• Before You Begin
  • Complete Agency Form
  • Enter Payment Info
  • Review & Submit
  • Confirmation

About this form

Please use this form to pay your medical care and prescription copayments billed on your monthly statement (form 0246) for services provided by a VA medical center or clinic.



Notice: The VA account number and payment amount are required to complete this form. If you need to obtain your VA account number, payment amount or account balance, please contact the VA Billing Office at 866-400-1238.

Accepted Payment Methods:

  • Bank account (ACH)
  • Debit or credit card
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  • Contact:
    HRC Help Desk
    Phone:
    888-827-4817 Hrs:7a-7p CT