Ds-10 Form - Us Department Of State (Page 2 of 2) in pdf

Ds-10 Form - Us Department Of State Page 2

PRIVACY ACT STATEMENT

AUTHORITIES: The information on this form is requested under the authority of 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C.

6039E; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.

PURPOSE: The purpose for requesting this information is to determine the place of birth of an applicant for a U.S. passport. The

collection of the Social Security number will be used to verify your identity only and no other purpose unless authorized by law.

ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign

government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses

include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism,

litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals

abroad.

More information on the Routine Uses for the system can be found in System of Records Notices State-05, Overseas Citizen

Services Records and State-26, Passport Records.

DISCLOSURE: Providing your Social Security number and the other information on this form is voluntary, but failure to provide the

information on this form may, given the form's purpose of verification of identity and the place of birth of an applicant for a U.S.

passport, result in processing delays or denial of the passport application.

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average 40 minutes per response, including the time required

for searching existing data sources, gathering the necessary data, providing the information and/or documentation required, and

reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control

number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them

to: U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational

Support, 2201 C Street, NW, Washington, D.C. 20520.

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DS-10 06-2014

Ds-10 Form - Us Department Of State Page 2