View Information Collection Request (ICR) Package

OMB Control No: 1405-0132	ICR Reference No: 202006-1405-002
Status: Historical Active	Previous ICR Reference No: 201706-1405-003
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 with change	Conclusion Date: 10/14/2020
	Date Received in OIRA: 06/08/2020
Terms of Clearance: Agency added a fillable PDF.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	10/31/2020
Responses	5,183	0	22,056
Time Burden (Hours)	3,455	0	14,711
Cost Burden (Dollars)	29,750	0	32,422

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:
	85 FR 8617	02/14/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 34273	06/03/2020
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	5,183	22,056	-16,873
Annual Time Burden (Hours)	3,455	14,711	-11,256
Annual Cost Burden (Dollars)	29,750	32,422	-2,672

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: Miscellaneous Actions

Short Statement: The previous submission calculated the number of respondents based on information request letters sent to applicants who require use of form DS-10. This is not the best source of data given that there is no way to confirm that the information request letter asking the respondent to submit form DS-10 resulted in compliance. Projections in this submission are based on information collected during a time and motion study recording the percentage of forms DS-11, Application for a U.S. Passport submitted with form DS-10, Birth Affidavit. The yearly projected numbers of respondents for form DS-11 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 (form DS-11) demand is the primary driver for form usage, as shown below in the table, form DS-10 is expected to increase or decrease in correlation with form DS-11 estimates through FY 2022.

Annual Cost to Federal Government: $5,731

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? No

Agency Contact: Maya Badiat 202 485-6530

View ICR - OIRA Conclusion