View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1615-0033	ICR Reference No: 200703-1615-007
Status: Historical Active	Previous ICR Reference No: 200603-1615-002
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Report of Medical Examination and Vaccination Record
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/15/2007
	Date Received in OIRA: 05/24/2007
Terms of Clearance: Approved for two years. While this form can be completed and saved electronically, it is not yet available for e-filing.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2009	36 Months From Approved	08/31/2007
Responses	800,000	0	800,000
Time Burden (Hours)	2,000,000	0	1,200,000
Cost Burden (Dollars)	0	0	48,648,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	800,000	800,000	0
Annual Time Burden (Hours)	2,000,000	1,200,000	800,000
Annual Cost Burden (Dollars)	0	48,648,000	-48,648,000

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: USCIS added the vaccination record to the instrument based on a comment. This new record increased the burden hours from 1 1/2 hours to 2 1/2 hours.

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