Information Collection

Medical Expense Report (VA Form 21P-8416)

IC 28397 under ICR 202306-2900-016 · OMB 2900-0161.

Documents and Forms

Document Name Document Type
Form VA Form 21P-8416 Medical Expense Report (VA Form 21P-8416) Form
VA Form 21P-8416 Medical Expense Report 21P-8416(6-20-23).pdf www.va.gov/vaforms Form
VA Form 21P-8416 Medical Expense Report 21P-8416(6-20-23).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Expense Report (VA Form 21P-8416)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.272 38 CFR 3.262

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(6-20-23).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: 88 FR 14108

Number of Respondents: 60,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	0	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.