EASEZRP2 ;ALB/AMA,TDM - Print 1010EZR, Cont., Page 2 ; 2/8/13 12:22pm
;;1.0;ENROLLMENT APPLICATION SYSTEM;**57,107**;Mar 15, 2001;Build 32
;
Q
;
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
;
N EASD
;
D HDR^EASEZRPF(.EALNE,.EAINFO)
S EASD=$NA(^TMP("EASEZR",$J,2))
;D PAP
;D FD
D DEP
D INC
D EXP
;
D FT^EASEZRPF(.EALNE,.EAINFO)
Q
;
PAP ; Print SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION
;
W !?34,"SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !?5,"The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the"
W !,"clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not"
W !,"required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by"
W !,"all individuals who must complete this form will average 24 minutes. This includes the time it will take to read instructions,"
W !,"gather the necessary facts and fill out the form."
W !?5,"Privacy Act Information: VA is asking you to provide the information on this form under 38 U.S.C. Sections 1710, 1712, and"
W !,"1722 in order for VA to determine your eligibility for medical benefits. Information you supply may be verified through a"
W !,"computer-matching program. VA may disclose the information that you put on the form as permitted by law. VA may make a ""routine"
W !,"use"" disclosure of the information as outlined in the Privacy Act systems of records notices and in accordance with the VHA Notice"
W !,"of Privacy Practices. Providing the requested information is voluntary, but if any or all of the requested information is not"
W !,"provided, it may delay or result in denial of your request for health care benefits. Failure to furnish the information will not"
W !,"have any affect on any other benefits to which you may be entitled. If you provide VA your Social Security Number, VA will use it"
;
W !,"to administer your VA benefits. VA may also use this information to identify veterans and persons claiming or receiving VA"
W !,"benefits and their records, and for other purposes authorized or required by law."
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
Q
;
FD ; Print VA 10-10EZR SECTION IV - FINANCIAL DISCLOSURE
;
W !?49,"SECTION IV - FINANCIAL DISCLOSURE"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"Disclosure allows VA to accurately determine whether certain Veterans will be charged copays for care and medications, their"
W !,"eligibility for other services and enrollment priority. Veterans are not required to disclose their financial information. Recent"
W !,"Combat Veterans (e.g., OEF/OIF/OND) like other Veterans may answer YES in Section IV and complete Sections V-VIII to have their"
W !,"priority for enrollment and financial eligibility for travel assistance, cost-free medications and/or medical care for services"
W !,"unrelated to military experience."
;
N EZRY,EZRN S (EZRY,EZRN)="___"
; IF NO ENTRY, THEN NO MEANS TEST, SO NO ANSWER
; IF @EASD@(998)="Y", THEN VET DECLINES TO GIVE INFO, SO ANSWER "NO"
I $D(@EASD@(998)) D
. S:@EASD@(998)="YES" EZRN=" X "
. S:@EASD@(998)="NO" EZRY=" X "
;
W !?3,EZRN," NO, I DO NOT WISH TO PROVIDE FINANCIAL INFORMATION IN SECTIONS V THROUGH VIII. If I am enrolled, I agree to pay applicable"
W !?7,"VA copayments. Sign and date the form in Section XI."
;
W !,?3,EZRY," YES, I WILL PROVIDE MY HOUSEHOLD FINANCIAL INFORMATION FOR LAST CALENDAR YEAR. Complete applicable Sections V through VIII."
W !?7,"Sign and date the form in Section XI."
