Information Collection

Birth Affidavit

IC 15005 under ICR 202006-1405-002 · OMB 1405-0132.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0132 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form D-10 Birth Affidavit Birth Affidavit	Form and Instruction
D-10 Birth Affidavit DS-10_30day_2020_Form_PDF Fillable.pdf	Form and Instruction

IC Title:

Birth Affidavit

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 50, 51 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	D-10			www.travel.state.gov	Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,183

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,183	-16,873	22,056
Annual IC Time Burden (Hours)	3,455	-11,256	14,711
Annual IC Cost Burden (Dollars)	29,750	-2,672	32,422

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.

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