About VA Form 10-323
- Form name: Veteran Repayment Plan (RPP) Agreement
- Form revision date: November 2022
- Related to: Health care
When to use this form
Use this form to set up a monthly repayment plan for VA health care copay bills.
Mail your completed form to your VA Consolidated Patient Account Center (CPAC). Don’t mail it to the VA facility where you receive care.
Downloadable PDF
Helpful links
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Find out how to update your direct deposit information online for disability compensation, pension, or education benefits.
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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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Submit an online request to get your DD214 or other military service records through the milConnect website.
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Learn how to access your VA records, benefit letters, and documents online.