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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.