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Electronic Diversity Visa Entry Form
Electronic Diversity Visa Entry Form
OMB: 1405-0153
IC ID: 276873
OMB.report
STATE/AFA
OMB 1405-0153
ICR 202508-1405-003
IC 276873
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0153 can be found here:
2025-08-05 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form DS-5501
Electronic Diversity Visa Entry Form
Form and Instruction
DS-5501 Electronic Diversity Visa Entry Lottery Form
DS-5501 Screenshots.pdf
www.dvlottery.state.gov
Form and Instruction
Justification for non-substantive change.docx
Justification for non-substantive change
IC Document
CCR 96771 Changes.docx
Change #1
IC Document
CCR 96772_Changes.docx
Change #2
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Electronic Diversity Visa Entry Form
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 42.33
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
DS-5501
Electronic Diversity Visa Entry Lottery Form
DS-5501 Screenshots.pdf
www.dvlottery.state.gov
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
International Affairs and Commerce
Subfunction:
Foreign Affairs
Privacy Act System of Records
Title:
Diversity Visa Entry
FR Citation:
90 FR 12281
Number of Respondents:
25,000,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
25,000,000
0
13,927,600
11,072,400
0
0
Annual IC Time Burden (Hours)
22,833,333
0
17,297,133
5,536,200
0
0
Annual IC Cost Burden (Dollars)
125,000,000
0
69,638,000
55,362,000
0
0
Documents for IC
Title
Document
Date Uploaded
Justification for non-substantive change
Justification for non-substantive change.docx
07/25/2017
Change #1
CCR 96771 Changes.docx
07/25/2017
Change #2
CCR 96772_Changes.docx
07/25/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.