Form VBA 26-1817 VBA 26-1817 Request for Determination of Loan Guaranty Eligibility U

OMB Approved No. 2900-0055
Respondent Burden: 15 Minutes
Expiration Date: XX/XX/20XX

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.) 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)

1C. APPLICANT'S DATE OF BIRTH (MM/DD/YYYY)
1D. APPLICANT'S DAYTIME TELEPHONE NO. (Including area code)
1E. APPLICANT'S EMAIL ADDRESS (If applicable)

1B. APPLICANT'S SOCIAL SECURITY NUMBER

2A. ARE YOU IN RECEIPT OF VA DEPENDENCY AND INDEMNITY COMPENSATION?
YES

NO

2B. VA FILE NO./VA CLAIM NUMBER

(If "YES," complete Item 5)

NOTE: If you are a veteran please complete Items 3A, 3B and 3C.
3A. BRANCH OF SERVICE

3B. SERVICE NUMBER (If applicable)

3C. PERIODS OF SERVICE

VETERAN INFORMATION
4A. FIRST, MIDDLE, LAST NAME OF VETERAN
4B. VETERAN'S SOCIAL SECURITY NUMBER

4D. VETERAN'S DATE OF BIRTH (MM/DD/YYYY)

4C. VETERAN'S SERVICE NO. (If applicable)

4E. DATE OF VETERAN'S DEATH (MM/DD/YYYY)

PRIOR LOAN INFORMATION
5. HAVE YOU PREVIOUSLY SECURED A VA DIRECT, GUARANTEED OR INSURED LOAN?
YES

NO

(If "YES," complete Item 7, 8, 9, and 10)

6. ADDRESS OF PROPERTY

7. VA LOAN NUMBER

8. DATE OF LOAN (MM/YYYY)

9. DO YOU STILL OWN THIS
PROPERTY?
YES

10. ADDRESS OF PROPERTY

11. VA LOAN NUMBER

12. DATE OF LOAN (MM/YYYY)

NO

13. DO YOU STILL OWN THIS
PROPERTY?
YES

NO

14. 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

ONE-TIME RESTORATION (NOTE: VA Loan Must Be Paid in Full)

CERTIFICATION: I CERTIFY THAT the above information is true and accurate to the best of my knowledge and belief.
15A. SIGNATURE OF APPLICANT (Unmarried surviving spouse)

15B. DATE SIGNED (MM/DD/YYYY)

PART II - FOR VA USE ONLY
16A. CHECK APPROPRIATE BOX
THE ABOVE NAMED APPLICANT IS ELIGIBLE AS THE UNMARRIED SURVIVING SPOUSE OF THE VETERAN LISTED.
APPLICANT IS NOT ELIGIBLE (If checked, complete Item 20B)
16B. REASON APPLICANT NOT ELIGIBLE

17. SIGNATURE

VA FORM
XXX 20XX

26-1817

18. TITLE

SUPERSEDES VA FORM 26-1817, SEP 2022,
WHICH WILL NOT BE USED.

19. DATE (MM/DD/YYYY)

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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,
Maine, Massachusetts, Michigan,
New Hampshire, New Jersey, New
York, Ohio, Pennsylvania, Rhode
Island, Vermont

Department of Veterans Affairs
Cleveland Regional Loan Center
1240 East Ninth Street
Cleveland, OH 44199

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
Commonwealth of the Northern
Marianas

Department of Veterans Affairs
VA Regional Office
Loan Guaranty Division (26)
459 Patterson Road
Honolulu, HI 96819

Arkansas, Louisiana, Oklahoma,
Texas

Department of Veterans Affairs
Houston Regional Loan Center
6900 Almeda Road
Houston, TX 77030-4200

Arizona, California, New Mexico,
Nevada

Department of Veterans Affairs
Phoenix Regional Loan Center
3333 N. Central Avenue
Phoenix, AZ 85012-2402

District of Columbia, Kentucky,
Maryland,Virginia,
West Virginia

Department of Veterans Affairs
Roanoke Regional Loan Center
210 Franklin Road, S.W.
Roanoke, VA 24011

Illinois, Iowa, Kansas, Minnesota,
Missouri, Nebraska, North Dakota,
South Dakota, Wisconsin

Department of Veterans Affairs
St. Paul Regional Loan Center
1 Federal Drive, Ft. Snelling
St. Paul, MN 55111-4050

Alabama, Florida, Mississippi,
Puerto Rico, U.S. Virgin Islands

Department of Veterans Affairs
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: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 2900-0055, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 15 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance
Officer at vapra@va.gov. Please refer to OMB Control No. 2900-0055 in any correspondence. Do not send your completed VA Form 26-1817 to this email address.

VA FORM 26-1817, XXX 20XX

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