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Federal forms, ICRs, and supporting documents

Information Collection Request

Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act

ICR 202006-0920-005 · OMB 0920-0006 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 4 422-1 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form Modified Available
Attachment D Non Research Determination.pdf Supplementary Document Uploaded 2020-06-10 Available
Attachment B - Published 60-day FRN-1.22.2020.pdf Supplementary Document Uploaded 2020-06-10 Repair queued
0920-0006 Supporting Statement B DGMQ-6.4.2020.docx Supporting Statement B Uploaded 2020-06-10 Available
0920-0006 Supporting Statement A DGMQ-6.8.20.docx Supporting Statement A Uploaded 2020-06-10 Available
Attachment 1C 8 CFR 212.7 Waiver of certain grounds of excludability.pdf Supplementary Document Uploaded 2014-05-07 Available
Attachment 1B 42 CFR Part 34 Medical Examination of Aliens.pdf Supplementary Document Uploaded 2014-05-07 Available
Attachment 1A - 8 USC 1182.pdf Supplementary Document Uploaded 2014-05-07 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6595 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form Modified
186935 Follow-up of Immigrants or Refugees with Class A Physical or Mental Condition Instruction Removed
ICR Details
0920-0006 202006-0920-005
Active 201703-0920-013
HHS/CDC 0920-0006
Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act
Revision of a currently approved collection   No
Regular
Approved without change 12/23/2020
Retrieve Notice of Action (NOA) 06/23/2020
  Inventory as of this Action Requested Previously Approved
12/31/2023 36 Months From Approved 12/31/2020
200 0 400
33 0 100
3,260 0 16,000
The goal of this collection is to provide CDC with adequate information to fulfill its responsibilities with regard to the processing of applications for waivers of inadmissibility on health related grounds, specifically mental health disorders with associated harmful behaviors. The information collected is required under U.S. immigration law and regulation. This revision removes the follow-up information collection.
US Code: 8 USC 1182 Name of Law: Aliens and Nationality
   US Code: 42 USC 34 Name of Law: Public Health Service Medical Exam of Aliens
   PL: Pub.L. 212 - 7 8 Name of Law: CFR
  
None
Not associated with rulemaking
  85 FR 3693 01/22/2020
85 FR 37662 06/23/2020
Yes
  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 200 400 0 -200 0 0
Annual Time Burden (Hours) 33 100 0 -67 0 0
Annual Cost Burden (Dollars) 3,260 16,000 0 -12,740 0 0
No
Yes
Miscellaneous Actions
Burden is reduced due to the elimination of one form as CDC does not receive information about the evaluation report of an applicant who received a waiver.
$72,634
No
    Yes
    No
No
No
No
No
Shari Steinberg 404 639-4942 [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.
06/23/2020