Report of Medical Examination and Vaccination Record

ICR 200710-1615-001

OMB: 1615-0033

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2007-10-05
IC Document Collections
IC ID
Document
Title
Status
20305 Modified
ICR Details
1615-0033 200710-1615-001
Historical Active 200703-1615-007
DHS/USCIS
Report of Medical Examination and Vaccination Record
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/15/2007
Retrieve Notice of Action (NOA) 10/09/2007
Approved for two years. While this form can be completed and saved electronically, it is not yet available for e-filing.
  Inventory as of this Action Requested Previously Approved
08/31/2009 08/31/2009 08/31/2009
800,000 0 800,000
2,000,000 0 2,000,000
0 0 0

The information on the application will be used by USCIS in considering eligibility for adjustment of status under 8 CFR part 209, 8 CFR 210.5, 245.1 and 245a.3.

US Code: 8 USC 1255 Name of Law: Immigration Nationality Act
  
None

Not associated with rulemaking

  71 FR 77772 12/27/2006
72 FR 13507 03/22/2007
Yes

1
IC Title Form No. Form Name
Report of Medical Examination and Vaccination Record I-693 Report of Medical Examination and Vaccination Record

  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 800,000 800,000 0 0 0 0
Annual Time Burden (Hours) 2,000,000 2,000,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
USCIS added the vaccination record to the instrument based on a comment. This new record increased the burden hours from 1 1/2 hours to 2 1/2 hours.

$48,648,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Lynn Feldman 202 272-8547

  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.
10/09/2007


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