Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16
Reinstatement without change of a previously approved collection
No
Regular
12/08/2023
Requested
Previously Approved
36 Months From Approved
28,933
0
14,467
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:
18 USC 1542-1544
Name of Law: False statement in application and use of passport
US Code:
8 USC 1001
Name of Law: Statements or Entries Generally
US Code:
18 USC 1621
Name of Law: Perjury Generally
US Code:
22 USC 211a
Name of Law: Authority to Grant, Issue, and Verify Passports
US Code:
22 USC 212-214
Name of Law: Persons Entitled to Passport
EO: EO 11295 Name/Subject of EO: Rules Governing the Granting, Issuing, and verifying of United States Passports
US Code:
8 USC 1104
Name of Law: Powers and duties of Secretary of State
The projected average number of DS-11 respondents from FY 2023-25 is 12,055,600. Through a Department-led frequency analysis, it was determined that 0.24% of DS-11s had a DS-5525 attached to it. Therefore, the projected number of respondents to the DS-5525 over the next 3 years is 28,933.
$6,193
No
Yes
Yes
No
No
No
No
Alan Jones 202 717-0683
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.
Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16
DS-5525_Expires 113023_OMB No. 1405 0216_30-Day FRN_Legal Authorities.docx
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16