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Description of 10 7959a
OMB Number 2900-0219 VA Health Administration Center CHAMPVA CHAMPVA Claim Form PO Box 469064 Denver CO 80246-9064 Est. Relationship to Patient VA FORM MAY 2010 10-7959a Notice Termination of marriage by divorce or annulment to the qualifying sponsor ends CHAMPVA eligibility as of midnight on the effective date of the dissolution of marriage. 501 and 1781. The purpose of collecting this information is to...
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