Va Form 21P-8416. Which will not be used. If you or a family member received compensation for injury, illness or death, you must report the date and amount of the recovery to va.
VA Form 21p 0969 Printable VA Form
Quickly access top tasks for frequently downloaded va forms. Mileage for privately owned vehicle travel for medical purposes. Va may be able to pay you at a higher rate if you identify expenses va considers allowable. These must be expenses you weren’t reimbursed for and don’t expect to be reimbursed for. In most instances, the amount received will be countable income for va purposes. Medical expense (physician or hospital charges, eyeglasses, oxygen rental, medical insurance, etc.) d. Which will not be used. Instructions for medical expense report. Worksheet for an assisted living, adult day care, or a similar facility. If no dates appear on this line, refer to the accompanying letter or eligibility verification report for the dates you should report medical expenses.
For whom paid (self, spouse, child, etc.) a. Va may be able to pay you at a higher rate if you identify expenses va considers allowable. Web search for va forms by keyword, form name, or form number. If no dates appear on this line, refer to the accompanying letter or eligibility verification report for the dates you should report medical expenses. Which will not be used. Which will not be used. Worksheet for an assisted living, adult day care, or a similar facility. These must be expenses you weren’t reimbursed for and don’t expect to be reimbursed for. In most instances, the amount received will be countable income for va purposes. Medical and dental expenses paid by you may be deductible from the income va counts when. Mileage for privately owned vehicle travel for medical purposes.