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
Q
;
DEP ; Print out VA 10-10EZR Section V, Dependent Information
;
W !?24,"SECTION V - DEPENDENT INFORMATION (Use a separate sheet for additional dependents)"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1. SPOUSE'S NAME (Last, First, Middle Name)",?57,"|2. CHILD'S NAME (Last, First, Middle Name)"
W !?3,$P(@EASD@(1),U),?57,"| ",@EASD@(2) ;,?94,"| ",@EASD@(9)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1A. SPOUSE'S MAIDEN NAME",?57,"|2A. CHILD'S RELATIONSHIP TO YOU"
W !?4,$P(@EASD@(1),U,2),?57,"| ",@EASD@(9)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1B. SPOUSE'S SOCIAL SECURITY NUMBER",?57,"|2B. CHILD'S SOCIAL SECURITY NUMBER",?94,"|2C. DATE CHILD BECAME YOUR DEPENDENT"
W !,?4,@EASD@(3),?57,"| ",@EASD@(7),?94,"| (mm/dd/yyyy) ",@EASD@(11)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1C. SPOUSE'S DATE OF BIRTH",?30,"|1D. DATE OF MARRIAGE",?57,"|2D. CHILD'S DATE OF BIRTH (mm/dd/yyyy)"
W !,"(mm/dd/yyyy) ",@EASD@(4),?30,"|(mm/dd/yyyy) ",@EASD@(10),?57,"| ",@EASD@(5) ;,?84,"| DISABLED BEFORE THE AGE OF 18? ",@EASD@(14)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1E. SPOUSE'S ADDRESS AND TELEPHONE NUMBER (Street, City,",?57,"|2E. WAS CHILD PERMANENTLY AND TOTALLY DISABLED BEFORE THE AGE OF 18? "
W !,?4,"State, ZIP)",?57,"|"
I $E(@EASD@(14))="Y" W " X YES ___NO"
I $E(@EASD@(14))="N" W " ___YES X NO"
I ($E(@EASD@(14))'="N")&($E(@EASD@(14),1)'="Y") W " ___YES ___NO"
W !?4,$P(@EASD@(6),U),?57,"|",$E(EALNE("UL"),1,74)
W !?4,$P(@EASD@(6),U,2),?57,"|2F. IF CHILD IS BETWEEN 18 AND 23 YEARS OF AGE, DID CHILD ATTEND SCHOOL"
W !?4,@EASD@(8),?57,"| LAST CALENDAR YEAR? " ;,@EASD@(15)
I $E(@EASD@(15))="Y" W " X YES ___NO"
I $E(@EASD@(15))="N" W " ___YES X NO"
I ($E(@EASD@(15))'="N")&($E(@EASD@(15))'="Y") W " ___YES ___NO"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"3. IF YOUR SPOUSE OR DEPENDENT CHILD DID NOT LIVE WITH",?57,"|2G. EXPENSES PAID BY YOUR DEPENDENT CHILD FOR COLLEGE, VOCATIONAL"
W !?3,"YOU LAST YEAR, DID YOU PROVIDE SUPPORT?",?57,"| REHABILITATION OR TRAINING (e.g., tuition, books, materials)"
W !?20 I ('$P(@EASD@(12),U))&('$P(@EASD@(12),U)) W "___YES X NO"
I ($P(@EASD@(12),U))!($P(@EASD@(12),U)) W " X YES ___NO"
W ?57,"| $",@EASD@(13)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
Q
;
INC ; Print out VA 10-10EZ Section VI, Gross Annual Income information
;
I $G(EASDG),+@EASD@(999) W !?6,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN (INCOME YEAR: ",@EASD@(999),")"
E W !?17,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !?69,"|",?76,"VETERAN",?90,"|",?97,"SPOUSE",?110,"|",?117,"CHILD 1"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1. GROSS ANNUAL INCOME FROM EMPLOYMENT (e.g., wages, bonuses, tips)",?69,"| $ ",$P(@EASD@("2C1"),U),?90,"| $ ",$P(@EASD@("2C1"),U,2),?110,"| $ ",$P(@EASD@("2C1"),U,3)
W !?3,"EXCLUDING INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"|",?90,"|",?110,"|"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"2. NET INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"| $ ",$P(@EASD@("2C3"),U),?90,"| $ ",$P(@EASD@("2C3"),U,2),?110,"| $ ",$P(@EASD@("2C3"),U,3)
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"3. LIST OTHER INCOME AMOUNTS (e.g., Social Security, compensation,",?69,"| $ ",$P(@EASD@("2C2"),U),?90,"| $ ",$P(@EASD@("2C2"),U,2),?110,"| $ ",$P(@EASD@("2C2"),U,3)
W !?3,"pension, interest, dividends). EXCLUDING WELFARE",?69,"|",?90,"|",?110,"|"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
Q
;
EXP ; Print out VA 10-10EZR Section VIII, Deductible Expense Information
;
I $G(EASDG),+@EASD@(999) W !?26,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES (INCOME YEAR: ",@EASD@(999),")"
E W !?37,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"1. NON-REIMBURSED MEDICAL EXPENSES PAID BY YOU OR YOUR SPOUSE (e.g., payments for doctors, dentists,",?110,"| $ ",@EASD@("2D1")
