Foreign Diplomatic Services Applications (FDSA)

Forms and Documents

Document Name	Status
Form DS-1972 United States Department of State Driver License and Tax Exemption Card Application Form and Instruction	Removed
Form DS-4285 PORT COURTESIES REQUEST Form	New
Form DS-4284 WHITE HOUSE TOURS REQUEST Form	New
Form DS-7675 FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT Form	New
Form DS-4155 VENDOR APPLICATION FOR OFM WEBSITE ACCOUNT Form and Instruction	New
Form DS-4140 APPLICATION FOR OFM WEBSITE ACCOUNT Form	New
Form DS-4139 SIGNATURE CARD Form	New
Form DS-4138 REQUEST FOR AIRPORT ESCORT SCREENING COURTESIES Form and Instruction	New
Form DS-2008 NOTICE OF TERMINATION OF DIPLOMATIC, CONSULAR, OR FOREIGN GOVERNMENT EMPLOYMENT Form and Instruction	New
Form DS-2007 NOTIFICATION OF DEPENDENTS OF DIPLOMATIC, CONSULAR AND FOREIGN GOVERNMENT EMPLOYEES Form and Instruction	New
Form DS-2006 NOTIFICATION OF CHANGE IDENTIFICATION CARD REQUEST Form and Instruction	New
Form DS-2005 NOTIFICATION OF APPOINTMENT OF HONORARY CONSULAR OFFIC Form and Instruction	New
Form DS-2004 NOTIFICATION OF APPOINTMENT OF FOREIGN GOVERNMENT EMPLOYEE Form and Instruction	New
Form DS-2003 NOTIFICATION OF APPOINTMENT OF FOREIGN DIPLOMATIC OFFICER AND CAREER CONSULAR OFFICER Form and Instruction	New
Form DS-1972D DRIVER LICENSE & TAX EXEMPTION APPLICATION Form	New
Form DS-1504 REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE Form and Instruction	New
Form DS-104 APPLICATION FOR REPLACEMENT PLATES Form and Instruction	New
Form DS-102 APPLICATION FOR TITLE Form and Instruction	New
Form DS-101 APPLICATION FOR REGISTRATION (PERSONAL VEHICLE) Form and Instruction	New
Form DS-100 APPLICATION FOR REGISTRATION (MISSION VEHICLE) INSTRUCTIONS Form and Instruction	New
Form DS-99 APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON GASOLINE Form and Instruction	New
Form DS-98 APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES Form	New
Form DS-7675 Foreign Missions Emergency Contact Form and Instruction	Removed
Form DS-4155 Vendor Application Form and Instruction	Removed
Form DS-4140 Application for OFM Website Account Form and Instruction	Removed
Form DS-4138 Request for Escort Screening Courtesies Form and Instruction	Removed
Form DS-4139 Photograph and Signature Card Form and Instruction	Removed
Form DS-2008E Application for Notification of Termination of Diplomatic, Consular, or Foreign Government Employment - eGov System Form and Instruction	Removed
Form DS-2007 Notification of Dependents of Diplomatic, Consular and Foreign Government Employees Form	Removed
Form DS-2006 Notification of Change Identification Card Request Form	Removed
Form DS-2005 Application for Notification of Appointment for Honorary Consular Officer Form	Removed
Form DS-2004 Applying for a Notification of Appointment of Foreign Government Employee Form	Removed
Form DS-2003 Applying for a Notification of Appointment of Foreign Diplomatic Officer, Career Consular Officer Form	Removed
Form DS-1504 Request for Customs Clearance of Merchandise Form	Removed
Form DS-104E Application for Replacement Plates - eGov System Form and Instruction	Removed
Form DS-99E Application for Exemption of Gasoline Tax - eGov System Form and Instruction	Removed
Form DS-102 Application for (Motor Vehicle) Title Form	Removed
Form DS-101 Application for Registration (Personal Vehicle) Form	Removed
Form DS-100 Application for Registration (Mission Vehicles) Form	Removed
Form DS-98E Application for a Diplomatic Tax Exemption for Taxes on Utilities - eGov System Form and Instruction	Removed
Form DS-1972T Application for a Mission or Personal Tax Exemption Card - eGov System Form and Instruction	Removed
Form DS-1972D United States Department of State Driver License - eGov System Form and Instruction	Removed
Supporting Statement 3_19_15.docx Supporting Statement A	2015-03-19

