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Learn what the PACT Act means for your VA benefits

About VA Form 10-10CG

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

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

Download VA Form 10-10CG (PDF)

Online tool

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

Go to the online tool

  • 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). 

    Download VA Form 10-10d (PDF)

  • VA Form 10-7959C

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

    Use VA Form 10-7959C or Formulario VA 10-7959c (español) when: 

    • 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 need to report changes in your other non-VA health insurance, such as new beneficiaries or coverage changes.
    Download VA Form 10-7959C (PDF)

Helpful links related to VA Form 10-10CG

  • Comprehensive family caregiver assistance eligibility information

    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.

  • CHAMPVA benefits eligibility information

    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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