Marital Status Questionnaire (21P-0537)

ICR 202203-2900-017

OMB: 2900-0495

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2022-06-07
Supplementary Document
2022-03-30
Supporting Statement A
2022-06-07
IC Document Collections
IC ID
Document
Title
Status
28678 Modified
ICR Details
2900-0495 202203-2900-017
Received in OIRA 201901-2900-007
VA VBA-P&F-YA
Marital Status Questionnaire (21P-0537)
Revision of a currently approved collection   No
Regular 06/07/2022
  Requested Previously Approved
36 Months From Approved 09/30/2022
2,756 17,808
230 1,484
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 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
  
None

Not associated with rulemaking

  87 FR 18075 03/29/2022
87 FR 34347 06/06/2022
No

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

  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
No
Yes
Miscellaneous Actions
The IC burden has decreased due to the decrease in the estimated number of respondents in the past year.

$159,004
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 maribel.aponte@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.
06/07/2022


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