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Routine: EASEZRP2

Package: Enrollment Application System

Routine: EASEZRP2


Information

EASEZRP2 ;ALB/AMA,TDM - Print 1010EZR, Cont., Page 2 ; 2/8/13 12:22pm

Source Information

Source file <EASEZRP2.m>

Entry Points

Name Comments DBIA/ICR reference
EN(EALNE,EAINFO,EASDG) ; Entry point, called from EN^EASEZRPF
; Input
; EALNE - Array of line formats for output
; EAINFO - Application Data array, see SETUP^EASEZRPF
; EASDG - Flag variable to signify request to print from DG options
PAP ; Print SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION
FD ; Print VA 10-10EZR SECTION IV - FINANCIAL DISCLOSURE
DEP ; Print out VA 10-10EZR Section V, Dependent Information
INC ; Print out VA 10-10EZ Section VI, Gross Annual Income information
EXP ; Print out VA 10-10EZR Section VIII, Deductible Expense Information

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !?34,"SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION"
  • Line Location: PAP+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: !?5,"The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the"
  • Line Location: PAP+5
Function Call: WRITE
  • Prompt: !,"clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not"
  • Line Location: PAP+6
Function Call: WRITE
  • Prompt: !,"required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by"
  • Line Location: PAP+7
Function Call: WRITE
  • Prompt: !,"all individuals who must complete this form will average 24 minutes. This includes the time it will take to read instructions,"
  • Line Location: PAP+8
Function Call: WRITE
  • Prompt: !,"gather the necessary facts and fill out the form."
  • Line Location: PAP+9
Function Call: WRITE
  • Prompt: !?5,"Privacy Act Information: VA is asking you to provide the information on this form under 38 U.S.C. Sections 1710, 1712, and"
  • Line Location: PAP+10
Function Call: WRITE
  • Prompt: !,"1722 in order for VA to determine your eligibility for medical benefits. Information you supply may be verified through a"
  • Line Location: PAP+11
Function Call: WRITE
  • Prompt: !,"computer-matching program. VA may disclose the information that you put on the form as permitted by law. VA may make a ""routine"
  • Line Location: PAP+12
Function Call: WRITE
  • Prompt: !,"use"" disclosure of the information as outlined in the Privacy Act systems of records notices and in accordance with the VHA Notice"
  • Line Location: PAP+13
Function Call: WRITE
  • Prompt: !,"of Privacy Practices. Providing the requested information is voluntary, but if any or all of the requested information is not"
  • Line Location: PAP+14
Function Call: WRITE
  • Prompt: !,"provided, it may delay or result in denial of your request for health care benefits. Failure to furnish the information will not"
  • Line Location: PAP+15
Function Call: WRITE
  • Prompt: !,"have any affect on any other benefits to which you may be entitled. If you provide VA your Social Security Number, VA will use it"
  • Line Location: PAP+16
Function Call: WRITE
  • Prompt: !,"to administer your VA benefits. VA may also use this information to identify veterans and persons claiming or receiving VA"
  • Line Location: PAP+18
Function Call: WRITE
  • Prompt: !,"benefits and their records, and for other purposes authorized or required by law."
  • Line Location: PAP+19
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: PAP+20
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: PAP+20
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: PAP+20
Function Call: WRITE
  • Prompt: !?49,"SECTION IV - FINANCIAL DISCLOSURE"
  • Line Location: FD+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: FD+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: FD+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: FD+3
Function Call: WRITE
  • Prompt: !,"Disclosure allows VA to accurately determine whether certain Veterans will be charged copays for care and medications, their"
  • Line Location: FD+5
Function Call: WRITE
  • Prompt: !,"eligibility for other services and enrollment priority. Veterans are not required to disclose their financial information. Recent"
  • Line Location: FD+6
Function Call: WRITE
  • Prompt: !,"Combat Veterans (e.g., OEF/OIF/OND) like other Veterans may answer YES in Section IV and complete Sections V-VIII to have their"
  • Line Location: FD+7
Function Call: WRITE
  • Prompt: !,"priority for enrollment and financial eligibility for travel assistance, cost-free medications and/or medical care for services"
