Get Va 10-10ez 2024-2025

The VA 10-10EZ form is essential for veterans seeking enrollment in the VA health care system. This guide provides a clear, step-by-step approach to help you effectively complete the form online and ensure your eligibility for medical benefits.

Follow the steps to fill out the VA 10-10EZ online.

1. Press the ‘Get Form’ button to download the VA 10-10EZ form and open it for editing.
2. Fill out Section I: General Information. Provide your name, preferred name, birth sex, and personal details such as social security number and contact information. Ensure the information is accurate to avoid delays.
3. Complete Section II: Military Service Information. Collect details regarding your military service, discharge type, and any awards received. This section verifies your eligibility based on your service.
4. Proceed to Section III: Insurance Information. List all health insurance providers, the policyholder's name, and relevant policy numbers. This is crucial for assessment of benefits.
5. Next, fill out Section IV: Dependent Information. Include details regarding your spouse and children who are dependents. Consider any applicable child support contributions.
6. In Section V: Employment Information, provide your employment status, company name, and contact details if applicable.
7. For eligible applicants, complete Section VI: Financial Disclosure. Only nonservice-connected veterans are required to disclose financial information for determining care eligibility.
8. Report any gross annual income in Section VII, specifying the income sources from you, your spouse, and dependent children.
9. In Section VIII, list previous calendar year deductible expenses. Include any non-reimbursed medical expenses relevant to your income assessment.
10. Sign and date the form in the Assignment of Benefits section. Ensure you or a delegated individual appropriately signs the form.
11. Attach any supporting documents or continuation sheets as needed before submitting your application.
12. Mail the completed application and any attachments to the Health Eligibility Center at the specified address.

Start completing your VA 10-10EZ form online today!