Application for Extended Care Services, VA Form 10-10EC
Revision of a currently approved collection
No
Regular
Approved without change
05/20/2025
04/18/2025
OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
05/31/2028
36 Months From Approved
05/31/2025
2,000
0
2,000
3,000
0
3,000
0
0
0
Title 38 U.S.C. Chapter 17 authorizes VA to provide hospital care, medical services, domiciliary care, and nursing home care to eligible Veterans. Title 38 U.S.C. § 1705 requires VA to design, establish, and operate a system of annual patient enrollment in accordance with a series of stipulated priorities. A consequence of this is that many groups of Veterans who are in a lower priority group (WWI Veterans, Veterans with disabilities rated as 0% service-connected seeking treatment for other than their service-connected conditions, Veterans exposed to a toxic substance, radiation, or environmental hazard and nonservice-connected Veterans) may request that they be allowed to be income tested in order to gain a higher priority. Title 38 U.S.C. § 1722 establishes eligibility assessment procedures for cost-free VA medical care, based on income levels, which will determine whether nonservice-connected and 0% service-connected non-compensable Veterans are able to defray the necessary expenses of care for nonservice-connected conditions. Title 38 U.S.C. § 1722A establishes the eligibility assessment procedures, based on income levels, for determining Veteransâ eligibility for cost-free medications. Title 38 U.S.C. § 1710B defines the procedures for establishing eligibility for cost-free Extended Care benefits. Title 38 U.S.C § 1729 authorizes VA to recover from Veteransâ health insurance carriers the cost of care furnished for their nonservice-connected conditions.
VA Form 10-10EC, Application for Extended Care Services, is used to collect financial information necessary to determine a Veteranâs copayment obligation for extended care services, also known as long term care (LTC). The 10-10EC design and formatting have been revised to clarify the instructions and make it easier to understand and complete the form. However, there are no changes to the anticipated annual number of responses or burden hours for this information collection.
US Code:
38 USC 1729
Name of Law: Recovery by the United States of the cost of certain
US Code:
38 USC 1705
Name of Law: Management of health care: patient enrollment system
US Code:
38 USC 1722
Name of Law: Eligibility assessment procedures for cost-free VA medical care
US Code:
38 USC 1722A
Name of Law: Determination of inability to defray necessary expenses;
US Code:
38 USC 1710B
Name of Law: Eligibility for hospital, nursing home, and domiciliary
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Application for Extended Care Services