Omb number 2900 0798-2026

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The document is a VA form (OMB Number: 2900-0798) for Veterans and beneficiaries to claim reimbursement for travel expenses related to medical care. It includes sections for the claimant's information, trip details, and statements certifying the accuracy of the claim. Eligibility criteria for reimbursement are outlined, along with instructions for completing and submitting the form. The document emphasizes the importance of providing accurate information and includes privacy act information regarding data usage.

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Click ‘Get Form’ to open the OMB Number 2900-0798 in the editor.
Begin with Section A, Traveler's Information. Fill in your name, Social Security Number (SSN), and date of birth. Ensure accuracy as this information is crucial for processing your claim.
Indicate your status by checking the appropriate box (Veteran, Caregiver, Attendant, Donor). If you select Caregiver, Attendant, or Donor, complete sections 3.a to 3.c with the Veteran's details.
Move to Section B for Trip Information. Provide the address from which you are claiming reimbursement and indicate if you are claiming return travel reimbursement. Specify your travel dates and mode of transport.
If applicable, itemize any additional expenses beyond mileage in the designated area and attach receipts for verification.
In Section C, read the penalty statement carefully before signing and dating the form to certify that all information provided is correct.

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