Application for a U.S. Passport: Name Change, Data Correction, and Limited Passport Book Replacement

Forms and Documents

Document Name	Status
Form DS-5504 Application for a U.S. Passport: Name Change, Data Corrections, and Limited Passport Book Replacement Form and Instruction	Modified
DS-5504 LegalAuthorities Updated Apr 08 2016.docx Supplementary Document	2016-09-06
DS-5504 Supp Statement-Final.docx Supporting Statement A	2016-09-06

IC Document Collections

IC ID	Document Title	Status
15051	Application for a U.S. Passport: Name Change, Data Corrections, and Limited Passport Book Replacement Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0160	ICR Reference No: 201609-1405-001
Status: Historical Active	Previous ICR Reference No: 201309-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application for a U.S. Passport: Name Change, Data Correction, and Limited Passport Book Replacement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/05/2016
	Date Received in OIRA: 09/06/2016
Terms of Clearance: State is authorized to continue to use the previously approved version of the DS-5504 until October 31, 2016.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved	01/31/2017
Responses	136,833	0	114,637
Time Burden (Hours)	91,222	0	76,425
Cost Burden (Dollars)	1,982,710	0	2,821,216

---

Abstract: The Application for a U.S. Passport: Name Change, Data Correction, and Limited Passport Book Replacement (DS-5504) is the form used by current passport holders who need to re-apply for a new passport within one year of the date of issuance for the following conditions: a) the passport holder's name has changed within the first year of the issuance of the passport; b) the passport holder needs correction of descriptive information on the data page of the passport; c) the passport holder wishes to obtain a fully valid passport after obtaining a full-fee passport with a limited validity of two years or less.

---

Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
  

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:
	81 FR 36375	06/06/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 59264	08/29/2016
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Application for a U.S. Passport: Name Change, Data Corrections, and Limited Passport Book Replacement	DS-5504	APPLICATION FOR A U.S. PASSPORT CORRECTIONS, NAME CHANGE WITHIN 1 YEAR OF PASSPORT ISSUANCE, AND LIMITED PASSPORT HOLDERS

---

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	136,833	114,637	0	22,196	0	0
Annual Time Burden (Hours)	91,222	76,425	0	14,797	0	0
Annual Cost Burden (Dollars)	1,982,710	2,821,216	0	-838,506	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: No

Burden Reduction Due to:

Short Statement: 15. The program adjustments reflect an increase in the number of projected respondents from 114,637 (previous 2013 – 2016) to 136,833 (FYs 2016-2018). Demand has continued to increase at a steady rate between 2013 through 2016. The annual number of respondents projected to use the DS-5504 for the next three years was adjusted to reflect the actual demand while taking into account a steady increase of all passport applications for Fiscal Years 2016 through 2018. With the rise in overall passport applications, it is expected that name changes, data corrections, and limited passport book replacement will increase accordingly. Demand forecast projections, by their nature, will have some uncertainty in their accuracy, which can explain differences between actual and forecast. The change in respondent costs is due to the elimination of the fees for name change documents (marriage certificate or court order documents) that were incorrectly attributed as a Cost to Respondent in the last submission. Respondents looking to change their names generally will have and/or obtain these types of documents on their own for a variety of reasons. The Department’s policy is to return all citizenship and identity documents, including marriage certificates or court orders, to the applicant, which means he or she does not incur a cost. Therefore, the only costs attributed to the respondent in this submission are for passport photographs, postage, and travel.

---

Annual Cost to Federal Government: $1,982,710

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: 09/06/2016

---