Non-substantive Change Memorandum - 2900-0091 - VA Health Benefits Application & Update Forms - Sept 2022

	Department of Veterans Affairs		Memorandum
Date:		September 27, 2022
From:		Acting Director, Stacey Echols Health Eligibility Center (HEC)
Subject:		Non-Substantive Changes for OMB Control No. 2900-0091
To:		VA Desk Officer, Matthew S. Eliseo Office of Management & Budget (OMB)
Cc:		VA PRA Clearance Officer, Maribel Aponte Office of Enterprise and Integration/Data Governance Analytics

1. See the following updated and new information for OMB Control No. 2900-0091:

1. Updates: The program office made the following updates to VA Forms 10-10EZ and 10-10EZR, as described below:

   1. Adjusted gender identity choices to conform with recommended language:

1. 10-10EZ:  Section I, Ques 3B and Section IV, Ques 1C

2. 10-10EZR:  Section I, Ques 3B and Section III, Ques 4

1. Included separate field to choose if Indian – with expanded definition of “Indian” in the Instructions on the first page of each form:

   1. 10-10EZ:  Ques 6

   2. 10-10EZR:  Ques 4

3. Forms now have fillable fields

2. Supplementary Documents: The previously approved and updated versions of VA Forms 10-10EZ and 10-10EZR are included with this request.

3. New Information: The only “new” information is the addition of a separate field to choose if Indian, with expanded definition of “Indian” added to Instructions, as described in section a.ii above.

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Signature