Courier Drop-Off List for U.S. Passport Applications

Forms and Documents

Document Name	Status
Form DS-4283 Courier Drop-Off List for U.S. Passport Applications Form and Instruction	Modified
DS-4283 Supp 30 Day OMB Violation.docx Supporting Statement A	2016-04-11
DS-4283 LegalAuthorities Finaldocx (2).docx Supplementary Document	2016-02-10

IC Document Collections

IC ID	Document Title	Status
220054	Courier Drop-Off List for U.S. Passport Applications Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0222	ICR Reference No: 201604-1405-001
Status: Historical Active	Previous ICR Reference No: 201602-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Courier Drop-Off List for U.S. Passport Applications
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/26/2016
	Date Received in OIRA: 04/11/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved
Responses	216,000	0	0
Time Burden (Hours)	36,000	0	0
Cost Burden (Dollars)	47,520	0	0

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Abstract: The information collected on the DS-4283 is used to facilitate the issuance of passports to U.S. nationals with imminent travel plans who hire private courier companies to deliver their applications to one of the Department’s domestic passport agencies. The Department asks courier company employees to complete the DS-4283 and submit the form with passport applications delivered in bulk to passport agencies in a designated drop-off box. Passport agencies use the form to track the submission of applications that a courier drops off. The form serves as a record of receipt of documents submitted to the Department and as an acknowledgment of who delivered these documents. The DS-4283 is part of a Department effort to facilitate the delivery of passport applications by private courier companies while maintaining the integrity of the passport application process.

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Authorizing Statute(s): US Code: 22 USC 2670 Name of Law: Authority to Establish, Maintain and Operate Passport Agencies
   US Code: 22 USC 211a Name of Law: Authority to Grant, Issue, and Verify Passports
  

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:
	80 FR 47021	08/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6921	02/09/2016
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Courier Drop-Off List for U.S. Passport Applications	DS-4283	Courier Drop-Off List for U.S. Passport Applications

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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	216,000	0	0	0	0	216,000
Annual Time Burden (Hours)	36,000	0	0	0	0	36,000
Annual Cost Burden (Dollars)	47,520	0	0	0	0	47,520

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:

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Annual Cost to Federal Government: $174,156

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: 04/11/2016

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