VA Form 10-10CG
Application for the Program of Comprehensive Assistance for Family Caregivers (PCAFC)
You are the primary family caregiver for a veteran who was seriously injured in the line of duty on or after 9/11/2001 (or pre-9/11 for veterans injured before that date, expanded eligibility as of 10/1/2020). You provide personal care services that prevent or delay nursing home placement.
- Who fills it
- caregiver
- Journey phase
- VA Healthcare
- Estimated time
- 60-90 minutes. Both the veteran AND the caregiver must complete sections of this form.
- When to file
- When the veteran has a serious injury or illness requiring personal care and the caregiver provides those services.
Official VA form page: https://www.va.gov/find-forms/about-form-10-10cg/
Gather before you start
- ▸Veteran: name, SSN, DOB, address, phone, service dates, VA facility of care
- ▸Veteran: diagnosis and description of care needs (what personal care the caregiver provides)
- ▸Caregiver: name, SSN, DOB, address, phone, relationship to veteran
- ▸Primary caregiver designation (only one primary; up to 2 secondary)
- ▸Medical documentation of veteran's condition and care needs
- ▸Veteran's treating VA clinician contact information
Attach with the form
- ▸Medical documentation supporting the veteran's care needs (clinical note, discharge summary)
Section I - Veteran Information
Blocks 1-10Veteran name, SSN, DOB, address, VA facility, diagnosisPII
The veteran's identifying information. Critically: list the VA medical center where the veteran receives primary VA care. VA will assign a caregiver support coordinator at that VAMC who will oversee the application. Also describe the veteran's diagnosis or condition that requires personal care assistance.
e.g., John Smith, Phoenix VA Medical Center; diagnosis: TBI with cognitive deficits, PTSD, left leg amputation; needs help with ADLs, medication management, transportation, emotional support.
Common mistakes
- ×Not listing the veteran's VA facility - this determines which Caregiver Support Coordinator handles the application.
- ×Vague diagnosis description - VA needs to understand the severity and care requirements.
Authority
- 38 USC 1720G - Program of Comprehensive Assistance for Family Caregivers.
- 38 CFR 17.500 - Program of Comprehensive Assistance for Family Caregivers eligibility criteria.
Section II - Primary Caregiver Information
Blocks 11-18Primary caregiver name, SSN, DOB, address, phone, relationshipPII
The primary caregiver is the designated main person providing care. Only one primary caregiver is allowed. The caregiver must be at least 18 years old and be a family member or live with the veteran. The primary caregiver receives the monthly stipend, health insurance (if no other coverage), and mental health services.
e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001; DOB: 05/10/1985
Common mistakes
- ×Multiple people applying as primary caregiver - only ONE primary is allowed; the others can apply as secondary caregivers.
- ×Not applying if you are a live-in caregiver who is not a biological relative - non-family members who live with the veteran can qualify.
Section III - Personal Care Services Provided
Blocks 19-24Description of personal care services the caregiver provides
Describe SPECIFICALLY what care you provide: bathing, dressing, feeding, medication administration, transportation to appointments, emotional support, monitoring for safety, managing behaviors (for TBI/PTSD), housekeeping as it relates to medical care. The more specific and detailed, the stronger the application. VA assigns a stipend tier based on the level of care (Tier 1-3).
e.g., Provide hands-on assistance with daily bathing and dressing (veteran cannot due to arm impairment). Administer medications 3x daily and monitor for adverse effects. Drive to all VA appointments (veteran cannot drive due to seizure disorder). Monitor for suicidal ideation (veteran has PTSD with passive SI). Prepare all meals (veteran has difficulty with fine motor tasks).
Common mistakes
- ×Generic descriptions ("I take care of him") without specific daily care tasks - VA assigns stipend tiers based on documented care intensity.
- ×Not including mental health/cognitive care tasks (safety monitoring, medication management, behavioral support) - these often determine the higher stipend tiers.
- ×Understating care needs - the stipend is based on the level of care provided; accurate documentation = appropriate compensation.
Related ClaimRecon tools
- form-guide-21-2680 - VA Form 21-2680 physician examination may support A&A documentation for higher PCAFC stipend tier.
Section IV - Veteran Certification
Blocks 25-27Veteran signature designating the caregiver(s)PII
The veteran must personally sign to designate the caregiver(s). If the veteran cannot sign due to incapacity, an alternate signer (VA Form 21-0972) may be used. The veteran is formally consenting to the caregiver having access to their VA health information.
(veteran signature/date)
Common mistakes
- ×Caregiver signing instead of the veteran - the veteran must personally designate the caregiver.
Section V - Caregiver Certification
Blocks 28-30Caregiver signature agreeing to program requirementsPII
The caregiver signs agreeing to complete required caregiver training, participate in assessments, allow VA home visits, and comply with program requirements. The program includes ongoing monitoring - VA will do reassessments periodically.
(caregiver signature/date)
Common mistakes
- ×Not understanding that participation requires ongoing VA oversight including possible home visits.
- ×Not knowing the program includes periodic reassessments and the stipend tier can change over time.
Statutory and regulatory authority
- 38 CFR 17.500 - Program of Comprehensive Assistance for Family Caregivers eligibility criteria.
- 38 USC 1720G - Program of Comprehensive Assistance for Family Caregivers.