Agency Information Collection Activities; Proposals, Submissions, and Approvals: Reimbursement Claim Forms

Agency Information Collection Activity: VA Reimbursement Claim Forms

DATES:

Comments must be received on or before November 23, 2026.

SUPPLEMENTARY INFORMATION:

Under the PRA of 1995, Federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. This request for comment is being made pursuant to Section 3506(c)(2)(A) of the PRA.

With respect to the following collection of information, VHA invites comments on: (1) whether the proposed collection of information is necessary for the proper performance of VHA's functions, including whether the information will have practical utility; (2) the accuracy of VHA's estimate of the burden of the proposed collection of information; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or the use of other forms of information technology.

Title: VA Reimbursement Claim Forms, 10-485 and 10-487.

OMB Control Number: 2900-0940. https://www.reginfo.gov/public/do/PRASearch (Once at this link, you can enter the OMB Control Number to find the historical versions of this Information Collection).

Type of Review: Revision of a currently approved collection.

Abstract: Veterans may claim reimbursement for certain medical and pharmaceutical costs, as authorized by 38 U.S.C. 1728. VA has been using VA Form 10-320 for Veterans requesting reimbursement for various out-of-pocket expenses that occurred as a result of non-VA medical services that may be eligible for payment under 38 CFR 17.4025 (Veterans Community Care Program), 38 CFR 17.120 (Unauthorized), 38 CFR 17.1002 (Millennium Bill), 38 CFR 17.1200-17.1230 (COMPACT Act) and Public Law 118-210 (Sec. 143 Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act).

The 10-320 form will be replaced by two forms: Veteran Reimbursement Claim Forms 10-485 and 10-487. Using two forms will allow Veteran claims for prescription drug reimbursement to be separated from claims for reimbursement of certain medical and transportation costs. This will make it simpler for Veterans to file claims instead of using one universal form for several different types of costs.

In order for VA to process and repay eligible out-of-pocket expenses, Veterans must submit necessary information to support their request and justify reimbursement. VA Form 10-485 will be used to collect information from Veterans seeking reimbursement for prescription drug costs. VA Form 10-487 will be used to collect information from Veterans seeking reimbursement for certain emergent medical or transportation costs. VA Form 10-320 will be discontinued when the two new forms are approved and published for use by Veterans.

Total Hours = 5,000 hours

Total Responses = 30,000

VA Form 10-485

Affected Public: Individuals or Households.

Estimated Annual Burden: 4,833 hours.

Estimated Average Burden per Respondent: 10 minutes.

Frequency of Response: One time.

Estimated Number of Responses: 29,000.

VA Form 10-487

Affected Public: Individuals or Households.

Estimated Annual Burden: 167 hours.

Estimated Average Burden per Respondent: 10 minutes.

Frequency of Response: One time.

Estimated Number of Responses: 1,000.

Authority: 44 U.S.C. 3501 et seq.