PRIVACY ACT STATEMENT
AUTHORITY: The State Department is authorized to collect this information pursuant to
8 U.S.C. § 1104(a)(1), 1104(a)(3), 1401, 1408, 1409, 22 U.S.C. § 211(a) and 213.
PURPOSE: The principal purpose of the information gathered is to determine if a U.S.
citizen/national parent(s) has met the statutory physical presence or residence
requirements to transmit U.S. citizenship to his/her child born abroad or in the United
States for U.S. non-citizen nationality; to establish parentage of the child; and to fulfill
the requirements of 8 U.S.C. 1409(a), which permits acknowledgment of paternity under
oath and requires the U.S. citizen father’s written agreement to provide financial support
for his children born abroad out of wedlock.
ROUTINE USES: The information solicited on this form may be made available to
Federal government entities such as the Social Security Administration, the Department
of Homeland Security, and Department of Justice, in connection with determinations of
citizenship status, administration of federal benefits, and law enforcement purposes as
set forth in the System of Records Notice for Overseas Citizens Records, STATE-05, 73
FR 24342 (2008) and the Department wide Prefatory Statement of Routine Uses, 73 FR
40649-40651 (2008). Information also can be made available to appropriate federal, state,
local or foreign government entities, such as state law enforcement agencies, state
prosecutors, judicial staff, local police, and INTERPOL, in connection with law
enforcement, safety, welfare and related matters, as set forth by the System of Records
Notice for Overseas Citizens Records, STATE-05, 73 FR 24342 (2008). These matters
include custody disputes and notification of next of kin.
Furnishing the information on this form is voluntary; however, failure to furnish the
requested information may delay or prevent you from documenting your child as a U.S.
citizen or national.
PAPERWORK REDUCTION ACT (PRA) STATEMENT
Public reporting burden for this collection of information is estimated to average 30
minutes per response, including time required for searching existing data sources,
gathering the necessary documentation, providing the information and/or documents
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: CA/OCS/PMO, 10th Floor, SA-17, U.S. Department of
State, Washington, DC 20036.
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