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:
0920-0006
ICR Reference No:
202507-0920-015
Status:
Active
Previous ICR Reference No:
202401-0920-001
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-25-0145
Title:
[NCEZID] Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act
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:
09/09/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/23/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2027
03/31/2027
03/31/2027
Responses
200
0
200
Time Burden (Hours)
33
0
33
Cost Burden (Dollars)
3,260
0
3,260
Abstract:
The goal of this collection is to provide CDC with adequate information to fulfill its responsibilities with regard to the processing of applications for waivers of inadmissibility on health-related grounds, specifically mental health disorders with associated harmful behaviors. The information collected is required under U.S. immigration law and regulation. CDC uses the information collected in 0920-0006 to review waiver applications for prospective immigrants and refugees to the United States. CDC assists DHS/USCIS in determining whether or not a prospective immigrant or refugee with a Class A health designation, specifically those mental health disorders with associated harmful behavior, may be admitted into the United States. Non-Substantive Change Request is submitted to make minor format changes including email and mailing addresses. There is no anticipated change to the approved burden hours.
Authorizing Statute(s):
US Code:
8 USC 1182
Name of Law: Aliens and Nationality
US Code:
42 USC 34
Name of Law: Public Health Service Medical Exam of Aliens
PL:
Pub.L. 212 - 7 8
Name of Law: CFR
Citations for New Statutory Requirements:
US Code: 8 USC 1182 Name of Law: TITLE 8—ALIENS AND NATIONALITY
US Code: 42 USC Part 34 Name of Law: Public Health Service
US Code: 8 USC 212 Name of Law: Department of Homeland Security
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:
88 FR 75593
11/03/2023
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 2956
01/17/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)
0920-0006, 4.422-1
STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY
,
STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY - Revised 21JUL2025
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
200
200
0
0
0
0
Annual Time Burden (Hours)
33
33
0
0
0
0
Annual Cost Burden (Dollars)
3,260
3,260
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:
$72,634
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.
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:
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
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:
07/23/2025
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