View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0216	ICR Reference No: 202312-1405-001
Status: Active	Previous ICR Reference No: 202101-1405-011
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: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2025
	Date Received in OIRA: 12/08/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2028	36 Months From Approved
Responses	28,933	0	0
Time Burden (Hours)	14,467	0	0
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 18 USC 1621 Name of Law: Perjury Generally
   US Code: 22 USC 211a Name of Law: Authority to Grant, Issue, and Verify Passports
   US Code: 22 USC 212-214 Name of Law: Persons Entitled to Passport
   EO: EO 11295 Name/Subject of EO: Rules Governing the Granting, Issuing, and verifying of United States Passports
   US Code: 8 USC 1104 Name of Law: Powers and duties of Secretary of State
   US Code: 18 USC 1542-1544 Name of Law: False statement in application and use of passport
   US Code: 8 USC 1001 Name of Law: Statements or Entries Generally

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	28,933	28,933	-12,484	12,484
Annual Time Burden (Hours)	14,467	14,467	-6,242	6,242
Annual Cost Burden (Dollars)	0	0	0	0

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 DS-11 respondents from FY 2023-25 is 12,055,600. Through a Department-led frequency analysis, it was determined that 0.24% of DS-11s had a DS-5525 attached to it. Therefore, the projected number of respondents to the DS-5525 over the next 3 years is 28,933.

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: Alan Jones 202 717-0683

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