Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16

Forms and Documents

Document Name	Status
Form DS-3053 Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16 Form and Instruction	Modified
DS-3053 Legal Authorities (6-2013).docx Supplementary Document	2013-06-20
DS-3053 Supporting Statement revised (8-19-2013).docx Supporting Statement A	2013-08-22

IC Document Collections

IC ID	Document Title	Status
14999	Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16 Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0129	ICR Reference No: 201306-1405-002
Status: Historical Active	Previous ICR Reference No: 201102-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16
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: 08/29/2013
	Date Received in OIRA: 06/20/2013
Terms of Clearance: DOS should further study and report on the practicality of electronic filing, in compliance with GPEA, in its next submission to OMB.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved	12/31/2013
Responses	556,075	0	1,025,000
Time Burden (Hours)	185,340	0	1,025,000
Cost Burden (Dollars)	1,390,188	0	2,562,500

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Abstract: The information collected on the DS-3053, "Statement of Consent: Issuance of a U.S. Passport to a Minor Under Age 16", is used in conjunction with the DS-11, "Application for a U.S. Passport". When a minor under the age of 16 applies for a passport and one of the minor's parents or legal guardians is unavailable at the time the passport application is executed, a completed and notarized DS-3053 can be used as the statement of consent. If the required statement is not submitted, the minor may not receive a U.S. Passport. The required statement may be submitted in other formats provided they meet statutory and regulatory requirements.

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Authorizing Statute(s): PL: Pub.L. 106 - 113 Section 1000 (a)(7)), Name of Law: Foreign Relations Authorization Act, Fiscal Year 2000 and 2001
   US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
   US Code: 8 USC 1104 Name of Law: Powers and duties of Secretary of State
   US Code: 18 USC 1542-1544 Name of Law: False statement in application and use of passport
   US Code: 22 USC 6039E Name of Law: Information concerning resident status
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 74044	12/12/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 36815	06/19/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16	DS-3053, DS-3053	Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16 ,   Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16

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ICR Summary 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	556,075	1,025,000	0	0	-468,925	0
Annual Time Burden (Hours)	185,340	1,025,000	0	0	-839,660	0
Annual Cost Burden (Dollars)	1,390,188	2,562,500	0	0	-1,172,312	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: The burden changes in this collection are due to the separation of the original collection into 2 separate collections and revised estimates of respondents.

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Annual Cost to Federal Government: $40,277

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: 06/20/2013

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