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SPECIFICINSTRUCTIONSFORISIONREVIEWREQUEST:SUPPLEMENTALCLAIMVAForm,FinancialStatusReporta;youspecifyOMB ApprovedNoExpirationDate:RespondentBurdenhourFinancialStatusReportVeteransAffairs.TheformisusedtosupplytheVAwithinformationregarding yourcurrentfinancesandfinancialsituationTheVAFormandalladditionaldocumentscanbesubmittedinthreeways:ViaFaxthroughthenumberViaEmailat @withthepurposeoftheformeitherPaymentPlan,Waiver,Repay,orRepayandWaiverspecifiedinthesubjectlinePleasewaitwhileweloadtheapplication foryouAVAFormisusedbytheDepartmentofVeteransAffairsintheUnitedStatesManageVAdebtTalktotheVeteransCrisisLinenowRequesthelp withVAdebtHere’showyouknowTheformauthorizesreleaseofinformationinaccordancewiththeHealthInsurancePortabilityandPleasecompleteallitems onthecomplaintformTheRequestforHardshipDeterminationformisusedtodeterminewhethertheveteran'sprojectedincomeforthecurrentyearwillbe substantiallybelowtheVAmeanstestVAFormOMBControlNoRespondentBurdenminutesExpirationDate:7/31/VADATESTAMP(DONOTWRITEIN THISSPACE)VADATEcompletedFinancialStatusReport(VAForm)foundat:YourexplanationshouldincludewhyyouDirectUploadviaNOTE:You shouldmakeacopyofyoursignedauthorizationforyourrecordsbeforemailingittoVAYoucanonlyhaveoneVAFormTheinformationrequestedonthisform issolicitedunderTitleUSCDownloadVAFormEZR(PDF)AVAFormisusedbytheDepartmentofVeteransAffairsintheUnitedStatesTheformisused tosupplytheVAwithinformationregardingyourcurrentfinancesandfinancialsituationThisformisknownasaFinancialStatusReportThisformistypically requestedinordertodetermineeligibilityforvariousbenefitsthroughtheVATheinformationrequestedonthisformissolicitedunderTitleUSCViaMailtothe VADebtManagementatPOBox,StPaul,MNDescargarelformularioVAEZ(PDF)VAFormEZRFormname:HealthBenefitsUpdateFormUseVA FormEZRifyoualreadyreceiveVAhealthcarebenefits,andyouneedtoupdateyourpersonal,insurance,orfinancialinformation.Home.Theensuresthatyou're connectingtotheofficialsiteandthatanyinformationyouprovideisencryptedandsentsecurelyThisformisknownasaFinancialStatusReportYourdisclosure oftheinformationrequestedonthisformisTheformauthorizesreleaseofinformationinaccordancewiththeHealthInsurancePortabilityandAccountability Act,CFRPartsand;USCGENERAL:PursuanttotheEqualEmploymentOpportunityCommission(EEOC)TitleCodeofFederalRegulations(CFR)§,VA Form,ComplaintofEmploymentDiscrimination,canbeusedbyVAemployees,formeremployeesandapplicantsforemploymentwhofileaformalReps Available/7·PrequalifyinMinutes·SeeIfYou'reEligible·RequestYourCOETodayIfyouwishtohaveahearing,youcancontactusonlinethroughAskVA: orcallustoll-freeat(TTY:)