View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1615-0033	ICR Reference No: 202108-1615-004
Status: Historical Active	Previous ICR Reference No: 201901-1615-011
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: Emergency	Approval Requested By: 09/08/2021
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/13/2021
	Date Received in OIRA: 09/08/2021
Terms of Clearance: The emergency is approved for a period of 6 months contingent on USCIS publishing a 60-day notice within 60 days of this approval date.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	6 Months From Approved	07/31/2022
Responses	667,000	0	667,000
Time Burden (Hours)	2,001,000	0	1,667,500
Cost Burden (Dollars)	329,331,250	0	329,331,250

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	667,000	667,000	0
Annual Time Burden (Hours)	2,001,000	1,667,500	333,500
Annual Cost Burden (Dollars)	329,331,250	329,331,250	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 is updating Form I-693 and its Instructions to allow for documentation of COVID-19 vaccination and associated guidance to civil surgeons and applicants. There is an increase in the estimated annual hour burden to respondents as a result of this change. USCIS estimates an increase of 0.5 hours per response across the entire respondent population.

Annual Cost to Federal Government: $42,130,634

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

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