Birth Affidavit Form For United States Passport
DS-1006-2008 Page 1 of 2
For Additional Comments
PRIVACY ACT STATEMENT
AUTHORITIES The information solicited on this form is requested pursuant to provisions in Titles 8 and 22 of the United States Code (U.S.C.), whether or not codified including specifically 22 U.S.C. 211a, 212, 213, and all regulations issued pursuant to Executive Order 11295 (August 5, 1966), including Part 51, Title 22, Code of Federal Regulations (CFR).
PURPOSE The primary purpose for soliciting the information is to establish citizenship, identity, and entitlement to the issuance of a U.S. passport. The information may also be used in connection with issuing other travel documents or evidence of citizenship, and in furtherance of the Secretary of State’s responsibility for the protection of U.S. nationals abroad.
ROUTINE USES The information solicited on this form may be made available as a routine use to other government agencies (such as the FBI, DHS, etc.), to assist the U.S. Department of State in adjudicating passport applications and requests for related services, and for law enforcement and administrative purposes. It may also be disclosed pursuant to court order. The information may be made available to foreign government agencies to fulfill passport control and immigration duties or to investigate or prosecute violations of law. The information may also be made available to private U.S. citizen ‘wardens’ designated by U.S. embassies and consulates for use in emergency evacuation situations.
Failure to provide the information requested on this form may result in the denial of a United States passport, related document, or service to the individual seeking such passport, document, or service.
PAPERWORK REDUCTION ACT STATEMENT
*Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. You are not required to respond to the collection of information unless this form displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.
DS-10 Page 2 of 2
- Date Of Birth Format Bangladesh