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About VA Form 10-10CG

Form name: Application for Comprehensive Assistance for Family Caregivers Program
Form revision date: April 2022
Related to: Family member benefits, Health care

When to use this form

Use VA Form 10-10CG to apply for the Program of Comprehensive Assistance for Family Caregivers. Each time a new caregiver is appointed, a new VA Form 10-10CG is required.

Downloadable PDF

Online tool

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

  • VA Form 10-10d

    Form name: Application for CHAMPVA Benefits

    If you’re the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).

  • VA Form 10-7959C

    Form name: CHAMPVA—Other Health Insurance (OHI) Certification

    Only use VA Form 10-7959C or Formulario VA 10-7959c (español) if one of these descriptions is true for you:

    • You’re applying for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and have other health insurance to declare as part of your VA Form 10-10d application, or
    • You’re already enrolled in CHAMPVA and need to report changes in your other non-VA health insurance, such as new beneficiaries or coverage changes. In this case, be sure to wait until you receive your enrollment packet in the mail before you submit this form.

    If you applied for CHAMPVA benefits by mail, download the PDF version of this form and send it to us by mail.

    If you applied for CHAMPVA benefits online, use our online tool to submit this form online.

Helpful links related to VA Form 10-10CG

  • Find out if you may be eligible for the Program of Comprehensive Assistance for Family Caregivers. This program offers support and services for caregivers of eligible Veterans who have a serious injury caused or made worse by their active-duty service on or after September 11, 2001, and are in need of personal care services.

  • Find out if you qualify for health care through our CHAMPVA program, the Department of Defense's TRICARE program, or one of our programs related to a Veteran's service-connected disability.

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