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: 201209-1615-001
Status: Historical Active	Previous ICR Reference No: 201107-1615-005
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-693
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 with change	Conclusion Date: 01/15/2013
	Date Received in OIRA: 10/31/2012
Terms of Clearance: Approved for two years only due to lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2013
Responses	565,180	0	800,000
Time Burden (Hours)	1,412,950	0	2,000,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	565,180	800,000	-234,820
Annual Time Burden (Hours)	1,412,950	2,000,000	-587,050
Annual Cost Burden (Dollars)	0	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: There has been a decrease of 587,050 in burden hours from those previously reported for this information collection. This change can be attributed to a decrease in the number of respondents from 800,000 respondents to 565,180. The decrease in the number of respondents is based on updated FY 2011 statistical data and the resulting adjustment in agency estimates.

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