Affidavit Regarding A Change of Name

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-60 Affidavit Regarding A Change of Name	Form	New	Repair queued
Form DS-60 Affidavit Regarding A Change of Name	Form and Instruction	Removed	Repair queued
DS-10_Expires 103123_OMB No. 1405-0132_30-Day FRN_Legal Authorities.docx	Supplementary Document	Uploaded 2023-10-26	Repair queued
DS-60_30day_2020_Legal Authorities Final.docx	Supplementary Document	Uploaded 2020-07-29	Repair queued
DS-10_Expires 103123_OMB No. 1405-0132_30-Day FRN_PRA Supporting Statement.docx	Supporting Statement A	Uploaded 2023-10-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
263050	Affidavit Regarding A Change of Name	Form	New
15007	Affidavit Regarding A Change of Name	Form and Instruction	Removed

ICR Details

OMB Control No: 1405-0133	ICR Reference No: 202310-1405-004
Status: Received in OIRA	Previous ICR Reference No: 202007-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Affidavit Regarding A Change of Name
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/26/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2023
Responses	3,617	2,592
Time Burden (Hours)	2,411	1,728
Cost Burden (Dollars)	0	14,878

---

Abstract: The Affidavit Regarding a Change of Name (DS-60) is submitted in conjunction with an application for a U.S. passport. It is used by Passport Services to collect information for the purpose of establishing that a passport applicant has adopted a new name without formal court proceedings or a marriage and has publicly and exclusively use the adopted name over a long period of time (generally five years). The affidavit must be executed by an affiant who has personal knowledge of the facts of the applicant's use of both their birth name and their newly adopted name in question.

---

Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
   EO: EO 11295 Name/Subject of EO: Rules governing the granting, issuing, and verifying of United States passports
  

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:
	88 FR 12117	08/14/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 12245	10/26/2023
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
Affidavit Regarding A Change of Name	DS-60	Affidavit Regarding a Change of Name
Affidavit Regarding A Change of Name	DS-60	Affidavit Regarding A Change of Name

---

ICR Summary of Burden

table that charts list 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	3,617	2,592	0	3,617	-2,592	0
Annual Time Burden (Hours)	2,411	1,728	0	2,411	-1,728	0
Annual Cost Burden (Dollars)	0	14,878	67,532	-67,532	-14,878	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The projected average number of form DS-11 respondents from FY 2023-2025 is 12,055,600. Through a Department-led time and motion study, it was determined that Form DS-60 was attached to 0.03 percent of Form DS-11 receipts. Therefore, the projected number of annual respondents for Form DS-60 is 3,617.

---

Annual Cost to Federal Government: $3,825

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: 10/26/2023

---