OMB control number

Questionnaire - Loss of United States Nationality; Attestations

OMB 1405-0178 · STATE/AFA.

OMB 1405-0178

The purpose of the DS-4079 questionnaire is to determine current citizenship status and the possibility of loss of United States citizenship. The information provided assists consular officers and the Department of State in determining if the U.S. citizen has lost his or her nationality by voluntarily performing an expatriating act with the intention of relinquishing United States nationality.

The latest form for Questionnaire - Loss of United States Nationality; Attestations expires 2027-10-31 and is listed under ICR 202504-1405-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form DS-4079 Loss of Citizenship	Form and Instruction
Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Justification for using MS Forms for DS 4079 PART I FINAL.docx	Justification for No Material/Nonsubstantive Change
Justification for using MS Forms for DS 4079 PART I FINAL.docx	Justification for No Material/Nonsubstantive Change
Non-Substantive Change 1405-0178 DS-4079.docx	Justification for No Material/Nonsubstantive Change
Non-Substantive Change 1405-0178 DS-4079.docx	Justification for No Material/Nonsubstantive Change
4079_Published.pdf	Supplementary Document
4079_Published.pdf	Supplementary Document
PublishedFR_07-19-2023.pdf	Supplementary Document
PublishedFR_07-19-2023.pdf	Supplementary Document
Legal Authorities.docx	Supplementary Document
Legal Authorities.docx	Supplementary Document
1405-0178 Supporting Statement - CLEAN 10.24.2024.docx	Supporting Statement A
1405-0178 Supporting Statement - CLEAN 10.24.2024.docx	Supporting Statement A
Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction
Questionnaire - Loss of United States Nationality; Attestations	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202504-1405-002	No material or nonsubstantive change to a currently approved collection	2025-04-22
202503-1405-007	No material or nonsubstantive change to a currently approved collection	2025-03-29
202309-1405-004	Revision of a currently approved collection	2023-09-29
202002-1405-003	Revision of a currently approved collection	2020-02-25	Approved with change
201701-1405-014	Extension without change of a currently approved collection	2017-01-17	Approved without change
201310-1405-003	Extension without change of a currently approved collection	2013-10-24	Approved with change
201010-1405-001	Revision of a currently approved collection	2010-10-05	Approved without change
200708-1405-001	New collection (Request for a new OMB Control Number)	2007-08-07	Approved without change

OMB Details

Questionnaire - Loss of United States Nationality; Attestations

Federal Enterprise Architecture: International Affairs and Commerce - Foreign Affairs

Information collection instruments
Form	Name	Electronic access	Type
Form DS-4079	Questionnaire - Loss of United States Nationality; Attestations	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.