Information Collection

Marital Status Questionnaire

IC 28678 under ICR 201602-2900-003 · OMB 2900-0495.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0495 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21P-0537 Marital Status Questionnaire	Form
21P-0537 Marital Status Questionnaire VA Form 21P-0537 (2-25-16).pdf vaww.va.gov/vaforms	Form

IC Title:

Marital Status Questionnaire

Agency IC Tracking Number:

2900-0495

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	21P-0537	Marital Status Questionnaire	VA Form 21P-0537 (2-25-16).pdf	vaww.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: 17,808

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,808	15,522	2,286
Annual IC Time Burden (Hours)	1,484	1,293	191
Annual IC Cost Burden (Dollars)	30,021	30,021	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.