Statement Regarding a Lost or Stolen Passport Book and/or Card

Forms and Documents

Document Name	Status
Form DS-64 Statement Regarding a Lost or Stolen Passport Book and/or Card Form	Modified
DS-64 Legal Authorities (2011).doc Supplementary Document	2011-03-16
DS-64 legal Authorities.doc Supplementary Document	2009-02-09
DS-64 Supporting Statement (2011).docx Supporting Statement A	2011-03-16
Justification for Changes to the DS-64073108.docx Justification for No Material/Nonsubstantive Change	2008-07-31

IC Document Collections

IC ID	Document Title	Status
14809	Statement Regarding a Lost or Stolen Passport Book and/or Card Form	Modified

ICR Details

OMB Control No: 1405-0014	ICR Reference No: 201103-1405-005
Status: Historical Active	Previous ICR Reference No: 200902-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Statement Regarding a Lost or Stolen Passport Book and/or Card
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/09/2011
	Date Received in OIRA: 03/16/2011
Terms of Clearance: Approved for two years only due to lack of GPEA complaince. OMB requests that DOS pursue development of an electronically fillable Form DS-64 and also a means of accepting electronic submission. DOS may be eligible for a full three year extension once an electronic fillable form and electronic signature option are publicly available. OMB also requests that DOS review the form and Privacy Act statement and at least six months prior to resubmission, update OMB on full compliance with the Plain Writing Act of 2010.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2013	36 Months From Approved	05/31/2011
Responses	122,500	0	122,500
Time Burden (Hours)	10,208	0	10,208
Cost Burden (Dollars)	0	0	0

---

Abstract: The form is used prior to passport issuance and solicits information relating to the loss or theft of a valid U.S. passport. The information is used by the United States Department of State to ensure that no person shall bear more than one valid or potentially valid U.S. passport book and passport card at any one time, except as authorized by the Department, and is also used to combat passport fraud and misuse.

---

Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 245	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 48	03/11/2011
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Statement Regarding a Lost or Stolen Passport Book and/or Card	DS-64, DS-64, DS-64	Statement Regarding a Lost or Stolen Passport ,   Statement Regarding a Lost or Stolen Passport ,   Statement Regarding Lost or Stolen Passport Book and/or Card

---

ICR Summary of Burden

	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	122,500	122,500	0	0	0	0
Annual Time Burden (Hours)	10,208	10,208	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/16/2011

---