Information Collection

Supplemental Questionnaire to Determine Entitlement for a U.S. Passport

IC 203623 under ICR 201208-1405-002 · OMB 1405-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0214 can be found here:

Documents and Forms

Document Name Document Type
Form DS-5513 Supplemental Questionnaire to Determine Entitlement for a U.S. Passport Form and Instruction
DS-5513 Supplemental Questionnaire to Determine Entitlement for DS-5513 Entitlement Questionnaire (6-2012).pdf Form and Instruction
DS-5513 Supplemental Questionnaire to Determine Entitlement for DS-5513 Entitlement Questionnaire revised (7-2013).pdf www.travel.state.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 50, B&C 22 CFR 51.23, 51.40, 51.45 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-5513	Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	DS-5513 Entitlement Questionnaire (6-2012).pdf		Yes	No	Fillable Printable
Form and Instruction	DS-5513	Supplemental Questionnaire to Determine Entitlement for a U.S. Passport	DS-5513 Entitlement Questionnaire revised (7-2013).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: 1,145	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
Annual Number of Responses for this IC	1,145	1,145
Annual IC Time Burden (Hours)	1,622	1,622
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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