Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16

Forms and Documents

Document Name	Status
Form DS-3053 Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16 Form	Modified
30-Day Supporting Statement.doc Supporting Statement A	2007-10-26

IC Document Collections

IC ID	Document Title	Status
14999	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16 Form	Modified

ICR Details

OMB Control No: 1405-0129	ICR Reference No: 200710-1405-005
Status: Historical Active	Previous ICR Reference No: 200506-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/11/2007
	Date Received in OIRA: 10/30/2007
Terms of Clearance: Approved contingent on OMB and State agreement that revised forms will not be used until revised regulations are effective.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	36 Months From Approved	08/31/2008
Responses	605,800	0	525,000
Time Burden (Hours)	605,800	0	525,000
Cost Burden (Dollars)	1,042,000	0	906,000

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Abstract: This form is used when both parents or legal guardians of a minor child under age 16 cannot be present at the time the minor's passport application is executed.

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Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
   PL: Pub.L. 106 - 113 Section 1000 (a)(7)), Name of Law: Foreign Relations Authorization Act, Fiscal Year 2000 and 2001
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1400-AC28	Final or interim final rulemaking	72 FR 44	03/07/2007

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	70 FR 65	04/06/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	70 FR 127	07/05/2005
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16	DS-3053, DS-3053, DS-3053	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 14 ,   Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16 ,   Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	605,800	525,000	0	80,800	0	0
Annual Time Burden (Hours)	605,800	525,000	0	80,800	0	0
Annual Cost Burden (Dollars)	1,042,000	906,000	0	136,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The age of a child needing consent of both parents for a passport has been raised from 14 to 16 years of age (RIN 1400-AC28). Burden information and form have been adjusted to reflect this program change.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/30/2007

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