PLEASE DO NOT MAKE PAYMENTS ON THIS WEB SITE IF:
YOU ARE PAYING A VA MEDICAL CO-PAYMENT. DMC does not collect nor have information concerning medical billing statements. If you wish to make a VA medical co-payment click here. If you need help completing the co-payment form call 866-400-1238.
YOU HAVE RECEIVED A COLLECTION LETTER FROM THE DEPARTMENT OF THE TREASURY GIVING YOU 10 DAYS TO MAKE PAYMENT TO AVOID FURTHER COLLECTION ACTION. If Treasury has sent you this letter, making a payment on this Web site will only delay application of the payment and will not preclude Treasury from adding fees to the amount you owe. Questions regarding Treasury collection should be directed to the telephone number on the Treasury collection letter.
YOU HAVE RECEIVED COLLECTION LETTERS OR PHONE CALLS FROM A PRIVATE COLLECTION AGENCY OR LAW FIRM. This means the Department of the Treasury has referred your account for private collection. Making payments on this Web site will delay application of those payments to your account and will not preclude fees charged by the collection agencies or law firms.
ARE YOU CURRENTLY DRAWING VA BENEFITS AND PAYING THE BALANCE OF YOUR DEBT?
If you are currently drawing VA benefits, it is possible that your debt has been offset from your next benefit check. To avoid overpaying your debt, you should contact the Debt Management Center at 800 827-0648 to confirm your balance before making a payment. If you make a payment and your debt balance is already cleared through offset, it can take up to 60 days to refund your payment. So please call before you make your payment. If you have difficulty getting through to DMC, we ask for your patience. We have added more telephone lines and operators and are making every effort to improve service.
|HELP WITH THIS FORM:|
|File Number||'File Number' is your VA claim number. This field must be 8 or 9 characters long.|
|Payee Number||'Payee Number' tells us whether the debtor is a veteran or service member, a child, a spouse, a vendee or parent of the veteran.|
|Person Entitled||'Person Entitled' is the first initial, middle initial (if there is one) and first four letters of the debtor's last name. If the entry on the collection letter after 'Person Entitled' does not have a middle initial, a blank will appear where the middle initial would be. Please leave the same space blank on this form.|
|Deduction Code||'Deduction code' is a number that tells us what type of benefit the debtor received when the debt was established.|
|First Name||Enter the first name of the person whose credit card, debit card or bank account will be used to send us a payment.|
|Last Name||Enter the last name of the person whose credit card, debit card or bank account will be used to send us a payment.|
|Daytime Phone||Enter the daytime telephone number of the person whose credit card, debit card or bank account will be used to send us a payment. We will call if a problem is encountered with the payment.|
|Payment Amount||Enter payment amounts in currency format.|
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|If you have questions, please call the VA Debt Management Center at 1-800-827-0648 between 7:30 am and 6:00 pm Central time.|
|YOUR PRIVACY IS IMPORTANT TO US. PLEASE READ THE FOLLOWING:|
Privacy Act Information: The information you furnish on this form, including your Social Security Number, is used to associate your payment with your accounts receivable record so that we may properly credit your account. Disclosure is voluntary. However, without disclosure, a credit card transaction or direct debit transaction cannot be processed. The responses you submit are confidential and protected from unauthorized disclosure by 38 U.S.C. 5701. The information may be disclosed outside the Department of Veterans Affairs (VA) only when authorized by the Privacy Act of 1974, as amended. The routine uses for which VA may disclose the information can be found in VA systems of records, including 58VA21/22, Compensation, Pension, Education and Rehabilitation Records-VA, and 88VA244, Accounts Receivable Records-VA. VA systems of records and alterations to the systems are published in the Federal Register. Any information provided by you, including your Social Security Number, may be used in computer matching programs conducted in connection with any proceeding for the collection of an amount owed by virtue of your participation in any benefit program administered by VA.
|Estimated Burden:||10 minutes|
Respondent Burden: VA may not conduct or sponsor and respondent is not required to respond to this collection of information unless it displays a valid OMB control number.
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
If you have comments regarding this burden estimate or any other aspect of this collection of information, contact:U.S. Department of Veterans Affairs
Debt Management Center
P.O. Box 11930
Ft. Snelling, MN 55111
1-800-827-0648 (Toll Free)
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