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This version of the form is not currently in use and is provided for reference only. Download this version of
VA Form 10-10CG
for the current year.
VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program
What Is VA Form 10-10CG?
VA Form 10-10CG, Application for Comprehensive Assistance for Family Caregivers Program is a form used for applying for the Program of Comprehensive Assistance for Family Caregivers (PCAFC) established by the Department of Veterans Affairs (VA) . The VA uses the information provided on this form to determine the applicant's eligibility to participate in the PCAFC.
The VA released the latest edition of the form on April 1, 2016 . An up-to-date VA Form 10-10CG fillable version is available for digital filing and download below.
The VA Form 10-10CG consists of three sections in total:
- Section I requires the veteran's (or service member's) general information. The required data includes their personal identifying information, the last place where they received treatment for their condition, and the name of the VA clinic where they receive or plan to receive health care services in the future.
- Section II is for the information about the veteran's primary family caregiver.
- Section III is intended for the veteran's secondary family caregivers. Secondary family caregiver participation is optional.
Program of Comprehensive Assistance for Family Caregivers
The VA PCAFC is a clinical program that allows a veteran to elect a single Primary Family Caregiver and up to two Secondary Family Caregivers. Veterans are eligible to apply for PCAFC if they meet the following criteria:
- They have sustained a serious injury or psychological trauma that happened in the line of duty on or after September 11, 2001;
- They require ongoing assistance with basic daily tasks;
- They need to be supervised due to difficulties with planning, concentration, and memory;
- They require at least six months of continuous caregiver support.
Participation in the program must support the veteran's rehabilitation progress to the fullest extent. The long-term goal of the PCAFC is the veteran's full rehabilitation resulting in discharge from the program. PCAFC eligibility must be reassessed annually.
VA 10-10CG Related Forms
The VA's Program of Comprehensive Assistance for Family Caregivers application has seven related forms:
- The VA Form 10-10M ( Medical Certificate ) is a document with the result of the veteran's medical examination. It is completed and signed by both the doctor and the veteran;
- The VA Form 10-10EZR ( Health Benefits Update Form ) is completed by veterans and submitted to the VA for updating personal, insurance-related, or financial information after enrolling in the VA benefits program;
- The VA Form 10-10SH ( State Home Program Application For Veteran Care Medical Certification ) is an application form for the State Veterans Home Program. The program provides quality care for veterans in nursing homes, domiciliaries, and adult day health care facilities;
- The VA Form 10-10EC ( Application For Extended Care Services ) is necessary for veterans that require assisted living or residential health care. The services provided by the VA include 24/7 nursing and medical care, physical therapy, help with daily tasks, and pain management;
- The VA Form 10-10HS ( Request for Hardship Determination ) is used by veterans with a decreased gross household income to determine eligibility for a copayment exemption for the remaining calendar year.
The VA Form 10-10EZ ( Application For Health Benefits ) - and the VA Form 10-10EZ ( Solicitud de Beneficios Médicos ) (Spanish) - are used by veterans to apply for VA Health Benefits.
Download VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program
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