IC Document Collections

IC ID	Document Title	Status
38741	United States Department of State Driver License and Tax Exemption Card Application Form and Instruction	Removed
214076	PORT COURTESIES REQUEST Form	New
214071	WHITE HOUSE TOURS REQUEST Form	New
214070	FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT Form	New
214069	VENDOR APPLICATION FOR OFM WEBSITE ACCOUNT Form and Instruction	New
214067	APPLICATION FOR OFM WEBSITE ACCOUNT Form	New
214064	SIGNATURE CARD Form	New
214059	REQUEST FOR AIRPORT ESCORT SCREENING COURTESIES Form and Instruction	New
214054	NOTICE OF TERMINATION OF DIPLOMATIC, CONSULAR, OR FOREIGN GOVERNMENT EMPLOYMENT Form and Instruction	New
214052	NOTIFICATION OF DEPENDENTS OF DIPLOMATIC, CONSULAR AND FOREIGN GOVERNMENT EMPLOYEES Form and Instruction	New
214049	NOTIFICATION OF CHANGE IDENTIFICATION CARD REQUEST Form and Instruction	New
214047	NOTIFICATION OF APPOINTMENT OF HONORARY CONSULAR OFFIC Form and Instruction	New
214046	NOTIFICATION OF APPOINTMENT OF FOREIGN GOVERNMENT EMPLOYEE Form and Instruction	New
214045	NOTIFICATION OF APPOINTMENT OF FOREIGN DIPLOMATIC OFFICER AND CAREER CONSULAR OFFICER Form and Instruction	New
214039	DRIVER LICENSE & TAX EXEMPTION APPLICATION Form	New
214032	REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE Form and Instruction	New
214030	APPLICATION FOR REPLACEMENT PLATES Form and Instruction	New
214028	APPLICATION FOR TITLE Form and Instruction	New
214027	APPLICATION FOR REGISTRATION (PERSONAL VEHICLE) Form and Instruction	New
214026	APPLICATION FOR REGISTRATION (MISSION VEHICLE) INSTRUCTIONS Form and Instruction	New
214025	APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON GASOLINE Form and Instruction	New
214024	APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES Form	New
198579	Foreign Missions Emergency Contact Form and Instruction	Removed
198578	Vendor Application Form and Instruction	Removed
192683	Application for OFM Website Account Form and Instruction	Removed
192682	Request for Escort Screening Courtesies Form and Instruction	Removed
192681	Photograph and Signature Card Form and Instruction	Removed
189076	Application for Notification of Termination of Diplomatic, Consular, or Foreign Government Employment - eGov System Form and Instruction	Removed
189075	Notification of Dependents of Diplomatic, Consular and Foreign Government Employees Form	Removed
189073	Notification of Change Identification Card Request Form	Removed
189071	Application for Notification of Appointment for Honorary Consular Officer Form	Removed
189070	Applying for a Notification of Appointment of Foreign Government Employee Form	Removed
189068	Applying for a Notification of Appointment of Foreign Diplomatic Officer, Career Consular Officer Form	Removed
189067	Request for Customs Clearance of Merchandise Form	Removed
189066	Application for Replacement Plates - eGov System Form and Instruction	Removed
189065	Application for Exemption of Gasoline Tax - eGov System Form and Instruction	Removed
189063	Application for (Motor Vehicle) Title Form	Removed
189061	Application for Registration (Personal Vehicle) Form	Removed
189058	Application for Registration (Mission Vehicles) Form	Removed
189049	Application for a Diplomatic Tax Exemption for Taxes on Utilities - eGov System Form and Instruction	Removed
189048	Application for a Mission or Personal Tax Exemption Card - eGov System Form and Instruction	Removed
189036	United States Department of State Driver License - eGov System Form and Instruction	Removed

ICR Details

OMB Control No: 1405-0105	ICR Reference No: 201411-1405-004
Status: Historical Active	Previous ICR Reference No: 201107-1405-009
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Foreign Diplomatic Services Applications (FDSA)
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: 03/19/2015
	Date Received in OIRA: 11/26/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	76,569	0	94,980
Time Burden (Hours)	13,536	0	28,628
Cost Burden (Dollars)	0	0	0

---

Abstract: Used by foreign VIP's to request diplomatic services.

