View Information Collection Request (ICR) Package

OMB Control No: 1405-0132	ICR Reference No: 201706-1405-003
Status: Historical Active	Previous ICR Reference No: 201406-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Birth Affidavit
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/31/2017
	Date Received in OIRA: 06/27/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	07/31/2017
Responses	22,056	0	21,585
Time Burden (Hours)	14,711	0	14,390
Cost Burden (Dollars)	32,422	0	247,580

Abstract: The Birth Affidavit (DS-10) form is submitted in conjunction with an application for a U.S. passport. It is used by Passport Services to collect information for the purpose of establishing the birth in the Unted States of a passport applicant who has not submitted an acceptable United States birth certificate with his or her passport application. An affiant who has personal knowledge of the fats of the applicant's birth in the United States must use the DS-10 in order to execute the affidavit.

Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
EO: EO 11295 Name/Subject of EO: Rules governing the granting, issuing, and verifying of United States passports

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 89181	12/09/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28928	06/26/2017
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Birth Affidavit	D-10

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	22,056	21,585	471
Annual Time Burden (Hours)	14,711	14,390	321
Annual Cost Burden (Dollars)	32,422	247,580	-215,158

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: 15. The hour burden adjustments indicated reflect an increase in the number of projected respondents from 21,585 (previous FYs 2015 – 2017) to 22,056 (FYs 2017-2019). Projections are based on information request letters sent to applicants that require the use of the DS-10. This method provides higher numbers than actual forms used since every applicant may not respond to the information request. The yearly projected numbers of respondents are based on demand forecast numbers from statistical models and historical trends of form usage. The primary driver for form usage is the demand forecast for each fiscal year. The next two fiscal years’ forecasts are updated on an annual basis so that each forecast uses the most recent, relevant date to project future demand. Given that projected passport application (DS-11) demand is the primary driver for form usage, as shown below in the table, the DS-10 is expected to increase and decrease steadily in correlation with the DS-11 application estimate through FY 2019.

Annual Cost to Federal Government: $330

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Alexys Stanley 202 485-6538

View ICR - OIRA Conclusion