Form VA Form 26-1817 VA Form 26-1817 Request for Determination of Loan Guaranty Eligibility -

OMB Approved No. 2900-0055
Respondent Burden: 15 minutes
Expiration Date: XX/XX/XXXX

REQUEST FOR DETERMINATION OF LOAN GUARANTY
ELIGIBILITY - UNMARRIED SURVIVING SPOUSES

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code
of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of records, 55VA26, Loan Guaranty Home,
Condominium and manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal
Register. Your obligation to respond is required in order to determine the surviving spouse's qualifications for a loan.
RESPONDENT BURDEN: We need this information to determine a surviving spouse's qualifications for a VA-guaranteed home loan. Title 38, U.S.C., section 3702 authorizes collection of
this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of
information unless a valid OMB control number is displayed. You are not required to respond to a collection of information is not displayed. Valid OMB control numbers can be located on the
OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
IMPORTANT: Complete this form if applying for home loan benefits as an unmarried surviving
spouse of a veteran whose death was service-connected. (Note: In some cases, surviving spouses
who remarry on or after age 57 may have eligibility.) DO NOT complete this form if requesting
restoration of previously used home loan benefit entitlement. Instead, complete VA Form 1880,
Request for a Certificate of Eligibility.

Atlanta Regional Loan Center
Attn: COE (262)
TO P. O. Box 100034
Decatur, GA 30031

PART I - (To be completed by the applicant)

1A. NAME AND ADDRESS OF APPLICANT (Unmarried surviving spouse)

4. FIRST, MIDDLE, LAST NAME OF VETERAN
6. LOCATION OF VA CLAIMS FILE (If known)

5. VA FILE NO.

xc-

1B. APPLICANT'S DAYTIME TELEPHONE NO. (Including area code)

7. VETERAN'S SERVICE NO.

2. APPLICANT'S BIRTH DATE

9. DATE OF VETERAN'S DEATH

NOTE: If you have had active military duty complete Items 3A, 3B and 3C below.
3A. BRANCH OF SERVICE

8. VETERAN'S BRANCH OF SERVICE

10. PERIODS OF DECEASED VETERAN'S MILITARY DUTY

3B. SERVICE NUMBER

A. FROM

B. TO

3C. PERIODS OF SERVICE
11A. HAVE YOU PREVIOUSLY APPLIED FOR DETERMINATION OF YOUR ELIGIBILITY FOR
LOAN GUARANTY BENEFITS?
YES

NO

LOCATION OF VA OFFICE
11B.

(If "Yes," complete Item 11B)

12A. HAVE YOU PREVIOUSLY RECEIVED A CERTIFICATE OF ELIGIBILITY FOR SUCH BENEFITS?
YES

NO

13A. HAVE YOU PREVIOUSLY SECURED A VA DIRECT, GUARANTEED OR INSURED LOAN?
YES

NO

12B.

(If "Yes," complete Item 12B)
13B.

(If "Yes," complete Item 13B)

IMPORTANT: If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your
spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you became eligible for benefits.)
(38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is available at http://www.va.gov/opa/marriage/.
CERTIFICATION: I CERTIFY THAT the above information is true and accurate to the best of my knowledge and belief.
14. SIGNATURE OF APPLICANT (Unmarried surviving spouse)

15. DATE

Federal statutes provide severe penalties for fraud, intentional misrepresentation or criminal connivance or conspiracy to influence the issuance of my guaranty or
insurance or the granting of any loan by the Department of Veterans Affairs.

PART II - FOR VA USE ONLY
SECTION A

TO

(Complete
address)

Adjudication Officer
Department of Veteran Affairs
Regional Office/Center

Loan Guaranty Officer

RETURN Department of Veterans Affairs
Regional Office/Center
TO

(After
completion of
Section B)

The foregoing request for determination of eligibility
is forwarded to you for appropriate action and
completion of Section B.

16. SIGNATURE OF LOAN GUARANTY OFFICER OR DESIGNEE

17.DATE

SECTION B
18A. CHECK APPROPRIATE BOX(ES)
THE ABOVE NAMED DECEASED VETERAN SERVED ON ACTIVE DUTY
AS DEFINED IN 38 U.S.C. 101(21) AND SERVED DURING A PERIOD OF
SERVICE SPECIFIED IN 38 U.S.C. 3702 AND IT HAS BEEN DETERMINED
THAT DEATH WAS FROM A SERVICE-CONNECTED DISABILITY. THE
ABOVE NAMED APPLICANT IS RECOGNIZED AS THE UNMARRIED
SURVIVING SPOUSE

18B. REASON APPLICANT NOT ELIGIBLE

APPLICANT IS NOT ELIGIBLE (If checked, complete Item 18B)
19. SIGNATURE

VA FORM
XXXX

26-1817

20. TITLE

SUPERSEDES VA FORM 26-1817, APR 2012, WHICH
WILL NOT BE USED.

21. DATE