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Federal forms, ICRs, and supporting documents

Information Collection Request

Questionnaire - Loss of United States Nationality; Attestations

ICR 202309-1405-004 · OMB 1405-0178 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations Form and Instruction Modified Repair queued
4079_Published.pdf Supplementary Document Uploaded 2023-09-29 Repair queued
PublishedFR_07-19-2023.pdf Supplementary Document Uploaded 2023-09-28 Repair queued
Legal Authorities.docx Supplementary Document Uploaded 2023-09-28 Repair queued
1405-0178 Supporting Statement.docx Supporting Statement A Uploaded 2023-09-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
181472 Questionnaire - Loss of United States Nationality; Attestations Form and Instruction Modified
ICR Details
1405-0178 202309-1405-004
Received in OIRA 202002-1405-003
STATE/AFA
Questionnaire - Loss of United States Nationality; Attestations
Revision of a currently approved collection   No
Regular 09/29/2023
  Requested Previously Approved
36 Months From Approved 09/30/2023
4,850 3,250
3,476 5,688
94,793 63,521
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 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 with the intention of relinquishing United States nationality.
US Code: 8 USC 1481(a) Name of Law: Immigration and Nationality Act (INA)
  
None
Not associated with rulemaking
  88 FR 46359 07/19/2023
88 FR 67419 09/29/2023
Yes
  Total Request 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 4,850 3,250 0 1,600 0 0
Annual Time Burden (Hours) 3,476 5,688 0 -2,212 0 0
Annual Cost Burden (Dollars) 94,793 63,521 0 31,272 0 0
No
Yes
Miscellaneous Actions
See Supporting Statement.
$306,762
No
    Yes
    Yes
No
No
No
No
Niki Enright 843 619-1260
  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.
09/29/2023