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Va10 7959f 1 Form: What You Should Know

To download the form: fill out and sign the form and print.  Foreign Medical Program Registration Form — 10 — Reg info.gov (1) For each service that you apply for, the date(s), the date(s), and the total period of service(s) as the basis of establishing eligibility should be verified through data from the department. The information provided must provide: (a) In the case of Active Duty, the date(s), the date(s), and the total period of enlistment (or the first and second days of release) as the basis of establishing eligibility; (b) In the case of Active and Selected Reserve/Reserve component personnel, the date(s), the date(s), and the total period of activation or the first and second days of release as the basis of establishing eligibility; and (c) For members on active duty or Selected Reserve/Reserve component status, the dates, including any period of reenlistment. (2) If your application is pending approval, you will need to demonstrate your current date(s) and total period of service by obtaining from the appropriate component that service. You may submit this with your completed form, but the component that you submit it with must accept it as proof of your eligibility to receive the benefits listed. (Note: If the foreign medical program for your service is from another government body, you may need to verify it using other documentation, such as a passport or other document. The VA may need to verify it for you). The purpose of a military service is to provide you with certain protections from the health care system and any treatment or procedure that involves injury. This can include benefits as listed on the VA's foreign medical benefits calculator or an assessment of your service record. If you submit an application with incorrect or incomplete information, your application might be denied. For more information click here. If you have any legal problems, please report them by calling your nearest Federal Veterans Affairs Healthcare System, Veterans Benefits Administration (VBA) office. For additional information, visit our website: Important: If you have a disability, you can call the VBA for immediate assistance at 1-877-222-VA-TALK (8387), in the United States or at, internationally.

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