OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202507-0920-015 · OMB 0920-0006 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0006 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY - Revised 21JUL2025 Form and Instruction Modified Repair queued
Form 4.422-1 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY Form and Instruction Modified Available
Form 4.422-1 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction Modified Repair queued
Change Request Memo_4.422_July 2025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-07-21 Repair queued
Change Request Memo_4.422_July 2025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-07-21 Repair queued
Attachment F Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
Attachment F Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
Attachment D Human Research Determination.pdf Supplementary Document Uploaded 2024-01-02 Available
Attachment D Human Research Determination.pdf Supplementary Document Uploaded 2024-01-02 Missing upstream
Supporting Statement B 2023.docx Supporting Statement B Uploaded 2024-01-17 Repair queued
Supporting Statement B 2023.docx Supporting Statement B Uploaded 2024-01-17 Missing upstream
Supporting Statement A 2023.docx Supporting Statement A Uploaded 2024-01-17 Available
Supporting Statement A 2023.docx Supporting Statement A Uploaded 2024-01-17 Missing upstream
Attachment A3 8 CFR 212.7 Waiver of certain grounds of excludability.pdf Supplementary Document Uploaded 2024-01-17 Available
Attachment A3 8 CFR 212.7 Waiver of certain grounds of excludability.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
Attachment A2 42 CFR Part 34 Medical Examination of Aliens.pdf Supplementary Document Uploaded 2024-01-17 Available
Attachment A2 42 CFR Part 34 Medical Examination of Aliens.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
Attachment A1 8 USC 1182.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
Attachment A1 8 USC 1182.pdf Supplementary Document Uploaded 2024-01-17 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
6595 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction ModifiedSTATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY - Revised 21JUL2025
6595 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction ModifiedSTATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY
6595 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction Modified
ICR Details
0920-0006 202507-0920-015
Active 202401-0920-001
HHS/CDC 0920-25-0145
[NCEZID] Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/09/2025
Retrieve Notice of Action (NOA) 07/23/2025
  Inventory as of this Action Requested Previously Approved
03/31/2027 03/31/2027 03/31/2027
200 0 200
33 0 33
3,260 0 3,260
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. CDC uses the information collected in 0920-0006 to review waiver applications for prospective immigrants and refugees to the United States. CDC assists DHS/USCIS in determining whether or not a prospective immigrant or refugee with a Class A health designation, specifically those mental health disorders with associated harmful behavior, may be admitted into the United States. Non-Substantive Change Request is submitted to make minor format changes including email and mailing addresses. There is no anticipated change to the approved burden hours.
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
  
US Code: 8 USC 1182 Name of Law: TITLE 8—ALIENS AND NATIONALITY
US Code: 42 USC Part 34 Name of Law: Public Health Service
US Code: 8 USC 212 Name of Law: Department of Homeland Security
Not associated with rulemaking
  88 FR 75593 11/03/2023
89 FR 2956 01/17/2024
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 200 200 0 0 0 0
Annual Time Burden (Hours) 33 33 0 0 0 0
Annual Cost Burden (Dollars) 3,260 3,260 0 0 0 0
No
No
$72,634
No
    Yes
    No
No
No
No
No
Jeffrey Zirger 404 639-7118 [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.
07/23/2025