Marital Status Questionnaire

Marital Status Questionnaire (21P-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⚠️ Notice: This information collection may be referencing outdated material.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 21P-0537 Marital Status Questionnaire Form
21P-0537 Marital Status Questionnaire VA Form 21P-0537 (2-25-16).pdf vaww.va.gov/vaforms 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	21P-0537	Marital Status Questionnaire	VA Form 21P-0537 (2-25-16).pdf	vaww.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17,808	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,808	15,522	2,286
Annual IC Time Burden (Hours)	1,484	1,293	191
Annual IC Cost Burden (Dollars)	30,021	30,021	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.