VA Form 10-5392
VA SERVICE ASSIGNMENTORGANIZATION NAME
As an Occasional Volunteer, I agree, for an indefinite period, with the following statement: I hereby waive all claims to monetary benefits for services rendered as a volunteer worker on
a “without compensation” basis. I understand that this waiver applies only to remuneration (compensation) for specific services rendered in a VA Voluntary Service (VAVS) Program
and is not related to any other VA services or benefits to which I am entitled. (NOTE: VA has entered into this agreement by the authority of 38 U.S.C. 7405(a)(1)(D). This agreement
may be cancelled by either party upon written notice.
OCCASIONAL VOLUNTEER TIME SHEET