Bene Travel White Paper

Veterans Health Administration White Paper

OMB No. 2900-0798 (Beneficiary Travel Mileage Reimbursement Application Form)

June 2016

Background:

The information collected will be used by VA Beneficiary Travel (BT) program to process mileage reimbursement claims for eligible veterans and other beneficiaries. This reimbursement is an essential tool for access to care as veterans have low income and the reimbursement offsets costs of gasoline and maintenance of their vehicles.

Certain information, including the recipient’s name and the starting and ending points of the trip, is necessary to process and calculate the reimbursement. The mileage reimbursement application form also includes certification that the recipient incurred cost and did not receive other funds in relation to the travel.

Changes in Justification:

There is no request to change the application form, and justification for the data gathering essentially remains the same, however some portions of the justification have been updated to reflect the passage of time. For instance, the original justification included the intention to replace an obsolete form and that has been accomplished; the version of the form used prior to submission to and approval by OMB in 2013 is no longer used. The application was made available via kiosk in VA facilities in April of 2015 and may also be printed off the web. Data collected from the form continues to be entered into VA information systems during the process of evaluating the claim.