Application for a U.S. Passport

Forms and Documents

Document Name	Status
Form DS-11 Application for a U.S. Passport Form and Instruction	Modified
Justification for Non-substantive 1405-0004.docx Justification for No Material/Nonsubstantive Change	2016-05-20
DS-11 Final Supporting Statement v3 (1-22-14).docx Supporting Statement A	2014-01-22
DS-11 LegalAuthorities (09-2013).docx Supplementary Document	2013-09-30

IC Document Collections

IC ID	Document Title	Status
14791	Application for a U.S. Passport Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0004	ICR Reference No: 201605-1405-003
Status: Historical Inactive	Previous ICR Reference No: 201309-1405-005
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application for a U.S. Passport
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 05/24/2016
	Date Received in OIRA: 05/20/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	01/31/2017	01/31/2017
Responses	10,351,043	0	10,351,043
Time Burden (Hours)	16,389,151	0	16,389,151
Cost Burden (Dollars)	142,844,393	0	142,844,393

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Abstract: This form collects information necessary to establish nationality, identity, and entitlement to the issuance of passports to U.S. citizens and non-citizen nationals.

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Authorizing Statute(s): 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:
	78 FR 22936	04/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 60008	09/30/2013
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
Application for a U.S. Passport	DS-11	Application for a US Passport

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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: $62,883,296

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: 05/20/2016

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