Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16

Forms and Documents

Document Name	Status
Form DS-3053 Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16 Form and Instruction	Modified
DS-3053 LEGAL AUTHORITIES Revised 3-16-2016.docx Supplementary Document	2016-07-08
Final SS.docx Supporting Statement A	2016-08-19

IC Document Collections

IC ID	Document Title	Status
14999	Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16 Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0129	ICR Reference No: 201607-1405-003
Status: Historical Active	Previous ICR Reference No: 201306-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16
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: 08/23/2016
	Date Received in OIRA: 07/08/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	465,848	0	556,075
Time Burden (Hours)	155,127	0	185,340
Cost Burden (Dollars)	1,164,620	0	1,390,188

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Abstract: The information collected on the DS-3053 is used to facilitate the issuance of passports to U.S. citizens and nationals under the age of 16. The primary purpose of soliciting the information is to ensure that both parents and/or all guardians consent to the issuance of a passport to a minor under the age 16, except where one parent has sole custody or there are exigent or special family circumstances.

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Authorizing Statute(s): PL: Pub.L. 106 - 113 Section 1000 (a)(7)), Name of Law: Foreign Relations Authorization Act, Fiscal Year 2000 and 2001
   US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
   US Code: 8 USC 1104 Name of Law: Powers and duties of Secretary of State
   US Code: 18 USC 1542-1544 Name of Law: False statement in application and use of passport
   US Code: 22 USC 6039E Name of Law: Information concerning resident status
  

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:
	81 FR 17754	03/30/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 43693	07/05/2016
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
Statement of Consent: Issuance of a U.S. Passport to a Minor Under the Age 16	DS-3053	Statment of Consent: Issuance of a US Passport to a Minor Under Age 16

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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	465,848	556,075	0	-90,227	0	0
Annual Time Burden (Hours)	155,127	185,340	0	-30,213	0	0
Annual Cost Burden (Dollars)	1,164,620	1,390,188	0	-225,568	0	0

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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: 15. Demand forecast projections, by their nature, will have some uncertainty in their accuracy, which can explain differences between actual and forecast. However, the decrease from the previous burden estimates (556,075 respondents to 465,848 and $1,390,188 in cost burden to respondents to $1,164,620) may be attributed to splitting the one form into two. The DS-5525, Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16, was introduced in the last three year cycle and the Department is still adjusting its impact on forecasts and workload.

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Annual Cost to Federal Government: $277,185

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: 07/08/2016

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