View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1405-0187	ICR Reference No: 202306-1405-005
Status: Historical Active	Previous ICR Reference No: 201811-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Affidavit of Physical Presence or Residence, Parentage and Support
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: 01/11/2024
	Date Received in OIRA: 06/28/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2027	36 Months From Approved	01/31/2024
Responses	63,819	0	17,950
Time Burden (Hours)	31,910	0	8,975
Cost Burden (Dollars)	360,516	0	360,516

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	63,819	17,950	45,869
Annual Time Burden (Hours)	31,910	8,975	22,935
Annual Cost Burden (Dollars)	360,516	360,516	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Department derived the hour time burden total by multiplying the average number of respondents (45,869) and burden time per response (30 minutes) required to complete this collection divided by one hour (60 minutes). The Department derived the hour cost burden total to respondents by multiplying the weighted hourly wage ($39.21) and the total hour time burden (22,935).

Annual Cost to Federal Government: $605,812

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: Alan Jones 202 717-0683

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