View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0133	ICR Reference No: 201709-1405-005
Status: Historical Active	Previous ICR Reference No: 201407-1405-005
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Affidavit Regarding A Change of Name
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: 09/29/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	161,239	0	183,037
Time Burden (Hours)	107,493	0	122,025
Cost Burden (Dollars)	272,494	0	2,152,515

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	161,239	183,037	-21,798
Annual Time Burden (Hours)	107,493	122,025	-14,532
Annual Cost Burden (Dollars)	272,494	2,152,515	-1,880,021

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

Burden Increase Due to:

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

Burden Reduction Due to: Changing Forms

Short Statement: The hour burden adjustments indicated reflects a slight increase in the number of projected affiants from 159,671 (previous FYs 2015-2017) to 161,239 (FYs 2017-2019). Projections are based on information request letters sent to applicants that require the use of the DS-60. The yearly projected numbers of affiants 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-60 is expected to increase and decrease in correlation with the DS-11 application estimate through FY 2019.

Annual Cost to Federal Government: $2,419

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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