Official VA Form

VA Form 10-1170

Application for Furnishing Long-Term Care to Beneficiaries of Veteran Affairs

VA Form 10-1170 — Application for Furnishing Long-Term Care to Beneficiaries of Veteran Affairs is an official U.S. Department of Veterans Affairs form. The current version was last revised 2006-11-12. It is 1 page 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: 2006-11-12
First issued: 2022-04-12
Pages: 1
Administered by: VHA

Frequently asked questions

What is VA Form 10-1170 used for?

Application for Furnishing Long-Term Care to Beneficiaries of Veteran Affairs. It is an official VA form, administered by VHA.

Where can I download the current VA Form 10-1170?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/vha-10-1170-fill.pdf (last revised 2006-11-12).

How long is VA Form 10-1170?

VA Form 10-1170 is 1 page long, last revised 2006-11-12.

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.

Nearby form numbers

VA Form 10-10HS — Request for Hardship Determination

VA Form 10-10M — Medical Certificate

VA Form 10-10SH — State Home Program Application for Veteran Care Medical Certification

VA Form 10-1223 — Report of Subcommittee on Human Studies

VA Form 10-1245C — VA/Department of Defense Sharing Agreement

VA Form 10-1274A — Inquiry On Availability Of An Instrument From VA Research Equipment Quick Use In