2900-0161 Revisions Description

2900-0161 Revisions Description.docx

Medical Expense Report (VA Form 21P-8416)

2900-0161 Revisions Description

OMB: 2900-0161

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Medical Expense Report, VA Form 21P-8416
OMB 2900-0161

Substantive Revisions of 2900-0161

  • Inserted Item 21 “IN HOME ATTENDANT EXPENSES” at the top of page 3

    • 21A – NAME OF PROVIDER

    • 21B – HOURLY RATE/NUMBER OF HOURS

    • 21C – AMOUNT PAID

    • 21D – DATE PAID

    • 21E – FOR WHOM PAID

  • Inserted “WORKSHEET: EXPENSES FOR CARE IN A FACILITY OTHER THAN A NURSING HOME” on page 5

  • Inserted “WORKSHEET: EXPENSES FOR IN-HOME ATTENDANT CARE” on page 6



Non-Substantive Revisions of 2900-0161

  • Page 1, “IMPORTANT NOTES” bullet 4 modified for clarity

  • Page 2, modified instructions under item 20 for clarity

  • Page 3, modified instructions under item 22 for clarity

Page 1

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSUPPORTING STATEMENT FOR VA FORM 10-2065, FUNERAL ARRANGEMENTS; VA FORM 10-10, APPLICATION FOR MEDICAL BENEFITS; VA FORM 10-10I,
AuthorPreferred Customer
File Modified0000-00-00
File Created2021-01-23

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