Information Collection

Supporting Statement Regarding Marriage

IC 28317 under ICR 200712-2900-015 · OMB 2900-0115.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0115 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-4171 Supporting Statement Regarding Marriage Form
VA Form 21-4171 Supporting Statement Regarding Marriage 21-4171.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supporting Statement Regarding Marriage	Agency IC Tracking Number:	2900-0115

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-4171	Supporting Statement Regarding Marriage	21-4171.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

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.