DS-4085 Supporting Statement v2 (10-2013)

SUPPORTING STATEMENT
FOR PAPERWORK REDUCTION ACT SUBMISSION

Application for Additional Visa Pages or Miscellaneous Passport Services
OMB Control # 1405-0159 (Form DS-4085)

A. JUSTIFICATION

1. The Application for Additional Visa Pages (Form DS-4085) is used by citizens and non-citizen nationals (hereinafter, collectively referred to as “nationals”) of the United States, who are applying for additional visa pages in a valid U.S. passport. It is also used to establish entitlement to, amendment, or cancelation of certain kinds of passport endorsements.
   
   
   

Under 22 United States Code (U.S.C.) Section 211a et seq. and Executive Order 11295 (August 5, 1966), the Secretary of State has authority to issue U.S. passports to U.S. citizens and non-citizen nationals. When the bearer of a valid U.S. passport applies for the addition of visa pages to that passport, the Department must confirm the applicant’s identity and eligibility to receive passport services before the Department can return the passport to the applicant with additional visa pages. Form DS-4085 requests information that is necessary to determine whether the applicant is eligible to receive passport services per the requirements of Title III of the Immigration and Nationality Act (INA) (U.S.C. sections 1402-1504), the regulations at 22 C.F.R. Parts 50 and 51, and other applicable treaties and laws.

2. The information collected on the DS-4085 is used to facilitate the issuance of additional visa pages into the valid U.S. passports of U.S. citizens and nationals. The primary purposes for soliciting the information is to establish entitlement to the issuance of additional visa pages, and to properly administer and enforce the laws pertaining to the issuance thereof. The secondary purposes for soliciting the information is to establish entitlement to, amendment, or cancelation of certain kinds of passport endorsements.

The DS-4085 is retained in the files of the Department of State, along with other documentation related to passport applications, adjudication, and issuance. Among other uses, these records are consulted when a U.S. passport has been lost, and the bearer has no evidence of nationality available or in support of any derivative claims to nationality made by an applicant’s children. The records may also be consulted by consular personnel in the event of an emergency abroad involving Americans: the application has a block for the name, address, and telephone number of a person to notify in the event of an emergency. Information from the DS-4085 may also be shared with outside users, and may be used, in accordance with the Privacy Act or as set forth in the Department of State’s Prefatory Statement of Routine Uses relative to the Privacy Act (Public Notice 6290 of July 15, 2008), or the Department’s System of Records Notice (State-26) for passport records.

The DS-4085 becomes part of the applicant’s passport file, which is protected by the Privacy Act. The information contained in this file cannot be released except as provided by the Privacy and Freedom of Information Acts.

Intentionally making a false statement on the DS-4085 may constitute a violation of 18 U.S.C. sections 1001, 1542, and/or 1621.

3. The DS-4085 is currently available online at http://www.travel.state.gov. However, the DS-4085 cannot be submitted electronically, because an applicant is required to physically submit his/her passport book in person or by mail along with this form to have the additional visa pages inserted into the passport book. The form can be filled out on-line and printed for manual signature and submission. When the application is complete, a 2-D barcode is printed on each form. This barcode is scanned by Passport Services, and automatically records the applicant’s information in our system. This process saves both Passport Services and the applicant time and reduces errors.

3. Aside from necessary, basic self-identification data, the information requested does not duplicate information otherwise available. The DS-4085 is the sole Department of State form used by applicants requesting to have additional visa pages added to their valid U.S. passports.

3. This collection of information does not significantly impact small businesses or other small entities.

3. The information collected on the DS-4085 is needed to establish entitlement to additional visa pages.

3. No such special circumstances exist.

3. The 60-day Federal Register Notice soliciting public comment was published on April 17, 2013 (78 FR 22936) and closed June 16, 2013. The Department of State received no comments on the 60-day notice in the Federal Register.