  • Line Location: FD+8
Function Call: WRITE
  • Prompt: !,"unrelated to military experience."
  • Line Location: FD+9
Function Call: WRITE
  • Prompt: !?3,EZRN," NO, I DO NOT WISH TO PROVIDE FINANCIAL INFORMATION IN SECTIONS V THROUGH VIII. If I am enrolled, I agree to pay applicable"
  • Line Location: FD+18
Function Call: WRITE
  • Prompt: !?7,"VA copayments. Sign and date the form in Section XI."
  • Line Location: FD+19
Function Call: WRITE
  • Prompt: !,?3,EZRY," YES, I WILL PROVIDE MY HOUSEHOLD FINANCIAL INFORMATION FOR LAST CALENDAR YEAR. Complete applicable Sections V through VIII."
  • Line Location: FD+21
Function Call: WRITE
  • Prompt: !?7,"Sign and date the form in Section XI."
  • Line Location: FD+22
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: FD+23
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: FD+23
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: FD+23
Function Call: WRITE
  • Prompt: !?24,"SECTION V - DEPENDENT INFORMATION (Use a separate sheet for additional dependents)"
  • Line Location: DEP+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+3
Function Call: WRITE
  • Prompt: !,"1. SPOUSE'S NAME (Last, First, Middle Name)",?57,"|2. CHILD'S NAME (Last, First, Middle Name)"
  • Line Location: DEP+5
Function Call: WRITE
  • Prompt: !?3,$P(@EASD@(1),U),?57,"| ",@EASD@(2)
  • Line Location: DEP+6
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+7
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+7
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+7
Function Call: WRITE
  • Prompt: !,"1A. SPOUSE'S MAIDEN NAME",?57,"|2A. CHILD'S RELATIONSHIP TO YOU"
  • Line Location: DEP+9
Function Call: WRITE
  • Prompt: !?4,$P(@EASD@(1),U,2),?57,"| ",@EASD@(9)
  • Line Location: DEP+10
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+11
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+11
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+11
Function Call: WRITE
  • Prompt: !,"1B. SPOUSE'S SOCIAL SECURITY NUMBER",?57,"|2B. CHILD'S SOCIAL SECURITY NUMBER",?94,"|2C. DATE CHILD BECAME YOUR DEPENDENT"
  • Line Location: DEP+13
Function Call: WRITE
  • Prompt: !,?4,@EASD@(3),?57,"| ",@EASD@(7),?94,"| (mm/dd/yyyy) ",@EASD@(11)
  • Line Location: DEP+14
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+15
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+15
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+15
Function Call: WRITE
  • Prompt: !,"1C. SPOUSE'S DATE OF BIRTH",?30,"|1D. DATE OF MARRIAGE",?57,"|2D. CHILD'S DATE OF BIRTH (mm/dd/yyyy)"
  • Line Location: DEP+17
Function Call: WRITE
  • Prompt: !,"(mm/dd/yyyy) ",@EASD@(4),?30,"|(mm/dd/yyyy) ",@EASD@(10),?57,"| ",@EASD@(5)
  • Line Location: DEP+18
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+19
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+19
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+19
Function Call: WRITE
  • Prompt: !,"1E. SPOUSE'S ADDRESS AND TELEPHONE NUMBER (Street, City,",?57,"|2E. WAS CHILD PERMANENTLY AND TOTALLY DISABLED BEFORE THE AGE OF 18? "
  • Line Location: DEP+21
Function Call: WRITE
  • Prompt: !,?4,"State, ZIP)",?57,"|"
  • Line Location: DEP+22
Function Call: WRITE
  • Prompt: " X YES ___NO"
  • Line Location: DEP+23
Function Call: WRITE
  • Prompt: " ___YES X NO"
  • Line Location: DEP+24
Function Call: WRITE
  • Prompt: " ___YES ___NO"
  • Line Location: DEP+25
Function Call: WRITE
  • Prompt: !?4,$P(@EASD@(6),U),?57,"|",$E(EALNE("UL"),1,74)
  • Line Location: DEP+26
Function Call: WRITE
  • Prompt: !?4,$P(@EASD@(6),U,2),?57,"|2F. IF CHILD IS BETWEEN 18 AND 23 YEARS OF AGE, DID CHILD ATTEND SCHOOL"
  • Line Location: DEP+27
Function Call: WRITE
  • Prompt: !?4,@EASD@(8),?57,"| LAST CALENDAR YEAR? "
  • Line Location: DEP+28
Function Call: WRITE
  • Prompt: " X YES ___NO"
  • Line Location: DEP+29
Function Call: WRITE
  • Prompt: " ___YES X NO"
  • Line Location: DEP+30
Function Call: WRITE
  • Prompt: " ___YES ___NO"
  • Line Location: DEP+31
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+32
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+32
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+32
Function Call: WRITE
  • Prompt: !,"3. IF YOUR SPOUSE OR DEPENDENT CHILD DID NOT LIVE WITH",?57,"|2G. EXPENSES PAID BY YOUR DEPENDENT CHILD FOR COLLEGE, VOCATIONAL"
  • Line Location: DEP+34
Function Call: WRITE
  • Prompt: !?3,"YOU LAST YEAR, DID YOU PROVIDE SUPPORT?",?57,"| REHABILITATION OR TRAINING (e.g., tuition, books, materials)"
  • Line Location: DEP+35
Function Call: WRITE
