View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0216	ICR Reference No: 202101-1405-011
Status: Historical Active	Previous ICR Reference No: 201908-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/09/2021
	Date Received in OIRA: 01/28/2021
Terms of Clearance: Any previous TOC remain in effect.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	11/30/2023	11/30/2023
Responses	12,484	0	12,484
Time Burden (Hours)	6,242	0	6,242
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	12,484	12,484
Annual Time Burden (Hours)	6,242	6,242
Annual Cost Burden (Dollars)	0	0

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: No

Burden Reduction Due to:

Short Statement: Demand forecast projections, by their nature, will have some uncertainty in their accuracy, which can explain differences between actual and forecast. The decrease from the previous estimates (43,526 respondents to 37,451) is attributed to the decrease in projected DS-11s over the next three years (from 11,763,831 for FY 2016-2018 to 11,015,000 from FY 2019 to 2021).

Annual Cost to Federal Government: $6,193

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

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