Affidavit of Support Under Sction 213A of the Act, and Contract Between Sponsor and Household Member

ICR 200106-1115-002

OMB: 1115-0214

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1115-0214 200106-1115-002
Historical Active 199807-1115-005
DOJ/INS
Affidavit of Support Under Sction 213A of the Act, and Contract Between Sponsor and Household Member
Extension without change of a currently approved collection   No
Regular
Approved without change 08/17/2001
Retrieve Notice of Action (NOA) 06/22/2001
Approved consistent with memo dated 8/3/01, and subsequent form change that removed the section on "use of benefits."
  Inventory as of this Action Requested Previously Approved
08/31/2004 08/31/2004 09/30/2001
950,300 0 590,000
2,443,350 0 558,500
0 0 0

The form is mandated by law for a petitioning relative to submit an affidavit on their relative's behalf. The executed form creates a contract between the sponsor and any entity that provides means-tested benefits.

None
None


No

1
IC Title Form No. Form Name
Affidavit of Support Under Sction 213A of the Act, and Contract Between Sponsor and Household Member I-864

  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 950,300 590,000 0 0 360,300 0
Annual Time Burden (Hours) 2,443,350 558,500 0 0 1,884,850 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
06/22/2001


© 2024 OMB.report | Privacy Policy