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OMB Control No: 1405-0076	ICR Reference No: 202609-1405-003
Status: Received in OIRA	Previous ICR Reference No: 202304-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application Under the Hague Convention on the Civil Aspects of International Child Abduction
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/10/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2027
Responses	400	332
Time Burden (Hours)	400	332
Cost Burden (Dollars)	12,000	9,960

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	400	332	68
Annual Time Burden (Hours)	400	332	68
Annual Cost Burden (Dollars)	12,000	9,960	2,040

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The majority of respondents that complete the DS-3013, submit the form by mail to the Office of Children’s Issues. The total average cost for courier delivery of the DS-3013 is $32.40. The overall delivery cost burden was computed by multiplying 392 respondents by $32.40, which equals $12,700.80.

Annual Cost to Federal Government: $37,808

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: Monica Gaw 202 736-9107 GAWMA@state.gov

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