Burden and Privacy Act information
OMB Control No. 2900-0940, an estimated burden of 10 minutes, and a Privacy Act notice saying the information is used to help determine entitlement to reimbursement for services rendered.
10-320
Veteran Reimbursement Claim Form
- Agency
- VA
- Revision
- June 2026
- Fillable fields
- 8
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-320: Veteran Reimbursement Claim Form
VA Form 10-320 is the U.S. Department of Veterans Affairs Veteran Reimbursement Claim Form, listed under health care on VA's page. VA's page says to use it to request reimbursement for out-of-pocket emergency prescription expenses from a pharmacy that's not in VA's network, and out-of-pocket expenses for unauthorized emergency care at non-VA facilities.
The form says that, in addition to meeting certain clinical and administrative requirements, to receive payment all individuals and entities must be enrolled as a vendor with the VA. It says information on how to become a vendor and where to submit the completed form is available at http://www.va.gov/COMMUNITYCARE/programs/veterans/File-a-Claim.asp.
The form is two pages: Section A for claimant information, Section B for the itemized bill requirements and Section C for a signed written explanation of why services were not obtained through VA. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-320
Section A: claimant information
Name, ICN or SSN, date of birth, a referral or authorization number if known, and address.
Section B: pharmacy documents
A valid receipt showing the amount paid for the prescription, the medication name, dosage or strength, quantity dispensed, prescribing provider's name, date dispensed, and pharmacy name and location.
Section B: emergency care documents
A billing statement with a description of charges and the dates of service, a receipt or statement of the amount paid, a description of the illness or injury and, if applicable, the primary insurance Explanation of Benefits (EOB).
Section C: explanation and signature
A written explanation of why services were not obtained through VA, a signature declaring under penalty of perjury that the information is true and accurate, and the date.
How to file VA Form 10-320
- 1
Check vendor enrollment
The instructions point to VA's community care File a Claim page for how to become a vendor and where to submit the completed form.
- 2
Fill in Section A
Enter the claimant's name, ICN or SSN, date of birth, address and any known referral or authorization number.
- 3
Gather the required documents
Section B says reimbursement requests are submitted with the listed documents to be considered for payment. Its note says medical documentation is required.
- 4
Explain and sign Section C
Write why services were not obtained through VA, then sign and date the declaration.
Why fill Form 10-320 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it
Where to submit
The form prints no mailing address. It says where to submit the completed form is available at http://www.va.gov/COMMUNITYCARE/programs/veterans/File-a-Claim.asp.
Not by email
The burden statement gives [email protected] for comments on the burden estimate and says do not send your completed VA Form 10-320 to this email address.
Medical documentation
The form says that if VA does not have adequate medical documentation on file, the reimbursement request may be denied for additional information.
Edition
JUN 2026, matching the June 2026 revision date on VA's form page. OMB Control No. 2900-0940 expires 03/31/2027.
Related forms
10-10143g
Non-VA Hospital Emergency Notification
31 fields, 1 page
10-3542
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
26 fields, 2 pages
10-10EZ
Instructions and Enrollment Application for Health Benefits
122 fields, 6 pages
10-5345
Request for and Authorization to Release Health Information
61 fields, 2 pages
Who uses VA Form 10-320?
VA's page and the form describe these uses.
Official sources and the blank
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Questions about Form 10-320
What does VA Form 10-320 cover?
VA's page says it is for out-of-pocket emergency prescription expenses from a pharmacy that's not in VA's network and out-of-pocket expenses for unauthorized emergency care at non-VA facilities.
What goes with a pharmacy claim?
Section B lists a valid receipt showing the amount paid, plus the medication name, dosage or strength, quantity dispensed, prescribing provider's name, date dispensed, and pharmacy name and location.
What goes with an emergency care claim?
A billing statement describing the charges and the dates of service, a receipt or statement showing the amount paid, a description of the illness or injury and, if applicable, the primary insurance Explanation of Benefits.
Does the claimant need to be a VA vendor?
The form says that to receive payment, all individuals and entities must be enrolled as a vendor with the VA, and points to VA's community care File a Claim page for how to become one.
Why does Section C ask about VA services?
Section C asks for a signed written explanation of why services were not obtained through the VA.
Where do I send VA Form 10-320?
The form does not print an address. It says where to submit it is available at http://www.va.gov/COMMUNITYCARE/programs/veterans/File-a-Claim.asp.