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

ICR 202012-2900-003

OMB: 2900-0115

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-05-03
Supplementary Document
2021-03-04
Supporting Statement A
2021-04-15
IC Document Collections
ICR Details
2900-0115 202012-2900-003
Received in OIRA 201708-2900-001
VA VBA-P&F-YA
Supporting Statement Regarding Marriage (VA Form 21P-4171)
Reinstatement without change of a previously approved collection   No
Regular 05/03/2021
  Requested Previously Approved
36 Months From Approved
2,400 0
800 0
19,088 0

VBA administers an integrated program of of benefits and services established by law for Veterans, service personnel, and their dependents, survivors, and/or beneficiaries. A claimant’s eligibility for pension benefits or Parents’ Dependency and Indemnity Compensation (DIC) is determined, in part, by countable income. VA Form 21P-4185 Report of Income from Property or Business, is used to report income and expenses that derived from rental property and/or the operation of a business. VBA uses this form to determine whether the claimant is eligible for VA benefits and, if eligibility exists, the proper rate of payment.

US Code: 38 USC 103 Name of Law: Special provisions relating to marriages
  
None

Not associated with rulemaking

  86 FR 11385 02/24/2021
86 FR 23492 05/03/2021
No

1
IC Title Form No. Form Name
Supporting Statement Regarding Marriage (VA Form 21P-4171) 21P-4171 Supporting Statement Regarding Marriage

  Total Request 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 0 0 2,400
Annual Time Burden (Hours) 800 0 0 0 0 800
Annual Cost Burden (Dollars) 19,088 0 0 0 0 19,088
No
No

$78,733
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 [email protected]

  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.
05/03/2021


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