  • Prompt: !?20
  • Line Location: DEP+36
Function Call: WRITE
  • Prompt: "___YES X NO"
  • Line Location: DEP+36
Function Call: WRITE
  • Prompt: " X YES ___NO"
  • Line Location: DEP+37
Function Call: WRITE
  • Prompt: ?57,"| $",@EASD@(13)
  • Line Location: DEP+38
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEP+39
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEP+39
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEP+39
Function Call: WRITE
  • Prompt: !?6,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN (INCOME YEAR: ",@EASD@(999),")"
  • Line Location: INC+2
Function Call: WRITE
  • Prompt: !?17,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN"
  • Line Location: INC+3
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INC+4
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INC+4
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INC+4
Function Call: WRITE
  • Prompt: !?69,"|",?76,"VETERAN",?90,"|",?97,"SPOUSE",?110,"|",?117,"CHILD 1"
  • Line Location: INC+6
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INC+7
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INC+7
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INC+7
Function Call: WRITE
  • Prompt: !,"1. GROSS ANNUAL INCOME FROM EMPLOYMENT (e.g., wages, bonuses, tips)",?69,"| $ ",$P(@EASD@("2C1"),U),?90,"| $ ",$P(@EASD@("2C1"),U,2),?110,"| $ ",$P(@EASD@("2C1"),U,3)
  • Line Location: INC+9
Function Call: WRITE
  • Prompt: !?3,"EXCLUDING INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"|",?90,"|",?110,"|"
  • Line Location: INC+10
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INC+11
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INC+11
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INC+11
Function Call: WRITE
  • Prompt: !,"2. NET INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"| $ ",$P(@EASD@("2C3"),U),?90,"| $ ",$P(@EASD@("2C3"),U,2),?110,"| $ ",$P(@EASD@("2C3"),U,3)
  • Line Location: INC+13
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INC+14
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INC+14
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INC+14
Function Call: WRITE
  • Prompt: !,"3. LIST OTHER INCOME AMOUNTS (e.g., Social Security, compensation,",?69,"| $ ",$P(@EASD@("2C2"),U),?90,"| $ ",$P(@EASD@("2C2"),U,2),?110,"| $ ",$P(@EASD@("2C2"),U,3)
  • Line Location: INC+16
Function Call: WRITE
  • Prompt: !?3,"pension, interest, dividends). EXCLUDING WELFARE",?69,"|",?90,"|",?110,"|"
  • Line Location: INC+17
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INC+18
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INC+18
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INC+18
Function Call: WRITE
  • Prompt: !?26,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES (INCOME YEAR: ",@EASD@(999),")"
  • Line Location: EXP+2
Function Call: WRITE
  • Prompt: !?37,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES"
  • Line Location: EXP+3
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+4
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+4
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+4
Function Call: WRITE
  • Prompt: !,"1. NON-REIMBURSED MEDICAL EXPENSES PAID BY YOU OR YOUR SPOUSE (e.g., payments for doctors, dentists,",?110,"| $ ",@EASD@("2D1")
  • Line Location: EXP+6
Function Call: WRITE
  • Prompt: !,"medications, Medicare, health insurance, hospital and nursing home)",?110,"|"
  • Line Location: EXP+7
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+8
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+8
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+8
Function Call: WRITE
  • Prompt: !,"2. AMOUNT YOU PAID LAST CALENDAR YEAR FOR FUNERAL AND BURIAL EXPENSES FOR YOUR DECEASED SPOUSE OR DEPENDENT",?110,"| $ ",@EASD@("2D2")
  • Line Location: EXP+10
Function Call: WRITE
  • Prompt: !,"CHILD (Also enter spouse or child's information in Section V.)",?110,"|"
  • Line Location: EXP+11
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: !,"3. AMOUNT YOU PAID LAST CALENDAR YEAR FOR YOUR COLLEGE OR VOCATIONAL EDUCATIONAL EXPENSES (e.g., tuition,",?110,"| $ ",@EASD@("2D3")
  • Line Location: EXP+14
Function Call: WRITE
  • Prompt: !,"books, fees, materials). DO NOT LIST YOUR DEPENDENTS' EDUCATIONAL EXPENSES.",?110,"|"
  • Line Location: EXP+15
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+16
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+16
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+16
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