Information Collection Request
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR and 10-10HS
ICR 202402-2900-023 · OMB 2900-0091 · Active
⚠️ Notice: This information collection may be outdated.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 |
Modified |
Form and Instruction |
Modified |
Form and Instruction |
Unchanged |
Form and Instruction |
Unchanged |
 2900-0091_Non-Substantive Change Memorandum_VA Forms 10-10EZ 10-10EZR_PACT Act-Sect 103 20240229.pdf Justification for No Material/Nonsubstantive Change | 2024-02-29 |
| 2900-0091_Non-Substantive Change Memorandum_VA Forms 10-10EZ 10-10EZR_PACT Act-Sect 103 20240229.pdf Justification for No Material/Nonsubstantive Change | 2024-02-29 |
Supporting Statement A | 2024-02-28 |
Supporting Statement A | 2024-02-28 |
Form 10-10EZR Updated VA Form 10-10EZR (2022)
SSA_2900-0091_VA Health Benefits Forms_10-10EZ and 10-10EZR_updated 02272024.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 256200 | Modified | ||
| 256200 | Modified | ||
| 256198 | Modified | ||
| 256198 | Modified | ||
| 244175 | Unchanged | ||
| 244175 | Unchanged |
Updated VA Form 10-10EZR (2022)ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | VA |
| OMB Control No | 2900-0091 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202209-2900-014 |
| Agency Tracking No | 2900-0091 |
| Date Submitted to OIRA | 2024-02-29 |
| Requested Expiration Date | 1969-12-31 |