Form VA Form 10-10d


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Get your Form VA Form 10-10d in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What is a 10-10D VA Form?

The application for CHAMPVA benefits VA Form 10-10D is a one-page blank that certain categories of veteran relatives can use to obtain health insurance. Depending on whether you have any other insurance coverage, you might also need to provide VA Form 10-7959C.

 VA Form 10-10d on PDFLiner

What do I need the printable VA Form 10-10D for?

  • Spouses or kids of disabled veterans use this form to obtain CHAMPVA health insurance benefits.
  • It can also be used by children or spouses of veterans who have already died for the same purposes.
  • If you ended your marriage to a disabled veteran, you cannot claim CHAMPVA benefits.
  • Also, you cannot claim these benefits if you already use DoD's TRICARE.

How to Fill Out VA Form 10-10D?

  1. Fill in sponsor (veteran) information: full name, SSN, VA file number, address, contact details, date of marriage, and date of death (if applicable).
  2. Now fill in your information: full name, SSN, address, date of birth, contact details, MEDICARE or other health insurance, and relationship to the veteran. There is room for three people on the form, but you can fill in more eligible relatives by attaching a sheet of paper to the main document.
  3. The filler or their official representative must put their signature. In the second case, you should also enter this person's personal data.

Who signs VA Form 10-10D?

In most cases, this document requires the signature of an applicant themselves, which can be spouses, kids, and stepchildren. However, if the applicant is unable to sign for any reason, an authorized representative can do it instead. This person must also indicate their name, contact details, exact address, and relationship to the applicant. Notarization or witness signatures are not required to submit the form to SSA.

 VA Form 10-10d on PDFLiner

Organizations that work with VA Form 10-10D fillable

  • Department of Veteran Affairs
Fillable online Form VA Form 10-10d
(4.6 / 5) 38 votes
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