Feb 19, 2025 · 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).

INSTRUCTIONS FOR COMPLETING ENROLLMENT APPLICATION FOR HEALTH BENEFITS Please Read Before You Start . . . What is VA Form 10-10EZ used for? For Veterans to apply for enrollment in the VA health care system.

Jul 11, 2024 · 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).

Veterans may complete or download the 10-10EZ form at the VA health eligibility website at https://www.1010ez.med.va.gov/sec/vha/1010ez. Veterans may also contact VA at 1 (877) 222-8387 (VETS) or visit the VA health eligibility website at www.va.gov/healtheligibility.

Make sure you sign and date VA Form 10-10EZ in Section XII. You or an individual to whom you have delegated your Power of Attorney must sign and date the form.

10-10EZ OMB Approved No. 2900-0091 Estimated Burden Avg. 30 min. ... VA FORM MAR 2015 10-10EZ PREVIOUS EDITIONS OF THIS FORM ARE NOT TO BE USED PAGE 1

The VA Form 10-10EZ is the form used to apply for health benefits at VA medical facilities. Submission of this application will provide us with the information we need to begin the enrollment process for you.

Nov 4, 2022 · 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 …

Feb 29, 2024 · If you provide VA your Social Security Number, VA will use it to administer your VA benefits. VA may also use this information to identify Veterans and persons claiming or receiving VA benefits and their records, and for other purposes authorized or required by law. VA FORM 10-10EZ, JUL 2022 HEC PAGE 3 OF 6 fOMB Control No. 2900-0091

SECTION VIII - CONSENT TO COPAYS AND TO RECEIVE COMMUNICATIONS By submitting this application, you are agreeing to pay the applicable VA copayments for care or services (including urgent care) as required by law. You also agree to receive communications from VA to your supplied email, home phone number, or mobile number. However, providing your email, …