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Signature Card
Foreign Diplomatic Services Applications (FDSA)
OMB: 1405-0105
IC ID: 276977
OMB.report
STATE/AFA
OMB 1405-0105
ICR 202508-1405-005
IC 276977
( )
Documents and Forms
Document Name
Document Type
Form DS-4139
SIGNATURE CARD
Form
DS-4139 SIGNATURE CARD
DS-4139.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SIGNATURE CARD
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
DS-4139
SIGNATURE CARD
DS-4139.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
International Affairs and Commerce
Subfunction:
Foreign Affairs
Privacy Act System of Records
Title:
SIGNATURE CARD
FR Citation:
90 FR 12787
Number of Respondents:
17,785
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
17,785
0
13,646
4,139
0
0
Annual IC Time Burden (Hours)
2,035
0
1,690
345
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.
