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Updated VA Form 10-10EZ (2022)
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR and 10-10HS
OMB: 2900-0091
IC ID: 256198
OMB.report
VA
OMB 2900-0091
ICR 202402-2900-023
IC 256198
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0091 can be found here:
2024-06-03 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 10-10EZ
Updated VA Form 10-10EZ (2022)
Form and Instruction
Form 10-10EZ
Updated VA Form 10-10EZ (2022)
Form and Instruction
10-10EZ Application for Health Benefits
VA Form 10-10EZ_updated 2022.pdf
Form and Instruction
10-10EZ - revised Application for Health Benefits
VA Form 10-10EZ_PACT Act - Sec 103 revisions_JAN 2024_v3.pdf
Form and Instruction
Information Collection (IC) Details
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