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View ICR - OIRA Conclusion

OMB Control No: 1405-0146	ICR Reference No: 201709-1405-004
Status: Historical Active	Previous ICR Reference No: 201407-1405-006
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement of Non-Receipt of a U.S. Passport
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: 10/30/2017
	Date Received in OIRA: 09/22/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	15,330	0	15,005
Time Burden (Hours)	3,833	0	3,751
Cost Burden (Dollars)	3,372	0	3,301

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	15,330	15,005	325
Annual Time Burden (Hours)	3,833	3,751	82
Annual Cost Burden (Dollars)	3,372	3,301	71

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: The hour burden adjustment reflects a slight increase in the number of projected respondents from 15,005 (previous FYs 2015 – 2016) to 15,330 (average of FYs 2017-2019). The yearly projected numbers of applicants 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 year forecasts are updated on an annual basis so that each forecast uses the most recent, relevant data 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-86 is expected to correlate with the DS-11 application estimate through FY 2019 as shown in the projections table below.

Annual Cost to Federal Government: $229

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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 Garcia 202 736-9216 garciaaa@state.gov

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