Report of Medical Examination and Vaccination Record

ICR 201006-1615-005

OMB: 1615-0033

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2010-06-16
Supplementary Document
2010-06-16
Justification for No Material/Nonsubstantive Change
2010-06-16
IC Document Collections
IC ID
Document
Title
Status
20305 Modified
ICR Details
1615-0033 201006-1615-005
Historical Active 200912-1615-001
DHS/USCIS
Report of Medical Examination and Vaccination Record
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/20/2010
Retrieve Notice of Action (NOA) 06/16/2010
  Inventory as of this Action Requested Previously Approved
10/31/2011 10/31/2011 10/31/2011
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

  74 FR 18737 04/24/2009
74 FR 33453 07/13/2009
Yes

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

  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

$48,648,000
No
No
No
Uncollected
No
Uncollected
Stephen Tarragon 202-272-8358 [email protected]

  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.
06/16/2010


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