Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (VA Form 21P-8416b)

OMB 2900-0545

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 in order to determine the amount of countable income. Without this information, 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 2021-03-31 and can be found here.

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