OMB 83-c

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/subagency

OMB Control Number

Department of Homeland Security, U.S. Citizenship and Immigrations Services
Enter only items that change
Current record

1615

0083

New record

Agency form number (s)
I-515A

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically
Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annual Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

The lead office of responsibility for the Form I-515A is the Student Exchange and Visitor Program (SEVP) office, Immigration
and Customs Enforcement (USICE). Accordingly, this form should be transferred to USICE. In addition, on the OMB inventory
under OMB Control Number 1615-0083, it lists Forms I-515, and I-515A. The Form I-515 is no longer used.
Signature of Senior Official or designee:

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

For OIRA Use

02/06