Application for Extended Care Services, VA Form 10-10EC

OMB 2900-0629

OMB 2900-0629

Collects information to establish eligibility for extended care benefits, establishes financial liability veteran to pay if accepted for placement in Extended Care Services, and establishes veteran has agreed to make any applicable copayment.

The latest form for Application for Extended Care Services, VA Form 10-10EC expires 2021-06-30 and can be found here.


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