Adoption Family Relief Act Refund Application

OMB Control No: 1405-0223	ICR Reference No: 201604-1405-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Adoption Family Relief Act Refund Application
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: 04/29/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/12/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2016	6 Months From Approved
Responses	600	0	0
Time Burden (Hours)	50	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Adoptive Family Relief Act allows for the waiver or refund certain immigrant visa fees for a lawfully adopted child. This collection will gather information to determine the extra fees these families have paid in order to refund them.

Emergency Justfication: Pursuant to 5 C.F.R. 1320.139(a)(2), the Department of State’s Bureau of Consular Affairs (CA) requests that OMB authorize the emergency processing of Form DS-7781. The Bureau of Consular Affairs is implementing immigrant visa fee refunds authorized under the Adoptive Family Relief Act (“the Act”) for families that have adopted orphan children in the Democratic Republic of the Congo. The Act allows the refund upon request of fees paid for renewal or replacement of an immigrant visa since March 27, 2013 if “the immigrant child was unable to use the original immigrant visa during the period of its validity as a direct result of extraordinary circumstances, including the denial of an exit permit; and if such inability was attributable to factors beyond the control of the adopting parent or parents and of the immigrant.” The form will assist the Department of State to properly process immigrant visa fee refund applications under the Act. The DS-7781 will be available electronically and will be submitted on paper to the embassy or consulate where the original adoption case was processed. The Bureau of Consular Affairs requests emergency OMB approval to begin the collection process to provide financial relief to U.S. citizens and to satisfy the intent of Congress and the Administration.

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Authorizing Statute(s): PL: Pub.L. 114 - 70 2 Name of Law: Adoptive Family Relief Act    US Code: 8 USC 1201 Name of Law: Immigration and Nationality Act    US Code: 8 USC 1202 Name of Law: Immigration and Nationality Act

Citations for New Statutory Requirements: PL: Pub.L. 114 - 70 2 Name of Law: Adoptive Family Relief Act

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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

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 Adoptive Family Relief Act Refund Application DS-7781 Adoptive Family Relief Act Refund Application

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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	600	0	600	0	0	0
Annual Time Burden (Hours)	50	0	50	0	0	0
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:

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Annual Cost to Federal Government: $3,840

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: Taylor Mauck 202 485-7635 [email protected]

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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: 04/12/2016

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