[Federal Register Volume 82, Number 43 (Tuesday, March 7, 2017)]
[Notices]
[Pages 12916-12917]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-04349]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0114]


Agency Information Collection Activity: Statement of Marital 
Relationship (VA Form 21-4170)

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Veterans Benefits Administration (VBA), Department of 
Veterans Affairs (VA), is announcing an opportunity for public comment 
on the proposed collection of certain information by the agency. Under 
the Paperwork Reduction Act (PRA) of 1995, Federal agencies are 
required to publish notice in the Federal Register concerning each 
proposed collection of information, including each proposed revision of 
a currently approved collection, and allow 60 days for public comment 
in response to the notice.
    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.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before May 8, 2017.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420 or email to [email protected]. Please refer to ``OMB Control 
No. 2900-0114'' in any correspondence. During the comment period, 
comments may be viewed online through the FDMS.

[[Page 12917]]


FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 
or FAX (202) 632-8925.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501--21), Federal agencies must obtain approval from the Office 
of Management and Budget (OMB) for each collection of information they 
conduct or sponsor. This request for comment is being made pursuant to 
Section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VBA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VBA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VBA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Title: Statement of Marital Relationship (VA Form 21-4170).
    OMB Control Number: 2900-0114.
    Type of Review: Revision of an 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.
    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.

    By direction of the Secretary.
Cynthia Harvey-Pryor
Department Clearance Officer, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-04349 Filed 3-6-17; 8:45 am]
 BILLING CODE 8320-01-P