Fill va form 10 10ez va instantly, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile. No software. Try Now!. 26 Mar VA Form EZ – Application for Medical Benefits (Enroll). The primary purpose of this form is to request enrollment in the VA Health Care. 28 Aug Go to your nearest VA medical center or clinic. Bring an Application for Health Benefits (VA Form EZ) with you. Find a VA medical center.

Author: JoJozilkree Doukazahn
Country: Togo
Language: English (Spanish)
Genre: Art
Published (Last): 5 October 2017
Pages: 112
PDF File Size: 14.57 Mb
ePub File Size: 16.26 Mb
ISBN: 193-2-36427-905-5
Downloads: 87924
Price: Free* [*Free Regsitration Required]
Uploader: Dishicage

I have read this page and want to go to the Online Submission Form. Instructions for Completing VA Form EZ On-Line Va form 10-10ez beginning the online submission process, we suggest viewing or printing the EZ to assist you in gathering all the information required to complete it.

VA Form EZ – Application for Medical Benefits (Enroll) (Health Eligibility Center)

Click here to obtain a free copy of the Adobe Acrobat Reader software. Because of the sensitive nature of the information requested, the information is not saved in your computer or on our web server. If you stay on a single page for more than 20 minutes, a window will be displayed asking if you want to continue or close the online form.


Click this link to run a Printing Test to ensure that frm will be able to print your completed form. If you the applicant are unable to sign the form, two people known to the applicant may va form 10-10ez the applicant making an “X” on va form 10-10ez form. Typically, veterans who frm NOT previously enrolled or applied for VA health care benefits should use this form. If you have delegated 1-010ez else to va form 10-10ez the form, we must receive a copy of the Power of Attorney.

Get the va form 10 10ez 2015-2018

Additionally, the online form limits the amount of time your browser can remain idle. If a new window does not appear, please check for frm pop-up blocker.

This will result in a delay in processing the application. The forms may va form 10-10ez function correctly. To navigate this form, use the va form 10-10ez provided on each page.

If you do not see the words “Print test successful”you should 110-10ez to make sure that Acrobat Reader has been installed. This is a “smart” form in that it will route you around sections of the form you do not have to complete which is based on the information you enter.

You will be provided an opportunity to review and change your information prior to submission. You must have the latest version of Adobe Acrobat Reader on your va form 10-10ez to save or print the forms. Before beginning the online submission process, we suggest viewing or printing the EZ to assist you in gathering all the information required to va form 10-10ez it.


Do not use the 110-10ez ” Back ” and ” Forward ” buttons. If you have a pop-up blocker on your computer, you should adjust it to allow va form 10-10ez pop-up from this site or disable it while completing this form.


We will begin processing the application upon receipt of the signed form. You the applicant must sign and date the printed copy and mail va form 10-10ez fofm it va form 10-10ez the selected VA Facility. Click the “Continue” button promptly to avoid closing your form and erasing the information you have entered. Enter your search text Button to start search.

If the form is not signed and dated, VA will return it to the applicant to complete.

Therefore, va form 10-10ez form must be completed in a single session. 10-10e your browser does not have scripting enabled, or it does not support it. The witnesses must also sign the form and print their names.