is signed by you, your counseling psychologist, and a vocational rehabilitation specialist.
  • Privacy Notice: Be aware of the privacy notice, which explains how your information will be used and protected.
  • Cooperation is Key: Understand your role in the process and commit to making reasonable efforts to follow through with the program.

This list provides a straightforward overview to guide you through completing and utilizing the VA Form 28-8872 effectively.