Information Collection

Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)

IC 6595 under ICR 201405-0920-005 · OMB 0920-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0006 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-02-0102: Alien Mental Waiver Program	FR Citation: 51 FR 42461

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	16,000	16,000

Documents for IC

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