Supporting Statement Regarding Marriage

ICR 199508-2900-019

OMB: 2900-0115

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
147137 Migrated
ICR Details
2900-0115 199508-2900-019
Historical Active 199208-2900-006
VA
Supporting Statement Regarding Marriage
Extension without change of a currently approved collection   No
Regular
Approved without change 09/20/1995
Retrieve Notice of Action (NOA) 08/23/1995
  Inventory as of this Action Requested Previously Approved
09/30/1998 09/30/1998 10/31/1995
2,400 0 0
800 0 800
0 0 0

38 U.S.C. 103 requires that marital status be clarified before benefits may be paid to or for a spouse. The form is used to gather necessary information from individuals who know the relationship which existed between parties, in those cases in which a common law marriage is claimed.

None
None


No

1
IC Title Form No. Form Name
Supporting Statement Regarding Marriage 21-4171

  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 2,400 0 0 2,400 0 0
Annual Time Burden (Hours) 800 800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/23/1995


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