Information Collection Request
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR, 10-10HS
ICR 202403-2900-006 · OMB 2900-0091 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0091 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 10-10EZR VA Form 10-10EZR |
Form and Instruction | Modified | Repair queued |
| Form 10-10EZ VA Form 10-10EZ |
Form and Instruction | Modified | Missing upstream |
| Form 10-10HS VA Form 10-10HS |
Form and Instruction | Modified | Repair queued |
 30-Day FRN_2900-0091_VA Health Benefits - Application Update Hardship Determ_10-10EZ 10-10EZR 10-10HS_pub 06032024.pdf |
Supplementary Document | Uploaded 2024-06-03 | Repair queued |
| 60-Day FRN_2900-0091_VA Health Benefits - Application Update Hardship Determ_10-10EZ 10-10EZR 10-10HS_pub 03222024.pdf |
Supplementary Document | Uploaded 2024-04-26 | Repair queued |
 SSA_2900-0091_VA Health Benefits Forms_10-10EZ 10-10EZR 10-10HS_updated Jun 2024.docx |
Supporting Statement A | Uploaded 2024-06-03 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 256200 |  VA Form 10-10EZR |
Form and Instruction | Modified | |
| 256198 | VA Form 10-10EZ |
Form and Instruction | Modified | |
| 244175 | VA Form 10-10HS |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | VA |
| OMB Control No | 2900-0091 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202402-2900-023 |
| Agency Tracking No | 2900-0091 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |