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View ICR - OIRA Conclusion

OMB Control No: 1405-0132	ICR Reference No: 202310-1405-003
Status: Active	Previous ICR Reference No: 202006-1405-002
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: 10/22/2024
	Date Received in OIRA: 10/26/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	10/31/2024
Responses	6,028	0	5,183
Time Burden (Hours)	4,018	0	3,455
Cost Burden (Dollars)	0	0	29,750

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	6,028	5,183	0	6,028	-5,183
Annual Time Burden (Hours)	4,018	3,455	0	4,018	-3,455
Annual Cost Burden (Dollars)	0	29,750	112,544	-112,544	-29,750

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: The projected average number of respondents for Form DS-11 from FY 2023-2025 is 12,055,600. Through a Department-led time and motion study, it was determined that Form DS-10 was attached to 0.05 percent of Form DS-11 receipts. Therefore, the projected number of annual respondents for Form DS-10 is 6,028.

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

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