Supplemental Questionnaire to Determine Entitlement for a U.S. Passport

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-5513 Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	Form and Instruction	Modified	Repair queued
DS-5513_30day_2019_Legal Authorities_FINAL.docx	Supplementary Document	Uploaded 2019-08-29	Repair queued
DS-5513_30day SuppStmt_2019_FINAL.docx	Supporting Statement A	Uploaded 2019-08-29	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203623	Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0214	ICR Reference No: 201908-1405-007
Status: Received in OIRA	Previous ICR Reference No: 201607-1405-005
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Supplemental Questionnaire to Determine Entitlement for a U.S. Passport
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/29/2019

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	4,076	3,257
Time Burden (Hours)	5,774	4,614
Cost Burden (Dollars)	0	0

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Abstract: The Supplemental Questionnaire to Determine Entitlement for a U.S. Passport is used to supplement an application for a U.S. passport when the applicant submits entitlement evidence that is insufficient or of questionable authenticity. It is used by Passport Services to collect additional information to further establish the entitlement of a passport applicant who has not submitted adequate evidence with his/her initial passport application.

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Authorizing Statute(s): US Code: 8 USC 1201-1503 Name of Law: Immigration and Nationality Act
  

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:
	84 FR 27828	06/14/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 45617	08/29/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	DS-5513	Supplemental Questionnaire to Determine Entitlement for a US passport

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	4,076	3,257	0	819	0	0
Annual Time Burden (Hours)	5,774	4,614	0	1,160	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: The program change reflects an increase in respondents’ use of this form from 3,257 to 4,076. This is likely due to the increase in number of DS-11s over the last three years.

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Annual Cost to Federal Government: $49,931

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.     Yes

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? No

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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: 08/29/2019

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