[Federal Register Volume 76, Number 109 (Tuesday, June 7, 2011)]
[Notices]
[Page 33027]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-13956]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0114]


Agency Information Collection (Statement of Marital Relationship) 
Activity Under OMB Review

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 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits 
Administration (VBA), 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; it includes the actual data collection instrument.

DATES: Comments must be submitted on or before July 7, 2011.

ADDRESSES: Submit written comments on the collection of information 
through http://www.Regulations.gov or to VA's OMB Desk Officer, OMB 
Human Resources and Housing Branch, New Executive Office Building, Room 
10235, Washington, DC 20503 (202) 395-7316. Please refer to ``OMB 
Control No. 2900-0114'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Washington, DC 20420, (202) 461-7485, FAX (202) 461-0966 or e-mail 
[email protected]. Please refer to ``OMB Control No. 2900-0114.''

SUPPLEMENTARY INFORMATION: 
    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 completed by individuals claiming to 
be common law widows/widowers of deceased veterans and by veterans and 
their claimed common law spouses to establish marital status. VA uses 
the information collected to determine whether a common law marriage 
was valid under the law of the place where the parties resided at the 
time of the marriage or under the law of the place where the parties 
resided when the right to benefits accrued.
    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 on March 25, 2011, at pages 16858-16859.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,708 hours.
    Estimated Average Burden per Respondent: 25 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 6,500.

    Dated: June 2, 2011.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-13956 Filed 6-6-11; 8:45 am]
BILLING CODE 8320-01-P