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

Documents and Forms

Document Name Document Type
Form 21P-4171 Supporting Statement Regarding Marriage (VA Form 21P-4171) Form
21P-4171 Supporting Statement Regarding Marriage VA Form 21P-4171 - New Burden Statement (508 Conformant 2-12-24) 3-27-24.pdf www.va.gov/vaforms Form
21P-4171 Supporting Statement Regarding Marriage VA Form 21P-4171 - New Burden Statement (508 Conformant 2-12-24) 3-27-24.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supporting Statement Regarding Marriage (VA Form 21P-4171)	Agency IC Tracking Number:	2900-0115

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.1(j) 38 CFR 3.50

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21P-4171	Supporting Statement Regarding Marriage	VA Form 21P-4171 - New Burden Statement (508 Conformant 2-12-24) 3-27-24.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA	FR Citation: 84 FR 4138

Number of Respondents: 2,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,400	0	2,400
Annual IC Time Burden (Hours)	792	-8	800
Annual IC Cost Burden (Dollars)	19,087	-1	19,088

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.