OMB control number
Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (VA Form 21P-8416b)
OMB 2900-0545 · VA.
OMB 2900-0545
VA Form 21P-8416b is used to gather information about certain expenses related to securing compensation based on personal injury or death. The form is used by claimants for VA income-based benefits to determine the amount of countable income. Without this information, the VA would be unable to properly determine entitlement to income-based benefits and the rate payable.
The latest form for Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (VA Form 21P-8416b) expires 2027-06-30 and is listed under ICR 202402-2900-015.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 21P-8416b Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (21P-8416b) | Form |
 30-Day FRN - 2900-0545 (2024).pdf | Supplementary Document |
| 2900-0545 Supporting Statement (21P-8416b).docx | Supporting Statement A |
| 60-Day FRN (published).pdf | Supplementary Document |
 Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (21P-8416b) |
Form |