Birth Affidavit

Forms and Documents

Document Name	Status
Form D-10 Birth Affidavit Form and Instruction	Modified
DS-10 Legal Authorities.docx Supplementary Document	2020-06-08
DS-10 Supporting Statement.docx Supporting Statement A	2020-06-08

IC Document Collections

IC ID	Document Title	Status
15005	Birth Affidavit Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0132	ICR Reference No: 202006-1405-002
Status: Active	Previous ICR Reference No: 201706-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Birth Affidavit
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: 10/14/2020
	Date Received in OIRA: 06/08/2020
Terms of Clearance: Agency added a fillable PDF.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	10/31/2020
Responses	5,183	0	22,056
Time Burden (Hours)	3,455	0	14,711
Cost Burden (Dollars)	29,750	0	32,422

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Abstract: The Birth Affidavit (DS-10) form is submitted in conjunction with an application for a U.S. passport. It is used by Passport Services to collect information for the purpose of establishing the birth in the Unted States of a passport applicant who has not submitted an acceptable United States birth certificate with his or her passport application. An affiant who has personal knowledge of the fats of the applicant's birth in the United States must use the DS-10 in order to execute the affidavit.

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Authorizing Statute(s): US Code: 22 USC 211a Name of Law: Authority to grant, issue, and verify passports
   EO: EO 11295 Name/Subject of EO: Rules governing the granting, issuing, and verifying of United States passports
  

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:
	85 FR 8617	02/14/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 34273	06/03/2020
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
Birth Affidavit	D-10	Birth Affidavit

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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	5,183	22,056	0	-16,873	0	0
Annual Time Burden (Hours)	3,455	14,711	0	-11,256	0	0
Annual Cost Burden (Dollars)	29,750	32,422	0	-2,672	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The previous submission calculated the number of respondents based on information request letters sent to applicants who require use of form DS-10. This is not the best source of data given that there is no way to confirm that the information request letter asking the respondent to submit form DS-10 resulted in compliance. Projections in this submission are based on information collected during a time and motion study recording the percentage of forms DS-11, Application for a U.S. Passport submitted with form DS-10, Birth Affidavit. The yearly projected numbers of respondents for form DS-11 are based on demand forecast numbers from statistical models and historical trends of form usage. The primary driver for form usage is the demand forecast for each fiscal year. The next two fiscal years’ forecasts are updated on an annual basis so that each forecast uses the most recent, relevant date to project future demand. Given that projected passport application (form DS-11) demand is the primary driver for form usage, as shown below in the table, form DS-10 is expected to increase or decrease in correlation with form DS-11 estimates through FY 2022.

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Annual Cost to Federal Government: $5,731

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 06/08/2020

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