Family member details
Last name, first name, middle initial, Social Security number and email address.
10-10068c
Camp Lejeune Family Member Program Information Update Form (VA Form 10-10068c)
- Agency
- VA
- Revision
- September 2025
- Fillable fields
- 60
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-10068c: Camp Lejeune Family Member Program Information Update Form
VA Form 10-10068c is the U.S. Department of Veterans Affairs Camp Lejeune Family Member Program Information Update Form. VA's form page says that if you're enrolled in the Camp Lejeune Family Member Program, you use it to update your contact information or health care coverage. The form's own note says it is to be used for updating your address, phone and/or health care coverage.
The form is two pages. Page 1 holds the family member's name, Social Security number and contact details, then a Health Care Coverage Update section. Page 2 holds the certification and signature, a block for someone other than the applicant who signs, the fax number and mailing address of the VA Financial Services Center, and the burden and Privacy Act statements.
You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-10068c
Address and phone changes
Yes or no boxes for a change of address and a phone number change, the street address, city, state and zip code, whether it is permanent or temporary with from and to dates, email or regular mail for correspondence, and two phone numbers.
Previous coverage
Whether this updates previous health care coverage and whether that coverage has ended. If it has, the name of the prior coverage and of other coverage, each with effective and end dates.
Current coverage
Whether you have health care coverage, including through an employer, spouse, significant other or federal or state plan, with checkboxes and effective dates for Medicare Part A, B, Advantage and D, Medicaid/State Assistance, TRICARE and CHAMPVA.
Other insurance
Primary and secondary insurance names with effective dates and HMO or PPO, and whether the coverage provides pharmacy benefits.
Certification
Permission for personal information to be used by appropriate Federal Government agencies and contractors, a statement on false statements and fraud, and the signature and date.
How to file VA Form 10-10068c
- 1
Fill in your name and number
Enter the family member's name and Social Security number. The directions say to complete all fields that require updating.
- 2
Update contact details
Mark whether the address or phone number is changing, enter the new details, and note whether the address is permanent or temporary.
- 3
Update health care coverage
Answer the coverage questions, give dates for coverage that ended, and check each plan you have with its effective date.
- 4
Sign and date it
Sign and date the certification on page 2. A signer other than the applicant also fills in their own name, address and phone.
- 5
Fax or mail it
The form says it may be faxed to 512-460-5536 or mailed to the Financial Services Center in Austin, TX.
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Where to send it and getting help
By fax
512-460-5536.
By mail
Department of Veterans Affairs, Financial Services Center, PO Box 149200, Austin, TX 78714-9200.
Questions
The form lists the Customer Service Center at 1-866-372-1144.
Privacy
The Privacy Act notice cites 38 USC 1787 and says information, including the Social Security number, may be disclosed to the Department of Defense, contractors, trading partners, health care providers and other suppliers of health care services to determine eligibility and payment.
Edition
The footer reads VA FORM SEP 2025 10-10068c. It carries OMB Control No. 2900-0822, which expires 09/30/2028, with an estimated burden of 15 minutes.
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Who uses VA Form 10-10068c?
VA's page and the form's directions describe who fills it in.
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Questions about Form 10-10068c
What can I update with VA Form 10-10068c?
The form says it is to be used for updating your address, phone and/or health care coverage. VA's page describes it as the form enrolled members use to update contact information or health care coverage.
Do I fill in every field?
The directions say to complete all fields that require updating.
Can a representative fill it out?
The directions are addressed to the Camp Lejeune Family Member, representative or POA. If someone other than the applicant signs, the form asks for that person's name, mailing address and telephone number.
Which health care coverage does the form ask about?
Medicare Part A, Part B, Medicare Advantage and Part D, Medicaid/State Assistance, TRICARE and CHAMPVA, plus primary and secondary insurance and whether the coverage includes pharmacy benefits.
Where do I send VA Form 10-10068c?
The form says it may be faxed to 512-460-5536 or mailed to Department of Veterans Affairs, Financial Services Center, PO Box 149200, Austin, TX 78714-9200.
Is this the form to apply to the program?
No. This form updates details for enrolled members. VA's forms list names VA Form 10-10068 as the Camp Lejeune Family Member Program Application.