VA FORM MAR 2015 10-10HS Page 1 HARDSHIP DETERMINATION to be completed by VA Hardship Granted circle one YES Hardship is granted Note The exemption is effective from the date the Veteran submitted the request until the last day of the calendar year in which the request was made. Request for Hardship Determination The Request for Hardship Determination form is used to determine whether the veteran s projected income for the current year will be substantially below the VA means test threshold due to a loss of income or increase in allowable deductible expenses. NO State reason not granted in comments. Date Veteran s electronic record updated in VA s information system VHA Staff Signature Date COMMENTS Document and/or attach any pertinent information impacting on the final decision. VETERAN NOTIFICATION Date Veteran Notified If hardship not granted provide Veteran with VA Form 4107VHA YOUR RIGHTS TO APPEAL OUR DECISION. PAGE 2. Veterans determined to have a financial hardship will be exem....
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How to fill out the VA 10-10HS online
The VA 10-10HS form is used to request a hardship determination, allowing veterans who face financial challenges to qualify for certain medical benefits. This guide provides a clear step-by-step approach to completing the form online, ensuring you can accurately convey your financial situation.
Follow the steps to successfully complete the form
- Click ‘Get Form’ button to obtain the VA 10-10HS form and open it in your preferred editing software.
- Begin filling out the form by entering your name in the 'Veteran's name' section. Ensure to provide your last name, first name, and middle name.
- Provide your Social Security number in the corresponding field to assist in identifying your record.
- Fill in your permanent address, including street, city, state, county, and zip code.
- Enter your home telephone number and, if applicable, your cellular telephone number, both including area codes.
- Indicate the reason for your hardship request by checking all applicable boxes. For each selected reason, add a detailed explanation as needed.
- Provide your projected household income for the current calendar year, detailing gross income from various sources, and include income for your spouse and children if applicable.
- List any non-reimbursed deductible expenses, such as medical bills, funeral costs, or educational expenses for the veteran.
- Review all completed sections for accuracy, ensuring all required information is provided.
- Once satisfied with your entries, you can save your changes, download the filled form, print it for physical submission, or share it as required.
Take the next step in securing your benefits by completing the VA 10-10HS online today.
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