Information Collection

Affidavit of Support under Section 213A of the Act and Notification of Reimbursement of Means-Tested Benefits

IC 12171 under ICR 199804-1115-002 · OMB 1115-0214.

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Information Collection (IC) Details

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IC Title:	Affidavit of Support under Section 213A of the Act and Notification of Reimbursement of Means-Tested Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-864A				No	No
Form	I-864				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 590,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	590,000	590,000
Annual IC Time Burden (Hours)	558,500	558,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.