
OMB Approved No. 2900-0092
Respondent Burden: 45 Minutes
Expiration Date: 11/30/2027
INFORMATION FOR VETERAN READINESS AND
EMPLOYMENT ENTITLEMENT DETERMINATION
INSTRUCTIONS:
This form is used during the comprehensive initial evaluation to assist with gathering information for an Entitlement Determination. For more
information, contact us at https://ask.va.gov or call us toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is
711. VA forms are available at www.va.gov/vaforms.
During the initial evaluation, the Vocational Rehabilitation Counselor (VRC) will review the form with the claimant to obtain additional and/or missing information necessary
to determine the claimant's entitlement to Chapter 31 benefits. The VRC will use their counseling skills while utilizing this form to assist with making an entitlement
determination. The VRC will review and discuss the responses from the claimant during the initial evaluation to address:
• Entitlement determination to VR&E Program, including Employment Handicap (EH) and Serious Handicap (SEH) determination, in accordance with 38 CFR § 21.51
and § 21.52.
• Assess the following factors as part of the initial evaluation:
(1) Determination of the effect(s) of claimant's Service-Connected Disabilities (SCD) and Non-Service-Connected Disabilities (NSCD) condition(s) on obtaining
and maintaining employment, and on independence in daily living;
(2) The claimant's physical and mental capabilities that may affect employability and ability to function independently in daily living activities in family and
community;
(3) The claimant's abilities, aptitudes, and interests;
(4) The claimant's personal history and current circumstances (including educational and training achievements, employment record, developmental and related
vocationally significant factors, and family and community adjustment); and
(5) Other factors that may affect the claimant's employability.
• Identification of barriers that impact claimant's employability.
CLAIMANT'S INFORMATION
CLAIMANT'S NAME (First, Middle Initial, Last)
VA FILE NUMBER (Last four)
VRC NAME
SECTION I: VERIFICATION OF CLAIMANT'S CONTACT INFORMATION
(Please verify the claimant's contact information. If the claimant's contact information has changed or is different, please
advise the claimant to update their contact information and/or marital status on VA.gov profile).
VA FORM
NOV 2024
28-1902w
SUPERSEDES VA FORM 28-1902w, JUL 2024,
WHICH WILL NOT BE USED
Page 1
VERIFIED CLAIMANT'S ADDRESS
VERIFIED CLAIMANT'S MARITAL STATUSVERIFIED CLAIMANT'S PHONE NUMBER
VERIFIED CLAIMANT'S EMAIL ADDRESS
SECTION II: REVIEW OF CLAIMANT'S CIVILIAN EMPLOYMENT HISTORY
(If the claimant provides their resume, it is not necessary to duplicate information in Items 1-9. However, the civilian employment
(including self-employment) history must be reviewed and discussed to identify any difficulties with job duties, obtaining and
maintaining employment, salary, full time, part-time, and reasons why claimant left job positions).
CLAIMANT PROVIDED RESUME (Please complete fields not on resume) CLAIMANT DID NOT PROVIDE RESUME (Please complete the section below)
1. IS THE CLAIMANT CURRENTLY EMPLOYED INCLUDING SELF EMPLOYMENT?
YES (If "Yes," go to #4) NO (If "No," go to #2)
3. WHAT DID THE CLAIMANT DO DURING THE PERIOD OF UNEMPLOYMENT?
2. IF THE CLAIMANT IS UNEMPLOYED, HOW LONG HAS THE CLAIMANT BEEN UNEMPLOYED?
• Development and analysis of information necessary to obtain a general understanding of the whole individual.
• Evaluation of claimant's capacity for suitable employment and/or independence in daily living, in accordance with 38 CFR § 21.50.