Request for Authentications Service

Forms and Documents

Document Name	Status
Form DS-4194 Request for Authentications Service Form and Instruction	New
Legal Authorities.docx Supplementary Document	2021-12-21
DS-4194_PRA Support Statement.docx Supporting Statement A	2021-12-21

IC Document Collections

IC ID	Document Title	Status
250865	Request for Authentications Service Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202112-1405-012
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Request for Authentications Service
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/21/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	47,094	0
Time Burden (Hours)	7,849	0
Cost Burden (Dollars)	0	0

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Abstract: The Request for Authentication Services (Form DS-4194) is used by individuals, institutions, and government agencies, to request the services provided by the U.S. Department of State’s Office of Authentications within the Bureau of Consular Affairs, Passport Services Directorate, Support Operations, Office of Technical Operations (CA/PPT/S/TO/AUT). This office provides authentication services to U.S. citizens and foreign nationals for documents to be used for legal and administrative purposes abroad under the seal of the U.S. Department of State.

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Authorizing Statute(s): US Code: 22 USC 2657 Name of Law: Custody of Seals and Property
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1400-AE12	Final or interim final rulemaking	86 FR 31617	06/15/2021

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 46308	08/18/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 86041	11/30/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Request for Authentications Service	DS-4194	Request for Authentications Service

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ICR Summary 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	47,094	0	0	47,094	0	0
Annual Time Burden (Hours)	7,849	0	0	7,849	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: New collection - please supporting statement.

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Annual Cost to Federal Government: $270,563

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: 12/21/2021

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