Va Form 10-10cg - Application For Comprehensive Assistance For Family Caregivers Program - Department Of Veterans Affairs
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5Instructions for Completing Application for the Program of Comprehensive Assistance
for Family Caregivers
Please Read Before You Start . . .
What is VA Form 10-10CG used for?
To apply for VA's Program of Comprehensive Assistance for Family Caregivers. VA will use the information on this form to
assist in determining your eligibility; a clinical assessment will also be required. An eligible Veteran may appoint one (1)
Primary Family Caregiver and up to two (2) Secondary Family Caregivers. On average, it will take 15 minutes to complete
the application including the time it will take you to read instructions, gather the necessary facts and fill out the form. Each
time a new Caregiver is appointed a new Form 10-10CG is required.
Where can I get help filling out the form and answers to questions?
You may use ANY of the following to request assistance: Ask VA to help you fill out the form by calling us at 1-877-222-
VETS (8387). Access VA's website at and select "Contact the VA". Locate and contact the Caregiver
Support Coordinator at your nearest VA health care facility. A Caregiver Support Coordinator locator is available at
http://
Contact the National Caregiver Support Line by calling 1-855-260-3274 or a Veterans Service
Organization.
Definitions of terms used in this form
Caregiver Support Coordinator (CSC):
A VA clinical professional who connects Caregivers of Veterans with VA and community resources offering supportive
programs and services. Caregiver Support Coordinators are located at every VA medical center and are designated
specialists in Caregiving issues.
Family Member:
A member of the Veteran's or Servicemember's family (including a parent, a spouse, a son or daughter, a step-family
member, and an extended family member), or an individual who lives full-time with the Veteran or Servicemember, or will
do so if approved as a Primary or Secondary Family Caregiver.
Injured in the Line of Duty (LOD):
An injury incurred or aggravated during active military service, unless the injury resulted from the Veteran's or
Servicemember's willful misconduct or abuse of alcohol or drugs, or it occurred while that individual was avoiding duty by
desertion, or absent without leave which materially interfered with the performance of military duty.
Power of Attorney (POA):
A Power of Attorney is an authorization for someone to act on the Veteran's or Servicemember's behalf when completing
this form.
Primary Family Caregiver:
A Family Member (defined herein), who is designated as a "primary provider of personal care services" under 38 U.S.C.
§1720G(a)(7)(A); and who meets the requirements of 38 C.F.R. §71.25.
Representative:
Refers to a Veteran's or Servicemember's court-appointed legal guardian or special guardian, Durable POA for Health
Care, or other designated health care agent. Copies of documentation regarding representatives are requested on this
application.
Secondary Family Caregiver:
An individual approved as a "provider of personal care services" for the eligible Veteran under 38 U.S.C. §1720G(a)(7)(A);
meets the requirements of 38 C.F.R. §71.25; and generally serves as a back-up to the Primary Family Caregiver.
Stipend:
An allowance given to a Primary Family Caregiver in acknowledgement of the sacrifices they are making to care for a
seriously injured eligible Veteran (as defined in 38 C.F.R §71.15).
10-10CG
VA FORM
April 2016
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