OMB control number
Health Eligibility Center (HEC) Income Verification (IV) Forms
OMB 2900-0867 · VA.
VHA Directive 1909 provides policy for the Department of Veterans Affairs (VA) Health Eligibility Center (HEC) Income Verification (IV) Program under authority of 38 United States Code (U.S.C.) 1722; 38 U.S.C. 5317. Title 38 U.S.C. 1722 established eligibility assessment procedures, based on income levels, for determining whether nonservice-connected (NSC) Veterans and non-compensable zero percent service-connected (SC) Veterans, who have no other special eligibility are eligible to receive Department of Veterans Affairs (VA) health care at no cost. Title 26 U.S.C. 6103 (l)(7) of the Internal Revenue Code, and 38 U.S.C. 5317 establish authority for VA to verify Veterans’ gross household income information against records maintained by the Internal Revenue Service (IRS) and Social Security Administration (SSA) when that information indicates the Veteran is eligible for cost-free VA health care. In accordance with VHA Directive 1909, it is VA policy that the Health Eligibility Center (HEC) is responsible for the Income Verification Program, i.e., verifying NSC and non-compensable zero percent SC Veterans’ gross household income through computer matching activity with IRS and SSA. The social security numbers (SSNs) of all Veterans and their spouses identified in the financial assessment will be verified under the Social Security Number Verification Information Exchange Agreement (IEA), between the SSA and VHA HEC, prior to income matching activity with IRS. If IRS and SSA income matching identifies discrepancies in the Veteran’s self-reported gross household income information that potentially impacts eligibility for VA health care benefits, HEC must independently verify the IRS and SSA income data. If the Veteran’s eligibility for VA health care benefits is changed as a result of the income verification process, HEC will transmit the updated eligibility information to those facilities that provided health services to the Veteran during the applicable income-reporting period. HEC’s Income Verification Division (IVD) sends Veterans and spouses individual letters and forms to confirm income information reported by IRS and SSA. HEC does not change the Veteran’s copay status until information supplied by IRS and SSA has been independently verified, either by the Veteran or through appropriate due process procedures. This collection has been revised by removing VA Form 10-302A because all relevant information can be reported on VA Form 10-302. There is a reduction in the burden hours due to the removal of VA Form 10-302A from the collection.
The latest form for Health Eligibility Center (HEC) Income Verification (IV) Forms expires 2028-07-31 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Form and Instruction |
Form and Instruction |
Form and Instruction |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supporting Statement A |
| Revision of a currently approved collection | 2025-06-23 | ||
|
Approved without change |
Reinstatement with change of a previously approved collection | 2022-03-15 | |
|
Approved without change |
New collection (Request for a new OMB Control Number) | 2018-10-11 |
IRS-SSA Veteran Reported Income
Federal Enterprise Architecture: Health - Health Care Services
| Form 10-301 | IRS-SSA Veteran Reported Income | Fillable Printable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.