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Use VA Form 10-10EZ if you’re a Veteran and want to apply for VA health care. You must be enrolled in VA health care to get care at VA health facilities or to have us cover your care at a community care provider (an approved non-VA provider).
The information provided on this form will be used by VA to determine your eligibility for medical benefits and on average will take 30 minutes to complete. This includes the time it will take to read instructions, gather the necessary facts and fill out the form.
What is VA Form 10-10EZ used for? SERVICE-CONNECTED (SC): A VA determination that an illness or injury was incurred or aggravated in the line of duty, in the active military, naval or air service.
What is VA Form 10-10EZ used for? SERVICE-CONNECTED (SC): A VA determination that an illness or injury was incurred or aggravated in the line of duty, in the active military, naval or air service.
VA Form 10-10EZ. OMB Control No. 2900-0091 Estimated Burden Avg. 30 min. Expiration Date 12/31/2020. APPLICATION FOR HEALTH BENEFITS. SECTION I - GENERAL INFORMATION. Federal law provides criminal penalties, including a fine and/or imprisonment for up to 5 years, for concealing a material fact or making a materially false statement.
Fill out an Application for Health Benefits (VA Form 10-10EZ). Download VA Form 10-10EZ (PDF) You or someone acting as your power of attorney must sign and date the form.
If you need community nursing home care, domiciliary care, adult day health care, geriatric evaluation, or respite care, you may need to fill out an Application for Extended Care Services (VA Form 10-10EC). Find out how to apply for VA health care benefits as a Veteran or service member.
The VA Form 10-10EZ allows veterans to apply for enrollment in the VA health care system. The VA uses the information provided on the form to determine the veteran’s eligibility for medical benefits.
What is VA Form 10-10EZ used for? • SERVICE-CONNECTED (SC): A VA determination that an illness or injury was incurred or aggravated in the line of duty, in the active military, naval or air service. • COMPENSABLE: A VA determination that a service-connected disability is severe enough to warrant monetary compensation.
What is VA Form 10-10EZ used for? Ask VA to help you fill out the form by calling or visiting a VA health care facility. Before you call or go to the VA health care