Supporting Statement Regarding Marriage (VA Form 21P-4171)

OMB 2900-0115

VA Form 21P-4171 is used to gather information that is needed to determine veteran's spouses' eligibility for benefits based on a common law marital relationship.

The latest form for Supporting Statement Regarding Marriage (VA Form 21P-4171) expires 2021-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 21P-4171 Supporting Statement Regarding Marriage (VA Form 21P-4171) Form
30-Day FRN - 2900-0115 (2024).pdf Supplementary Document
2900-0115 Supporting Statement (21P-4171).docx Supporting Statement A
2900-0115 60-Day FRN (21P-4171).docx Supplementary Document
Supporting Statement Regarding Marriage (VA Form 21P-4171) Form

All Historical Document Collections

202401-2900-010 Approved without change	Revision of a currently approved collection	2024-04-15
202012-2900-003 Approved with change	Reinstatement without change of a previously approved collection	2021-05-03
201708-2900-001 Approved without change	Reinstatement without change of a previously approved collection	2017-12-27
201310-2900-018 Approved without change	Revision of a currently approved collection	2014-06-02
201103-2900-013 Approved without change	Extension without change of a currently approved collection	2011-06-24
200712-2900-015 Approved without change	Extension without change of a currently approved collection	2008-04-03
200506-2900-004 Approved with change	Revision of a currently approved collection	2005-06-14
200205-2900-010 Approved with change	Revision of a currently approved collection	2002-05-15
199904-2900-004 Approved without change	Reinstatement without change of a previously approved collection	1999-04-12
199508-2900-019 Approved without change	Extension without change of a currently approved collection	1995-08-23
199208-2900-006 Approved without change	Extension without change of a currently approved collection	1992-08-27
199003-2900-003 Approved without change	Reinstatement with change of a previously approved collection	1990-03-23
198406-2900-017 Approved without change	Extension without change of a currently approved collection	1984-06-19
198104-2900-008 Approved without change	Extension without change of a currently approved collection	1981-04-17
198101-2900-036 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-22
197606-2900-018 Approved without change	Revision of a currently approved collection	1976-06-29