About this form

Make payments for VHA Family Member Program Debts to include ChampVA and Spina Bifida, Overpayments, and Personal Injury Cases

If you were overpaid for medical claims by VAs Foreign Medical Program, Civilian Health and Medical Program of Veterans Affairs (CHAMPVA), Spina Bifida Health Care Benefits Program, Camp Lejeune Family Member Program, or Children of Women Vietnam Veterans Health Benefits Program, you must submit your refund to VA electronically using this form. It may also be used for payments relating to CHAMPVA personal injury cases. It should NOT be used for medical copays, deductibles, or donations.

Accepted Payment Methods:

• Bank account (ACH)
• Debit or credit card