File 1010EZ_HOLDING(712) Data List
| APPLICATION # |
WEB SUBMISSION ID |
RELATED MESSAGE # |
APPLICANT NAME |
DATA ELEMENTS |
SERVICES REQUESTED |
COMMENTS |
APPLICANT SSN&DOB |
ENTRY DATE |
ENTERED BY |
SOURCE |
VETERAN TYPE |
LINK TO FILE #2 |
NEW PATIENT |
VERSION # |
EXPECT COPY FROM VET |
FINANCIAL DISCLOSURE |
DATE SIGNED BY APPLICANT |
VERIFY DATE |
VERIFIED BY |
APPLICANT E-MAIL |
APPOINTMENT REQUESTED |
APPLYING TO |
REVIEW DATE |
REVIEWED BY |
PRINT DATE |
PRINTED BY |
FILING DATE |
FILED BY |
UPDATE DATE |
UPDATED BY |
CLOSE DATE |
CLOSED BY |
FILING TASK |