Official VA Form

VA Form 10-7959C

CHAMPVA—Other Health Insurance (OHI) Certification

VA Form 10-7959C — CHAMPVA—Other Health Insurance (OHI) Certification is an official U.S. Department of Veterans Affairs form used for family member benefits, health care. The current version was last revised 2013-08-20. It is 2 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: 2013-08-20
First issued: 2022-10-20
Pages: 2
Administered by: VHA

Family member benefitsHealth care

Frequently asked questions

What is VA Form 10-7959C used for?

CHAMPVA—Other Health Insurance (OHI) Certification. 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 10-7959C?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/VA-10-7959c-fill.pdf (last revised 2013-08-20).

How long is VA Form 10-7959C?

VA Form 10-7959C is 2 pages long, last revised 2013-08-20.

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

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Nearby form numbers

VA Form 10-7396b — Complications of Surgical Procedures - Continuation Sheet
VA Form 10-7919 — Request For Library Materials
VA Form 10-7959A — CHAMPVA Claim Form
VA Form 10-7959D — CHAMPVA Potential Liability Claim
VA Form 10-7959E — Claim for Miscellaneous Expenses
VA Form 10-7959f-1 — Foreign Medical Program (FMP) Registration Form