Information Collection Request
Questionnaire - Loss of United States Nationality; Attestations
ICR 202503-1405-007 · OMB 1405-0178 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1405-0178 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations |
Form and Instruction | Unchanged | Repair queued |
| Form DS-4079 Questionnaire - Loss of United States Nationality; Attestations |
Form and Instruction | Unchanged | Repair queued |
 Non-Substantive Change 1405-0178 DS-4079.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2025-03-29 | Repair queued |
| Non-Substantive Change 1405-0178 DS-4079.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2025-03-29 | Repair queued |
 4079_Published.pdf |
Supplementary Document | Uploaded 2023-09-29 | 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 |
| PublishedFR_07-19-2023.pdf |
Supplementary Document | Uploaded 2023-09-28 | Repair queued |
| Legal Authorities.docx |
Supplementary Document | Uploaded 2023-09-28 | Repair queued |
| Legal Authorities.docx |
Supplementary Document | Uploaded 2023-09-28 | Repair queued |
| 1405-0178 Supporting Statement - CLEAN 10.24.2024.docx |
Supporting Statement A | Uploaded 2024-10-24 | Repair queued |
| 1405-0178 Supporting Statement - CLEAN 10.24.2024.docx |
Supporting Statement A | Uploaded 2024-10-24 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 181472 |  Questionnaire - Loss of United States Nationality; Attestations |
Form and Instruction | Unchanged | |
| 181472 | Questionnaire - Loss of United States Nationality; Attestations |
Form and Instruction | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | STATE/AFA |
| OMB Control No | 1405-0178 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202309-1405-004 |
| Date Submitted to OIRA | 2025-03-29 |
| Requested Expiration Date | 1969-12-31 |