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View ICR - OIRA Conclusion

OMB Control No: 1405-0133	ICR Reference No: 202310-1405-004
Status: Active	Previous ICR Reference No: 202007-1405-001
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: 10/22/2024
	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	3,617	0	2,592
Time Burden (Hours)	2,411	0	1,728
Cost Burden (Dollars)	0	0	14,878

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	3,617	2,592	0	3,617	-2,592
Annual Time Burden (Hours)	2,411	1,728	0	2,411	-1,728
Annual Cost Burden (Dollars)	0	14,878	67,532	-67,532	-14,878

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 form DS-11 respondents from FY 2023-2025 is 12,055,600. Through a Department-led time and motion study, it was determined that Form DS-60 was attached to 0.03 percent of Form DS-11 receipts. Therefore, the projected number of annual respondents for Form DS-60 is 3,617.

Annual Cost to Federal Government: $3,825

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: Alan Jones 202 717-0683

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