Medical Expense Report

Medical Expense Report (VA Form 21P-8416)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0161 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21P-8416 Medical Expense Report Form
VA Form 21P-8416 Medical Expense Report 21P-8416(4-28-16).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Medical Expense Report	Agency IC Tracking Number:	2900-0161

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.262 38 CFR 3.272

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21P-8416	Medical Expense Report	21P-8416(4-28-16).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 74 FR 29275

Number of Respondents: 96,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	96,400	0	96,400
Annual IC Time Burden (Hours)	48,200	0	48,200
Annual IC Cost Burden (Dollars)	974,845	974,845	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.