VA Form 10-10EZ

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Get your VA 10-10EZ in 3 easy steps

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

What is VA Form 10-10EZ?

VA form 10-10EZ is also known as Application for Health Benefits. It is released by the Department of Veterans Affairs and can be used only by veterans. Without the documents that confirm that you are a veteran, you can’t apply for health care of this type. Before you use this form, you need to enroll in a VA program for health care.

Registration must be made in the nearby health facility of your choice that supports the program. The department will cover all the expenses for your procedures. Many veterans still don’t know what is VA form 10-10EZ used for and pay for their health care themselves. However, the template fixes the situation.

To receive free medical treatment as a veteran you need to fill the template with the data asked by the Department to prove that you are eligible to use benefits. The form is not big and does not take a long time to fill out. If you need assistance with it, you can contact the Veterans Service Organization.

VA Form 10-10EZ on PDFLiner

What I need the VA Form 10-10EZ for?

  • Veterans need to learn how to fill out VA form 10-10EZ to receive free health care benefits and appropriate treatment. To use the form, there must be proof of veteran’s status and eligibility to use the benefits;
  • Department of Veterans Affairs also requires the document to keep the record of each veteran that uses the health care program;
  • This document is required by the medical establishment that works with veterans to be able to provide free of charge services and receive compensation from the government. Without VA 10-10EZ form, veterans can’t use all the health care advantages provided for veterans.

How to Fill Out VA Form 10-10EZ?

If you want to find VA 10 10EZ form you have to visit the Department of Veterans Affairs official website. There you will be able to read its description and even open a PDF and read the basic requirements. However, you will not be able to fill it online once you open it.

To do this, you need a PDF editor like PDFLiner that offers a wide range of tools to complete empty sections and even create your personal electronic signature. After you complete the document, you can save it on your device, send it to the department by email, or print it and send it by regular mail. Here is what you need to include in VA form 10-10EZ online:

  1. Decide which type of benefit you apply for and put the tick in the appropriate box;
  2. Provide the name, maiden name of the mother, gender, race, social security number, and date of birth. Identify your religion, address, phone number, and marital status;
  3. Provide information on the military service, including the name of the last branch, entry date, discharge date, and the number of military service. Answer a few questions in the table;
  4. Provide insurance information;
  5. Put the data about the dependent if you have any. If you have more than one you need to use extra sheets for each of them;
  6. Provide information on your employment;
  7. Share the data on the last calendar year's gross income and deductible expenses;
  8. Sign the document and put the current date.

VA Form 10-10EZ on PDFLiner

Organizations that work with VA Form 10-10EZ

  • Department of Veterans Affairs of the United States of America.

Where to submit VA form 10-10EZ?

Once you fill in all the sections that are required in the form, you have to send it. It is better to print the document and send it to the Health Eligibility Center. However, if you can’t do it, you need to contact the Veterans Center and ask for details. You can do it online or by phone. You still have to wait till the response will be returned from the Department.

Form Versions

2021 Fillable VA 10-10EZ (2021) Fill Out Form
Fillable online VA 10-10EZ
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