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.