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

ICR 202402-2900-023

OMB: 2900-0091

Federal Form Document

Forms and Documents

Document Name	Status
Form 10-10EZR Updated VA Form 10-10EZR (2022) Form and Instruction	Modified
Form 10-10EZR Updated VA Form 10-10EZR (2022) Form and Instruction	Modified
Form 10-10EZ Updated VA Form 10-10EZ (2022) Form and Instruction	Modified
Form 10-10EZ Updated VA Form 10-10EZ (2022) Form and Instruction	Modified
Form 10-10HS VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged
Form 10-10HS VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged
2900-0091_Non-Substantive Change Memorandum_VA Forms 10-10EZ 10-10EZR_PACT Act-Sect 103 20240229.pdf Justification for No Material/Nonsubstantive Change	2024-02-29
2900-0091_Non-Substantive Change Memorandum_VA Forms 10-10EZ 10-10EZR_PACT Act-Sect 103 20240229.pdf Justification for No Material/Nonsubstantive Change	2024-02-29
SSA_2900-0091_VA Health Benefits Forms_10-10EZ and 10-10EZR_updated 02272024.docx Supporting Statement A	2024-02-28
SSA_2900-0091_VA Health Benefits Forms_10-10EZ and 10-10EZR_updated 02272024.docx Supporting Statement A	2024-02-28

IC Document Collections

IC ID	Document Title	Status
256200	Updated VA Form 10-10EZR (2022) Form and Instruction	Modified
256200	Updated VA Form 10-10EZR (2022) Form and Instruction	Modified
256198	Updated VA Form 10-10EZ (2022) Form and Instruction	Modified
256198	Updated VA Form 10-10EZ (2022) Form and Instruction	Modified
244175	VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged
244175	VA Form 10-10HS -- Request for Hardship Determination Form and Instruction	Unchanged