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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 28317 under ICR 202401-2900-010 · OMB 2900-0115.

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Supporting Statement Regarding Marriage (VA Form 21P-4171) 2900-0115
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.1(j) 38 CFR 3.50

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

General Government Legislative Functions

58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA  84 FR 4138

2,400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 792 0 -8 0 0 800
Annual IC Cost Burden (Dollars) 19,087 0 -1 0 0 19,088

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