Application for Civil Surgeon Designation

ICR 202206-1615-002

OMB: 1615-0114

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2022-07-25
Supplementary Document
2022-07-25
Supporting Statement A
2022-06-28
Supplementary Document
2018-04-10
Supplementary Document
2020-05-01
Supplementary Document
2018-04-10
Supplementary Document
2015-10-27
IC Document Collections
IC ID
Document
Title
Status
192797 Modified
ICR Details
1615-0114 202206-1615-002
Received in OIRA 202007-1615-029
DHS/USCIS I-910
Application for Civil Surgeon Designation
Extension without change of a currently approved collection   No
Regular 07/26/2022
  Requested Previously Approved
36 Months From Approved 07/31/2022
470 470
940 940
24,205 24,205

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

  87 FR 8598 02/15/2022
87 FR 31255 05/23/2022
No

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

  Total Request 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 470 470 0 0 0 0
Annual Time Burden (Hours) 940 940 0 0 0 0
Annual Cost Burden (Dollars) 24,205 24,205 0 0 0 0
No
No

$368,950
No
    Yes
    Yes
No
No
No
No
Melanie Frank 202 527-4488 [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.
07/26/2022


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