SUPPORTING STATEMENT
FOR PAPERWORK REDUCTION ACT SUBMISSION
Statement of Exigent/Special Family Circumstances for Issuance
of a U.S. Passport to a Minor under Age 16
OMB Number 1405-0216
DS-5525
The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian’s unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.
The DS-5525 form assists the U.S. Department of State to administer the regulations in 22 C.F.R. 51.28 requiring that both parents and/or any guardian consent to the issuance of a passport to a minor under age 16, unless the applying parent has sole custody, or certain exceptions apply. This regulation was mandated by Section 236 of the Admiral James W. Nance and Meg Donovan Foreign Relations authorization Act, Fiscal Year 2000 and 2001 (enacted by Public Law 106-113, Div. B, Section 1000 (a)(7)), and helps to prevent international child abduction, child trafficking, and other forms of passport fraud.
Form DS-5525 is used by Passport Services to establish a possible exigent/special family circumstance exception to Public Law 106-113, Section 236, requiring two parent consent for a minor’s passport application.
The DS-5525 is intended to be submitted with the DS-11, which cannot be submitted electronically. As required by 22 C.F.R. Part 51, all DS-11 applicants (and applicants under 16) must appear in person for the execution of a passport application. However, the DS-5525 is on the Department’s website, www.travel.state.gov where it can be filled out on-line and printed for manual signature and submission.
Aside from necessary basic self-identification data, the information requested does not duplicate information otherwise available.
The DS-5525 does not involve small businesses or other small entities.
The DS-5525, “Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16” is used in conjunction with the “Application for a U.S. Passport” (DS-11). The DS-5525 can serve as the statement describing exigent or special family circumstances, which is required if written consent of the non-applying parent or guardian cannot be obtained when the passport application is executed for a minor under age 16. The statement must explain the reason for the request. The form is not to be used if the non-applying parent or guardian refuses, or claims it is inconvenient to provide notarized consent (using the DS-3053) for the minor applicant. If the required statement is not submitted, or the circumstances do not meet the requirements, the minor shall not receive a passport. Use of the DS-5525 is not mandatory. The required statement may be submitted in other formats provided they meet statutory and regulatory requirements.
No such special circumstances exist.
The Department of State published a 60-day notice in the Federal Register to solicit public comments on March 30, 2016 (81 FR 17753).
The Department received one non-substantive comment from the 60-day notice in the Federal Register. The comment was received from Ms. Jean Public. The commentator stated that “this form should be banned no kids should be let into this country from any foreign country and especially not under allegedly exigent circumstances. We need to stop the allowance of all of these foreigners into the usa…”
The Department responded that this comment is outside of scope of this information collection. This form is only applicable to U.S. citizen and non-citizen U.S. national parents applying for a passport for their U.S. citizen and non-citizen U.S. national minors and is designed to be used in the rare circumstances when the written consent of the non-applying or guardian parent cannot be obtained.
This information collection does not provide any payment or gift to respondents.
This form includes a Privacy Act Statement explaining the routine uses of the information collected under the Act. The Department provides no assurance of confidentiality, other than those provided by statute.
The DS-5525 does not ask questions of a sensitive nature.
Passport Services estimates that the average time required for this information collection is 30 (minutes) per response. Therefore, the estimated total annual burden for the collection is:
43,526 (number of respondents) x 30 (minutes) / 60 = 21,763 hours per year.
The estimated number of minutes 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.
To estimate the cost to respondents for this form based on the hourly wage and weighted wage multiplier, the Department calculated the following:
$22.71 (mean hourly earnings based on estimated income per hour from the Bureau of Labor Statistics) x 1.4 (weighted wage multiplier) = $31.79 weighted wage
21,763 (annual hours) x $31.79 (weighted wage) = $691,846 (hour burden cost)
There is no cost to respondents.
The DS-5525 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. Based on the projected number of 43,526 respondents (which will be rounded up to 44,000) per year for the next three years, at a cost of $35.00 per thousand, the contractor printing cost to the Federal Government is $1,540.
During Passport Services’ review of production standards in 2015, the Office of Adjudication conducted a “frequency analysis” to determine, among other things, how long it takes to process certain applications and how often certain forms were submitted as current technology does not keep track of this information. Analysts went into the field, and counted approximately 39,229 DS-11 applications to obtain a statistically significant sample of the workload. The sample showed that approximately 0.37% of all DS-11 applications were accompanied by form DS-5525. Therefore, based on a projected workload of 11,763,831 DS-11 applications per year over the next three years, the Department estimates that approximately 43,526 applications per year would be accompanied by a DS-5525.
Based on the Office of Adjudication’s observations, the average processing time for a DS-5525 is 0.85 hour. The Department’s Bureau of Budget and Planning places the hourly wage of a domestic Civil Service employee over the three years span of FY 2015, FY 2016, and FY 2017 at $67.12/hr.
($67.12/60) x 0.85 = $0.95 per DS-5525
$0.95 x 43,526 respondents = $41,350 labor costs
Combine the $41,350 labor costs with the $1,540 contractor printing cost yields an annualized total Federal government cost of $42,890.
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 estimates (115,050 respondents to 43,526) may be attributed to the short time this form has been in existence. 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.
In addition to some formatting changes, the Department revamped the “Use of This Form” section and “Form Instructions” in order to make the sections more concise and easier to understand.
Some questions were combined and/or separated out to allow the respondents to better respond to the questions asked. Previously, questions were asked in a freeform format which, unfortunately, resulted in incomplete responses.
Quantitative summaries of Department of State passport activities are published periodically on the Department of State website at: http://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.
This collection does not employ statistical methods.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | SUPPORTING STATEMENT FOR |
| Author | USDOS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |