Marital Status Questionnaire

Marital Status Questionnaire (21-0537)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0495 can be found here:

Documents and Forms

Document Name Document Type
Form 21-0537 Marital Status Questionnaire Form
21-0537 Marital Status Questionnaire VA Form 21-0537 (DOMA - 6-18-18).pdf Form

Information Collection (IC) Details

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	VA Form 21-0537 (DOMA - 6-18-18).pdf		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,286	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,286	2,286
Annual IC Time Burden (Hours)	191	191
Annual IC Cost Burden (Dollars)	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.