Information Collection

Electronic Diversity Visa Entry Form

IC 15041 under ICR 201005-1405-001 · OMB 1405-0153.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0153 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-5501 Electronic Diversity Visa Entry Form	Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form, Part One EDV PartOne.doc www.travel.state.gov	Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form, Part Two EDV PartTwo.doc www.travel.state.gov	Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form , Part One (5/14/07 1405-0153 EDV Part One 5-14-07.doc www.travel.state.gov	Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form , Part Two (5/14/07 1405-0153 EDV Part Two 5-14-07.doc www.travel.state.gov	Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form, Part 1 & 2 (5-2010 DS-5501 DV Screenshots (5-2010).docx www.travel.state.gov	Form and Instruction

IC Title:

Electronic Diversity Visa Entry Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 42.33

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-5501	Electronic Diversity Visa Entry Form, Part One	EDV PartOne.doc	www.travel.state.gov	Yes	Yes	Fillable Printable
Form and Instruction	DS-5501	Electronic Diversity Visa Entry Form, Part Two	EDV PartTwo.doc	www.travel.state.gov	Yes	Yes	Fillable Printable
Form and Instruction	DS-5501	Electronic Diversity Visa Entry Form , Part One (5/14/07)	1405-0153 EDV Part One 5-14-07.doc	www.travel.state.gov	Yes	Yes	Fillable Printable
Form and Instruction	DS-5501	Electronic Diversity Visa Entry Form , Part Two (5/14/07)	1405-0153 EDV Part Two 5-14-07.doc	www.travel.state.gov	Yes	Yes	Fillable Printable
Form and Instruction	DS-5501	Electronic Diversity Visa Entry Form, Part 1 & 2 (5-2010)	DS-5501 DV Screenshots (5-2010).docx	www.travel.state.gov	Yes	Yes	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,000,000	6,000,000
Annual IC Time Burden (Hours)	3,000,000	3,000,000
Annual IC Cost Burden (Dollars)	60,000,000	60,000,000

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.