View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1615-0114	ICR Reference No: 202005-1615-001
Status: Historical Active	Previous ICR Reference No: 201804-1615-001
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 with change	Conclusion Date: 07/23/2020
	Date Received in OIRA: 05/06/2020
Terms of Clearance: Approved for two years only due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved	07/31/2020
Responses	470	0	538
Time Burden (Hours)	940	0	1,076
Cost Burden (Dollars)	24,205	0	26,459

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	470	538	-68
Annual Time Burden (Hours)	940	1,076	-136
Annual Cost Burden (Dollars)	24,205	26,459	-2,254

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 is a decrease of 136 hours in the estimated annual hour burden, which resulted from a decrease in the estimated number of respondents to this collection of information. Although the form for this information collection has been modified to collect additional address and interpreter information from applicants and the instructions have been revised for greater clarity, the modifications did not necessitate an increase in the estimated hour burden per response.

Annual Cost to Federal Government: $368,950

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: Melanie Frank 202 527-4488 melanie.r.frank2@uscis.dhs.gov

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