Special Immigrant Visa Biodata Form

OMB Control No: 1405-0203	ICR Reference No: 201201-1405-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Special Immigrant Visa Biodata Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/29/2012
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/03/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	6 Months From Approved
Responses	12,000	0	0
Time Burden (Hours)	4,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Special immigrant visa applicants who qualify for and request resettlement assistance from the Department of State must complete this form for each family member and submit it via email as a scanned attachment to the National Visa Center at [email protected] .

Emergency Justfication: The Bureau of Population, Refugees and Migration, which administers the provision of refugee resettlement benefits to SIV recipients who elect them, provides a loan for travel to the United States and funds basic living assistance and support for up to 90 days after the SIV recipient arrives in the United States. A PRM-funded resettlement agency uses the information collected in this form to select the resettlement site best suited to the SIV recipient given any U.S.-based family or other ties, and to make appropriate preparations for their arrival, including arranging medical services that may be necessary. The delay in the preparation of this package for OMB occurred as a result of discussions on ways to refine this form in order to collect better information for use by the resettlement agencies in the provision of services, and the removal of language which incorrectly indicated that SIV holders may be denied a visa if this form was not submitted. Applicants will still be able to apply for and receive an SIV without this form. However, receipt of resettlement benefits to which they are entitled by law could be jeopardized. Without this form, the Bureau of Population, Refugees and Migration would not have a mechanism by which to gather detailed information from Iraqi and Afghan SIV recipients that is used to place them in appropriate resettlement locations and to provide the necessary housing, medical, and other benefits that applicants may require. As these visa holders are all former employees of the U.S. government or U.S. government contractors in Iraq and Afghanistan, the United States has a special interest in ensuring that these individuals receive the full range of benefits available to them.

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Authorizing Statute(s): PL: Pub.L. 110 - 181 1244(g) Name of Law: The Refugee Crisis in Iraq Act    PL: Pub.L. 111 - 8 602 Name of Law: The Omnibus Appropriations Act    PL: Pub.L. 109 - 163 1059 Name of Law: National Defense Authorization Act    PL: Pub.L. 110 - 161 525 Name of Law: Consolidated Appropriations Act

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 249	12/28/2011
Did the Agency receive public comments on this ICR? No

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

IC Title Form No. Form Name Special Immigrant Visa Biodata Form DS-234 Special Immigrant Visa Biodata Form

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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	12,000	0	0	12,000	0	0
Annual Time Burden (Hours)	4,000	0	0	4,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden change indicated is due to this submission as a new collection.

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Annual Cost to Federal Government: $94,880

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? No

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: Sumitra Siram 202 453-9250

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Common Form ICR:  No

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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: 01/03/2012

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