Photograph and Signature Card

Foreign Diplomatic Services Applications (FDSA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0105 can be found here:

Documents and Forms

Document Name Document Type
Form DS-4139 Photograph and Signature Card Form and Instruction
DS-4139 Photograph and Signature Card DS4139 (2).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Photograph and Signature Card	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-4139	Photograph and Signature Card	DS4139 (2).pdf		No		Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.