VAFORMS.NET – VA Form 21-4170 – Statement of Marital Relationship – The VA Form 21-4170 is a Statement of Marital Relationship. This document is required for all eligible veterans. It may be completed online or printed. Regardless of the method you choose, it is important to make sure that the information you provide is accurate and current. Once you have the right information, you can make submitting this document a much simpler process.
Download VA Form 21-4170 – Statement of Marital Relationship
| Form Number | VA Form 21-4170 – |
| Form Title | Statement of Marital Relationship |
| Edition Date | June 2022 |
| File Size | 2 MB |
What is a VA Form 21-4170?
The purpose of VA Form 21-4170 is to determine your eligibility for pension benefits. The information you provide on this form will be confidential. The information contained in this form is part of the VA’s system of records, which includes employment, education, and vocational rehabilitation records. You must write your Social Security number on each page of the form.
The information you provide on this form may be used in computer matching programs with other agencies to determine your eligibility for benefits. In some cases, this information will also be used to collect amounts owed to the United States by virtue of participating in benefit programs. Be sure to provide accurate information on this form.
Once you have completed your form, you can easily submit it online. You can upload a VA form 21-4170 by using the New Document button or by importing it from a link. Once it is saved, you can adjust the form’s appearance by adding or removing fields and inserting text or images. You can even include checkmarks or areas for filling out information.
Where Can I Find a VA Form 21-4170?
This form is required to file claims for a veteran’s benefits. The veteran must list all sources of income and expenses for medical care. The form also asks for the name and social security number of the beneficiary. The veteran and the beneficiary must be on the same page to ensure that the information is accurate.
It is possible to electronically submit the form to the VA. However, you need to know the claim number so that you can properly fill out the form. You must also include the date on the form of your original filing and the earliest effective date, which is usually the date you filed your original claim.
The information collected on this form will be used to determine the number of your pension benefits. The VA will not deny benefits to you if you refuse to provide your Social Security number. Currently, federal statutes require the disclosure of SSNs.
VA Form 21-4170 – Statement of Marital Relationship
The VA Form 21-4170 is a form that gathers information to verify the validity of a common-law marriage. It’s used by common-law widows of deceased veterans and by veterans and their claimed common-law spouses. Without a valid marriage, benefits can’t be authorized. The form takes 25 minutes to complete per respondent. There are approximately 6500 respondent forms.
VA Form 21-4170 must be completed online. It’s not difficult to do, and it’s completely confidential. The form is available in various formats, including fillable PDF forms that can be completed online and printed out. Alternatively, you can use an xft file to fill out the form. While the xft file will save your information, it can’t be edited after you’ve submitted it.
The Veteran and Spouse must also complete the Aid & Attendance Worksheet. This form requires the Veteran and Spouse to list their income and assets. The Veteran must also list his or her Social Security number.
VA Form 21-4170 Example
