Marital Status Questionnaire

ICR 201002-2900-012

OMB: 2900-0495

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2010-06-04
IC Document Collections
IC ID
Document
Title
Status
28678 Modified
ICR Details
2900-0495 201002-2900-012
Historical Active 200706-2900-037
VA 2900-0495
Marital Status Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 08/03/2010
Retrieve Notice of Action (NOA) 06/10/2010
  Inventory as of this Action Requested Previously Approved
08/31/2013 36 Months From Approved 08/31/2010
2,270 0 2,270
189 0 189
0 0 0

VA Form 21-0537 is necessary to determine whether a surviving spouse is still entitled to DIC benefits.

US Code: 38 USC 6102 Name of Law: Fraudulent acceptance of payments
   US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
  
None

Not associated with rulemaking

  75 FR 42 03/04/2010
75 FR 90 05/11/2010
No

1
IC Title Form No. Form Name
Marital Status Questionnaire 21-0537 Marital Status Questionnaire

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,270 2,270 0 0 0 0
Annual Time Burden (Hours) 189 189 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The increase in the reporting burden is due to each DIC recipient under age 57 receiving VA Form 21-0537 approximately once every eight years.

$4,917
No
No
No
Uncollected
No
Uncollected
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/10/2010


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