Supporting Statement Regarding Marriage

ICR 201103-2900-013

OMB: 2900-0115

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2011-06-03
IC Document Collections
IC ID
Document
Title
Status
28317 Modified
ICR Details
2900-0115 201103-2900-013
Historical Active 200712-2900-015
VA 2900-0115
Supporting Statement Regarding Marriage
Extension without change of a currently approved collection   No
Regular
Approved without change 08/12/2011
Retrieve Notice of Action (NOA) 06/24/2011
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved 08/31/2011
2,400 0 2,400
800 0 800
0 0 0

VA Form 21-4171 is used to gather information that is needed to determine veteran's spouses' eligibility for benefits based on a common law marital relationship.

US Code: 38 USC 103 Name of Law: Special provisions relating to marriages
  
None

Not associated with rulemaking

  76 FR 53 03/18/2011
76 FR 105 06/01/2011
No

1
IC Title Form No. Form Name
Supporting Statement Regarding Marriage VA Form 21-4171 Supporting Statement Regarding Marriage

  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 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 800 800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$54,167
No
No
No
No
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.
06/24/2011


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