Information Collection

Information for Determining Possible Loss of U.S. Citizenship

IC 181472 under ICR 200708-1405-001 · OMB 1405-0178.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0178 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-4079 Information for Determining Possible Loss of U.S. Citizenship	Form and Instruction
DS-4079 Questionnaire: Information for Determining Possible Loss DS-4079 .pdf	Form and Instruction

IC Title:

Information for Determining Possible Loss of U.S. Citizenship

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 22 CFR 50.40 22 CFR 50.50

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-4079	Questionnaire: Information for Determining Possible Loss of U.S. Citizenship	DS-4079 .pdf		Yes	No	Fillable Printable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Investigation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,298

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,298	2,298
Annual IC Time Burden (Hours)	575	575
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.