Marital Status Questionnaire (21P-0537)

Forms and Documents

Document Name	Status
Form 21P-0537 Marital Status Questionnaire Form	Modified
30-day FRN - 2900-0495 (6-6-22).pdf Supplementary Document	2022-06-07
60-Day FRN (2900-0495).pdf Supplementary Document	2022-03-30
2900-0495, Supporting Statement (VA Form 21-0537).docx Supporting Statement A	2022-06-07

IC Document Collections

IC ID	Document Title	Status
28678	Marital Status Questionnaire Form	Modified

ICR Details

OMB Control No: 2900-0495	ICR Reference No: 202203-2900-017
Status: Received in OIRA	Previous ICR Reference No: 201901-2900-007
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Marital Status Questionnaire (21P-0537)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/07/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2022
Responses	2,756	17,808
Time Burden (Hours)	230	1,484
Cost Burden (Dollars)	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 38 USC 101(3) Name of Law: Definition of Surviving Spouse
   US Code: 38 USC 103 Name of Law: Special Provisions Relating to Marriages
   PL: Pub.L. 116 - 315 2009 Name of Law: Eligibility for dependency and indemnity compensation for surviving spouses who remarry after age
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18075	03/29/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 34347	06/06/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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

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ICR Summary of Burden

	Total Request	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	2,756	17,808	0	-15,052	0	0
Annual Time Burden (Hours)	230	1,484	0	-1,254	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The IC burden has decreased due to the decrease in the estimated number of respondents in the past year.

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Annual Cost to Federal Government: $159,004

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/07/2022

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