[Federal Register Volume 82, Number 159 (Friday, August 18, 2017)]
[Notices]
[Pages 39489-39490]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-17462]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0114]


Agency Information Collection Under OMB Review: Statement of 
Marital Relationship

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
this notice announces that the Veterans Benefits Administration, 
Department of Veterans Affairs, will submit the collection of 
information abstracted below to the Office of Management and Budget 
(OMB) for review and comment. The PRA submission describes the nature 
of the information collection and its expected cost and burden and it 
includes the actual data collection instrument.

DATES: Comments must be submitted on or before September 18, 2017.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
<a href="/cdn-cgi/l/email-protection#afc0c6ddcef0dcdacdc2c6dcdcc6c0c1efc0c2cd81cac0df81c8c0d9"><span class="__cf_email__" data-cfemail="67080e1506381412050a0e14140e080927080a054902081749000811">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-
0114'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department

[[Page 39490]]

of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, 
(202) 461-5870 or email <a href="/cdn-cgi/l/email-protection#096a70677d6160682761687b7f6c7024797b70667b497f68276e667f"><span class="__cf_email__" data-cfemail="4b2832253f23222a65232a393d2e32663b393224390b3d2a652c243d">[email protected]</span></a>. Please refer to 
``OMB Control No. 2900-0114'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Authority: 44 U.S.C. 3501-21.
    Title: Statement of Marital Relationship (VA Form 21-4170).
    OMB Control Number: 2900-0114.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 21-4170 is 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.
    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 82 FR 43 on March 7, 2017, pages 12916 and 
12917.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 2,708.
    Estimated Average Burden per Respondent: 25 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 6,500.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of Quality and Compliance, 
Department of Veterans Affairs.
[FR Doc. 2017-17462 Filed 8-17-17; 8:45 am]
BILLING CODE 8320-01-P


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