VA 1010EZ PDF Template

[toc] If a veteran wishes to apply for the VA healthcare system, they must fill out a number of different forms. This paperwork is filed with the VA’s office. Once it’s completed, the veteran is given access to the VA healthcare system. Any dependents of the veteran will also be part of the same healthcare system. The 1010EZ form is one of these pieces of paperwork.

Veterans will use the form to apply to be enrolled in the Veterans Affairs healthcare system. The VA office will use whatever information is provided on the for to determine whether the applicant is eligible for medical benefits. On average, the form only takes about 30 minutes to complete, including the time spent reading the instructions and gathering your relevant facts.

Before you begin the application, you should check whether you meet the eligibility requirements for VA healthcare benefits. You should also gather together the following documents:

The tax return you most recently filed

The tax return you most recently filed

The Social Security numbers for your dependents and yourself

The Social Security numbers for your dependents and yourself

Account numbers for whatever current health insurance you might have, whether this is employer insurance, private insurance, or Medicare

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The information on this documentation will be required on the application form. It’s best to get everything together before you start filling out the form, as this helps to streamline the process.

The document can be used by veterans who meet the eligibility requirements for VA healthcare benefits. These are the main eligibility requirements:

For people who enlisted following September 7, 1980, or whose active duty started following October 16, 1981, you should have served the entire period you were called to active duty or 24 continuous months, unless you meet any of the other eligibility requirements

For people who enlisted following September 7, 1980, or whose active duty started following October 16, 1981, you should have served the entire period you were called to active duty or 24 continuous months, unless you meet any of the other eligibility requirements

You served before September 7, 1980

You served before September 7, 1980

You were discharged due to a disability that was either caused or worsened by your time in active-duty service

You were discharged due to a disability that was either caused or worsened by your time in active-duty service

You were discharged due to a hardship or “early out”

You were discharged due to a hardship or “early out”

You are a former or current National Guard or Reserves member who was called to duty through a federal order and completed the full period of active duty

If your discharge was anything except honorable, you might not qualify for VA healthcare benefits. To qualify, you’ll need to have your discharge upgraded through either an application or a review process.

When an eligible veteran wants to apply for healthcare benefits through the VA, the 1010EZ form is the one they use. The form puts together all of the information the VA needs about your military service, healthcare needs, and dependents.

You might be more likely to receive benefits due to an enhanced eligibility status if you meet any of these requirements:

You receive financial compensation for a disability connected to your service

You receive financial compensation for a disability connected to your service

You were discharged because of a disability that resulted from or worsened because of active duty

You were discharged because of a disability that resulted from or worsened because of active duty

You are a Combat Veteran who has recently been discharged

You are a Combat Veteran who has recently been discharged

You receive a VA pension

You receive a VA pension

You are a former POW or have received the Purple Heart

You are a former POW or have received the Purple Heart

You qualify for Medicaid benefits

You qualify for Medicaid benefits

You served during the Vietnam War between 1962 and 1975

You served during the Vietnam War between 1962 and 1975

You served during the Gulf War between 1990 and 1998

You served during the Gulf War between 1990 and 1998

You served at least thirty days at Camp Lejeune from 1953 through 1987

Even if you don’t meet these qualifications, you might still be eligible for benefits because of a low income.

If you don’t use this form to apply for healthcare benefits, you won’t be eligible to receive the healthcare benefits that the VA offers. You’ll still be free to receive insurance benefits from whatever insurance provider you use.

Sections I through III must be completed by all veterans applying.

Section I is the General Information section. Answer all questions according to their prompts. In Section II, you’ll provide your military service information. For people who don’t receive benefits from the VA right now, you might attach a copy of your separation or discharge papers to expedite application processing.

Section III will require you to provide information about all health insurance companies with whom you have coverage, including any coverage that’s provided through a significant other or spouse. You should bring your insurance cards to every healthcare appointment.

Sections IV through VI only need to be filled out by 0% noncompensable SC veterans and NSC veterans. The Financial Disclosure Requirements don’t apply if you meet any of the qualifications for priority benefits listed above. You aren’t required to provide financial information, but failure to do so will result in the VA denying your healthcare application.

Section IV is where you’ll record your dependent information. If you provide for your spouse, they qualify as a dependent. Your children also qualify, as do child support contributions.

Section V will record your gross annual income from the previous calendar year, while Section VI calculates your deductible expenses from the previous calendar year. Section VII is where you’ll sign and date the form.

If you need to fill out any continuation sheets, they should be attached to the application. Supporting materials should also be attached, as should a copy of any Power of Attorney documents.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/va-form-1010ez.pdf”]