About this form

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

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

Payments for other VA Stations or programs will not be accepted.

If you were overpaid for medical claims by Civilian Health and Medical Program of Veterans Affairs (CHAMPVA), Spina Bifida Health Care Benefits Program or VA Foreign Medical 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. DO NOT  use for medical copays, deductibles, or donations.

Accepted Payment Methods:

• Bank account (ACH)
• Debit or credit card

With an account you can:

• See the payments you made since you created an account.
• Store payment information so you don't have to re-enter it.
• Copy a form you already submitted the next time you need to make a payment.

To take advantage of these benefits, you can Sign In . If you don't have an existing account, you will have the option to create an account on the sign-in page. To continue as a guest user, click the 'Continue to the Form' button.