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VA Form 10-10EZR
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR and 10-10HS
OMB: 2900-0091
IC ID: 256200
OMB.report
VA
OMB 2900-0091
ICR 202402-2900-001
IC 256200
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0091 can be found here:
2024-02-29 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 10-10EZR
VA Form 10-10EZR
Form and Instruction
10-10EZR Health Benefits Update Form
VA Form 10-10EZR.pdf
Form and Instruction
10-10EZR Health Benefits Update Form
VA Form 10-10EZR_PACT Act - Section 103_updates_Jan 2024.pdf
Form and Instruction
Information Collection (IC) Details
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