Fillable Form VA 10-3542

What is Form VA 10-3542?

Form VA 10-3542, otherwise known as Veteran Beneficiary Claim for Reimbursement of Travel Expenses, is a form issued by the Department of Veterans Affairs. It allows eligible veterans of the United States army to be reimbursed for their travel expenses.

Can I fill out Form VA 10-3542?

If you are an eligible veteran or a duly noted representative of one and would like to be reimbursed for your travel expenses, then you can fill out this form.

If you are any of the following, then you are eligible to avail of travel reimbursement:

• Veterans rated by VA 30% or more service-connected for travel relating to any condition
• Veterans rated by VA less than 30% for travel relating to their service-connected condition
• Veterans receiving VA pension benefits for travel relating to any condition
• Veterans with annual income below the maximum applicable annual rate of pension for any condition
• Veterans who are unable to defray the cost of travel (as defined by current Beneficiary Travel regulations)
• Veterans traveling in relation to a Compensation and Pension (C&P) examination
• Certain Veterans in emergency situations
• Beneficiaries of other Federal Agencies when authorized by that agency
• Allied beneficiaries when authorized by appropriate foreign government agency
• Certain non-Veterans when related to care of a Veteran (Caregivers under National Caregivers Program, medically required attendants, VA transplant care donor and support person, or other claimants subject to current regulatory guidelines)

What do I need to fill out Form VA 10-3542?

As the claimant, you will be needing to provide your full legal name, your social security number (SSN), and your date of birth. You will also need to know your status as a claimant. Specifically, you need to know if you are a caregiver under the National Caregiver Program, an attendant who is medically authorized by the VA, a donor under the VA transplant care, the veteran himself or herself, or another unspecified type of claimant.

If you are not the veteran seeking reimbursement, you must place his or her full legal name on the space provided, as well as their social security number, and their date of birth.

You will also have to provide information regarding the trip(s) taken. Initially, you have to provide the address from where you have travelled from. This means you must indicate the street number, city, state, and corresponding ZIP code. You must also indicate the beginning date, followed by their mode of transportation (e.g. car, train, bus, or taxi)

If you are not claiming return travel reimbursement to the address given previously, then you must indicate the street, number, city, and ZIP code of the address of return travel. You must also indicate the ending date of the trip and the mode of transportation once again.

You will also need an itemized list of other expenses that do not fall under mileage,such as tolls, parking, lodging, and meals.

You will also need the treating facility name. If you would like to indicate the treating facility’s address, you are free to do so but it is not required for the purpose of filling out this form.

To finalize all of this information, you will need to affix your signature as the claimant, and indicate the date of signing.

How do I fill out Form VA 10-3542?

We will be guiding you through the process of filling out Form VA 10-3542 by giving you a step-by-step tutorial on how to complete this form.

Read through the form carefully and identify exactly what kind of information you would need to fill this form out. For your convenience, we have provided you with a list of information that you would need in the “What do I need to fill out Form VA 10-3542” section.

Before attempting to fill out this form, ensure that all information that you are about to place is completely accurate and truthful. This is a government-issued document and as such it should be treated with the utmost level of care and attention.

Section A. Traveler’s Information
This section of the form will ask for your information as the traveler to be reimbursed.

As the claimant, write down your full legal name in the last name, first name, then middle name format. Afterward, provide your social security number, then write down your date of birth in the MM/DD/YYYY format.

Next, indicate your status as the claimant by checking the appropriate box. Indicate whether you are the veteran in question, a caregiver under the National Caregiver Program, attendant who is medically authorized by the VA, a donor under VA Transplant Care, or other (please specify).

If you did not indicate that you are a veteran, you will be asked to input the full legal name of the veteran in the space provided, following the last name, first name, then middle name format once again. Following that, provide the veteran’s social security number and date of birth following the MM/DD/YYYY format.

Section B. Trip Information
This section of the form will ask you for information regarding the expenses of the trip that will be reimbursed.

First, write down the address from which you traveled. The specific details that you would be needing for this part are the street, city, state, and ZIP code. This is followed by the beginning date of the trip and the mode of transportation (e.g. car, train, bus, taxi, etc.)

You must then indicate whether you will be claiming return travel reimbursement to either the address previously listed or a separate address. Indicate whether you are returning to the previously mentioned address by checking the appropriate box. If you answered “No” then you must place the address which you returned to. You will be needing the same specific details in this part of the form that were previously asked of you, like the street, city, state, and ZIP code.

You will next be asked if you would like to claim reimbursement for any additional expenses, other than mileage such as tolls, parking, lodging, and meals. List down these expenses in the space(s) provided.

Finally for this section, you must write down the treating facility name and indicate whether it is a VA or non-VA location. You may also indicate the address of the treating facility, however this is entirely optional and not required for the purpose of filling out this form.

Certification
To verify that all the information that you have provided within this form is truthful, place your signature as the claimant and the date of signing in the MM/DD/YYYY format.

After you have completed everything thus far, congratulations, you have successfully completed Form VA 10-3542.