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About VA Form 10-10CG

Form name: Application for Comprehensive Assistance for Family Caregivers Program
Related to: Family member benefits, Health care
Form revision date: April 2022

When to use this form

Use VA Form 10-10CG to apply for the Program of Comprehensive Assistance for Family Caregivers. Each time a new caregiver is appointed, a new VA Form 10-10CG is required.

Downloadable PDF

Online tool

You can apply online instead of filling out and sending us the paper form.

  • VA Form 10-10d

    Form name: Application for CHAMPVA Benefits

    If you’re the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs). 

  • VA Form 10-7959C

    Form name: CHAMPVA—Other Health Insurance (OHI) Certification

    Use VA Form 10-7959C or Formulario VA 10-7959c (español) when: 

    • You’re applying for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and have other health insurance to declare as part of your VA Form 10-10d application. 
    • Or you need to report changes in your other non-VA health insurance, such as new beneficiaries or coverage changes.

Helpful links related to VA Form 10-10CG

  • Find out if you may be eligible for the Program of Comprehensive Assistance for Family Caregivers. This program offers support and services for caregivers of eligible Veterans who have a serious injury caused or made worse by their active-duty service on or after September 11, 2001, and are in need of personal care services.

  • Find out if you qualify for health care through our CHAMPVA program, the Department of Defense's TRICARE program, or one of our programs related to a Veteran's service-connected disability.

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