Opening statement
The paragraph at the top explains what the designation does, that a VA employee can be named only if a family member, that it can be changed or revoked in writing and that it is only a delivery of possession.
10-10118
Designee for Patient Personal Property
- Agency
- VA
- Revision
- November 2014
- Fillable fields
- 16
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-10118: Designee for Patient Personal Property
VA Form 10-10118 is the U.S. Department of Veterans Affairs Designee for Patient Personal Property. The form says it is an official document where you can designate an individual to whom VA will deliver your personal funds and effects in the event of your death in a VA medical facility.
The form also says the designee may not be a VA employee unless that employee is a member of your family, and that you may change or revoke the designation in writing at any time. It says delivery to the designee is only a delivery of possession, and does not affect the title to the funds or effects or the person legally entitled to own them.
The form is one page with three parts: patient information, designee information and the patient's signature. 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 10-10118
Part I: Patient information
Items 1 to 7: name, last 4 of the Social Security number, street address, city, state and ZIP, and home, work and mobile phone numbers with area code.
Part II: Designee information
Items 8 to 14: the designee's name, a date of admission, the designee's street address, city, state and ZIP, and home, work and mobile phone numbers with area code.
Part III: Patient signature
By signing, the patient designates the person listed as a recipient of the patient's personal effects. There is a signature line and a date.
Privacy Act and Paperwork Reduction Act notice
It says filling out the form is a choice, that not filling it out has no effect on the benefits you are entitled to receive, and that it takes about 3 minutes. OMB Control No. 2900-0817.
How to fill out VA Form 10-10118
- 1
Read the opening statement
It explains who can be named and what delivery to the designee does and does not change.
- 2
Fill in Part I
Enter your name, the last 4 of your Social Security number, your address and your phone numbers.
- 3
Name your designee in Part II
Enter the designee's name, the date of admission and the designee's address and phone numbers.
- 4
Sign and date Part III
Your signature designates the person listed as a recipient of your personal effects.
- 5
Update it in writing if needed
The form says you may change or revoke the designation in writing at any time.
Why fill Form 10-10118 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what it changes
Where to send it
The form and VA's page do not print a mailing address or a submission method. VA's page offers the form as a downloadable PDF.
Changing or revoking it
The form says you may change or revoke the designation in writing at any time.
Is it optional?
The Privacy Act notice says you may choose to fill out this form or not, and that if you don't, there won't be any effect on the benefits you are entitled to receive.
Edition
The PDF footer reads VA FORM NOV 2014 10-10118, matching the November 2014 revision date on VA's page. The form prints OMB Approval Number 2900-0817 and an OMB EXP Date of 11/30/2017.
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Who uses VA Form 10-10118?
The form describes who fills it in and what the designation does.
Official sources and the blank
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Questions about Form 10-10118
What is VA Form 10-10118 used for?
The form says it is an official document where you can designate an individual to whom VA will deliver your personal funds and effects in the event of your death in a VA medical facility.
Can a VA employee be my designee?
The form says the designee may not be a VA employee unless such employee is a member of your family.
Does naming a designee change who owns my property?
The form says delivery to the designee is only a delivery of possession and does not affect the title to the funds or effects, or the person legally entitled to ownership of them.
Can I change my designee later?
Yes. The form says you may change or revoke the designation in writing at any time.
Is filling out VA Form 10-10118 required?
The Privacy Act notice says you may choose to fill out this form or not. It says that without this information VA may not understand your preferences, and that not filling it out has no effect on the benefits you are entitled to receive.