OMB control number

Medical Expense Report (VA Form 21P-8416)

OMB 2900-0161 · VA.

OMB 2900-0161

VA Form 21P-8416 is used by claimants and beneficiaries to report unreimbursed medical expenses for the purpose of reducing their countable income associated with needs-based benefit programs such as VA Pension and Parents’ Dependency and Indemnity Compensation (DIC). Unreimbursed medical expenses are deducted from otherwise countable income to determine eligibility for income-based benefits and the rate payable.

The latest form for Medical Expense Report (VA Form 21P-8416) expires 2026-10-31 and is listed under ICR 202306-2900-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form VA Form 21P-8416 Medical Expense Report (VA Form 21P-8416)	Form
2023-20470.pdf	Supplementary Document
SupportingStatement (2900-0161).docx	Supporting Statement A
60-Day FRN Published (2900-0161, 8416).pdf	Supplementary Document
Medical Expense Report (VA Form 21P-8416)	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202306-2900-016	Revision of a currently approved collection	2023-09-21	Approved with change
202107-2900-012	Reinstatement without change of a previously approved collection	2021-11-02	Approved without change
201809-2900-002	Revision of a currently approved collection	2018-09-18	Approved with change
201604-2900-020	Revision of a currently approved collection	2016-09-08	Approved without change
201412-2900-017	Revision of a currently approved collection	2015-01-02	Comment filed on proposed rule and continue
201310-2900-004	Revision of a currently approved collection	2014-07-08	Approved without change
201112-2900-007	No material or nonsubstantive change to a currently approved collection	2012-03-05	Approved without change
201103-2900-001	Extension without change of a currently approved collection	2011-06-09	Approved without change
200712-2900-006	Extension without change of a currently approved collection	2008-04-15	Approved without change
200505-2900-001	Revision of a currently approved collection	2005-05-02	Approved with change
200204-2900-001	Extension without change of a currently approved collection	2002-04-05	Approved without change
199907-2900-003	Reinstatement with change of a previously approved collection	1999-07-12	Approved without change
199508-2900-047	Extension without change of a currently approved collection	1995-08-28	Approved without change
199208-2900-007	Revision of a currently approved collection	1992-08-04	Approved without change
198908-2900-004	Extension without change of a currently approved collection	1989-08-24	Approved without change
198608-2900-007	Revision of a currently approved collection	1986-08-19	Approved without change
198511-2900-010	No material or nonsubstantive change to a currently approved collection	1985-11-18	Approved with change
198501-2900-006	Revision of a currently approved collection	1985-01-23	Approved without change
198112-2900-005	Revision of a currently approved collection	1981-12-30	Approved without change
198011-2900-055	No material or nonsubstantive change to a currently approved collection	1980-11-06	Approved with change
197703-2900-005	Revision of a currently approved collection	1977-03-07	Approved without change