2025 Printable Template
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Form last updated: 03/2024. Please verify this is the current version before use.
Easily complete & submit your VA 10-10D form
Follow these simple steps to fill, sign, and send your VA 10-10D form online.
Fill out your form
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Sign the form
Add your electronic signature to the fillable VA 10-10D form to certify it came directly from you.
Send it to the requester
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What is a VA 10-10D used for?
VA Form 10-10D is used by eligible dependents of veterans to apply for healthcare coverage through the CHAMPVA program. This form helps determine eligibility for medical services and benefits under CHAMPVA.
Who needs to fill out a VA 10-10D form
Eligible dependents of veterans must complete this form to apply for CHAMPVA benefits.
How to fill out a VA 10-10D online?
Follow these steps to complete your VA 10-10D form online.
Frequently Asked Questions
Find quick answers to common questions about our PDF editor.
It is an application form for dependents of veterans to apply for CHAMPVA healthcare benefits.
Eligible dependents of veterans must complete this form to access CHAMPVA benefits.
It is not required if you are enrolled in Medicare, qualify for TRICARE, or are already receiving CHAMPVA benefits.
