Information Collection Request
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR and 10-10HS
ICR 202402-2900-001 · 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⚠️ Notice: This information collection may be outdated.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 Name | Status |
|---|---|
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Form and Instruction |
Unchanged |
Supplementary Document | 2024-02-06 |
Supporting Statement A | 2024-02-06 |
Form 10-10EZR VA Form 10-10EZR
2900-0091_Emergency OMB PRA Clearance Request Memorandum_(PACT Act-Sec 103)_02022024.pdf
SSA_2900-0091_VA Health Benefits Forms_10-10EZ and 10-10EZR_revised 02022024.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 256200 | Modified | ||
| 256198 | Modified | ||
| 244175 | Unchanged |
VA Form 10-10EZRICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | VA |
| OMB Control No | 2900-0091 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202209-2900-014 |
| Agency Tracking No | 2900-0091 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 2024-02-20 |