View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1405-0113
ICR Reference No:
202503-1405-005
Status:
Active
Previous ICR Reference No:
202207-1405-004
Agency/Subagency:
STATE/AFA
Agency Tracking No:
Title:
Medical Examination for Immigrant or Refugee Applicant
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/24/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/20/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2025
12/31/2025
12/31/2025
Responses
331,236
0
220,824
Time Burden (Hours)
110,412
0
110,412
Cost Burden (Dollars)
49,685,400
0
49,685,400
Abstract:
Forms for this collection are completed by panel physicians for refugees and aliens seeking immigrant visas to the U.S. The collection records medical information necessary to determine whether refugees or immigrant visa applicants have medical conditions affecting the public health and requiring treatment.
Authorizing Statute(s):
US Code:
8 USC 1201(d)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1182(a)(1)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1182 (d)(5)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1522(b)(4)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1202(f)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1101
Name of Law: Immigration and Nationality Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 11698
03/31/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 11781
07/20/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Medical Examination for Immigrant or Refugee Applicant
DS-3026, DS-2054, DS-3025, DS-3030
Vaccination Documentation Worksheet
,
Medical History and Physical Examination Worksheet
,
Medical Examination for Immigrant or Refugee Applicant
,
Tuberculosis Worksheet
Medical Examination for Immigrant or Refugee Applicant
DS-3025
Vaccination Documentation Worksheet
Medical Examination for Immigrant or Refugee Applicant
DS-2054, DS-3025, DS-3026, DS-3030
Report of Medical Examination by Panel Physician
,
Vaccination Documentation
,
Medical History and Physical Examination Worksheet
,
Tuberculosis Worksheet
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
331,236
220,824
0
0
110,412
0
Annual Time Burden (Hours)
110,412
110,412
0
0
0
0
Annual Cost Burden (Dollars)
49,685,400
49,685,400
0
0
0
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:
Annual Cost to Federal Government:
$248,427
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.
No
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.
No
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:
Anabel Moreno-Mendez 571 720-4400
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
03/20/2025
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