Quick answer
Before you apply for CHAMPVA, gather the information VA Form 10-10d asks for about the Veteran sponsor and every applicant, then collect the supporting records that apply to your situation. The exact packet is different for a spouse, surviving spouse, child, student, Medicare beneficiary, or applicant with other health insurance.
The most important distinction is required versus optional evidence. VA currently identifies some records as required in particular situations, while other records are optional but may help VA process the application faster. Use the checklist below to assemble the right materials without assuming that every document applies to every applicant.
You can print this page and mark each item as you gather it.
Before you use the checklist
☐ Confirm that CHAMPVA is the right program. Review Who Qualifies for CHAMPVA? if you are not sure whether the applicant has a CHAMPVA eligibility pathway.
☐ Use the current application. VA's current Form 10-10d page lists the Application for CHAMPVA Benefits and identifies the current paper-form revision as April 2025.
☐ Know whether you are applying online or with the paper form. VA currently allows CHAMPVA applications online, by mail, or by fax. The supporting evidence is based on the applicant's circumstances, not simply the submission method.
Two situations have a different starting point:
- Primary Family Caregivers: VA says qualifying Primary Family Caregivers under the Program of Comprehensive Assistance for Family Caregivers are enrolled in CHAMPVA automatically after VA determines they qualify. They do not submit a separate Form 10-10d.
- Newborn children: VA says to first obtain the child's Social Security number and then add the child as a dependent of the Veteran sponsor before applying for CHAMPVA for the child.
Printable CHAMPVA application checklist
1. Veteran sponsor information
The current paper Form 10-10d asks for the following sponsor information. Gather it before you start so you do not have to stop mid-application.
☐ Veteran's full legal name
☐ Social Security number
☐ Current street address, city, state, and ZIP code
☐ Country code and phone number
☐ Email address
☐ Date of birth
☐ Date of marriage, when applicable
☐ Whether the Veteran is deceased
☐ If deceased, date of death
☐ If deceased, whether the Veteran died while on active military service
2. Information for each applicant
Gather the following for every person being included in the application:
☐ Full legal name
☐ Social Security number
☐ Date of birth
☐ Current street address, city, state, and ZIP code
☐ Email address
☐ Phone number
☐ Sex as requested on the current form
☐ Whether the applicant is enrolled in Medicare
☐ Whether the applicant has other health insurance
☐ Relationship to the Veteran sponsor
The paper Form 10-10d has space for three applicants. Its instructions say that if you need more space, complete another Form 10-10d in its entirety, sign it, and submit it with the application packet.
3. Medicare and other health insurance records
If an applicant has Medicare or other health insurance, gather the insurance information before applying.
☐ Front and back of the applicant's Medicare or other health insurance card
☐ Front and back of the Medicare Part D card, if the applicant has Part D
☐ CHAMPVA Other Health Insurance Certification information for that applicant
For a paper Form 10-10d, the current form states that each applicant who reports Medicare or other health insurance must submit VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification. VA's current Form 10-7959c page explains that applicants using the online process can submit the OHI information through VA's online tool.
If the applicant is age 65 or older and is not entitled to Medicare, also gather:
☐ A Social Security Administration Notice of Disallowance showing that the applicant does not qualify for Medicare Part A
CHAMPVA's Medicare eligibility rules are governed by 38 CFR § 17.271 and include specific Part A and Part B provisions and limited legacy exceptions. This checklist focuses on what to gather, not on deciding a complex Medicare eligibility question.
4. Spouse or surviving-spouse relationship records
VA currently describes the following as optional supporting documents that may help it process the application faster for a spouse or surviving spouse:
☐ Marriage certificate, or
☐ Certificate of civil union, or
☐ Common-law marriage affidavit
If a surviving spouse remarried before age 55 and that later marriage ended, VA also lists these as optional supporting evidence, as applicable:
☐ Divorce decree, or
☐ Annulment decree, or
☐ Death certificate
Do not treat these optional records as universally required simply because they can speed verification. Follow any specific request VA sends for your case.
