Information Collection

Birth Affidavit

IC 15005 under ICR 201406-1405-003 · OMB 1405-0132.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0132 can be found here:

Documents and Forms

Document Name Document Type
Form D-10 Birth Affidavit Form and Instruction
D-10 Birth Affidavit DS-10 (6-2014).pdf www.travel.state.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Birth Affidavit	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 50, 51 (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	D-10	Birth Affidavit	DS-10 (6-2014).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: 21,585	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,585	-133,265	154,850
Annual IC Time Burden (Hours)	14,390	-24,323	38,713
Annual IC Cost Burden (Dollars)	247,580	247,580	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.