PDF-Letter of approval will state this amount subject to amendment for i

DATE mmddyyyySIGNATURE OF APPROVING OFFICIAL HISA COMMITTEE CHAIRMAN PROSTHETIC REPRESENTATIVE CHIEF of PROSTHETICS 100103Page 2 of 2 VA FORM JUN 2015 ADVANCE PAYMENT

application information improvements alterations information application alterations improvements structural form amount yyyy date type veteran improvement disability applicant hisa

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