Form VA Form 26-1817 VA Form 26-1817 Request for Determination of Loan Guaranty Eligibility -

OMB Approved No. 2900-0055
Respondent Burden: 15 Minutes
Expiration Date: XX/XX/XXXX

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.

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

6. VETERAN'S SERVICE NO.

1E. APPLICANT'S DATE OF BIRTH

7. VETERAN'S BRANCH OF SERVICE

8. DATE OF VETERAN'S DEATH

NOTE: If you are a veteran please complete Items 2A, 2B and 2C.
2A. BRANCH OF SERVICE

5. LOCATION OF VA CLAIMS FILE (If known)

xc-

9. PERIODS OF DECEASED VETERAN'S MILITARY DUTY

2B. SERVICE NUMBER

A. FROM

B. TO

2C. PERIODS OF SERVICE
10A. ARE YOU IN RECEIPT OF VA DEPENDENCY AND INDEMNITY COMPENSATION?
YES

10B. VA CLAIM NUMBER

NO (If "YES," complete Item 10B)

11. HAVE YOU PREVIOUSLY APPLIED FOR DETERMINATION OF YOUR
ELIGIBILITY FOR LOAN GUARANTY BENEFITS?
YES

12. HAVE YOU PREVIOUSLY RECEIVED A CERTIFICATE OF
ELIGIBILITY FOR SUCH BENEFITS?
YES

NO

13. HAVE YOU PREVIOUSLY SECURED A VA DIRECT,
GUARANTEED OR INSURED LOAN?
(If "YES," complete Items 14, 15,
YES
NO and 16)

14. ADDRESS OF PROPERTY

NO
15. VA LOAN NUMBER

16. DATE OF LOAN
(Month, Year)

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.
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

TO

(Complete
address)

Adjudication Officer
Department of Veteran Affairs
Regional Office/Center

The foregoing request for determination of eligibility is
forwarded to you for appropriate action and completion
of Section B.

RETURN
TO

(After
completion of
Section B)

Loan Guaranty Officer
Department of Veterans Affairs
Regional Office/Center

19A. SIGNATURE OF LOAN GUARANTY OFFICER OR DESIGNEE

19B. DATE SIGNED

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.
APPLICANT IS NOT ELIGIBLE (If checked, complete Item 20B)
21. SIGNATURE
VA FORM
XXX XXXX

26-1817

22. TITLE
SUPERSEDES VA FORM 26-1817, FEB 2017,
WHICH WILL NOT BE USED.

23. DATE

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If you live in:

Please send your completed application to:

Georgia, North Carolina, South
Carolina, Tennessee

Department of Veterans Affairs
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,
Montana, Oregon, Utah,
Washington, Wyoming

Department of Veterans Affairs
Denver Regional Loan Center
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
Houston Regional Loan Center
Texas
6900 Almeda Road
Houston, TX 77030-4200
Arizona, California, New
Department of Veterans Affairs
Phoenix Regional Loan Center
Mexico, Nevada
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, XXX XXXX

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