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: 200710-1615-001
Status: Historical Active	Previous ICR Reference No: 200703-1615-007
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Report of Medical Examination and Vaccination Record
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/15/2007
	Date Received in OIRA: 10/09/2007
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	08/31/2009	08/31/2009
Responses	800,000	0	800,000
Time Burden (Hours)	2,000,000	0	2,000,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	800,000	800,000
Annual Time Burden (Hours)	2,000,000	2,000,000
Annual Cost Burden (Dollars)	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: 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.

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.