Federal Medical Care Recovery Act Bill Requests

The purpose of collecting this information is to provide basic information from which potential liability can be assessed for VA to recover the cost of care from the liable party instead of the American taxpayer and Veteran paying for the care. Failure to provide any or all of the requested information may delay or result in VA’s inability to create accident-related billing, assert a claim for reimbursement, and assist the Veteran in their personal injury or workers compensation claim. Without a third party paying for the care, the Veteran may owe VA co-payments. [With regards to the CHAMPVA form alone: Failure to provide any or all of the requested information may delay or result in VA’s inability to provide CHAMPVA benefits.] -- THE CHAMPVA FORM HAS BEEN WITHDRAWN FROM THIS ICR

The latest form for Federal Medical Care Recovery Act Bill Requests expires 2022-07-31 and can be found here.