However, a public comment was received on the proposed DS-82, “U.S. Passport Renewal Application for Eligible Individuals” form (OMB Control No. 1405-0020) regarding the wording in the Electronic Passport Statement. The commenter stated that he was confused about which type of passport to select when completing the form because the instructions refer to “a type of electronic passport book containing an embedded electronic chip, which was called an “Electronic Passport.”  In response, the Department replied with the following:

All passport books issued by the U.S. Department of State at this point in time are Electronic Passports Books that contain an embedded electronic chip.  The Electronic Passport Statements in the Instructions sections in all public-use passport forms do not currently state this fact clearly. Therefore, as the result of this suggestion, the Department has revised the first sentence of the Electronic Passport Statement in the DS-82 as well as all other Public-Use Passport Forms from “The U.S. Department of State now issues a type of passport book containing an embedded electronic chip called an “Electronic Passport” to read: “The U.S. Department of State now issues an “Electronic Passport” book, which contains an embedded electronic chip.”

Therefore, this change has been made to the Electronic Passport Statement on page 3 of the DS-4085 form instructions.

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

10. This form includes a Privacy Act Statement explaining the routine uses of the information collected under the Act and referencing the Passport Systems of Records Notices (SORN) under the following:

State 26: http://www.state.gov/documents/organization/102790.pdf, and

State 05: http://www.state.gov/documents/organization/102787.pdf

11. The DS-4085 collection of information asks the respondent to provide a Social Security number in order to confirm the applicant’s identity. Passport Services must confirm that the person applying for additional passport services is the same person to whom the U.S. passport was originally issued.

12. Passport Services estimates that the average time required for this information collection is 20 (minutes) per response. Therefore, the estimated total annual burden for the collection is:

68,559 (number of respondents) x 20 (minutes) / 60 = 22,853 hours per year.

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

22,853 (annual hours) x $31.64 (weighted wage) = $723,068 (hour burden cost)

The estimated number of minutes required 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. The sampling was completed through consultation with a small group of Consular Affairs employees to validate the time.

13. DS-4085 applications are submitted primarily by mail. Per information received

from the United States Postal Service, the estimated cost burden for postage is approximately $1.25 per application.

The estimated Cost to the Respondent is shown in the table below:

68,559 respondents

X

$1.25

=

$85,700 Total Cost to Respondents

The current DS-4085 application fee of $82.00 is a non-refundable processing fee retained by the U.S. Department of State for cost recovery, and is not considered a respondent cost.

14. The DS-4085 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. Using the estimated projection of 68,000 respondents per year for FYs 2013 – 2016 at a cost of $24.50 per thousand, the contractor cost to the Federal Government is $1,666.00.

15. The projected adjustments reflect a decrease in the number of respondents from 146,000 (previous 2010 – 2013) to 68,559 (FYs 2013-2016). The previous number of respondents was estimated based on a 2009 projection for those three years. However, using actual receipts for 2010 – 2012, the average total amounted to 125,282.70. Demand has decreased at a steady rate between 2010 through 2012 based on the addition of the choice between a 28 page book (standard) or a 52 page book (non-standard) option at the top of page 1 of the DS-11 form. Therefore, since many applicants are opting for the 52 page book on the DS-11 form, the demand for the DS-4085 “Application for Additional Visa Pages” has correspondingly decreased. The number of applicants that will choose the 52 page option was estimated at less than 1% of the population and was based on previous DS-4085 receipts. Given this decreasing trend the new model was adjusted to reflect an average of 68,559 respondents per year for FY 2013 – 2016.

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

The change in respondent costs is due to the elimination of the fees that were incorrectly attributed as a Cost to Respondent in the last submission. The only cost attributed to the respondent in this submission is postage.

In addition to general format changes, the following content changes have been made to the form:

• Page 3 Instructions – Under the heading “Electronic Passport Statement”, the first sentence, “The U.S. Department of State now issues a type of passport book containing an embedded electronic chip called an ‘Electronic Passport.’” has been revised to read “The U.S. Department of State now issues an ‘Electronic Passport’ book, which contains an embedded electronic chip.”

• Page 1 Form – Under Line Item 15, Travel Plans: The words “Date of Trip” have been replaced with “Departure Date” and the words “Duration of Trip” have been replaced with “Return Date”.

• Page 1 Form - In the first signature block, “Applicant’s Signature – age 16 and older”, the word “Legal” has been added before “Signature”.

• Page 1 Form - The second signature block “Parent’s/Legal Guardian’s Signature (if identifying minor)” has been revised to now read “Mother/Father/Parent/Legal Guardian’s Signature (if identifying minor)”.

The Department estimates that these changes will not result in an increase in the current burden time of 20 minutes.

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

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

18. 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.