VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR and 10-10HS

ICR 202402-2900-001

OMB: 2900-0091

Federal Form Document

Forms and Documents

Document Name	Status
Form 10-10EZR VA Form 10-10EZR Form and Instruction	Modified
Form 10-10EZ VA Form 10-10EZ Form and Instruction	Modified
Form 10-10HS VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged
2900-0091_Emergency OMB PRA Clearance Request Memorandum_(PACT Act-Sec 103)_02022024.pdf Supplementary Document	2024-02-06
SSA_2900-0091_VA Health Benefits Forms_10-10EZ and 10-10EZR_revised 02022024.docx Supporting Statement A	2024-02-06

IC Document Collections

IC ID	Document Title	Status
256200	VA Form 10-10EZR Form and Instruction	Modified
256198	VA Form 10-10EZ Form and Instruction	Modified
244175	VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged