Application for Civil Surgeon Designation

ICR 201307-1615-004

OMB: 1615-0114

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2013-07-23
Supplementary Document
2013-07-30
Supplementary Document
2013-07-22
Supplementary Document
2013-07-22
Supplementary Document
2013-07-22
Supplementary Document
2013-07-22
Supplementary Document
2013-07-22
Supporting Statement A
2013-07-30
IC Document Collections
IC ID
Document
Title
Status
192797 Modified
ICR Details
1615-0114 201307-1615-004
Historical Active 201009-1615-022
DHS/USCIS I-910
Application for Civil Surgeon Designation
Revision of a currently approved collection   No
Regular
Approved with change 10/22/2013
Retrieve Notice of Action (NOA) 07/31/2013
Approved for two years only due to partial GPEA compliance.
  Inventory as of this Action Requested Previously Approved
10/31/2015 36 Months From Approved 10/31/2013
923 0 1,200
1,708 0 1,200
0 0 738,000

This information collection is required to determine whether a physician meets the statutory and regulatory requirement for civil surgeon designation.

US Code: 8 USC 1182 Name of Law: U.S. Code
  
None

1615-AB80 Final or interim final rulemaking 75 FR 58962 09/24/2010

  78 FR 14586 03/06/2013
78 FR 36559 06/18/2013
No

1
IC Title Form No. Form Name
Application for Civil Surgeon Designation I-910 Application for Civil Surgeon Designation

  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 923 1,200 0 0 -277 0
Annual Time Burden (Hours) 1,708 1,200 0 785 -277 0
Annual Cost Burden (Dollars) 0 738,000 0 0 -738,000 0
Yes
Miscellaneous Actions
No
The agency has revised its estimate of the hour burden per response due to a review the amount of information collected and the detail required to be submitted in support of the application. Based upon this review, the agency has increased the estimated hour burden per response to a level more commensurate with the effort to respond.

$567,465
No
No
No
No
No
Uncollected
John Ramsay 202 646-4247 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/31/2013


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