Veteran/debtor information
Name and account number completed by VA, then the Veteran's address, city, state, ZIP, telephone number and best time to call.
10-323
Veteran Repayment Plan (RPP) Agreement
- Agency
- VA
- Revision
- November 2022
- Fillable fields
- 23
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-323: Veteran Repayment Plan (RPP) Agreement
VA Form 10-323 is the U.S. Department of Veterans Affairs Veteran Repayment Plan (RPP) Agreement. VA's form page says to use it to set up a monthly repayment plan for VA health care copay bills. It is an installment agreement with the Veterans Health Administration (VHA) that states a debt amount, a monthly payment and a number of monthly payments.
The form is two pages. Page 1 holds the Veteran/debtor information, six numbered terms, the signature and a For VHA Use Only box. Page 2 has instructions and considerations. The form marks the name and account number as completed by VA, and the address and telephone details as completed by the Veteran. VA's page says to mail the completed form to your VA Consolidated Patient Account Center (CPAC), not to the VA facility where you receive care. 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 10-323
Term 1: the debt and installments
An acknowledgment of the debt to VHA, including principal, interest and other costs as of a date, the monthly payment amount and the number of monthly payments.
Terms 2 and 3: new charges
How charges for services received after the plan starts are handled, and a checkbox to add new charges to the plan. The form says VHA will contact you to restructure the agreement if new terms extend the plan beyond 36 months.
Terms 4 to 6: missed payments and due date
Contacting the Health Resource Center when a payment can't be made or to end the agreement, and a monthly due date of the 28th day of each month after written notice that the plan is set up.
Signature and VHA use box
The signature and date showing agreement with the payment amount, term and requirements, then the For VHA Use Only approval box.
Page 2: instructions and considerations
Six instructions for completing and mailing the form, and considerations such as the minimum installment, the 36 month term and how to raise the installment amount.
How to complete VA Form 10-323
- 1
Read the whole form
The first instruction on page 2 says to read the form in its entirety.
- 2
Add your contact details
Provide your address, telephone number and best time to call in the box marked to be completed by the Veteran.
- 3
Choose whether to add new charges
The instructions say to check the box under Number 3 to consent to adding new charges to an established plan that includes past debt.
- 4
Review the installment amount
The considerations say the Veteran may increase the installment amount by crossing out the amount provided and writing in the amount to pay, and that installments cannot be less than $25 per month.
- 5
Sign and date it
Sign and date the form. The form says the signature indicates agreement with the payment amount, term and requirements.
- 6
Mail it and wait for approval
Mail the form to your CPAC, with your own postage, then wait for approval and further instructions on where to remit payments.
Why fill Form 10-323 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
Mail to your CPAC
VA's form page says to mail the completed form to your VA Consolidated Patient Account Center (CPAC), not to the VA facility where you receive care, and links to a page to find the CPAC mailing address. The blank PDF prints Attn: Installment Agreement Payments without a street address.
Postage
The instructions say the sender is responsible for their own postage.
Payments
The form says the place where you send the signed form may not be the same place where you send payments, and to wait for instructions on where to remit them.
Questions
Health Resource Center (HRC) at 866-400-1238 between 7:00 am and 7:00 pm, Central Time, Monday through Friday, as printed on the form.
Edition
The footer reads VA FORM NOV 2022 10-323, matching the November 2022 revision date on VA's form page.
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Who completes VA Form 10-323?
The form splits the boxes between VA and the Veteran.
Official sources and the blank
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Questions about Form 10-323
What is VA Form 10-323 used for?
VA's form page says to use it to set up a monthly repayment plan for VA health care copay bills.
What is the smallest monthly installment?
The form says Repayment Plan payments (installments) cannot be less than $25 per month.
How long can a repayment plan last?
The form says the term of installments cannot exceed 36 months without pre-approval from Veteran Services.
When is each payment due?
The form says the monthly payment is due by the 28th day of each month after written notice that the plan is set up. Payments can be made any time in the month but must be received by the 28th to be considered current.
Can new copay charges be added to the plan?
Yes, with the checkbox under Term 3. The form says VHA will contact you to restructure a new agreement if the new terms extend the plan beyond 36 months.
Where is VA Form 10-323 mailed?
VA's form page says to mail it to your VA Consolidated Patient Account Center (CPAC), not to the VA facility where you receive care.
What if a monthly payment can't be made?
Term 4 says to contact the Health Resource Center at 866-400-1238 between 7:00 am and 7:00 pm, Central Time, Monday through Friday. It says that otherwise the remaining balance becomes due in full and VHA may take collection action as provided by law.