This form is used by USCIS to
determine an applicant's eligibility for a replacement document
that was lost, mutilated or destroyed, or if the applicant's name
was changed by marriage or by court order after the original
document was issued. Additionally, this form is used by a
naturalized citizen applicant who desires to obtain a special
certificate of recognition as a citizen of the United States by a
foreign country.
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:
(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;
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.