2900-0091_Non-Substantive Change Memorandum_VA Forms 10-10EZ 10-10EZR_PACT Act-Sect 103 updates - 02292024

Department of
Veterans Affairs

Memorandum

Date:

February 29, 2023

From:

Lisa Rosenmerkel, Acting VA Chief Data Officer & Executive Director
for Data Governance & Analytics
Office of Enterprise Integration

Subject:

Non-Substantive Changes for OMB Control No. 2900-0091

To:

VA Desk Officer, Office of Management & Budget (OMB)

Cc:

VA PRA Clearance Officer, Maribel Aponte
Data Governance & Analytics, Office of Enterprise and Integration

The following are updates and new information for OMB Control No. 2900-0091:
VA Forms 10-10EZ and 10-10EZR have been updated pursuant to Section 103 of Public Law
117-168, titled Sergeant First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics (PACT) Act of 2022, to capture expansion of the health care eligibility
benefit for Veterans who may have experienced toxic exposure risk activity (TERA) during their
military service.
a. Updates: The program office has made the following updates to VA Forms 10-10EZ
and 10-10EZR, as described below:
i.

ii.
iii.
iv.
v.

vi.

Updated estimated average burden for each form:
1. 10-10EZ: changed from 30 min to 35 min.
2. 10-10EZR: changed from 24 min to 27 min.
Updated Military Service Information Section on the 10-10EZ:
1. Ques 2, removed sub-questions G – J.
Updated the website address for questions in the Instructions on the 10-10EZR.
Renumbered the Sections in the Instructions on the 10-10EZR based on the new
section added.
Updated the return address on both forms:
1. 10-10EZ: updated under Submitting Your Application.
2. 10-10EZR: updated under the Where do I mail my update?
Updated the Instructions for Section II Military Service Information on the 1010EZ.

vii.

Updated the verbiage in the Dependent Information for expenses paid by a
dependent child on each form:
1. 10-10EZ: Section IV – Dependent Information, Ques 2g.
2. 10-10EZR: Section IV – Dependent Information, Ques 14.

b. Supplementary Documents: The currently approved and updated versions of VA
Forms 10-10EZ and 10-10EZR are included with this request. The updated Supporting
Statement A also is included, which describes the form changes and the associated de
minimis change in the estimated average burden for each form.
c. New Information:
i.
Military Service Information section:
1. 10-10EZ: added Ques 3 a – e.
2. 10-10EZR: added Section III Military Service Information.
ii.
Added the Instructions for Section III Military Service Information on the 1010EZR.
iii.
Added Definitions for TERA and Reportable Income to each form:
1. 10-10EZ: added under Definitions of terms used on this form.
2. 10-10EZR: added under Definitions of terms used on this form.
iv.
Added a bullet for TERA in Section VI – Financial Disclosure in the Instructions
on the 10-10EZ.

_____________________________
Signature

2/29/2024