Information Collection

Application for Authorization to Issue Certification for Health Care Workers and Related Requirements

IC 20415 under ICR 201107-1615-003 · OMB 1615-0086.

Documents and Forms

Document Name Document Type
I-905instr (Web_08-26-11).pdf Instruction
I-905 Application for Authorization to Issue Certification for i-905.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Authorization to Issue Certification for Health Care Workers and Related Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 212

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			I-905instr (Web_08-26-11).pdf		Yes	No	Printable Only
Form	I-905	Application for Authorization to Issue Certification for Health Care Workers and Related Requirements	i-905.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28,010	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	28,010	0	28,010
Annual IC Time Burden (Hours)	51,280	0	51,280
Annual IC Cost Burden (Dollars)	4,552,300	300	4,552,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.