Request for Determination of Possible Loss of United States Citizenship

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-4079 Request for Determination of Possible Loss of United States Citizenship	Form and Instruction	Modified	Available
Final -Supporting Statement DS-4079 6-10.docx	Supporting Statement A	Uploaded 2020-06-10	Available
DS-4079 Legal Authorities.docx	Supplementary Document	Uploaded 2020-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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: 202002-1405-003
Status: Active	Previous ICR Reference No: 201701-1405-014
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Request for Determination of Possible Loss of United States Citizenship
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/10/2020
	Date Received in OIRA: 02/25/2020
Terms of Clearance: Agency made revisions to the supporting statement to provide additional clarity regarding the processes associated with this information collection and the estimation of burden associated with this information collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved	06/30/2020
Responses	3,250	0	600
Time Burden (Hours)	5,688	0	400
Cost Burden (Dollars)	63,521	0	0

---

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.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 57545	10/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10806	02/25/2020
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

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

---

ICR Summary of Burden

table that charts list 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	3,250	600	0	2,650	0	0
Annual Time Burden (Hours)	5,688	400	0	5,288	0	0
Annual Cost Burden (Dollars)	63,521	0	0	63,521	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: Based on the average number of respondents in the past 3 years (FY16-FY18), the number of respondents increased to 3,250 resulting in an associated increase in burden to 812 hours. The reason the number of respondents changed is because the number of respondents that complete the form varies from year to year depending on the number of citizens who may have relinquished their U.S. citizenship. Cost burden has increased due to the number of respondents on average that submit the DS-4079. The cost burden of $63,521 was not included in previous iterations of the Supporting Statement.

---

Annual Cost to Federal Government: $61,812

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

---

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: 02/25/2020

---