Application for Civil Surgeon Designation

ICR 201804-1615-001

OMB: 1615-0114

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2018-05-17
Supplementary Document
2018-04-24
Supplementary Document
2018-04-24
Supplementary Document
2018-04-10
Supplementary Document
2018-04-10
Supplementary Document
2018-04-10
Supplementary Document
2018-04-10
Supplementary Document
2018-04-10
Supplementary Document
2018-04-24
Supplementary Document
2015-10-27
Supporting Statement A
2018-05-17
IC Document Collections
IC ID
Document
Title
Status
192797 Modified
ICR Details
1615-0114 201804-1615-001
Historical Active 201612-1615-007
DHS/USCIS I-910
Application for Civil Surgeon Designation
Revision of a currently approved collection   No
Regular
Approved without change 05/29/2018
Retrieve Notice of Action (NOA) 05/17/2018
Approved for two years only due to partial GPEA compliance.
  Inventory as of this Action Requested Previously Approved
05/31/2020 36 Months From Approved 05/31/2018
538 0 725
1,076 0 1,450
26,459 0 3,625

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

  83 FR 2815 01/19/2018
83 FR 15395 04/10/2018
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 538 725 0 0 -187 0
Annual Time Burden (Hours) 1,076 1,450 0 0 -374 0
Annual Cost Burden (Dollars) 26,459 3,625 0 0 22,834 0
No
No
The estimated annual hour burden for this collection of information has decreased as a result of a decrease in the estimated number of respondents. The estimated annual cost burden to respondents for this collection of information has increased because USCIS updated our estimate of the cost that respondents may incur. The form for this information collection has been modified to collect additional information from applicants, and the instructions have been revised for greater clarity and to provide new information about USCIS signature requirements.

$422,330
No
    Yes
    Yes
No
No
No
Uncollected
Kerstin Jager 214 489-8022 [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.
05/17/2018


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