Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

ICR 202109-1405-001

OMB: 1405-0014

Federal Form Document

Forms and Documents
Supplementary Document
Supporting Statement A
ICR Details
1405-0014 202109-1405-001
Received in OIRA 201807-1405-004
Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card
Revision of a currently approved collection   No
Regular 09/10/2021
  Requested Previously Approved
36 Months From Approved 11/30/2021
643,400 643,400
53,617 53,617
4,632 4,632

This form is used in conjunction with a DS-11, "Application for a U.S. Passport", or submitted separately to report loss or theft of a U.S. passport. Passport Services collects the information when a U.S. citizen or non-citizen national applies for a new U.S. passport and has been issued a previous, still valid U.S. passport that has been lost or stolen, or when a passport holder independently reports it lost or stolen. Passport applicants can either download the form from the internet or obtain one at any Passport Agency or Acceptance Facility.

US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports

Not associated with rulemaking

  86 FR 31366 06/11/2021
86 FR 50586 09/09/2021

IC Title Form No. Form Name
Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card DS-64 Statement Regarding a Lost or Stolen Passport Book and/or Card

  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 643,400 643,400 0 0 0 0
Annual Time Burden (Hours) 53,617 53,617 0 0 0 0
Annual Cost Burden (Dollars) 4,632 4,632 0 0 0 0

Alexys Garcia 202 736-9216 [email protected]


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.

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