Information Collection

Electronic Diversity Visa Entry Form

IC 15041 under ICR 201307-1405-007 · OMB 1405-0153.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0153 can be found here:

Documents and Forms

Document Name Document Type
Form DS-5501 Electronic Diversity Visa Entry Form Form and Instruction
DS-5501 Electronic Diversity Visa Entry Form DS-5501 Screen Captures (7-2013).pdf www.dvlottery.state.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Electronic Diversity Visa Entry Form	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 42.33

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-5501	Electronic Diversity Visa Entry Form	DS-5501 Screen Captures (7-2013).pdf	www.dvlottery.state.gov	Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,000,000	2,000,000	6,000,000
Annual IC Time Burden (Hours)	4,000,000	1,000,000	3,000,000
Annual IC Cost Burden (Dollars)	60,000,000	0	60,000,000

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.