CHAMPVA forms in one place
Educational information only, not medical, legal, or insurance advice. Confirm with CHAMPVA and your provider. Last checked against VA sources: October 9, 2026.
Always get forms from VA. Don’t use copies from other sites, which may be out of date. We link only to VA.gov. Links checked: October 9, 2026.
| Form | When to use it | Official links |
|---|---|---|
| 10-10d: Application for CHAMPVA Benefits | To apply for CHAMPVA for yourself or a family member | Form page / apply online · PDF |
| 10-7959c: Other Health Insurance Certification | When you apply and have other insurance or Medicare, or whenever your other insurance changes | Form page · PDF |
| 10-7959a: CHAMPVA Claim Form | When you paid a provider or pharmacy yourself and want to be paid back (within 1 year) | Form page / file online · PDF |
| 10-7959d: CHAMPVA Potential Liability Claim | When CHAMPVA asks about an injury or possible work-related illness (for example, a car accident), to sort out whether another party should pay | Form page · PDF |
| 10-0998: Your Rights to Seek Further Review | Read it when you disagree with a decision. It explains your review options and deadlines | Form page · PDF |
| 20-0996: Higher-Level Review | To ask a senior reviewer to look at the same evidence again | Form page |
| 10182: Board Appeal (Notice of Disagreement) | To have a Veterans Law Judge review the decision | Form page · PDF |
| Supplemental Claim | When you have new and relevant evidence. Your decision letter names the form and where to send it | VA decision reviews |
| 21-4142: Authorization to Disclose Information | If you want VA to request records from a provider for a Supplemental Claim | Form page |
Not a form, but useful: Meds by Mail, direct deposit and claim info, and after you apply.
AskCHAMPVA does not fill out or file forms for anyone. For free help, contact an accredited VSO.