Information Collection Request
VA Health Benefits: Application, Update, Hardship Determination - VA Forms 10-10EZ,10-10EZR, 10-10HS
ICR 202403-2900-006 · 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⚠️ Notice: This information collection may be outdated.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 |
Modified |
Supplementary Document | 2024-06-03 |
Supplementary Document | 2024-04-26 |
Supporting Statement A | 2024-06-03 |
Form 10-10EZR VA Form 10-10EZR
30-Day FRN_2900-0091_VA Health Benefits - Application Update Hardship Determ_10-10EZ 10-10EZR 10-10HS_pub 06032024.pdf
SSA_2900-0091_VA Health Benefits Forms_10-10EZ 10-10EZR 10-10HS_updated Jun 2024.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 256200 | Modified | ||
| 256198 | Modified | ||
| 244175 | Modified |
VA Form 10-10EZRICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | VA |
| OMB Control No | 2900-0091 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202402-2900-023 |
| Agency Tracking No | 2900-0091 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |