About VA Form 10-10172
- Form name: Community Care Provider—Request for Service
- Related to: VHA
- Form last updated: April 2022
Downloadable PDF
Download VA Form 10-10172 (PDF)Helpful links
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Change your direct deposit information
Find out how to update your direct deposit information online for disability compensation, pension, or education benefits.
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Change your address
Find out how to change your address and other information in your VA.gov profile for disability compensation, claims and appeals, VA health care, and other benefits.
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Request your military records, including DD214
Submit an online request to get your DD214 or other military service records through the milConnect website.
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Get your VA records and documents online
Learn how to access your VA records, benefit letters, and documents online.