Va Form 26 1817 – Fill Out and Use

OMB Approved No. 2900-0055

Respondent Burden: 15 Minutes

Expiration Date: 12/31/2022

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 http://www.va.gov/opa/marriage/.

PART I - (To be completed by the applicant)

1A. NAME AND ADDRESS OF APPLICANT (Unmarried surviving spouse)

3A. FIRST, MIDDLE, LAST NAME OF VETERAN

3B. VETERAN'S DATE OF BIRTH

1B. APPLICANT'S SOCIAL SECURITY NUMBER

3C. VETERAN'S SOCIAL SECURITY NUMBER

1C. APPLICANT'S DAYTIME TELEPHONE NO. (Including area code)

4. VA FILE NO.

5. LOCATION OF VA CLAIMS FILE (If known)

XC-

1D. APPLICANT'S EMAIL ADDRESS (If applicable)

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

13. HAVE YOU PREVIOUSLY SECURED A VA DIRECT,

14. ADDRESS OF PROPERTY

15. VA LOAN NUMBER

16. DATE OF LOAN

GUARANTEED OR INSURED LOAN?

(MONTH, YEAR)

(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):

CERTIFICATION: I CERTIFY THAT the above information is true and accurate to the best of my knowledge and belief.

18A. SIGNATURE OF APPLICANT (Unmarried surviving spouse)	18B. DATE SIGNED

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		RETURN	Loan Guaranty Officer
TO	Department of Veteran Affairs		TO	Department of Veterans Affairs
	Regional Office/Center			Regional Office/Center
(Complete			(After
address)			completion of
			Section B)

SECTION B

VA FORM	26-1817	SUPERSEDES VA FORM 26-1817, FEB 2017,	PAGE 1
DEC 2019		WHICH WILL NOT BE USED.

If you live in:	Please send your completed application to:
Georgia, North Carolina, South	Department of Veterans Affairs
Carolina, Tennessee	Atlanta Regional Loan Center
	P.O. Box 100023
	Decatur, GA 30031-7023
Connecticut, Delaware, Indiana,	Department of Veterans Affairs
Maine, Massachusetts, Michigan,	Cleveland Regional Loan Center
New Hampshire, New Jersey,	1240 East Ninth Street
New York, Ohio, Pennsylvania,	Cleveland, OH 44199
Rhode Island, Vermont
Alaska, Colorado, Idaho,	Department of Veterans Affairs
Montana, Oregon, Utah,	Denver Regional Loan Center
Washington, Wyoming	P.O. Box 25126
	Denver, CO 80225
Hawaii, Guam, American Samoa	Department of Veterans Affairs
Commonwealth of the Northern	VA Regional Office
Marianas	Loan Guaranty Division (26)
	459 Patterson Road
	Honolulu, HI 96819
Arkansas, Louisiana, Oklahoma,	Department of Veterans Affairs
Texas	Houston Regional Loan Center
	6900 Almeda Road
	Houston, TX 77030-4200
Arizona, California, New	Department of Veterans Affairs
Mexico, Nevada	Phoenix Regional Loan Center
	3333 N. Central Avenue
	Phoenix, AZ 85012-2402
District of Columbia, Kentucky,	Department of Veterans Affairs
Maryland,Virginia,	Roanoke Regional Loan Center
West Virginia	210 Franklin Road, S.W.
	Roanoke, VA 24011
Illinois, Iowa, Kansas,	Department of Veterans Affairs
Minnesota, Missouri, Nebraska,	St. Paul Regional Loan Center
North Dakota, South Dakota,	1 Federal Drive, Ft. Snelling
Wisconsin	St. Paul, MN 55111-4050
Alabama, Florida, Mississippi,	Department of Veterans Affairs
Puerto Rico, U.S. Virgin Islands	St. Petersburg Regional Loan Center
	9500 Bay Pines Boulevard
	St. Petersburg, FL 33744

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, published in the Federal Register. Your obligation to respond is required in order to determine the surviving spouse's qualifications for a loan. Giving us your SSN account information is voluntary. VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

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 www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 26-1817, DEC 2019

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