OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status

ICR 201008-1615-001 · OMB 1615-0070 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form I-643 Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction Modified Repair queued
PIA.pdf Supplementary Document Uploaded 2010-08-12 Repair queued
SORN.htm Supplementary Document Uploaded 2010-08-12 Repair queued
Aprroved PTA.pdf Supplementary Document Uploaded 2010-08-12 Repair queued
Published 30-Day Notice 8-9-10.doc Supplementary Document Uploaded 2010-08-12 Repair queued
Published 60-Day Notice 5-4-10.doc Supplementary Document Uploaded 2010-08-12 Repair queued
Public Law 97-359.pdf Supplementary Document Uploaded 2010-08-12 Available
I-643 Support State 8-3-10 (clean).doc Supporting Statement A Uploaded 2010-08-12 Repair queued
Reference Citations 4-20-10.doc Supplementary Document Uploaded 2010-08-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
20384 Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction Modified
ICR Details
1615-0070 201008-1615-001
Historical Active 200908-1615-002
DHS/USCIS
Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status
Extension without change of a currently approved collection   No
Regular
Approved without change 10/08/2010
Retrieve Notice of Action (NOA) 08/12/2010
Approved for only two years due to partial GPEA compliance.
  Inventory as of this Action Requested Previously Approved
10/31/2012 36 Months From Approved 10/31/2010
195,000 0 195,000
178,620 0 178,620
0 0 0
Certain refugees and asylees, must use this form when applying for adjustment of status with USCIS. USCIS will submit the data collected on this form to HHS. HHS will include this information when submitting it's annual report to Congress under section 413(a) of the Immigration and Nationality Act.
PL: Pub.L. 99 - 603 202 Name of Law: Cuban/Haitian Entrants
   US Code: 8 USC 1522 Name of Law: U.S. Code
  
None
Not associated with rulemaking
  75 FR 23784 05/04/2010
75 FR 47824 08/09/2010
No
  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 195,000 195,000 0 0 0 0
Annual Time Burden (Hours) 178,620 178,620 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$3,935,100
No
No
No
Uncollected
No
Uncollected
Stephen Tarragon 202-272-8358 [email protected]
  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.
08/12/2010