Application for a U.S. Passport

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-11 Application for a U.S. Passport	Form and Instruction	Modified	Available
1405-0004 Passport Application Non-sub justification (9-2012).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2012-09-20	Available
1405-0004 Passport Application Non-sub justification (4-2012).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2012-04-02	Available
DS-11 Supporting Statement (1-2011).docx	Supporting Statement A	Uploaded 2011-02-08	Available
Legal Authorities - DS-11 (1-2011).doc	Supplementary Document	Uploaded 2011-02-07	Available
Air Change Justification.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2007-06-28	Available
Legal Authorities--DS-11.doc	Supplementary Document	Uploaded 2007-06-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14791	Application for a U.S. Passport	Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0004	ICR Reference No: 201209-1405-002
Status: Historical Active	Previous ICR Reference No: 201204-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application for a U.S. Passport
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2012
	Date Received in OIRA: 09/20/2012
Terms of Clearance: State has requested to use a previously OMB-approved version of the form due to processing issues with a new format.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12/31/2013	12/31/2013
Responses	12,500,000	0	12,500,000
Time Burden (Hours)	17,708,333	0	17,708,333
Cost Burden (Dollars)	1,801,830,000	0	1,801,830,000

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Abstract: This form collects information necessary to establish nationality, identity, and entitlement to the issuance of passports to U.S. citizens and non-citizen nationals.

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Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1400-AC22	Final or interim final rulemaking	71 FR 200	10/17/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 118	06/21/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 197	10/13/2010
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for a U.S. Passport	DS-11, DS-11, DS-11	Application for a US Passport ,   Application for a U.S. Passport ,   Application for a U.S. Passport

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ICR Summary of Burden

table that charts list 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	12,500,000	12,500,000	0	0	0	0
Annual Time Burden (Hours)	17,708,333	17,708,333	0	0	0	0
Annual Cost Burden (Dollars)	1,801,830,000	1,801,830,000	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $934,360

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 09/20/2012

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