OMB
.report
Search
Marital Status Questionnaire
Marital Status Questionnaire
OMB: 2900-0495
IC ID: 28678
OMB.report
VA
OMB 2900-0495
ICR 201002-2900-012
IC 28678
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0495 can be found here:
2022-06-07 - Revision of a currently approved collection
2019-05-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 21-0537
Marital Status Questionnaire
Form
21-0537 Marital Status Questionnaire
21-0537.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Marital Status Questionnaire
Agency IC Tracking Number:
2900-0495
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
21-0537
Marital Status Questionnaire
21-0537.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Legislative Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,270
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,270
0
0
0
0
2,270
Annual IC Time Burden (Hours)
189
0
0
0
0
189
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.