---

Authorizing Statute(s): US Code: 22 USC 4301 Name of Law: Foreign Missions Act
  

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:
	79 FR 54772	09/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 70609	11/26/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
Application for Notification of Appointment for Honorary Consular Officer	DS-2005	Application for Notification of Appointment for Honorary Consular Officer
Notification of Change Identification Card Request	DS-2006	Notification of Change Identification Card Request
Notification of Dependents of Diplomatic, Consular and Foreign Government Employees	DS-2007	Notification of Dependents of Diplomatic, Consular and Foreign Government Employees
Application for Notification of Termination of Diplomatic, Consular, or Foreign Government Employment - eGov System	DS-2008E	Application for Notification of Termination of Diplomatic, Consular, or Foreign Government Employment
Photograph and Signature Card	DS-4139	Photograph and Signature Card
Request for Escort Screening Courtesies	DS-4138	Request for Escort Screening Courtesies
Application for OFM Website Account	DS-4140	Application for OFM Website Account
Vendor Application	DS-4155	Vendor Application for OFM Website Account
Foreign Missions Emergency Contact	DS-7675	Foreign Mission Emergency Afterhours Contact
APPLICATION FOR REGISTRATION (PERSONAL VEHICLE)	DS-101	APPLICATION FOR REGISTRATION (PERSONAL VEHICLE)
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE	DS-1504	REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
United States Department of State Driver License and Tax Exemption Card Application	DS-1972	U.S. Department of State Driver License & Tax Exemption Card Application
Application for Registration (Mission Vehicles)	DS-100	Application for Registration (Mission Vehicles)
APPLICATION FOR REGISTRATION (MISSION VEHICLE) INSTRUCTIONS	DS-100	APPLICATION FOR REGISTRATION (MISSION VEHICLE)
APPLICATION FOR TITLE	DS-102	APPLICATION FOR TITLE
APPLICATION FOR REPLACEMENT PLATES	DS-104	APPLICATION FOR REPLACEMENT PLATES
NOTIFICATION OF APPOINTMENT OF FOREIGN DIPLOMATIC OFFICER AND CAREER CONSULAR OFFICER	DS-2003	NOTIFICATION OF APPOINTMENT OF FOREIGN DIPLOMATIC OFFICER AND CAREER CONSULAR OFFICER
NOTIFICATION OF APPOINTMENT OF FOREIGN GOVERNMENT EMPLOYEE	DS-2004	NOTIFICATION OF APPOINTMENT OF FOREIGN GOVERNMENT EMPLOYEE
NOTIFICATION OF APPOINTMENT OF HONORARY CONSULAR OFFIC	DS-2005	NOTIFICATION OF APPOINTMENT OF HONORARY CONSULAR OFFICER
Application for a Mission or Personal Tax Exemption Card - eGov System	DS-1972T	Application for a Mission or Personal Tax Exemption Card
Application for Registration (Personal Vehicle)	DS-101	Application for Registration (Personal Vehicle)
Application for (Motor Vehicle) Title	DS-102	Application for (Motor Vehicle) Title
Application for Exemption of Gasoline Tax - eGov System	DS-99E	Application for Exemption of Gasoline Tax
Application for Replacement Plates - eGov System	DS-104E	Application for Replacement Plates
Request for Customs Clearance of Merchandise	DS-1504	Request for Customs Clearance of Merchandise
Applying for a Notification of Appointment of Foreign Diplomatic Officer, Career Consular Officer	DS-2003	Applying for a Notification of Appointment of Foreign Diplomatic Officer, Career Consular Officer
Applying for a Notification of Appointment of Foreign Government Employee	DS-2004	Applying for a Notification of Appointment of Foreign Government Employee
NOTICE OF TERMINATION OF DIPLOMATIC, CONSULAR, OR FOREIGN GOVERNMENT EMPLOYMENT	DS-2008	NOTICE OF TERMINATION OF DIPLOMATIC, CONSULAR, OR FOREIGN GOVERNMENT EMPLOYMENT
SIGNATURE CARD	DS-4139	SIGNATURE CARD
APPLICATION FOR OFM WEBSITE ACCOUNT	DS-4140	APPLICATION FOR OFM WEBSITE ACCOUNT
WHITE HOUSE TOURS REQUEST	DS-4284	WHITE HOUSE TOURS REQUEST
PORT COURTESIES REQUEST	DS-4285	PORT COURTESIES REQUEST
APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON GASOLINE	DS-99	APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON GASOLINE
DRIVER LICENSE & TAX EXEMPTION APPLICATION	DS-1972D, DS-1972T, DS-1972	DRIVER LICENSE APPLICATION ,   TAX EXEMPTION APPLICATION ,   DRIVER LICENSE and TAX EXEMPTION CARD APPLICATION
APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES	DS-98	APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES
NOTIFICATION OF CHANGE IDENTIFICATION CARD REQUEST	DS-2006	NOTIFICATION OF CHANGE IDENTIFICATION CARD REQUEST
NOTIFICATION OF DEPENDENTS OF DIPLOMATIC, CONSULAR AND FOREIGN GOVERNMENT EMPLOYEES	DS-2007	NOTIFICATION OF DEPENDENTS OF DIPLOMATIC, CONSULAR AND FOREIGN GOVERNMENT EMPLOYEES
REQUEST FOR AIRPORT ESCORT SCREENING COURTESIES	DS-4138	REQUEST FOR AIRPORT ESCORT SCREENING COURTESIES
VENDOR APPLICATION FOR OFM WEBSITE ACCOUNT	DS-4155	VENDOR APPLICATION FOR OFM WEBSITE ACCOUNT
FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT	DS-7675	FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT
Application for a Diplomatic Tax Exemption for Taxes on Utilities - eGov System	DS-98E	Application for a Diplomatic Tax Exemption for Taxes on Utilities
United States Department of State Driver License - eGov System	DS-1972D	United States Department of State Driver License

---

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	76,569	94,980	0	-86,737	68,326	0
Annual Time Burden (Hours)	13,536	28,628	0	-30,361	15,269	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden changes due to changes to included forms.

---

Annual Cost to Federal Government: $3,312,529

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: 11/26/2014

---