Application for Civil Surgeon Designation

ICR 201510-1615-007

OMB: 1615-0114

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2015-10-30
Supplementary Document
2015-10-27
Supplementary Document
2016-05-10
Supplementary Document
2016-05-10
Supplementary Document
2015-10-27
Supplementary Document
2015-10-27
Supplementary Document
2015-10-30
Supplementary Document
2015-10-27
Supporting Statement A
2015-10-30
IC Document Collections
IC ID
Document
Title
Status
192797 Modified
ICR Details
1615-0114 201510-1615-007
Historical Active 201307-1615-004
DHS/USCIS I-910
Application for Civil Surgeon Designation
Revision of a currently approved collection   No
Regular
Approved with change 05/10/2016
Retrieve Notice of Action (NOA) 10/30/2015
Approved for two years only due to partial GPEA compliance.
  Inventory as of this Action Requested Previously Approved
05/31/2018 36 Months From Approved 05/31/2016
725 0 923
1,450 0 1,708
3,625 0 0

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

Not associated with rulemaking

  80 FR 37648 07/01/2015
80 FR 60697 10/07/2015
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 725 923 0 0 -198 0
Annual Time Burden (Hours) 1,450 1,708 0 0 -258 0
Annual Cost Burden (Dollars) 3,625 0 0 0 3,625 0
No
No
The overall decrease in hour burden is due to the reduced number of respondents estimated to respond to this collection of information.

$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.
10/30/2015


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