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⚠️ Notice: This information collection may be referencing outdated material.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 21P-8416 Medical Expense Report Form and Instruction
21P-8416 Medical Expense Report 2900-0161 21P-8416(12-14).pdf www.vba.va.gov/pubs/forms/VBA-21P-8416-ARE.pdf Form and Instruction

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 and Instruction	21P-8416	Medical Expense Report	2900-0161 21P-8416(12-14).pdf	https://www.vba.va.gov/pubs/forms/VBA-21P-8416-ARE.pdf	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: 60,000	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	60,000	-36,400	96,400
Annual IC Time Burden (Hours)	30,000	-18,200	48,200
Annual IC Cost Burden (Dollars)	0	-974,845	974,845

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.