Information Collection

Information from Remarried Widow(er)

IC 28149 under ICR 201103-2900-012 · OMB 2900-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0038 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-4103 Information from Remarried Widow(er)	Form
21-4103 Information From Remarried Widow/er 21-4103-ARE.pdf www.va.gov/vaforms/	Form

IC Title:

Information from Remarried Widow(er)

Agency IC Tracking Number:

2900-0038

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-4103	Information From Remarried Widow/er	21-4103-ARE.pdf	http://www.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: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	334	334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.