Get Va Form 0877 2021-2024

/ CLAIM NO. FOR ONLY Skip if Non-Veteran SUPERSEDES VA FORM 0877 APR 2008 WHICH WILL NOT BE USED. SIGNATURE OF EACH DATE SIGNED. Form Approved OMB No* 2900-0675 Respondent Burden 5 Minutes VETBIZ VENDOR INFORMATION PAGES VERIFICATION PROGRAM PRIVACY ACT STATEMENT The information collected on this form is necessary to meet the eligibility of veteran-owned small business concerns under Public Law 109-461 Section 8127 requirements. We will use the information to identify any VA records. Furnishing the information on this form including your Social Security Number No* and VA File/Claim No* is voluntary however if the information is not furnished VA will not recognize your small business as veteran-owned or service-disabled veteran-owned* Your obligation to respond is voluntary. PAPERWORK REDUCTION ACT NOTICE The collection of information meets the requirement of Public Law 109-461 Section 8127 f 4 as amended by Section 2 of the Paperwork Reduction Act of 1995. This form has been created to provide an efficient way for the Department of Veterans Affairs to collect and verify veterans and service-disabled veterans in Vendor Information Pages VIP. We estimate the time to fill out the form to be about 5 minutes to read the instructions gather the facts and answer the questions. 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 if this number is not displayed* PART I - CONSENT TO ACCESS AND VERIFY VETERAN S OWNER S /VETERAN S STOCKHOLDER S RECORD S Each veteran owner/veteran stockholder named herein authorizes consent for the Center for Veterans Enterprise CVE personnel to access and verify their records. CVE will match your information with records maintained by VA s Beneficiary Identification Records Locator Subsystem database. Please see http //www. vip*vetbiz. gov for definitions of veteran service-disabled veteran owner stockholder Veteran-Owned Small Business VOSB Service-Disabled Veteran-Owned Small Business SDVOSB and eligible surviving spouse. PART II - AFFIRMATION By electronically signing or FAXing this signed form to 202 303-3330 and I affirm that the articles of incorporation or other legal documents establishing the business are filed with my state and such articles established that at least 51 of the business is owned and controlled or in the case of stock at least 51 of the stock is owned by veterans or service-disabled veterans or eligible surviving spouses as stated in Public Law 109-461 Section 8127 k 2. I affirm that each of the owners of the business or in the case of a business with stock each of the stockholders is eligible to participate in Federal contracting and that neither the business nor any of the individual owners appears on the Excluded Parties List at http //epls. gov as identified in Federal Acquisition Regulation 9. 404-3. I further affirm that I have read and understand the language in 13 CFR 125. 10 and that the business is controlled by individuals eligible to participate in the SDVOSB program if I am claiming SDVOSB status.