Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status

Forms and Documents

Document Name	Status
Form I-643 Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction	Modified
I-643 30 Day Notice Published (5-29-07).doc Supplementary Document	2007-06-06
INA 413.doc Supplementary Document	2007-05-31
Public Law 97-359.pdf Supplementary Document	2007-05-31
Section 202 of Pub. Law 99-603.doc Supplementary Document	2007-05-31
60 Day published 3-19-07.doc Supplementary Document	2007-05-31
I-643 Support State. 5-22-07.doc Supporting Statement A	2007-05-31

IC Document Collections

IC ID	Document Title	Status
20384	Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction	Modified

ICR Details

OMB Control No: 1615-0070	ICR Reference No: 200705-1615-009
Status: Historical Active	Previous ICR Reference No: 200312-1615-002
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/15/2007
	Date Received in OIRA: 06/06/2007
Terms of Clearance: Approved for only one year due to GPEA non-compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2008	36 Months From Approved	08/31/2007
Responses	195,000	0	195,000
Time Burden (Hours)	178,620	0	32,370
Cost Burden (Dollars)	0	0	0

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Abstract: Certain refugees and asylees, must use this form when applying for adjustment of status with USCIS. USCIS will submit the data collected on this form to HHS. HHS will include this information when submitting it's annual report to Congress under section 413(a) of the Immigration and Nationality Act.

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Authorizing Statute(s): US Code: 8 USC 1522 Name of Law: Immigration and Nationality Act
  

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 12809	03/19/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 29529	05/29/2007
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
Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status	I-643	Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status

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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	195,000	195,000	0	0	0	0
Annual Time Burden (Hours)	178,620	32,370	0	0	146,250	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: There has been an increase of 146,250 burden hours. When this information was previously submitted to OMB, USCIS recorded the time of 10 minutes to complete this form. Upon further review, USCIS estimates that the time to complete and submit the form is closer to 55 minutes.

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Annual Cost to Federal Government: $3,935,100

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: 06/06/2007

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