Va Form 21p 8416

A Medical Expense Report is a document employed by the Department of Veterans Affairs that is used to file a claim for expenses related to medical care. Formally known as a VA Form 21P-8146, a veteran would use this document to request aid from the Department for the cost of medical expenses or for transportation costs in relation to medical appointments. This form collects the full name, VA file number, and social security number of the veteran, along with the medical expenses that are being claimed. Once all the pertinent information is collected and submitted to he VA, the veteran’s reimbursement can be calculated.

What is a VA Form 21P 8416?

This form is known as a Medical Expense Report. The VA Form 21P-8146 is used by the United States Department of Veterans Affairs. This form will be used by a veteran in order to file a claim for the expenses related to medical care. This can be related to the cost of medical treatments or the transportation to and from medical appointments.
 The first section of this form requires information about the claimant. This includes full name, social security number, VA file number, and address. After this, you can list the medical expenses. For transportation expenses, you’ll need to include the medical facility you went to and the amount of miles you traveled. List how much you paid for this visit. For medical expenses, list each individual expenses and how much you paid personally. The total will be calculated and the VA will use the form to determine how much may be covered.

Most Common Uses

This form is commonly used to report medical or dental expenses that you paid for yourself or a relative who is a member of your household.  Common expenses include: hospital expenses, doctor's office fees, dental fees, prescription/non-prescription drug costs, vision care costs, medical insurance premiums, nursing home costs, hearing aid costs, home health service expenses, expenses related to transportation to a hospital, doctor, or other medical facility, monthly Medicare deduction.

Components of a VA Form 21P 8416

A VA Form 21P-8416 contains the following sections:

  • Personal Information
  • Mileage for Privately Owned Vehicle Travel for Medical Purposes
  • In-home Attendant Expenses
  • Itemization of Medical Expenses
  • Worksheet for In-Home Attendant Expenses
  • Worksheet for an Assisted Living, Adult Day Care, or a Similar Facility

Privacy Act Notice

The 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 routine uses such as civil or criminal law enforcement, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register.

Respondent Burden

The VA needs this information to determine whether medical expenses you paid may be used to reduce the amount of income we count in determining eligibility for veterans benefits (38 U.S.C. 1503). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. OMB Control No. 2900-0161.

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Sample Va Form 21p 8416

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Sample Va Form 21p 8416

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