DS-5525 Supporting Statemebnt (6-2013)

SUPPORTING STATEMENT

FOR PAPERWORK REDUCTION ACT SUBMISSION

Statement of Exigent/Special Family Circumstances for Issuance

of a U.S. Passport to a Minor under Age 16

OMB #1405-XXXX (Form DS-5525)

A. JUSTIFICATION

1. The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian’s unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.

The DS-5525 form assists the U.S. Department of State to administer the regulations in 22 C.F.R. 51.28 requiring that both parents and/or any guardian consent to the issuance of a passport to a minor under age 16, except where one parent has sole custody, or certain exceptions apply. This regulation was mandated by Section 236 of the Admiral James W. Nance and Meg Donovan Foreign Relations authorization Act, Fiscal Year 2000 and 2001 (enacted by Public Law 106-113, Div. B, Section 1000 (a)(7)), and helps to prevent international child abduction, child trafficking, and other forms of passport fraud.

False statements on the DS-5525 are prosecutable under U.S. law, including the provisions of 18 U.S.C. sections 1001 and 1542.

2. Form DS-5525 is used by Passport Services to establish a possible exigent/special family circumstance to Public Law 106-113, Section 236, requiring two parent consent for a minor’s passport application.

3. The DS-5525 is intended to be submitted with the DS-11, which cannot be submitted electronically. As required by 22 C.F.R. Part 51, all DS-11 applicants (and applicants under 16) must appear in person for the execution of a passport.  However, upon OMB approval of the proposed form, it will be placed on the Department’s website where it can be filled out on-line and printed for manual signature and submission.

3. Aside from necessary basic self-identification data, the information requested does not duplicate information otherwise available.

3. The DS-5525 does not involve small businesses or other small entities.

3. The DS-5525, “Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16” is used in conjunction with the “Application for a U.S. Passport” (DS-11). The DS-5525 can serve as the statement describing exigent or special family circumstances, which is required if written consent of the non-applying parent or guardian cannot be obtained when the passport application is executed for a minor under age 16. The statement must explain the reason for the request. The form is not to be used if it is merely inconvenient for the non-applying parent or guardian to provide notarized consent (using the DS-3053) for the minor applicant. If the required statement is not submitted, or the circumstances do not meet the requirements, the minor may not receive a passport. Use of the DS-5525 is not mandatory. The required statement may be submitted in other formats provided they meet statutory and regulatory requirements.

3. No such special circumstances exist.

3. The 60-day Federal Register Notice soliciting public comment was published on December 17, 2012 (77 FR 74725) and closed February 15, 2013.

The Department of State received one comment from the 60-day notice in the Federal Register. The commenter noted that “both parents should be there in person when this form is applied for…and there are instances where one parent kidnaps the child and goes to another country and the taxpayers get the bill to get the child back; therefore, both parents need to be there to say yes I want a passport for my child.”

The Department responded by stating that we comply with Section 51.28(a)(5) of Title 22 of the U.S. Code of Federal Regulations, which specifically provides that a passport application for a minor under the age of 16 may be executed by one parent or legal guardian only when exigent circumstances or special family circumstances exist.

3. This information collection does not provide any payment or gift to respondents.

3. This form includes a Privacy Act Statement explaining the routine uses of the information collected under the Act. The Department provides no assurance of confidentiality, other than those provided by statute.

3. The DS-5525 does not ask questions of a sensitive nature.

3. Passport Services estimates that the average time required for this information collection is 30 (minutes) or 0.5 (hour) per response. Therefore, the estimated total annual burden for the collection is:

115,050 (number of respondents) x 0.5 hour = 57,525 hours per year.

The estimated number of minutes per response is based on a sampling of the time required to search existing data sources, gather the necessary information, provide the information required, review the final collection, and submit the collection to Passport Services for processing.

Previously, the information regarding special family circumstances was collected using the DS-3053. The DS-5525 form is a new form that is being proposed to collect only exigent/special family circumstances information. Therefore, in order to determine the burden time, Passport Services conducted a small in-house sampling of Consular Affairs employees, which when averaged was approximately 30 minutes per response.

To estimate the cost to respondents for this form based on the hourly wage and weighted wage multiplier, the Department calculated the following:

$22.60 (mean hourly earnings based on estimated income per hour from the Bureau of Labor Statistics) x 1.4 (weighted wage multiplier) = $31.64 weighted wage

57,525 (annual hours) x $31.64 (weighted wage) = $1,820,091 (hour burden cost)

3. There is no application fee associated with this collection. Form DS-5525 is submitted in conjunction with form DS-11, Application for a U.S. Passport.

3. The DS-5525 will be produced by a contractor with cost-plus-fixed-fee line items for materials and/or supplies purchase functions. The estimate provided to the Department by the contractor includes costs for contractor labor, supplies, equipment, printing, materials, delivery, overhead, support staff, etc. Based on the projected number of respondents per year for the next three years (115,050), the contractor estimated a cost to the federal government of approximately $8,392. The cost projection for the DS-5525 is the contractor’s best estimate based on the number of proposed respondents.  As the DS-5525 is a proposed new form, future cost projections will be more accurate once the form is placed in production over the next three years.

3. While the proposed DS-5525 is a new form, this information was previously collected under the DS-3053. During Passport Services’ review of production standards in 2011, the Office of Adjudication conducted a “frequency analysis” to determine, among other things, how often certain forms were submitted, as current technology does not keep track of this information.  Analysts went into the field and counted approximately 20,000 DS-11 applications to obtain a statistically significant sample of the workload. The sample showed that approximately 0.78% of all DS-11 applications submitted were accompanied by a form DS-3053 that included a statement of exigent/special family circumstances from the applying parent or guardian, the proposed DS-5525. Therefore, using the 0.78% from the sampling and applying a workload projection of 14,750,000 million DS-11 applications per year over the next three years, the Department estimates that approximately 115,050 applications would be accompanied by the DS-5525, Statement of Exigent/Special Family Circumstances.

Demand forecast projections, by their nature, will have some uncertainty in their accuracy, which can explain differences between actual and forecast.

In addition to general format changes, an oath will be placed onto the proposed DS-5525 form. The oath is located above the signature line on Page 2 of the form and states:

• “OATH: I declare under penalty of perjury that all statements made in this supporting document are true and correct.”

3. Quantitative summaries of Department of State passport activities are published periodically on the Department of State website at: http://www.travel.state.gov/. Such summaries do not involve the use of complex analytical techniques.

3. The expiration date for OMB approval will be displayed.

3. The Department is not requesting any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

This collection does not employ statistical methods.