Instructions
Notes on using the form, payment based on the exchange rate on the date service was rendered, other health insurance, translation, the timely filing requirement and direct deposit.
10-7959f-2
Foreign Medical Program (FMP) Claim Cover Sheet (VA Form 10-7959f-2)
- Agency
- VA
- Revision
- August 2025
- Fillable fields
- 15
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-7959f-2: Foreign Medical Program (FMP) Claim Cover Sheet
VA Form 10-7959f-2 is the U.S. Department of Veterans Affairs Foreign Medical Program (FMP) Claim Cover Sheet. VA's form page says that if you get medical care outside the U.S. for a service-connected condition, VA Form 10-7959f-2 is used to file a claim for reimbursement with the FMP. The form says to attach itemized invoices or receipts.
Page 1 holds the instructions and three sections: Veteran information, the diagnosis or nature of the illness or injury, and the claimant certification. Page 2 holds the Privacy Act and burden statements. VA's page says you can file a claim online instead of filling out and sending the paper form.
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 10-7959f-2
Section I: Veteran information
Name, Social Security number, VA claim file number, date of birth, physical address (residence) and mailing address with country, telephone number and email address.
Section II: Diagnosis and billing details
The itemized billing statement includes the provider's full name and medical title, office address, phone and billing address, and a description of each service or drug, its billed charge and the dates of service.
Section III: Claimant certification
The Veteran's signature and date, both marked required, a certification that the information represents actual services, dates and fees charged, and the choice of payee.
Page 2 notices
The Privacy Act statement under Title 38, U.S.C. 1724 and the burden statement, with an average of 11 minutes per respondent.
How to file VA Form 10-7959f-2
- 1
Collect the itemized bills
The form says all claim forms are accompanied by the provider's itemized billing statement with the information listed in Section II.
- 2
Fill in Section I
Print the Veteran's identification and contact details, including the residence and mailing addresses and their countries.
- 3
Attach proof of payment
The form says to attach a receipt of payment for each itemized billing statement to process reimbursement.
- 4
Sign and choose the payee
Sign and date Section III, which the form marks as required, and check whether payment goes to the Veteran or the provider.
- 5
Send it or file online
The form's header lists the FMP mailing address, fax number and email address. VA's page says the claim can also be filed online.
Why fill Form 10-7959f-2 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 and getting help
Mailing address
Foreign Medical Program (FMP), PO Box 200, Spring City, PA 19475.
Phone, fax and email
Telephone number: 1-833-930-0816. Fax number: 1-303-331-7803. Email: [email protected].
Online
VA's form page says you can file a claim online instead of filling out and sending the paper form.
Filing window
The form says: "Claims must be received no later than two years from the date of service, or in case of inpatient care, within two years from the date of discharge."
Edition
The current edition is dated AUG 2025. It carries OMB Control Number 2900-0648, which expires 03/31/2027.
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Who uses VA Form 10-7959f-2?
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Questions about Form 10-7959f-2
What is VA Form 10-7959f-2 used for?
VA's form page says that if you get medical care outside the U.S. for a service-connected condition, VA Form 10-7959f-2 is used to file a claim for reimbursement with the Foreign Medical Program.
Can I file an FMP claim online?
Yes. VA's form page says you can file a claim online instead of filling out and sending the paper form.
Is there a filing deadline?
The form says claims must be received no later than two years from the date of service, or in case of inpatient care, within two years from the date of discharge.
Do my bills need to be in English?
The form's instructions say: "We will translate your claim."
Which exchange rate is used?
The form says payment is based on the exchange rate on the date service was rendered.
What if I have other health insurance?
The form says to attach the Explanation of Benefits from the other health insurance company and an itemized billing statement, and that dates of service and provider charges on the EOB must match the billing statements.
Can FMP pay me by direct deposit?
The form says Veterans with U.S. bank accounts on file with VA for benefit payments can now receive their FMP reimbursements by direct deposit, managed through VA.gov.