Printable checklist: CHAMPVA application (VA Form 10-10d)
Educational information only, not medical, legal, or insurance advice. Confirm with CHAMPVA and your provider. Last verified against VA.gov: October 9, 2026 (VA page updated Aug 7, 2026). Changelog
Fill out
- VA Form 10-10d: Section I (veteran), Section II (each applicant), Section III (signature and date)
- VA Form 10-7959c for each applicant with Medicare or other insurance
Attach copies (as they apply)
- Front and back of each health insurance card, Medicare card, and Part D card
- Spouse: marriage certificate, civil union certificate, or common-law marriage affidavit (optional, speeds processing)
- Remarried surviving spouse whose remarriage ended: divorce decree, annulment decree, or death certificate
- Child: birth certificate (optional); adoption papers if adopted; proof of marriage for stepchildren
- Student 18–23: school certification letter
- Child disabled before 18: disability (“helpless child”) rating letter (optional)
- Age 65+ and not Medicare-eligible: Social Security notice of disallowance
Send
- Online at va.gov/forms/10-10d, or
- Mail: VHA Office of Integrated Veteran Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475, or
- Fax: 303-331-7809
- Keep copies and write down the date sent: ____________
Card arrives in up to 6 weeks after approval. Questions: 800-733-8387.