VA Form 10-10CG: Family Caregiver Program Application

What is VA Form 10-10CG?

VA Form 10-10CG is the application for VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC). The instructions say a veteran may appoint one Primary Family Caregiver applicant and up to two Secondary Family Caregiver applicants, and that a new form is needed each time a new caregiver is requested, including a caregiver moving from secondary to primary or back.

The application has one page per person: the veteran (with the VA medical center where they get or plan to get care), the Primary Family Caregiver, and one page for each Secondary Family Caregiver. Each person gives their name, SSN or tax ID, date of birth, sex, home address, phones and email, caregivers add a mailing address and their relationship to the veteran, and everyone signs their own certification.

FileIt pre-fills the veteran's page from your vault, lets you switch each caregiver's page on, and prints every answer on VA's own PDF (FEB 2025 edition). It can send one eSignature request to the veteran and each caregiver, or you can sign by hand. The finished application is saved in the vault; you send it yourself, and FileIt never submits it.

Who fills it: The veteran and the caregiver applicants, or a representative with documented authority.
Caregivers: One Primary and up to two Secondary Family Caregiver applicants per application.
Signatures: Each person signs and dates their own page: the veteran (or representative) and every caregiver applicant.
Send to: 10-10CG Evidence Intake Center, PO Box 5154, Janesville, WI 53547-5154, or give it to your facility's Caregiver Support Program staff.
Where it applies: The form says the program isn't provided to people living outside the 50 states, DC and the U.S. territories.
Edition: VA Form 10-10CG, FEB 2025 (OMB No. 2900-0768, expires 01/31/2027)

Who needs to fill out VA Form 10-10CG?

Veterans who need personal care services and want a family member or live-in helper recognized as their caregiver.
Spouses, parents, children, step-family and extended family members applying to be a Primary or Secondary Family Caregiver.
Someone who isn't family but lives with the veteran full-time, or will once designated.
Service members undergoing medical discharge who qualify under the program's definition of veteran.

When to use VA Form 10-10CG

When a veteran first applies to the program with their caregivers.
When adding a new Primary or Secondary Family Caregiver.
When an approved caregiver wants to change between primary and secondary, which the instructions say needs a new form.

What you need before you start

Legal names, as on a driver's license or Social Security card, for the veteran and each caregiver.
Social Security numbers (or tax IDs), dates of birth, home addresses with county, and phone numbers for everyone.
The name of the VA medical center or clinic where the veteran gets or plans to get care.
Each caregiver's relationship to the veteran.
If a representative signs for anyone, proof of their authority, such as a power of attorney, guardianship order, or VA Form 21-0972, 21-22 or 21-22a.

What’s on VA Form 10-10CG

The 2025 edition has 6 pages. FileIt asks for it in 4 parts, and it is signed by Veteran and Primary family caregiver and Secondary family caregiver 1 and Secondary family caregiver 2:

Section I: VeteranVeteran
Section II: Primary Family Caregiver applicantPrimary family caregiver
Section III: Secondary Family Caregiver applicant 1Secondary family caregiver 1
Section III: Secondary Family Caregiver applicant 2Secondary family caregiver 2

How to fill out VA Form 10-10CG, step by step

1 Section I: Veteran

Name, SSN or tax ID, date of birth, sex, the street address where you live (not a P.O. box), county, phones, email and your VA medical center or clinic. The veteran or a representative signs, certifying the people named are involved in their care and consenting to share the information they need.

2 Section II: Primary Family Caregiver

The same personal details, a mailing address if different, and the relationship to the veteran. The caregiver certifies they're at least 18, family or living with the veteran full-time, and agrees to provide personal care services.

3 Section III: Secondary Family Caregivers

Up to two, one per page, with the same details and certifications. You can apply with only a primary, only secondaries, or both.

Common mistakes to avoid

Using a P.O. box as the street address, which the form asks you not to do.
Leaving out a signature or date for one of the applicants. The instructions say missing information can delay or deny benefits.
Applying with no caregiver at all: the veteran's page needs at least a Primary or a Secondary Family Caregiver to go with it.
A representative signing without attaching documents that show their authority.
Not sending VA Form 10-10EZ when the veteran isn't yet enrolled in VA health care, as the instructions suggest.

After you fill it out

Collect every signature, through FileIt eSignature (each signer only signs their own page) or by hand, and mail the application to the 10-10CG Evidence Intake Center or give it to the Caregiver Support Program staff.

Attach VA Form 10-10EZ if the veteran isn't enrolled, or 10-10EZR to update an enrolled veteran's information.

The instructions say Caregiver Support Program staff will contact you to review the application and next steps. Keep the PDF in your vault until then.

Fill out VA Form 10-10CG online with FileIt

Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 83 fields in all. Your answers save as you go.
Check the live preview. Watch your answers land on the real U.S. Department of Veterans Affairs (VHA) form, and let FileIt do any worksheet arithmetic.
Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault. Sign it, or send it for e-signature.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start VA Form 10-10CG now — it’s free

VA Form 10-10CG: frequently asked questions

How many caregivers can apply?

One Primary Family Caregiver applicant and up to two Secondary Family Caregiver applicants, according to the instructions.

Does a caregiver have to be a relative?

No. Caregivers certify that they're either a family member, including step-family and extended family, or not family but living with the veteran full-time, or will be once designated.

Is there an age requirement?

Yes. Each caregiver applicant certifies they are at least 18 years old.

Can I apply online instead?

The form's attention box and instructions say you can apply online at VA's family caregivers page, which they call the fastest way.

Can someone sign for the veteran?

A representative with authority to act for the veteran or caregiver may sign, and the instructions ask for supporting documents to be sent with the application.

Official sources

Blank form (PDF), published by U.S. Department of Veterans Affairs (VHA): https://www.va.gov/vaforms/medical/pdf/10-10CG.pdf
Official instructions and guidance: https://www.va.gov/find-forms/about-form-10-10cg/
Edition shown on this page: VA Form 10-10CG, FEB 2025 (OMB No. 2900-0768, expires 01/31/2027) (checked 2026-10-19).

FileIt is not affiliated with or endorsed by U.S. Department of Veterans Affairs (VHA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-19.