Information Collection

VA Form 10-10HS

IC 244175 under ICR 202603-2900-018 · OMB 2900-0091.

Documents and Forms

Document Name Document Type
Form 10-10HS VA Request for Hardship Determination VA Form 10-10HS Form and Instruction
10-10HS VA Request for Hardship Determination VA Form 10-10HS.pdf www.va.gov/vaforms/medical/pdf/vha-10-10HS.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VA Form 10-10HS	Agency IC Tracking Number:	2900-0091

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10HS	VA Request for Hardship Determination	VA Form 10-10HS.pdf	http://www.va.gov/vaforms/medical/pdf/vha-10-10HS.pdf	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	7,000	7,000
Annual IC Time Burden (Hours)	1,750	1,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].