Marital Status Questionnaire (VA Form 21P-0537)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 21P-0537 Marital Status Questionnaire	Form	Modified	Available
Form 21P-0537 Marital Status Questionnaire	Form	Modified	Repair queued
30-Day (published) 2900-0495.pdf	Supplementary Document	Uploaded 2025-08-28	Repair queued
30-Day (published) 2900-0495.pdf	Supplementary Document	Uploaded 2025-08-28	Repair queued
60-DAY (published) 2900-0495.pdf	Supplementary Document	Uploaded 2025-08-25	Repair queued
60-DAY (published) 2900-0495.pdf	Supplementary Document	Uploaded 2025-08-25	Repair queued
2900-0495 (21P-0537) - Supporting Statement 8-28-25.docx	Supporting Statement A	Uploaded 2025-08-28	Available
2900-0495 (21P-0537) - Supporting Statement 8-28-25.docx	Supporting Statement A	Uploaded 2025-08-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28678	Marital Status Questionnaire	Form	Modified	Marital Status Questionnaire
28678	Marital Status Questionnaire	Form	Modified

ICR Details

OMB Control No: 2900-0495	ICR Reference No: 202502-2900-009
Status: Active	Previous ICR Reference No: 202203-2900-017
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Marital Status Questionnaire (VA Form 21P-0537)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2025
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved	11/30/2025
Responses	2,756	0	2,756
Time Burden (Hours)	230	0	230
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21P-0537 is used to verify a surviving spouse’s current marital status to verify his or her continuing entitlement to DIC benefits. The form letter is automatically generated and mailed to DIC beneficiaries. Agency action depends on the information provided by the beneficiary. If the information provided supports the beneficiary’s continued entitlement to benefits, no action is taken. If the information provided by the beneficiary does not support continued entitlement to benefits, VA will take action to terminate benefit payments, based on the facts found.

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Authorizing Statute(s): US Code: 38 USC 103 Name of Law: Special Provisions Relating to Marriages
   PL: Pub.L. 116 - 315 2009 Name of Law: Eligibility for dependency and indemnity compensation for surviving spouses who remarry after age
   US Code: 38 USC 101(3) Name of Law: Definition of Surviving Spouse
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 27071	06/25/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 42066	08/28/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Marital Status Questionnaire	21P-0537	Marital Status Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	2,756	2,756	0	0	0	0
Annual Time Burden (Hours)	230	230	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $31,042

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/28/2025

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