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Federal forms, ICRs, and supporting documents

Information Collection

VA Form 10-10EZ

IC 256198 under ICR 202603-2900-018 · OMB 2900-0091.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

VA Form 10-10EZ 2900-0091
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 58.12

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 10-10EZ Application for Health Benefits VA Form 10-10EZ.pdf Yes Yes Fillable Fileable

Health Health Care Services

24VA19 Patient Medical Record - VA   78 FR 17778

540,000 0
   
Individuals or Households
 
   25 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 540,000 0 0 0 0 540,000
Annual IC Time Burden (Hours) 315,000 0 0 0 0 315,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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