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 Loss of Citizenship MS Form and Instructions- Screenshots .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: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 50.50 22 CFR 50.40

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	Loss of Citizenship	MS Form and Instructions- Screenshots .pdf		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title: Loss of Citizenship	FR Citation: 88 FR 12128

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4,850	4,850
Annual IC Time Burden (Hours)	3,476	3,476
Annual IC Cost Burden (Dollars)	94,793	94,793

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.