Information Collection

Application for Additional Visa Pages or Miscellaneous Passport Services

IC 15049 under ICR 201102-1405-004 · OMB 1405-0159.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0159 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-4085 Application for Additional Visa Pages or Miscellaneous Passport Services	Form
DS-4085 Application for Additional VISA PAges Internet Form DS-4085.pdf www.travel.state.gov	Form
DS-4085 Application for Additional Visa Pages or Miscellaneous P DS-4085 10-25-07.pdf www.travel.state.gov	Form and Instruction
DS-4085 Application for additional VISA Pages or Miscellaneous P OMB passback DS-4085 12-11-07.pdf www.travel.state.gov	Form and Instruction
DS-4085 Application for Additional VISA Pages or Miscellaneous P DS-4085 (2-2010).pdf www.travel.state.gov	Form and Instruction
DS-4085 Application for Additional Visa Pages or Miscellaneous P DS-4085 (1-2011).pdf www.travel.state.gov	Form and Instruction
Justification of Changes for DS-4085.doc Justification of Changes for DS-4085	IC Document
Justification for Nonsub Change DS-4085 (2-2010).doc Justification of Nonsub changes for DS-4085 (2-2010)	IC Document

IC Title:

Application for Additional Visa Pages or Miscellaneous Passport Services

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 50-51 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	DS-4085	Application for Additional VISA PAges	Internet Form DS-4085.pdf	www.travel.state.gov	Yes	No	Fillable Printable
Form and Instruction	DS-4085	Application for Additional Visa Pages or Miscellaneous Passport Services	DS-4085 10-25-07.pdf	www.travel.state.gov	Yes	No	Fillable Printable
Form and Instruction	DS-4085	Application for additional VISA Pages or Miscellaneous Passport Services	OMB passback DS-4085 12-11-07.pdf	www.travel.state.gov	Yes	No	Fillable Printable
Form and Instruction	DS-4085	Application for Additional VISA Pages or Miscellaneous Passport Services	DS-4085 (2-2010).pdf	www.travel.state.gov	Yes	No	Fillable Printable
Form and Instruction	DS-4085	Application for Additional Visa Pages or Miscellaneous Passport Services	DS-4085 (1-2011).pdf	www.travel.state.gov	Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 146,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	146,000	0	86,000	60,000
Annual IC Time Burden (Hours)	48,667	0	28,667	20,000
Annual IC Cost Burden (Dollars)	17,645,300	16,802,300	0	843,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification of Changes for DS-4085	Justification of Changes for DS-4085.doc	10/26/2007
Justification of Nonsub changes for DS-4085 (2-2010)	Justification for Nonsub Change DS-4085 (2-2010).doc	02/23/2010

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