OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16

ICR 201607-1405-004 · OMB 1405-0216 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 Form and Instruction Modified Available
Legal Authorities - DS-5525.docx Supplementary Document Uploaded 2016-07-08 Available
DIR Review - DS-5525 2016 30-daysupstmntex FINAL.docx Supporting Statement A Uploaded 2016-07-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
207427 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 Form and Instruction Modified
ICR Details
1405-0216 201607-1405-004
Historical Active 201306-1405-004
STATE/AFA
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16
Revision of a currently approved collection   No
Regular
Approved without change 08/30/2016
Retrieve Notice of Action (NOA) 07/08/2016
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 08/31/2016
43,526 0 115,050
21,763 0 57,525
0 0 0
The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian's unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.
US Code: 8 USC 1104 Name of Law: Powers and duties of Secretary of State
   US Code: 18 USC 1542-1544 Name of Law: False statement in application and use of passport
   US Code: 26 USC 6039E Name of Law: Information concerning resident status
  
None
Not associated with rulemaking
  81 FR 17753 03/30/2016
81 FR 43696 07/05/2016
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 43,526 115,050 0 -71,524 0 0
Annual Time Burden (Hours) 21,763 57,525 0 -35,762 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Changing Forms
Demand forecast projections, by their nature, will have some uncertainty in their accuracy, which can explain differences between actual and forecast. However, the decrease from the previous estimates (115,050 respondents to 43,526) may be attributed to the short time this form has been in existence. The DS-5525, Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16, was introduced in the last three year cycle and the Department is still adjusting its impact on forecasts and workload.
$42,890
No
No
No
No
No
Uncollected
Alexys Garcia 202 736-9216 [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.
07/08/2016