Questionnaire - Loss of United States Nationality; Attestations

Documents and Forms

Document Name Document Type
Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations Form and Instruction
DS-4079 Questionnaire - Loss of United States Nationality; Attes DS-4079.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Questionnaire - Loss of United States Nationality; Attestations	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 50.40 22 CFR 50.50

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-4079	Questionnaire - Loss of United States Nationality; Attestations	DS-4079.pdf		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,850	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,850	1,600	3,250
Annual IC Time Burden (Hours)	3,476	-2,212	5,688
Annual IC Cost Burden (Dollars)	94,793	31,272	63,521

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.