Application for Replacement Naturalization/Citizenship Document

ICR 200301-1115-002

OMB: 1115-0015

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1115-0015 200301-1115-002
Historical Active 199907-1115-002
DOJ/INS
Application for Replacement Naturalization/Citizenship Document
Extension without change of a currently approved collection   No
Regular
Approved without change 01/13/2004
Retrieve Notice of Action (NOA) 01/31/2003
Approved. DHS will transfer this collection from a DOJ-sponsored to a DHS-sponsored OMB number. DHS will also resubmit this information collection with a revised form that includes both the new OMB number and the expiration date for the form.
  Inventory as of this Action Requested Previously Approved
01/31/2007 01/31/2007 01/31/2004
22,567 0 22,567
20,671 0 20,671
3,498,000 0 3,272,000

This form is used by the Service to determine an applicant's eligibility for a replacement document that was lost, mutilated or destroyed, or if the applicant's name was changed by marriage or by cour order after the original document was issued. Additionally, this form is used by a naturalized citizen applicant who desires to obtain a special certificate of recognition as a citizen of the United States by a foreign country.

None
None


No

1
IC Title Form No. Form Name
Application for Replacement Naturalization/Citizenship Document N-565

  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 22,567 22,567 0 0 0 0
Annual Time Burden (Hours) 20,671 20,671 0 0 0 0
Annual Cost Burden (Dollars) 3,498,000 3,272,000 0 226,000 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.
01/31/2003


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