W !,"medications, Medicare, health insurance, hospital and nursing home)",?110,"|"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"2. AMOUNT YOU PAID LAST CALENDAR YEAR FOR FUNERAL AND BURIAL EXPENSES FOR YOUR DECEASED SPOUSE OR DEPENDENT",?110,"| $ ",@EASD@("2D2")
W !,"CHILD (Also enter spouse or child's information in Section V.)",?110,"|"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
;
W !,"3. AMOUNT YOU PAID LAST CALENDAR YEAR FOR YOUR COLLEGE OR VOCATIONAL EDUCATIONAL EXPENSES (e.g., tuition,",?110,"| $ ",@EASD@("2D3")
W !,"books, fees, materials). DO NOT LIST YOUR DEPENDENTS' EDUCATIONAL EXPENSES.",?110,"|"
W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HEASEZRP2 9182 printed Sep 23, 2025@19:31:08 Page 2
EASEZRP2 ;ALB/AMA,TDM - Print 1010EZR, Cont., Page 2 ; 2/8/13 12:22pm
+1 ;;1.0;ENROLLMENT APPLICATION SYSTEM;**57,107**;Mar 15, 2001;Build 32
+2 ;
+3 QUIT
+4 ;
EN(EALNE,EAINFO,EASDG) ; Entry point, called from EN^EASEZRPF
+1 ; Input
+2 ; EALNE - Array of line formats for output
+3 ; EAINFO - Application Data array, see SETUP^EASEZRPF
+4 ; EASDG - Flag variable to signify request to print from DG options
+5 ;
+6 NEW EASD
+7 ;
+8 DO HDR^EASEZRPF(.EALNE,.EAINFO)
+9 SET EASD=$NAME(^TMP("EASEZR",$JOB,2))
+10 ;D PAP
+11 ;D FD
+12 DO DEP
+13 DO INC
+14 DO EXP
+15 ;
+16 DO FT^EASEZRPF(.EALNE,.EAINFO)
+17 QUIT
+18 ;
PAP ; Print SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION
+1 ;
+2 WRITE !?34,"SECTION IX - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION"
+3 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+4 ;
+5 WRITE !?5,"The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the"
+6 WRITE !,"clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not"
+7 WRITE !,"required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by"
+8 WRITE !,"all individuals who must complete this form will average 24 minutes. This includes the time it will take to read instructions,"
+9 WRITE !,"gather the necessary facts and fill out the form."
+10 WRITE !?5,"Privacy Act Information: VA is asking you to provide the information on this form under 38 U.S.C. Sections 1710, 1712, and"
+11 WRITE !,"1722 in order for VA to determine your eligibility for medical benefits. Information you supply may be verified through a"
+12 WRITE !,"computer-matching program. VA may disclose the information that you put on the form as permitted by law. VA may make a ""routine"
+13 WRITE !,"use"" disclosure of the information as outlined in the Privacy Act systems of records notices and in accordance with the VHA Notice"
+14 WRITE !,"of Privacy Practices. Providing the requested information is voluntary, but if any or all of the requested information is not"
+15 WRITE !,"provided, it may delay or result in denial of your request for health care benefits. Failure to furnish the information will not"
+16 WRITE !,"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"
+17 ;
+18 WRITE !,"to administer your VA benefits. VA may also use this information to identify veterans and persons claiming or receiving VA"
+19 WRITE !,"benefits and their records, and for other purposes authorized or required by law."
+20 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+21 QUIT
+22 ;
FD ; Print VA 10-10EZR SECTION IV - FINANCIAL DISCLOSURE
+1 ;
+2 WRITE !?49,"SECTION IV - FINANCIAL DISCLOSURE"
+3 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+4 ;
+5 WRITE !,"Disclosure allows VA to accurately determine whether certain Veterans will be charged copays for care and medications, their"
+6 WRITE !,"eligibility for other services and enrollment priority. Veterans are not required to disclose their financial information. Recent"
+7 WRITE !,"Combat Veterans (e.g., OEF/OIF/OND) like other Veterans may answer YES in Section IV and complete Sections V-VIII to have their"
+8 WRITE !,"priority for enrollment and financial eligibility for travel assistance, cost-free medications and/or medical care for services"
+9 WRITE !,"unrelated to military experience."
