1725 REQUEST INFO (5)    FEE BASIS LETTER (161.3)

Consideration of possible VA financial assistance is being given your
claim under the Veterans Millennium Health Care and Benefits Act, H.R.
2116.  However, before your claim can be reviewed it will be necessary
that we receive the following information:

If the formal claim(s) and/or additional evidence, statement(s), etc., as
for the costs incurred in obtaining the above information.
 
Sincerely,
   
  
  
  
Chief, Medical Administration Service
requested above, are not received within (30) days from the date of this
letter, your claim will be deemed abandoned and payment/reimbursement will
not be considered on the basis of such abandoned claim, or any future
claim for the same expenses.  If an extension is required to submit the
requested documentation, it will be necessary that you contact the VA
facility designated as the clinic of jurisdiction for your area.
 
The Department of Veterans Affairs will assume no financial responsibility