5. Dependent-child records
For a dependent child, gather the records that match the child's situation.
VA says a birth certificate is optional but may help process a child's application faster:
☐ Birth certificate
The following records are required in the listed special situations on VA's current CHAMPVA benefits page:
☐ Adopted child: adoption papers
☐ Stepchild: proof of the marriage between the Veteran sponsor and the child's other parent
☐ Student age 18 to 23: school certification letter proving enrollment
If the child became permanently unable to support themselves before age 18, VA says a disability rating letter for the child can help process the application:
☐ VA disability rating letter for the child, if applicable
6. School certification for a student age 18 to 23
The current Form 10-10d instructions say the school certification should be on school letterhead and include:
☐ Student's full name
☐ Student's Social Security number
☐ Exact beginning date of the school term or enrollment period
☐ Projected graduation date
VA.gov currently says a student between ages 18 and 23 who remains enrolled in school must submit school certification and recertify as required to maintain eligibility. For the broader eligibility rules and continuing certification, see CHAMPVA for Full-Time Students Ages 18–23.
7. Final application check
Before you submit, make one final pass through the application and attachments.
☐ Every applicant who has Medicare or other health insurance has the required OHI information
☐ Front and back of every required insurance or Medicare card are included
☐ Any required adoption, stepchild, or school records are included
☐ Optional relationship records you want VA to use for faster verification are included
☐ Applicant and sponsor names, dates of birth, Social Security numbers, and addresses are consistent across the forms and supporting records
☐ If using the paper Form 10-10d, the certification is signed and dated
☐ If more than three applicants are included on paper, each additional Form 10-10d is completed in full and signed
☐ You have retained a copy of the completed application and supporting records for your files
Required, conditional, and optional documents at a glance
| Situation | What to gather | How VA currently describes it |
|---|---|---|
| Medicare or other health insurance | Insurance/Medicare card copies and OHI information | Required when applicable |
| Medicare Part D | Front and back of Part D card | Required when applicable |
| Age 65+ and not entitled to Medicare Part A | SSA Notice of Disallowance | Required when applicable |
| Spouse or surviving spouse | Marriage, civil-union, or common-law evidence | Optional; may speed processing |
| Surviving spouse whose pre-55 remarriage ended | Divorce, annulment, or death evidence | Optional; may help document the change |
| Dependent child | Birth certificate | Optional; may speed processing |
| Adopted child | Adoption papers | Required when applicable |
| Stepchild | Proof of sponsor's marriage to the child's other parent | Required when applicable |
| Student age 18–23 | School certification | Required when applicable |
| Child unable to support themselves before 18 | VA disability rating letter | Optional; may help processing |
What to do after the checklist is complete
If you want to submit electronically, use How to Apply for CHAMPVA Online.
If you plan to send a paper application, use How to Apply for CHAMPVA by Mail or Fax for the current submission workflow. Keeping the submission instructions on those method-specific pages avoids relying on an old saved address or fax number.
Common application-preparation mistakes
- Treating every suggested relationship document as mandatory, even when VA labels it optional.
- Missing a conditionally required document, such as adoption papers, stepchild proof, or school certification.
- Reporting Medicare or other health insurance without also preparing the required OHI information.
- Copying only one side of a Medicare, Part D, or other insurance card.
- Starting a newborn application before obtaining the child's Social Security number and adding the child as the Veteran's dependent.
- Using an older saved Form 10-10d instead of checking VA's current form page.
- Forgetting the certification signature or date on a paper application.
- Assuming this checklist determines eligibility. It organizes application evidence; VA makes the eligibility determination.
Source check
This checklist is based on VA's current CHAMPVA benefits instructions, the current Form 10-10d and its school-certification instructions, VA's OHI form guidance, the current CHAMPVA Guidebook, and the CHAMPVA eligibility regulation. Because forms and operational instructions can change, re-check the linked VA pages before submitting.