CHAMPVA Eligibility - VHA Office of Integrated Veteran Care, Department of Veterans Affairs fax number

Fax destination details

Department

VHA Office of Integrated Veteran Care

Purpose

Submitting CHAMPVA eligibility forms (VA Form 10-10d and VA Form 10-7959c) by fax to 303-331-7809, or mailing to the CHAMPVA Eligibility address; online submission is also available.

Form

VA Form 10-10d; VA Form 10-7959C — Application for CHAMPVA Benefits (10-10d); CHAMPVA—Other Health Insurance Certification (10-7959C)

Address

PO Box 137, Spring City, PA 19475

Voice phone

800-733-8387

Website

Visit organization website

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Fill VA Form 10-10d with required applicant/dependent information; use VA Form 10-7959c to report other health insurance. Attach supporting documents as required and submit via fax to 303-331-7809 or by mail.