Information Collection

Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16

IC 207427 under ICR 202312-1405-001 · OMB 1405-0216.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16	Form and Instruction
Form DS-5525 STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16	Form and Instruction
DS-5525 STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR IS DS-5525_30day_2019_Form (PDF)_FINAL.pdf	Form and Instruction
DS-5525 STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR IS DS-5525_30day_2019_Form (PDF)_FINAL.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 34,50-51 (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	DS-5525			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: 12,484

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-12,484	12,484
Annual IC Time Burden (Hours)	-6,242	6,242
Annual IC Cost Burden (Dollars)	0	0

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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