Information Collection

Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

IC 14809 under ICR 201711-1405-004 · OMB 1405-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-64 Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card	Form and Instruction
DS-64 Screenshots 2017.pdf travel.state.gov	Other-Pilot Web Application for DS-6
DS-64 Statement Regarding a Lost or Stolen U.S. Passport Book DS-64 (5-2015).pdf	Form and Instruction

IC Title:

Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 51.8(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-64	Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card	DS-64 (5-2015).pdf		Yes	No	Printable Only
Other-Pilot Web Application for DS-64			DS-64 Screenshots 2017.pdf	travel.state.gov	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 527,334

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	527,334	527,334
Annual IC Time Burden (Hours)	87,889	87,889
Annual IC Cost Burden (Dollars)	47,560	47,560

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.