VA Form 1107 at a glance
What it is: Request for repairs, and/or accessories.
Where and when to file: Wrap the carton, attach the Denver Acquisition & Logistics Center postage-free label, and deposit it in U.S. Postal Service mail. Attach the Denver Acquisition & Logistics Center postage-free label to the package and deposit it in U.S. Postal Service mail.
A filled-in VA Form 1107 example: a repair request for a dead device
How to fill out VA Form 1107, box by box
Your information and the date mailed
Enter your last name, first name and middle initial, your date of birth (MM/DD/YYYY) and the last four digits of your Social Security number.
Enter the date mailed (MM/DD/YYYY).
Enter your home mailing address.
Device information
Under device information, enter the make and the model.
Under device information, enter the serial number(s).
Section I - Repairs, description of defects
In Section I, check the appropriate box(es) for the description of defects.
The boxes are dead, fades, intermittent, moisture damage, tele coil dead/weak, noisy, weak, distorted, excessive battery drain and feedback.
Section II - Accessories, items needed and remarks
In Section II, enter the item(s) needed.
Write any remarks in box 2 of Section II.
If your situation is different
When repairs are needed
Fill out completely all items in the top section and Section I (Repairs), and enclose the form in the carton along with the defective device.
Wrap the carton, attach the Denver Acquisition & Logistics Center postage-free label, and deposit it in U.S. Postal Service mail.
Send the complete device: transmitter, receiver, cords, tubing, etc.
When accessories are needed for this device
Fill out completely all items in the top section and Section II (Accessories). Indicate the item(s) needed: cords, tubing, wax guards, ear hooks, etc. Please indicate the length when ordering cords or straight tubing.
Place defective items (cords or tubing if necessary) in the package along with this card.
Attach the Denver Acquisition & Logistics Center postage-free label to the package and deposit it in U.S. Postal Service mail.
Sources
[1] VA Form 1107 (OCT 2006), Request for Repairs, and/or Accessories, U.S. Department of Veterans Affairs (the Official source link on this page).