Va Form 10 at a glance
What it is: Foreign Medical Program (FMP) Registration Form: Veterans can use this form to register in the VA Foreign Medical Program.
Where and when to file: Complete the form and submit it to the FMP office, or fax it to 1-303-331-7803.
A filled-in Va Form 10 example: a Veteran living abroad registers
How to fill out Va Form 10, box by box
Veteran Information - Please Print
Under Veteran Information - Please Print, enter Veteran Last Name, Veteran First Name and MI.
Enter Social Security Number, VA Claim File Number and Date of Birth (MM/DD/YYYY).
Not supplying the SSN may delay processing your claims.
Physical Address (Residence) and Mailing Address
Enter the Physical Address (Residence) with its Country, and the Mailing Address with its Country.
If eligible, an FMP Benefits Authorization Letter will be issued to you at your mailing address.
Telephone Number and Email Address
Enter your Telephone Number and Email Address.
Signing the form
Sign in ink on Veteran Signature (Required) and enter the Date (Required) (MM/DD/YYYY).
More rules for Va Form 10
All items must be completed; if not applicable, write or type None or N/A.
Common questions about Va Form 10
Where do I file it?
Foreign Medical Program, PO Box 469061, Denver, CO 80246-9061 USA.
Is there a penalty?
Federal law provides criminal penalties, including a fine and/or imprisonment, for any materially false, fictitious, or fraudulent statement or representation (See 18 U.S.C. 287 and 1001).
What am I certifying when I sign?
You certify that the information is correct and true to the best of your knowledge and belief.
Sources
[1] Foreign Medical Program (FMP) Registration Form (JUN 2021), VA Form 10-7959f-1 (the Official source link on this page).