Statement Regarding Lost or Stolen Passport

OMB Control No: 1405-0014	ICR Reference No: 200902-1405-001
Status: Historical Active	Previous ICR Reference No: 200807-1405-010
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement Regarding Lost or Stolen Passport
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: 04/02/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/11/2009
Terms of Clearance: Approved for two years only due to lack of GPEA complaince. OMB requests that DOS pursue development of an electronically fillable Form DS-64 and also a means of accepting electronic submission. DOS may be eligible for a full three year extension once an electronic fillable form and electronic signature option are publicly available.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2009
Responses	122,500	0	105,000
Time Burden (Hours)	10,208	0	8,800
Cost Burden (Dollars)	0	0	0

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Abstract: It is necessary to submit a statement (DS-64) with an application for a new passport when a previous or potentially valid passport cannot be presented. Individuals may also submit the form independent of a passport application to reflect the loss or theft of a passport.

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Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 203	10/20/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 21	02/03/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name Statement Regarding Lost or Stolen Passport DS-64, DS-64 Statement Regarding a Lost or Stolen Passport ,   Statement Regarding a Lost or Stolen Passport

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	122,500	105,000	0	0	17,500	0
Annual Time Burden (Hours)	10,208	8,800	0	0	1,408	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The change in burden indicated is due to the implementation of the Western Hemisphere Travel Initiatice (WHTI)since this collection's last renewal

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Andrina Agnew 2026632445

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(i) Why the information is being collected;
			(ii) Use of information;
			(iii) Burden estimate;
			(iv) Nature of response (voluntary, required for a benefit, or mandatory);
			(v) Nature and extent of confidentiality; and
			(vi) Need to display currently valid OMB control number;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date: 02/11/2009

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