Skip to Content

Application for CHAMPVA benefits

Form name:Application for CHAMPVA Benefits (VA Form 10-10d)
Form revision date: April 2025
Related to: Family member and caregiver benefits, Health care

When to use this form

If you’re the spouse, dependent, or survivor of a Veteran who meets certain requirements, use VA Form 10-10d to apply for healthcare benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).

Downloadable PDF

Online tool

You can apply online instead of filling out and sending us the paper form.

Helpful links related to VA Form 10-10d

  • Learn how eligible spouses and children of Veterans can get healthcare benefits through CHAMPVA.

  • Find out about VA benefits for spouses, dependents, survivors, and family caregivers.

  • Use this form if you recently applied for CHAMPVA benefits and we asked for your other non-VA health insurance information. Or if you’re currently enrolled in CHAMPVA and need to report changes to your other non-VA health insurance information.

Last updated: