Request for Determination of Possible Loss of United States Citizenship

Forms and Documents

Document Name	Status
Form DS-4079 Request for Determination of Possible Loss of United States Citizenship Form and Instruction	Modified
DS-4079 Legal Authorities.doc Supplementary Document	2017-01-17
FINAL - DS-4079 Supporting Statement.doc Supporting Statement A	2017-01-17

IC Document Collections

IC ID	Document Title	Status
181472	Request for Determination of Possible Loss of United States Citizenship Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0178	ICR Reference No: 201701-1405-014
Status: Historical Active	Previous ICR Reference No: 201310-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Request for Determination of Possible Loss of United States Citizenship
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/28/2017
	Date Received in OIRA: 01/17/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	02/28/2017
Responses	600	0	1,729
Time Burden (Hours)	400	0	432
Cost Burden (Dollars)	0	0	32,532

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Abstract: The purpose of the DS-4079 questionnaire is to determine current citizenship status and the possibility of loss of United States citizenship. The information provided assists consular officers and the Department of State in determining if the U.S. citizen has lost his or her nationality by voluntarily performing an expatriating act with the intention of relinquishing United States nationality.

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Authorizing Statute(s): US Code: 8 USC 1481(a) Name of Law: Immigration and Nationality Act (INA)
  

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 52945	08/10/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 4449	01/13/2017
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
Request for Determination of Possible Loss of United States Citizenship	DS-4079	Request for Determination of Possible Loss of United States Citizenship

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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	600	1,729	0	-1,129	0	0
Annual Time Burden (Hours)	400	432	0	-32	0	0
Annual Cost Burden (Dollars)	0	32,532	0	-32,532	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: Miscellaneous Actions

Short Statement: The number of applicants varies from year to year depending on the number of citizens who may have relinquished their U.S. citizenship. The Department reevaluated the time it takes for applicants to complete the DS-4079 and determined that the increase from 15 minutes to 40 minutes is a more fair representation of applicants’ efforts. This change is based on a feedback we received from U.S. diplomatic missions abroad. The cost to the respondent shows a difference of 32,532 because the cost of the respondent has changed from $32,532 to zero. Consular Affairs has stated there are no required costs associated with the respondent delivering the form to a U.S. diplomatic mission ahead of his/her interview. The applicant may choose to email the unsigned form or send the unsigned form via mail to the U.S. diplomatic mission ahead of their interview, but not required.

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Annual Cost to Federal Government: $8,071,738

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: 01/17/2017

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