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O NOT print) 6B. EVENING TELEPHONE NO. (Include Area Code) 7B. DATE PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it is false, or fraudulent acceptance of any payment to which you are not entitled. PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, code.

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The times of distressing complicated legal and tax forms have ended. With US Legal Forms the whole process of creating legal documents is anxiety-free. The best editor is right close at hand giving you various useful tools for completing a Medical Expense Report Template. The following tips, combined with the editor will assist you through the entire process.

  1. Click the orange Get Form option to start modifying.
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