Marital Status Questionnaire (21P-0537)

ICR 201602-2900-003

OMB: 2900-0495

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2016-06-07
Supplementary Document
2016-03-30
Supplementary Document
2016-03-17
Supporting Statement A
2016-09-22
IC Document Collections
IC ID
Document
Title
Status
28678 Modified
ICR Details
2900-0495 201602-2900-003
Historical Active 201406-2900-022
VA VBA-P&F-YM
Marital Status Questionnaire (21P-0537)
Revision of a currently approved collection   No
Regular
Approved with change 09/26/2016
Retrieve Notice of Action (NOA) 06/09/2016
  Inventory as of this Action Requested Previously Approved
09/30/2019 36 Months From Approved 09/30/2016
17,808 0 2,286
1,484 0 191
30,021 0 0

VA Form 21P-0537 is used to verify a surviving spouse’s current marital status to verify his or her continuing entitlement to DIC benefits. The form letter is automatically generated and mailed to DIC beneficiaries. Agency action depends on the information provided by the beneficiary. If the information provided supports the beneficiary’s continued entitlement to benefits, no action is taken. If the information provided by the beneficiary does not support continued entitlement to benefits, VA will take action to terminate benefit payments, based on the facts found.

US Code: 38 USC 103 Name of Law: Special Provisions Relating to Marriages
   US Code: 38 USC 101(3) Name of Law: Definition of Surviving Spouse
  
None

Not associated with rulemaking

  81 FR 16283 03/25/2016
81 FR 36661 06/07/2016
No

1
IC Title Form No. Form Name
Marital Status Questionnaire 21P-0537 Marital Status Questionnaire

  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 17,808 2,286 0 15,522 0 0
Annual Time Burden (Hours) 1,484 191 0 1,293 0 0
Annual Cost Burden (Dollars) 30,021 0 0 30,021 0 0
Yes
Miscellaneous Actions
No
VBA re-estimated the annual number of respondents based on real claim data contained in our benefits database. The estimated completion time of five (5) minutes has not increased since the last submission.

$62,507
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@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.
06/09/2016


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