Request for Fee Waiver Denial Letter

Forms and Documents

Document Name	Status
Form G-1054 Request for Fee Waiver Denial Letter Form and Instruction	Modified
PRA G-1054 Reference Cites 12-23-05.doc Supplementary Document	2007-04-10
30-Day Published 4-10-07.doc Supplementary Document	2007-04-10
60-Day Published 2-1-07.doc Supplementary Document	2007-04-10
PRA G-1054 Supp. Statement 4-5-07.DOC Supporting Statement A	2007-04-10

IC Document Collections

IC ID	Document Title	Status
43929	Request for Fee Waiver Denial Letter Form and Instruction	Modified

ICR Details

OMB Control No: 1615-0089	ICR Reference No: 200704-1615-001
Status: Historical Active	Previous ICR Reference No: 200606-1615-010
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Request for Fee Waiver Denial Letter
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2007
	Date Received in OIRA: 08/02/2007
Terms of Clearance: Approved for only one year due to GPEA noncompliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2008	36 Months From Approved	09/30/2007
Responses	16,000	0	16,000
Time Burden (Hours)	20,000	0	20,000
Cost Burden (Dollars)	0	0	0

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Abstract: The data will be used by USCIS to determine eligibility for a fee waiver associated with the requested immigration benefit. The Form G-1054 serves the purpose of standardizing the denial of a request for a fee waiver, and will ensure that the basic information is provided to consistently assess eligibility when the requestor resubmits his or her request for a fee waiver.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 4722	02/01/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 17928	04/10/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Fee Waiver Denial Letter	G-1054	Request for Fee Waiver Denial Letter

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ICR Summary of Burden

	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	16,000	16,000	0	0	0	0
Annual Time Burden (Hours)	20,000	20,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $640,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/02/2007

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