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VA Form 21P-8416B Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death
What Is VA Form 21P-8416B?
VA Form 21P-8416B, Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death is a form published by the Department of Veterans Affairs (VA) . It is used by veterans to provide information, in order to determine their eligibility for income-based benefits and the rate payable. This form is used to report received compensations for injury or death.
The latest version of the form was released on March 1, 2018 , with all previous editions obsolete. A fillable VA Form 21P-8416B is available for download below.
When a claimant is awarded compensation by another entity or government agency based on a personal injury or death, compensation is considered a countable income for VA purposes. The claimant should keep all receipts or other providing documentation of payments for at least 3 years after VA makes a decision on a medical expense claim.
This form is related to VA Form 21P-8416, Medical Expense Report. The VA 21P-8416 is used to report medical or dental expenses that are not or will not be reimbursed. The reported expenses can be paid to the veteran or a member of their family.
VA Form 21P-8416B Instructions
The form is distributed without any filling guidelines provided by the VA.
How to Fill Out VA Form 21P-8416B?
Instructions for VA Form 21P-8416B are as follows:
- Part I (Personal Identification Information) is for the personal information of the veteran and the claimant. Item 1 is for the veteran's full name. The veteran's social security number is entered in Item 2. The VA file number is given in Item 3. Item 4 is for the date of birth. If applicable, the veteran's service number is entered in Item 5. The claimant's full name is entered in Item 6. Item 7 is for the current mailing address, including the ZIP code. Items 8 and 9 are for the claimant's phone number and email address respectively.
- Part II (Explanation of Expenses) is a chart designed for listing the claimed expenses. Column A is for naming the purpose of expense, such as Legal Fees, Fees for Expert Witnesses, Medical Expenses Paid Before Date of Recovery, etc. The paid amount is entered in Column B. Column C is for the date of payment. The name of the service provided, such as attorney or doctor, is entered in Column D. Column E is for indicating the organization that paid the compensation.
- The second page of the form should contain the veteran's social security number entered on the top of the form. If the space provided on the form is not enough, a separate sheet of paper with columns corresponding to those on the form should be used and attached to the form.
- The claimant should sign and date the completed form, certifying that all provided information is true.
Where Do I Send VA Form 21P-8416B?
The form may be presented in person or mailed to the local VA benefits office. The mailing address for the VA Form 21P-8416B can be obtained through the VA website. Submitting a claim through the Veteran's Online Application is not possible, because the VONAPP website is no longer available.
Download VA Form 21P-8416B Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death
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