Information Collection

Application for Authorization to Issue Certification for Health Care Workers and Related Requirements

IC 20415 under ICR 201107-1615-003 · OMB 1615-0086.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-905 Application for Authorization to Issue Certification for Health Care Workers and Related Requirements Application for Authorization to Issue Certification for Health Care Workers and Related Requirements	Form
I-905instr (Web_08-26-11).pdf	Instruction
I-905 Application for Authorization to Issue Certification for i-905.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 212

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-905				Yes	No	Fillable Printable
Instruction					Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28,010

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	28,010	0	28,010
Annual IC Time Burden (Hours)	51,280	0	51,280
Annual IC Cost Burden (Dollars)	4,552,300	300	4,552,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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