Electronic Diversity Visa Entry Form

Forms and Documents

Document Name	Status
Form DS-5501 Electronic Diversity Visa Entry Form Form and Instruction	Modified
DS-5501 Legal Authorities.doc Supplementary Document	2019-08-29
Final - DS-5501 30 Day Supporting Statement 8-27-2019.docx Supporting Statement A	2019-08-29

IC Document Collections

IC ID	Document Title	Status
15041	Electronic Diversity Visa Entry Form Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0153	ICR Reference No: 201908-1405-006
Status: PreApproved	Previous ICR Reference No: 201707-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Electronic Diversity Visa Entry Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Preapproved	Conclusion Date: 08/29/2019
	Date Received in OIRA: 08/29/2019
Terms of Clearance: Any previous terms of clearance are still in effect. Additionally, prior to re-submission of this ICR to OMB, the agency should consult with OIRA regarding how the framing of passport-requirement exemptions on the form may have impacted potentially-disqualifying responses from applicants.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved	01/31/2021
Responses	14,589,023	0	11,072,400
Time Burden (Hours)	7,294,512	0	5,536,200
Cost Burden (Dollars)	72,945,115	0	55,362,000

---

Abstract: The Department of State utilizes the Electronic Diversity Visa Lottery (EDV) Entry Form to elicit information necessary to ascertain the applicability of the legal provisions of the diversity immigrant visa program. The foreign nationals complete the electronic entry forms and then applications are randomly selected for further participation in the program.

---

Authorizing Statute(s): US Code: 8 USC 1011 Name of Law: Immigration and Nationality Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1400-AE74	Proposed rulemaking	84 FR 25989	06/05/2019

---

Federal Register Notices & Comments

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
Electronic Diversity Visa Entry Form	DS-5501	Electronic Diversity Visa Entry Lottery Form

---

ICR Summary of Burden

	Total Preapproved	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	14,589,023	11,072,400	0	3,516,623	0	0
Annual Time Burden (Hours)	7,294,512	5,536,200	0	1,758,312	0	0
Annual Cost Burden (Dollars)	72,945,115	55,362,000	0	17,583,115	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: This collection is revised to include additional questions for EDV lottery entrants regarding information from a valid, unexpired passport. As a result, the time burden has increased to reflect the additional requirement of adding passport information.

---

Annual Cost to Federal Government: $501,793

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 08/29/2019

---