Information Collection

Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16

IC 14999 under ICR 200710-1405-005 · OMB 1405-0129.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0129 can be found here:

Documents and Forms

Document Name Document Type
Form DS-3053 Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16 Form
DS-3053 Statement of Consent or Special Circumstances: Issuance Internet DS-3053 Form.pdf www.travel.state.gov Form
DS-3053 Statement of Consent or Special Circumstances: Issuance DS-3053 10-23-2007.pdf www.travel.state.gov Form and Instruction
DS-3053 Statement of Consent or Special Circumstances: Issuance OMB Passback DS-3053 12-4-07.pdf www.travel.state.gov Form and Instruction
Justification for change to DS-3053.doc Justification for change to DS-3053 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 51.27

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DS-3053	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 14	Internet DS-3053 Form.pdf	www.travel.state.gov	No		Fillable Printable
Form and Instruction	DS-3053	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16	DS-3053 10-23-2007.pdf	www.travel.state.gov	Yes	No	Fillable Printable
Form and Instruction	DS-3053	Statement of Consent or Special Circumstances: Issuance of a Passport to a Minor Under Age 16	OMB Passback DS-3053 12-4-07.pdf	www.travel.state.gov	Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 605,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	605,800	80,800	525,000
Annual IC Time Burden (Hours)	605,800	80,800	525,000
Annual IC Cost Burden (Dollars)	1,042,000	136,000	906,000

Documents for IC

Title	Document	Date Uploaded
Justification for change to DS-3053	Justification for change to DS-3053.doc	10/26/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.