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Note this need on your application in the emergency award section. Expenses. What expenses are eligible for reimbursement?(a) Application for Compensation or Reimbursement. Use VA Form 21p8416 to report medical or dental expenses that you have paid for yourself or for a family member living in your household. This form is to be used to seek reimbursement for out of pocket medical expenses pertaining to the treatment of an accepted condition. (Pursuant to NAC 616C.150). Claim for Reimbursement for Expenditures on Official Business. New Jersey Victims of Crime Compensation Office (VCCO) compensates victims of crime for losses and expenses resulting from certain criminal acts. Complete this form, including your workers' compensation claim number, and send it to the insurer that processes your claim. Reimbursement is used when the subject is paid back for travel expenses such as mileage, lodging, food while traveling.