CIS Ombudsman Case Problem Submission Worksheet

OMB Control No: 1601-0004	ICR Reference No: 201007-1601-001
Status: Historical Active	Previous ICR Reference No: 200901-1601-001
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: CIS Ombudsman Case Problem Submission Worksheet
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/17/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/22/2010
Terms of Clearance: This ICR is being given one year approval due to the paper form not stating that electronic submission is possible. When the electronic submission of this form has been activated and CIS has changed the paper form to reflect the option for electronic submission, the form would be eligible for a three-year approval. OMB notes that this collection was used in violation of the PRA from 03/31/2010 to the approval of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2011	36 Months From Approved
Responses	2,600	0	0
Time Burden (Hours)	2,600	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection will be used by the Citizenship and Immigration (CIS) Ombudsman to identify problem areas, propose changes, and assist individuals experiencing problems during the processing of an immigration benefit with U.S. Citizenship and Immigration Services (USCIS)

---

Authorizing Statute(s): PL: Pub.L. 107 - 296 452 Name of Law: The Homeland Security Act of 2002

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 22609	04/29/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 41506	07/16/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name CIS Ombudsman Case Problem Submission Form DHS-7001 CIS Ombudsman Case Problem Submission Worksheet

---

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	2,600	0	0	0	0	2,600
Annual Time Burden (Hours)	2,600	0	0	0	0	2,600
Annual Cost Burden (Dollars)	0	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $106,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Raymond Mills 202 357-8100

---

Common Form ICR:  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:
		(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: 07/22/2010

---