
OMB Control Number 29000648 Estimated Burden Avg: 11 minutes Expiration Date: 03/31/2027Foreign Medical Program (FMP) Claim Cover Sheet Foreign Medical Program PO Box 469061, Denver, CO 802469061.
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How to fill out the VA 10-7959f-2 online
The VA 10-7959f-2 form is essential for veterans seeking reimbursement for medical services received outside the United States. This guide will provide clear and concise instructions to effectively complete the form online, ensuring a smooth submission process.
Follow the steps to successfully complete the VA 10-7959f-2 form.
- Click 'Get Form' button to obtain the form and open it in your preferred document editor.
- In Section I, enter your veteran information. Provide your last name, first name, date of birth in MM/DD/YYYY format, Social Security number, VA claim file number, physical address, mailing address, country, telephone number, and email address.
- Move to Section II and describe the diagnosis or nature of the illness or injury for which you are claiming reimbursement.
- In Section III, provide the claimant certification. Ensure that all itemized billing statements include required provider information: full name and medical title, office address, office telephone number, and billing address, if different from the office address.
- Detail the claim information by providing a narrative description of each service and/or drug, along with each service’s billed charge and the corresponding date(s) of service.
- Sign and date the form where indicated. Your signature certifies that the information provided is accurate and that all attachments are correct.
- Prepare to submit the form. Attach itemized invoices or receipts and ensure that you include the required receipts of payment for each itemized billing statement.
- Review your completed form for accuracy and completeness, then save any changes and download or print the form for your records.
Complete your VA 10-7959f-2 form online today to ensure timely processing of your claims.
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