Va Form 26-1817 - Request For Determination Of Loan Guaranty Eligibility - Unmarried Surviving Spouses
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2OMB Approved No. 2900-0055
Respondent Burden: 15 Minutes
Expiration Date: 12/31/2019
REQUEST FOR DETERMINATION OF LOAN GUARANTY
ELIGIBILITY - UNMARRIED SURVIVING SPOUSES
IMPORTANT: Please read the Privacy Act and Respondent Burden information on page 2 before completing the form.
IMPORTANT: Complete this form if applying for home loan benefits as an unmarried surviving spouse of a veteran whose death was service-connected. (Note: In
some cases, surviving spouses who remarry on or after age 57 may have eligibility.) DO NOT complete this form if requesting restoration of previously used home loan
benefit entitlement. Instead, complete VA Form 26-1880, Request for a Certificate of Eligibility. Please send your completed application to the appropriate address
shown on Page 2.
IMPORTANT: If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse
resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you become eligible for benefits) (38 U.S.C. §
103(c)). Additional guidance on when VA recognizes marriages is available at
(To be completed by the applicant)
PART I -
(Unmarried surviving spouse)
3A. FIRST, MIDDLE, LAST NAME OF VETERAN
1A. NAME AND ADDRESS OF APPLICANT
3B. VETERAN'S DATE OF BIRTH
1B. APPLICANT'S SOCIAL SECURITY NUMBER
3C. VETERAN'S SOCIAL SECURITY NUMBER
(Including area code)
(If known)
1C. APPLICANT'S DAYTIME TELEPHONE NO.
4. VA FILE NO.
5. LOCATION OF VA CLAIMS FILE
xc-
(If applicable)
1D. APPLICANT'S EMAIL ADDRESS
6. VETERAN'S SERVICE NO.
7. VETERAN'S BRANCH OF SERVICE
1E. APPLICANT'S DATE OF BIRTH
8. DATE OF VETERAN'S DEATH
NOTE: If you are a veteran please complete Items 2A, 2B and 2C.
9. PERIODS OF DECEASED VETERAN'S MILITARY DUTY
2A. BRANCH OF SERVICE
2B. SERVICE NUMBER
A. FROM
B. TO
2C. PERIODS OF SERVICE
10A. ARE YOU IN RECEIPT OF VA DEPENDENCY AND INDEMNITY COMPENSATION?
10B. VA CLAIM NUMBER
YES
NO (If "YES," complete Item 10B)
11. HAVE YOU PREVIOUSLY APPLIED FOR DETERMINATION OF YOUR
12. HAVE YOU PREVIOUSLY RECEIVED A CERTIFICATE OF
ELIGIBILITY FOR LOAN GUARANTY BENEFITS?
ELIGIBILITY FOR SUCH BENEFITS?
YES
NO
YES
NO
16. DATE OF LOAN
13. HAVE YOU PREVIOUSLY SECURED A VA DIRECT,
14. ADDRESS OF PROPERTY
15. VA LOAN NUMBER
(Month, Year)
GUARANTEED OR INSURED LOAN?
(If "YES," complete Items 14, 15,
YES
NO
and 16)
17. INDICATE WHAT YOU ARE SEEKING A VA-GUARANTEED HOME LOAN FOR (Check appropriate box):
PURCHASE LOAN
CASH OUT REFINANCE LOAN
INTEREST RATE REDUCTION REFINANCE LOAN
CERTIFICATION: I CERTIFY THAT the above information is true and accurate to the best of my knowledge and belief.
(Unmarried surviving spouse)
18B. DATE SIGNED
18A. 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 is
19B. DATE SIGNED
19A. SIGNATURE OF LOAN GUARANTY OFFICER OR DESIGNEE
forwarded to you for appropriate action and completion
of Section B.
SECTION B
20A. CHECK APPROPRIATE BOX
20B. 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 MEETS THE DEFINITION OF VETERAN AS SPECIFIED IN TITLE 38
U.S.C. 3701. THE ABOVE NAMED APPLICANT IS RECOGNIZED AS THE UNMARRIED
SURVIVING SPOUSE.
(If checked, complete Item 20B)
APPLICANT IS NOT ELIGIBLE
21. SIGNATURE
22. TITLE
23. DATE
VA FORM
26-1817
SUPERSEDES VA FORM 26-1817, DEC 2016,
Page 1
FEB 2017
WHICH WILL NOT BE USED.
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