Agency Information Collection Activities; Proposals, Submissions, and Approvals: Statement of Marital Relationship

Agency Information Collection Activity Under OMB Review: Statement of Marital Relationship

Dates

Comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice by clicking on the following link www.reginfo.gov/public/do/PRAMain, select "Currently under Review-Open for Public Comments", then search the list for the information collection by Title or "OMB Control No. 2900-0114."

Supplementary Information

Title: Statement of Marital Relationship (VA Form 21-4170).

OMB Control Number: 2900-0114 https://www.reginfo.gov/public/do/PRASearch.

Type of Review: Revision of a currently approved collection.

Abstract: VA Form 21-4170 is primarily used to gather information that is necessary to determine whether a valid common law marriage was established. The form is used by persons claiming to be common law widows/widowers of deceased veterans and by veterans and their claimed common law spouses. Benefits cannot be authorized unless a valid marriage is established. No changes have been made to this form. The respondent burden has decreased due to the estimated number of receivables averaged over the past year.

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published at 89 FR 35305, May 1, 2024.

Affected Public: Individuals or Households.

Estimated Annual Burden: 827 hours.

Estimated Average Burden per Respondent: 25 minutes.

Frequency of Response: One time.

Estimated Number of Respondents: 1,984 per year.

Authority: 44 U.S.C. 3501 et seq.