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[Doc] Va Form 10-10, Application For Medical Benefits: What You Should Know
VA Forms 10-10EZ (VA Forms) 2. CHAM PVA 10-10d 3. CHAM PVA 10-10d, 10-40-e If you choose to file using the VA Forms 10-10EZ, “Application for Health Benefits, we ask that you complete those sections to the best of your skill and ability. As long as you do not get lost or have any questions about the process as described above, you do not have to answer those sections. Your answers to the questions regarding your own personal, economic, financial, housing, and other lifestyle are necessary when your information is provided for any of the other options. In the case of the CHAM PVA 10-10d, 10-40-e, and 10-10d,, those questions are: 1. Are there reasons why you will not be able to work for your employer? If so, how can we accommodate you? 2. If you do intend to be self-employed at some point, are there other jobs that you plan to take on? If so, when do you plan to start? 3. What do you expect to have to contribute in order for you to get this care? If you are an active duty veteran, please include the dates and a brief description of your service and where you will be living at the time of application. You may not need to answer this question. You may answer these questions about your health care for one year after you receive the medical care, so you must write your information on the form, not on a piece of paper and then give it to the person who provides the medical care or to your caregiver. If you need more time to complete the application, you can wait three months or until you have received the benefits for one year, whichever comes FIRST. Use your own handwriting and provide your answers verbatim. Do not sign your answers. Do not write “Yes” or “No,” just your name, address, and date. Make sure the answers are accurate. Do not forget to sign off on the page where you list the names of all friends, relatives, and employers who are not present at the time of application. To request VA Form 10-10EZ, see VA Forms Section #2.
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