Statement Regarding a Lost or Stolen Passport Book and/or Card

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-64 Statement Regarding a Lost or Stolen Passport Book and/or Card	Form and Instruction	Modified	Available
DS-64 Supporting Statement (final rev 8-6-2013).docx	Supporting Statement A	Uploaded 2013-08-07	Available
DS-64 Legal Authorities (3-2013).docx	Supplementary Document	Uploaded 2013-03-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14809	Statement Regarding a Lost or Stolen Passport Book and/or Card	Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0014	ICR Reference No: 201303-1405-003
Status: Historical Active	Previous ICR Reference No: 201103-1405-005
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement Regarding a Lost or Stolen Passport Book and/or Card
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: 08/14/2013
	Date Received in OIRA: 03/13/2013
Terms of Clearance: Approved for two years only due to lack of GPEA compliance. OMB requests that DOS continue to pursue development of a means of accepting electronic submission.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2013
Responses	991,351	0	122,500
Time Burden (Hours)	174,312	0	10,208
Cost Burden (Dollars)	396,838	0	0

---

Abstract: The form is used prior to passport issuance and solicits information relating to the loss or theft of a valid U.S. passport. The information is used by the U.S. Department of State to ensure that no person shall bear more than one valid or potentially valid U.S. passport book and/or card at any one time, except as authorized by the Department, and is also used to combat passport fraud and misuse.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 67860	11/14/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 15799	03/12/2013
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Statement Regarding a Lost or Stolen Passport Book and/or Card	DS-64, DS-64	Statement Regarding a Lost or Stolen Passport Book and/or Card

---

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	991,351	122,500	0	0	868,851	0
Annual Time Burden (Hours)	174,312	10,208	0	91,700	72,404	0
Annual Cost Burden (Dollars)	396,838	0	0	396,838	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Burden change due to increased respondent universe and addition of ID photocopy requirement and postage.

---

Annual Cost to Federal Government: $30,662,457

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

---

Common Form ICR:  No

---

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: 03/13/2013

---