Adoption Family Relief Act Refund Application

OMB Control No: 1405-0223	ICR Reference No: 202604-1405-003
Status: Historical Active	Previous ICR Reference No: 201912-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Adoption Family Relief Act Refund Application
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/20/2026
Terms of Clearance: OMB is reinstating this collection for a period of 3 months to allow the agency to request that the control number be formally discontinued.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	6 Months From Approved
Responses	20	0	0
Time Burden (Hours)	2	0	0
Cost Burden (Dollars)	94	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.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 47032	09/06/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 72101	12/30/2019
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	20	0	0	0	0	20
Annual Time Burden (Hours)	2	0	0	0	0	2
Annual Cost Burden (Dollars)	94	0	0	0	0	94

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: $758

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

Agency Contact: Robert Schlicht 202 486-6685 [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: 04/20/2026

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