Va Form 26-1817 - Request For Determination Of Loan Guaranty Eligibility - Unmarried Surviving Spouses

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OMB Approved No. 2900-0055
Respondent Burden: 15 minutes
REQUEST FOR DETERMINATION OF LOAN GUARANTY
ELIGIBILITY - UNMARRIED SURVIVING SPOUSES
PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code
of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of records, 55VA26, Loan Guaranty Home,
Condominium and manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal
Register. Your obligation to respond is required in order to determine the surviving spouse's qualifications for a loan.
RESPONDENT BURDEN: We need this information to determine a surviving spouse's qualifications for a VA-guaranteed home loan. Title 38, U.S.C., section 3702 authorizes collection of
this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of
information unless a valid OMB control number is displayed. You are not required to respond to a collection of information is not displayed. Valid OMB control numbers can be located on the
OMB Internet Page at If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
IMPORTANT: Complete this form if applying for home loan benefits as an
Atlanta Regional Loan Center
unmarried surviving spouse of a veteran whose death was service-connected. (Note:
Attn: COE (262)
In some cases, surviving spouses who remarry on or after age 57 may have
TO
eligibility.) DO NOT complete this form if requesting restoration of previously used
P. O. Box 100034
home loan benefit entitlement. Instead, complete VA Form 1880, Request for a
Decatur, GA 30031
Certificate of Eligibility.
(To be completed by the applicant)
PART I -
(Unmarried surviving spouse)
1A. NAME AND ADDRESS OF APPLICANT
4. FIRST, MIDDLE, LAST NAME OF VETERAN
5. VA FILE NO.
(If known)
6. LOCATION OF VA CLAIMS FILE
xc-
(Including area code)
1B. APPLICANT'S DAYTIME TELEPHONE NO.
7. VETERAN'S SERVICE NO.
8. VETERAN'S BRANCH OF SERVICE
2. APPLICANT'S BIRTH DATE
9. DATE OF VETERAN'S DEATH
NOTE: If you have had active military duty complete Items 3A, 3B and 3C below.
10. PERIODS OF DECEASED VETERAN'S MILITARY DUTY
3A. BRANCH OF SERVICE
3B. SERVICE NUMBER
A. FROM
B. TO
3C. PERIODS OF SERVICE
11A. HAVE YOU PREVIOUSLY APPLIED FOR DETERMINATION OF YOUR ELIGIBILITY FOR
LOCATION OF VA OFFICE
LOAN GUARANTY BENEFITS?
11B.
If "Yes," complete Item 11B)
YES
NO
(
12A. HAVE YOU PREVIOUSLY RECEIVED A CERTIFICATE OF ELIGIBILITY FOR SUCH BENEFITS?
12B.
YES
NO
(If "Yes," complete Item 12B)
13A. HAVE YOU PREVIOUSLY SECURED A VA DIRECT, GUARANTEED OR INSURED LOAN?
13B.
(If "Yes," complete Item 13B)
YES
NO
CERTIFICATION: I CERTIFY THAT the above information is true and accurate to the best of my knowledge and belief.
(Unmarried surviving spouse)
15. DATE
14. SIGNATURE OF APPLICANT
Federal statutes provide severe penalties for fraud, intentional misrepresentation or criminal connivance or conspiracy to influence the issuance of my guaranty or
insurance or the granting of any loan by the Department of Veterans Affairs.
PART II - FOR VA USE ONLY
SECTION A
Adjudication Officer
Loan Guaranty Officer
RETURN
Department of Veteran Affairs
Department of Veterans Affairs
TO
TO
Regional Office/Center
Regional Office/Center
(Complete
(After
address)
completion of
Section B)
The foregoing request for determination of eligibility
16. SIGNATURE OF LOAN GUARANTY OFFICER OR DESIGNEE
17.DATE
is forwarded to you for appropriate action and
completion of Section B.
SECTION B
18A. CHECK APPROPRIATE BOX(ES)
18B. REASON APPLICANT NOT ELIGIBLE
THE ABOVE NAMED DECEASED VETERAN SERVED ON ACTIVE DUTY
AS DEFINED IN 38 U.S.C. 101(21) AND SERVED DURING A PERIOD OF
SERVICE SPECIFIED IN 38 U.S.C. 3702 AND IT HAS BEEN DETERMINED
THAT DEATH WAS FROM A SERVICE-CONNECTED DISABILITY. THE
ABOVE NAMED APPLICANT IS RECOGNIZED AS THE UNMARRIED
SURVIVING SPOUSE
(If checked, complete Item 18B)
APPLICANT IS NOT ELIGIBLE
19. SIGNATURE
20. TITLE
21. DATE
26-1817
VA FORM
SUPERSEDES VA FORM 26-1817, NOV 2007, WHICH
APR 2012
WILL NOT BE USED.

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