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

ICR 202504-2900-005

OMB: 2900-0091

Federal Form Document

Forms and Documents

Document Name	Status
Form 10-10EZR VA Form 10-10EZR Form and Instruction	Modified
Form 10-10EZ VA Form 10-10EZ Form and Instruction	Modified
Form 10-10HS VA Form 10-10HS Form and Instruction	Unchanged
2900-0091_White Paper_Non-Substantive Change Request_VA Health Benefits Forms_04182025.docx Justification for No Material/Nonsubstantive Change	2025-04-24
30-Day FRN_2900-0091_VA Health Benefits - Application Update Hardship Determ_10-10EZ 10-10EZR 10-10HS_pub 06032024.pdf Supplementary Document	2024-06-03
60-Day FRN_2900-0091_VA Health Benefits - Application Update Hardship Determ_10-10EZ 10-10EZR 10-10HS_pub 03222024.pdf Supplementary Document	2024-04-26
SSA_2900-0091_VA Health Benefits Forms_updated Apr 2025.docx Supporting Statement A	2025-04-08

IC Document Collections

IC ID	Document Title	Status
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	Unchanged