OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Request for Determination of Possible Loss of United States Citizenship

ICR 201310-1405-003 · OMB 1405-0178 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DS-4079 Request for Determination of Possible Loss of United States Citizenship Form and Instruction Modified Available
Legal Authorities (10-2013).doc Supplementary Document Uploaded 2013-10-24 Available
1405-0178 Supporting Statement v2 (1-30-14).doc Supporting Statement A Uploaded 2014-01-30 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
181472 Request for Determination of Possible Loss of United States Citizenship Form and Instruction Modified
ICR Details
1405-0178 201310-1405-003
Historical Active 201010-1405-001
STATE/AFA
Request for Determination of Possible Loss of United States Citizenship
Extension without change of a currently approved collection   No
Regular
Approved with change 01/30/2014
Retrieve Notice of Action (NOA) 10/24/2013
In its next submission, State Department will report on efforts to provide an electronic filing option.
  Inventory as of this Action Requested Previously Approved
01/31/2017 36 Months From Approved 01/31/2014
1,729 0 1,132
432 0 283
32,532 0 0
The purpose of the DS-4079 questionnaire is to determine current citizenship status and the possibility of loss of United States citizenship. The information provided in the questionnaire assists consular officers and the Department of State in determining if the U.S. citizen has lost his or her nationality by voluntarily performing an expatriating act.
US Code: 8 USC 1481(a) Name of Law: Immigration and Nationality Act (INA)
  
None
Not associated with rulemaking
  78 FR 39823 07/02/2013
78 FR 63560 10/24/2013
No
  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 1,729 1,132 0 0 597 0
Annual Time Burden (Hours) 432 283 0 0 149 0
Annual Cost Burden (Dollars) 32,532 0 0 0 32,532 0
No
No
Burden hours have increased because of an increase in number of respondents. Burden costs have increased due to calculation for mileage travel costs and Express mail costs for document submission.
$125,356
No
No
No
No
No
Uncollected
Derek Rivers 202 736-9082 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/24/2013