+10 ;
+11 NEW EZRY,EZRN
SET (EZRY,EZRN)="___"
+12 ; IF NO ENTRY, THEN NO MEANS TEST, SO NO ANSWER
+13 ; IF @EASD@(998)="Y", THEN VET DECLINES TO GIVE INFO, SO ANSWER "NO"
+14 IF $DATA(@EASD@(998))
Begin DoDot:1
+15 if @EASD@(998)="YES"
SET EZRN=" X "
+16 if @EASD@(998)="NO"
SET EZRY=" X "
End DoDot:1
+17 ;
+18 WRITE !?3,EZRN," NO, I DO NOT WISH TO PROVIDE FINANCIAL INFORMATION IN SECTIONS V THROUGH VIII. If I am enrolled, I agree to pay applicable"
+19 WRITE !?7,"VA copayments. Sign and date the form in Section XI."
+20 ;
+21 WRITE !,?3,EZRY," YES, I WILL PROVIDE MY HOUSEHOLD FINANCIAL INFORMATION FOR LAST CALENDAR YEAR. Complete applicable Sections V through VIII."
+22 WRITE !?7,"Sign and date the form in Section XI."
+23 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+24 QUIT
+25 ;
DEP ; Print out VA 10-10EZR Section V, Dependent Information
+1 ;
+2 WRITE !?24,"SECTION V - DEPENDENT INFORMATION (Use a separate sheet for additional dependents)"
+3 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+4 ;
+5 WRITE !,"1. SPOUSE'S NAME (Last, First, Middle Name)",?57,"|2. CHILD'S NAME (Last, First, Middle Name)"
+6 ;,?94,"| ",@EASD@(9)
WRITE !?3,$PIECE(@EASD@(1),U),?57,"| ",@EASD@(2)
+7 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+8 ;
+9 WRITE !,"1A. SPOUSE'S MAIDEN NAME",?57,"|2A. CHILD'S RELATIONSHIP TO YOU"
+10 WRITE !?4,$PIECE(@EASD@(1),U,2),?57,"| ",@EASD@(9)
+11 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+12 ;
+13 WRITE !,"1B. SPOUSE'S SOCIAL SECURITY NUMBER",?57,"|2B. CHILD'S SOCIAL SECURITY NUMBER",?94,"|2C. DATE CHILD BECAME YOUR DEPENDENT"
+14 WRITE !,?4,@EASD@(3),?57,"| ",@EASD@(7),?94,"| (mm/dd/yyyy) ",@EASD@(11)
+15 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+16 ;
+17 WRITE !,"1C. SPOUSE'S DATE OF BIRTH",?30,"|1D. DATE OF MARRIAGE",?57,"|2D. CHILD'S DATE OF BIRTH (mm/dd/yyyy)"
+18 ;,?84,"| DISABLED BEFORE THE AGE OF 18? ",@EASD@(14)
WRITE !,"(mm/dd/yyyy) ",@EASD@(4),?30,"|(mm/dd/yyyy) ",@EASD@(10),?57,"| ",@EASD@(5)
+19 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+20 ;
+21 WRITE !,"1E. SPOUSE'S ADDRESS AND TELEPHONE NUMBER (Street, City,",?57,"|2E. WAS CHILD PERMANENTLY AND TOTALLY DISABLED BEFORE THE AGE OF 18? "
+22 WRITE !,?4,"State, ZIP)",?57,"|"
+23 IF $EXTRACT(@EASD@(14))="Y"
WRITE " X YES ___NO"
+24 IF $EXTRACT(@EASD@(14))="N"
WRITE " ___YES X NO"
+25 IF ($EXTRACT(@EASD@(14))'="N")&($EXTRACT(@EASD@(14),1)'="Y")
WRITE " ___YES ___NO"
+26 WRITE !?4,$PIECE(@EASD@(6),U),?57,"|",$EXTRACT(EALNE("UL"),1,74)
+27 WRITE !?4,$PIECE(@EASD@(6),U,2),?57,"|2F. IF CHILD IS BETWEEN 18 AND 23 YEARS OF AGE, DID CHILD ATTEND SCHOOL"
+28 ;,@EASD@(15)
WRITE !?4,@EASD@(8),?57,"| LAST CALENDAR YEAR? "
+29 IF $EXTRACT(@EASD@(15))="Y"
WRITE " X YES ___NO"
+30 IF $EXTRACT(@EASD@(15))="N"
WRITE " ___YES X NO"
+31 IF ($EXTRACT(@EASD@(15))'="N")&($EXTRACT(@EASD@(15))'="Y")
WRITE " ___YES ___NO"
+32 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+33 ;
+34 WRITE !,"3. IF YOUR SPOUSE OR DEPENDENT CHILD DID NOT LIVE WITH",?57,"|2G. EXPENSES PAID BY YOUR DEPENDENT CHILD FOR COLLEGE, VOCATIONAL"
