Instructions and definitions
Pages 1 and 2 explain what the form is used for, where to get help, terms such as Eligible Veteran, Family Caregiver and Representative, how to submit and what happens next.
10-10CG
Application for Comprehensive Assistance for Family Caregivers Program
- Agency
- VA
- Revision
- February 2025
- Fillable fields
- 87
- Pages
- 6
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-10CG: Application for Comprehensive Assistance for Family Caregivers Program
VA Form 10-10CG is the U.S. Department of Veterans Affairs application for the Program of Comprehensive Assistance for Family Caregivers (PCAFC). The form says VA will use the information on it to assist in determining eligibility. VA's form page says each time a new caregiver is appointed, a new VA Form 10-10CG is required.
The PDF has six pages: two pages of instructions with definitions, then Section I for the Veteran, Section II for one Primary Family Caregiver applicant and Section III, on two pages, for up to two Secondary Family Caregiver applicants. Each applicant signs and dates their own section. The form estimates 15 minutes to complete.
VA's page says you can apply online instead of filling out and sending the paper form. 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 10-10CG
Section I: Veteran
Name, Social Security or Tax Identification Number, date of birth, sex, current street address (not a PO Box), county, phone numbers, email and the VA medical center or clinic for health care.
Veteran certification
The Veteran certifies that the people named are involved in their care and consents to sharing information needed for that involvement, then signs Item 17 and dates Item 18.
Section II: Primary Family Caregiver
The applicant's details, a mailing address if different, and relationship to the Veteran, then certifications that include being at least 18 and agreeing to perform personal care services, and a signature in Item 22.
Section III: Secondary Family Caregivers
The same fields and certifications as Section II, on page 5 and again on page 6 for a second Secondary Family Caregiver applicant.
Burden and Privacy Act notices
Page 2 gives OMB Control No. 2900-0768, an average burden of 15 minutes and the Privacy Act information, including the CARMA record system.
How to apply with VA Form 10-10CG
- 1
Read the instructions
The form asks you to read the Paperwork Reduction Act and Privacy Act information on page 2 before submitting.
- 2
Fill in Section I for the Veteran
Use the Veteran's legal name and the street address where the Veteran resides, not a PO Box.
- 3
Add the caregiver sections that apply
The form says to complete Sections I and II when appointing only a Primary Family Caregiver, and Sections I and III when appointing only Secondary Family Caregivers.
- 4
Complete every starred field
Fields marked with an asterisk (*) are required, including signatures and dates for each applicant. The form says missing information may result in a delay or denial of PCAFC benefits.
- 5
Attach supporting papers
Include documentation of a Representative's authority if one signs. The form says a Veteran not enrolled in VA health care can submit VA Form 10-10EZ with it, and an enrolled Veteran may submit VA Form 10-10EZR.
- 6
Mail, hand carry or apply online
Mail it to the 10-10CG Evidence Intake Center, mail or hand carry it to your Facility CSP Staff, or apply online on VA.gov.
Why fill Form 10-10CG 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 to send it and getting help
Mailing address
10-10CG Evidence Intake Center, PO Box 5154, Janesville, WI 53547-5154.
In person
The form says you may also mail or hand carry it to your Facility CSP Staff for processing, found through the Caregiver Support Line or the Find Your Caregiver Support Team feature at caregiver.va.gov.
Online application
VA's form page says you can apply online instead of filling out and sending the paper form. The form calls applying online the fastest way to submit.
Help with the form
The instructions list the Caregiver Support Line at 1-855-260-3274, the Contact Us option at va.gov, the Caregiver Support Team at your nearest VA health care facility and a Veterans Service Organization.
What happens next
The form says a member of the Facility CSP Staff will contact you to review the application and discuss next steps.
Edition
The current edition is dated FEB 2025. It carries OMB Control No. 2900-0768, which expires 01/31/2027.
Related forms
10-10d
Application for CHAMPVA Benefits (VA Form 10-10d)
73 fields, 3 pages
10-7959C
CHAMPVA Other Health Insurance (OHI) Certification (VA Form 10-7959c)
51 fields, 2 pages
10-10EZ
Instructions and Enrollment Application for Health Benefits
122 fields, 6 pages
10-10EZR
Health Benefits Update Form
99 fields, 5 pages
21-22
Appointment of Veterans Service Organization as Claimant’s Representative
63 fields, 4 pages
21-0972
Alternate Signer Certification (VA Form 21-0972)
49 fields, 3 pages
Who uses VA Form 10-10CG?
The form's instructions describe who fills in and signs each section.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form 10-10CG
Can I apply for the family caregiver program online?
Yes. VA's form page says you can apply online instead of filling out and sending the paper form, and the form calls online the fastest way to submit.
How many caregivers can be named on one application?
The form says a Veteran may appoint one Primary Family Caregiver applicant and up to two Secondary Family Caregiver applicants.
Which sections does each person complete?
The Veteran completes Section I, the Primary Family Caregiver applicant Section II and each Secondary Family Caregiver applicant Section III. Each signs and dates their own section.
Can someone sign for the Veteran or a caregiver?
The form says a Representative may sign on behalf of a Veteran or Family Caregiver applicant, with supporting documentation of the Representative's authority.
Does a caregiver switching roles need a new form?
Yes. The form says a new 10-10CG is required each time a new Primary or Secondary Family Caregiver is requested, including an approved caregiver moving between the two roles.
Where do I mail VA Form 10-10CG?
The form lists 10-10CG Evidence Intake Center, PO Box 5154, Janesville, WI 53547-5154.
Does the program cover people living outside the United States?
The form says VA does not provide the program to individuals residing outside the 50 states, the District of Columbia, and the U.S. Territories.