View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1615-0033	ICR Reference No: 202209-1615-003
Status: Historical Active	Previous ICR Reference No: 202201-1615-003
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 without change	Conclusion Date: 03/09/2023
	Date Received in OIRA: 12/27/2022
Terms of Clearance: Approved for two years due to lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2025	36 Months From Approved	07/31/2025
Responses	667,000	0	667,000
Time Burden (Hours)	2,001,000	0	2,001,000
Cost Burden (Dollars)	329,331,250	0	329,331,250

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	667,000	667,000
Annual Time Burden (Hours)	2,001,000	2,001,000
Annual Cost Burden (Dollars)	329,331,250	329,331,250

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:

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: Samantha Stout 704 762-0352 samantha.j.stout@uscis.dhs.gov

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