Supporting Statement Regarding Marriage (21P-4171)

ICR 201310-2900-018

OMB: 2900-0115

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2014-05-06
Supplementary Document
2014-03-17
Supporting Statement A
2014-03-24
IC Document Collections
IC ID
Document
Title
Status
28317 Modified
ICR Details
2900-0115 201310-2900-018
Historical Active 201103-2900-013
VA 2900-0115 VBA-P&F-DB
Supporting Statement Regarding Marriage (21P-4171)
Revision of a currently approved collection   No
Regular
Approved without change 08/05/2014
Retrieve Notice of Action (NOA) 06/02/2014
  Inventory as of this Action Requested Previously Approved
08/31/2017 36 Months From Approved 08/31/2014
2,400 0 2,400
800 0 800
0 0 0

VA Form 21P-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

  79 FR 10 01/15/2014
79 FR 73 04/16/2014
No

1
IC Title Form No. Form Name
Supporting Statement Regarding Marriage (21P-4171) 21P-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
Crystal Rennie 202 632-7492 crystal.rennie@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.
06/02/2014


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