View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1615-0114	ICR Reference No: 201804-1615-001
Status: Historical Active	Previous ICR Reference No: 201612-1615-007
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-910
Title: Application for Civil Surgeon Designation
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: 05/29/2018
	Date Received in OIRA: 05/17/2018
Terms of Clearance: Approved for two years only due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2018
Responses	538	0	725
Time Burden (Hours)	1,076	0	1,450
Cost Burden (Dollars)	26,459	0	3,625

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	538	725	-187
Annual Time Burden (Hours)	1,076	1,450	-374
Annual Cost Burden (Dollars)	26,459	3,625	22,834

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: The estimated annual hour burden for this collection of information has decreased as a result of a decrease in the estimated number of respondents. The estimated annual cost burden to respondents for this collection of information has increased because USCIS updated our estimate of the cost that respondents may incur. The form for this information collection has been modified to collect additional information from applicants, and the instructions have been revised for greater clarity and to provide new information about USCIS signature requirements.

Annual Cost to Federal Government: $422,330

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? Uncollected

Agency Contact: Kerstin Jager 214 489-8022 kerstin.a.jager@uscis.dhs.gov

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