VA Form 10-10d Printable, Fillable in PDF

VA Form 10-10d Printable, Fillable in PDF – Application for CHAMPVA Benefits (VA Form 10-10d), is a health benefits application form that can be used to apply for a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of some health care services and supplies with eligible veterans under certain circumstances.

VA Form 10-10d Printable, Fillable in PDF

DD Form 10-10D was replaced by the most recent version of the application, which was launched on July 1, 2014. All prior versions of the application were rendered outdated as a result of the replacement. A fillable version of the most recent VA Form 10-10d is available for download below and may also be obtained on the VA website.

In order to be eligible for benefits under the Civilian Health and Medical Program of the Veterans Health Administration (CHAMPVA), individuals must fall into one of three categories:

  • The spouse or child of a veteran who has been determined by a VA regional office to have a permanent and complete service-connected ailment or disability; and
  • An individual who has died as a consequence of a VA-rated service-connected condition, or who was at the time of death rated permanently and completely disabled from a service-connected condition; or an individual who has been rated permanently and totally disabled from a service-connected condition.
  • The surviving spouse or child of a person who died in the course of duty and not as a result of his or her own misbehavior

Instructions For VA Form 10-10d

The form is sent without any instructions on how to fill it out correctly. Instructions for each stage are provided below.

The VA Form 10-10d: What to Fill Out and When

Sections 1 through 3 of the CHAMPVA Form 10-10d are:

  • The first section contains information on the sponsoring company. A sponsor is a veteran on the basis of whom the applicant’s CHAMPVA eligibility is determined. It is necessary to provide the veteran’s complete name, social security number, Veterans Affairs file number, postal address with ZIP code, telephone number, and, if relevant, the veteran’s date of birth, date of marriage, and date of death. If the veteran is dead, the application must say whether or not they died while serving in the military. If the veteran died while on active duty, the applicant must state this as well.
  • A detailed profile of the candidate is required in Section 2. There are many pieces of information they must provide: their complete name, social security number, postal address (with ZIP code), telephone number, date of birth, and relationship to the veteran The applicant must state whether or not they are registered in Medicare, as well as whether or not they have additional health insurance policies in place. Completion of VA Form 10-7959c, as well as the attachment of a Medicare Card to the VA Form 10-10d, are required for positive responses.
  • Certificates are obtained under Section 3. School verification of full-time attendance from a college, vocational school, or high school must be filed in order to extend CHAMPVA benefits to students between the ages of 18 and 23. This includes the student’s complete name, telephone number, relationship to the applicant, and address information, which includes the street address, city, state, and zip code of the application.

VA Form 10-10d Printable, Fillable in PDF

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