+35 WRITE !?3,"YOU LAST YEAR, DID YOU PROVIDE SUPPORT?",?57,"| REHABILITATION OR TRAINING (e.g., tuition, books, materials)"
+36 WRITE !?20
IF ('$PIECE(@EASD@(12),U))&('$PIECE(@EASD@(12),U))
WRITE "___YES X NO"
+37 IF ($PIECE(@EASD@(12),U))!($PIECE(@EASD@(12),U))
WRITE " X YES ___NO"
+38 WRITE ?57,"| $",@EASD@(13)
+39 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+40 QUIT
+41 ;
INC ; Print out VA 10-10EZ Section VI, Gross Annual Income information
+1 ;
+2 IF $GET(EASDG)
IF +@EASD@(999)
WRITE !?6,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN (INCOME YEAR: ",@EASD@(999),")"
+3 IF '$TEST
WRITE !?17,"SECTION VI - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN"
+4 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+5 ;
+6 WRITE !?69,"|",?76,"VETERAN",?90,"|",?97,"SPOUSE",?110,"|",?117,"CHILD 1"
+7 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+8 ;
+9 WRITE !,"1. GROSS ANNUAL INCOME FROM EMPLOYMENT (e.g., wages, bonuses, tips)",?69,"| $ ",$PIECE(@EASD@("2C1"),U),?90,"| $ ",$PIECE(@EASD@("2C1"),U,2),?110,"| $ ",$PIECE(@EASD@("2C1"),U,3)
+10 WRITE !?3,"EXCLUDING INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"|",?90,"|",?110,"|"
+11 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+12 ;
+13 WRITE !,"2. NET INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"| $ ",$PIECE(@EASD@("2C3"),U),?90,"| $ ",$PIECE(@EASD@("2C3"),U,2),?110,"| $ ",$PIECE(@EASD@("2C3"),U,3)
+14 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+15 ;
+16 WRITE !,"3. LIST OTHER INCOME AMOUNTS (e.g., Social Security, compensation,",?69,"| $ ",$PIECE(@EASD@("2C2"),U),?90,"| $ ",$PIECE(@EASD@("2C2"),U,2),?110,"| $ ",$PIECE(@EASD@("2C2"),U,3)
+17 WRITE !?3,"pension, interest, dividends). EXCLUDING WELFARE",?69,"|",?90,"|",?110,"|"
+18 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+19 QUIT
+20 ;
EXP ; Print out VA 10-10EZR Section VIII, Deductible Expense Information
+1 ;
+2 IF $GET(EASDG)
IF +@EASD@(999)
WRITE !?26,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES (INCOME YEAR: ",@EASD@(999),")"
+3 IF '$TEST
WRITE !?37,"SECTION VII - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES"
+4 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+5 ;
+6 WRITE !,"1. NON-REIMBURSED MEDICAL EXPENSES PAID BY YOU OR YOUR SPOUSE (e.g., payments for doctors, dentists,",?110,"| $ ",@EASD@("2D1")
+7 WRITE !,"medications, Medicare, health insurance, hospital and nursing home)",?110,"|"
+8 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+9 ;
+10 WRITE !,"2. AMOUNT YOU PAID LAST CALENDAR YEAR FOR FUNERAL AND BURIAL EXPENSES FOR YOUR DECEASED SPOUSE OR DEPENDENT",?110,"| $ ",@EASD@("2D2")
+11 WRITE !,"CHILD (Also enter spouse or child's information in Section V.)",?110,"|"
+12 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+13 ;
+14 WRITE !,"3. AMOUNT YOU PAID LAST CALENDAR YEAR FOR YOUR COLLEGE OR VOCATIONAL EDUCATIONAL EXPENSES (e.g., tuition,",?110,"| $ ",@EASD@("2D3")
+15 WRITE !,"books, fees, materials). DO NOT LIST YOUR DEPENDENTS' EDUCATIONAL EXPENSES.",?110,"|"
+16 WRITE ?131,$CHAR(13)
if EALNE("ULC")="-"
WRITE !
WRITE EALNE("UL")
+17 QUIT
