Historical Records Services Request

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form G-1041A Historical Records Services Request	Form	Modified	Available
Screen Shots.pdf	Supplementary Document	Uploaded 2009-04-22	Available
G-1041 G-1041A Support Stat 4-22-09.doc	Supporting Statement A	Uploaded 2009-04-22	Available
References.doc	Supplementary Document	Uploaded 2009-03-02	Available
Published 30 Day Note - 2-23-09.doc	Supplementary Document	Uploaded 2009-03-02	Available
60-Day Published 11-14-08.doc	Supplementary Document	Uploaded 2009-03-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
20431	Historical Records Services Request	Form	Modified

ICR Details

OMB Control No: 1615-0096	ICR Reference No: 200902-1615-007
Status: Historical Active	Previous ICR Reference No: 200601-1615-001
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Historical Records Services Request
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: 04/29/2009
	Date Received in OIRA: 04/22/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	36 Months From Approved	04/30/2009
Responses	26,597	0	16,000
Time Burden (Hours)	13,299	0	8,000
Cost Burden (Dollars)	602,860	0	514,000

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Abstract: The Genealogy Program is necessary to provide a more timely response to requests for genealogical and historical records. Form G-1041 is provided as a convenient means for persons to provide data necessary to perform a search of historical agency indices. Form G-1041A provides a convenient means for persons to identify a particular record desired under the Genealogy Program. The forms provide rapid identification of such requests and ensures expeditious handling. Persons such as researchers, historians, and social scientists seeking ancestry information for genealogical, family history and heir location purposes will use Forms G-1041 and G-1041A.

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Authorizing Statute(s): US Code: 8 USC 1356 Name of Law: U.S. Code
  

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:
	73 FR 67537	11/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8100	02/23/2009
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Historical Records Services Request	G-1041, G-1041A	Geneology Records Request ,   Historical Records Services Request

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ICR Summary of Burden

table that charts list 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	26,597	16,000	0	0	10,597	0
Annual Time Burden (Hours)	13,299	8,000	0	0	5,299	0
Annual Cost Burden (Dollars)	602,860	514,000	0	0	88,860	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 5,299 burden hours associated with this information collection. This is related to an increase in the estimated number of respondents that will avail themselves to requesting historical records. There is also an increase of $88,860 for this information collection. This is attributable to the increase in the number of respondents multiplied by the fee charge.

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Annual Cost to Federal Government: $0

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)? No

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: 04/22/2009

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