Official VA Form

VA Form 10-10d

Application for CHAMPVA Benefits

VA Form 10-10d — Application for CHAMPVA Benefits is an official U.S. Department of Veterans Affairs form used for family member benefits, health care. The current version was last revised 2014-07-09. It is 3 pages long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2014-07-09
First issued: 2023-08-29
Pages: 3
Administered by: VHA

Family member benefitsHealth care

Frequently asked questions

What is VA Form 10-10d used for?

Application for CHAMPVA Benefits. It is an official VA form in the Family member benefits, Health care categories, administered by VHA.

Where can I download the current VA Form 10-10d?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/VA_Form_10-10d.pdf (last revised 2014-07-09).

How long is VA Form 10-10d?

VA Form 10-10d is 3 pages long, last revised 2014-07-09.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

You are not the first person to deal with this

BaseNeed is a members-only community for service members, veterans, spouses and their families. Nothing posted inside is public — not on Google, not on Facebook. That is the point: people talk about moves, money and paperwork there, and that only works behind a door.

Join free — 30 seconds →

No account needed for these: VA facilities · BAH calculator · Jobs · Housing

More Family member benefits forms

VA Form 10-3542 — Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
VA Form 10-7959C — CHAMPVA—Other Health Insurance (OHI) Certification
VA Form 21P-8768 — Disability Pension Award Attachment
VA Form 21P-10197 — Legal Summary—Dependency and Indemnity Compensation
VA Form 21P-0969 — Income and Asset Statement in Support of Claim for Pension or Parents' Dependency and Indemnity Compensation (DIC)
VA Form 21P-10195 — Legal Summary—Accrued Benefits
VA Form 21P-10198 — Legal Summary—Survivors Pension
VA Form 22-1990e — Application for Family Member to Use Transferred Benefits

Nearby form numbers

VA Form 10-10CG — Application for Comprehensive Assistance for Family Caregivers Program
VA Form 10-10CG(S) — Application for the Program of Comprehensive Assistance for Family Caregivers – Spanish
VA Form 10-10CG(T) — Application for the Program of Comprehensive Assistance for Family Caregivers – Tagalog
VA Form 10-10EC — Application for Extended Care Services
VA Form 10-10EZ — Instructions and Enrollment Application for Health Benefits
VA Form 10-10EZR — INSTRUCCIONES PARA COMPLETAR EL FORMULARIO DE ACTUALIZACIÓN DE LOS BENEFICIOS MÉDICOS