Affidavit of Physical Presence or Residence, Parentage and Support

Forms and Documents

Document Name	Status
Form DS-5507 Affidavit of Parentage, Physical Presence and Support Form and Instruction	Modified
DS-5507 Legal Authorities (6-2012).doc Supplementary Document	2012-06-05
DS-5507 Supporting Statement (6-2012).docx Supporting Statement A	2012-06-05

IC Document Collections

IC ID	Document Title	Status
189229	Affidavit of Parentage, Physical Presence and Support Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0187	ICR Reference No: 201206-1405-001
Status: Historical Active	Previous ICR Reference No: 200905-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Affidavit of Physical Presence or Residence, Parentage and Support
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/16/2012
	Date Received in OIRA: 06/05/2012
Terms of Clearance: OMB notes this information collection request should have been submitted as a revision. State Department will report upon its next submission to OMB for approval progress towards full GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved	12/31/2012
Responses	17,784	0	15,026
Time Burden (Hours)	8,892	0	7,513
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the information collection is to determine if U.S. citizen/national parent(s) possesses the requisite physical presence or residence in the United States prior to their child's birth to transmit U.S. citizenship (or U.S. non-citizen nationality) to the child, to establish parentage of the child, and to fulfill the requirements of 8 U.S.C. 1409(a) which requires a written statement of financial support to be provided by U.S. citizen fathers for children born out of wedlock.

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Authorizing Statute(s): US Code: 8 USC 1401, 1408, 1409 Name of Law: Aliens and Nationality
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4858	01/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 32710	06/01/2012
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Affidavit of Parentage, Physical Presence and Support	DS-5507	Affidavit of Physical Presence or Residence, Parentage and Support

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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	17,784	15,026	0	0	2,758	0
Annual Time Burden (Hours)	8,892	7,513	0	0	1,379	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: Burden change due to increased number of respondents.

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Annual Cost to Federal Government: $60,110

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

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Common Form ICR:  No

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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: 06/05/2012

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