SUPPORTING STATEMENT
Report of Medical Examination and Vaccination Record
Form I-693
(OMB No. 1615-0033)
A. Justification.
Section 245 of the Immigration and Nationality Act (Act) requires that applicants for adjustment of status to that of a lawful permanent resident in the United States must establish that they are admissible to the United States, as if they were first arriving. The medical grounds of inadmissibility are found in section 212(a)(1)(A) of the Act. In addition, section 232(b) of the Act, requires that medical officers of the U.S. Public Health Service (PHS) certify any physical or mental defect or disease observed in arriving aliens. When PHS medical officers are not available, U.S. Citizenship and Immigration Services (USCIS) must designate private physicians to serve as civil surgeons. Because PHS medical officers have not been available for many years, USCIS has been designating private physicians to serve as civil surgeons, in accordance with section 232(b) of the Act.
Section 212(a)(1)(A) of the Act states that the medical grounds of inadmissibility are determined according to the regulations prescribed by the Secretary of Health and Human Services (HHS). The applicable HHS regulations are found at 42 CFR part 34. The corresponding USCIS regulations are found at 8 CFR part 232.
In addition, the civil surgeons are responsible for certifying to the USCIS the information necessary to determine whether applicants for adjustment of status are inadmissible on medical grounds. Form I-693 is used by the civil surgeons to report the results of the medical examination to the USCIS.
The information on the application will be used by USCIS in considering the eligibility for adjustment of status under 8 CFR Parts 209, 210.5, 245.1, and 245(a)(3).
The use of this form currently provides the most efficient means for collecting and processing the required data. This form does reside on USCIS’ Web site and can be completed and saved electronically. However, this form cannot be e-filed. This form has not been designated for e-filing under the Business Transformation Project.
A review of the USCIS automated forms tracking system was accomplished and revealed no duplication. There is no similar data collected.
This collection of information does not have an impact on small businesses or other small entities.
If the required information is not collected, USCIS will not be able to correctly determine the eligibility of an applicant for lawful permanent resident status, creating a potential public health risk or denying the applicant an immigration benefit to which he or she may be legally entitled.
There are no special circumstances associated with this information collection.
USCIS published a 60-day notice in the Federal Register on May 13, 2011, at 76 FR 24908 informing the public that it was extending this information collection. The notice allowed for a 60-day public comment period, and USCIS did not receive any comments. USCIS published a 30-day notice in the Federal Register on July 13, 2011, at 76 FR 41282, and has not received any comments to date.
The USCIS does not provide payments or gifts to respondents in exchange for a benefit sought.
There is no assurance of confidentiality. The system of record notice associated with this information collection is the United States Citizenship and Immigration Services Benefits Information System, which was published in the Federal Register on September 29, 2008, at 73 FR 56596. The privacy impact assessment associated with this information collection is USCIS Benefits Processing of Applicants Other Than Petitions for Naturalization, Refugee Status, and Asylum.
Some of the information requested on this form is of a sensitive nature. This includes whether an applicant has been diagnosed with tuberculosis, syphilis, or other communicable diseases or suffers from a physical or mental disorder, drug abuse or addiction. This information must be included in the form to determine whether an applicant has a condition that may make him or her ineligible for adjustment of status on public health grounds.
Annual Reporting Burden:
Number of Respondents 800,000
Number of Responses per Respondent 1
Total Annual Responses 800,000
Hours per Response 2.5
Total Annual Reporting Burden 2,000,000
The annual reporting burden is 2,000,000. This figure was derived by multiplying the number of respondents (800,000) x (1) frequency of response x (2.5) (2 ½) hours per response.
This estimation is based on prior USCIS experience with the program and is calculated as follows: learning about the form (30 minutes); making an appointment with a civil surgeon for a medical exam (15 minutes); taking the medical exam (1 hour); reading the results of the Tuberculin Skin Test (TST) or Interferon Gamma Release Assay (IGRA), which requires a second appointment with the civil surgeon (30 minutes); reporting the results of the medical exam on the form (10 minutes); and submitting the medical exam report to USCIS (5 minutes).
There are no capital or start-up costs associated with this information collection. Any cost burdens to respondents as a result of this information collection are identified in Item 14. (There is no fee associated with the collection of this information.)
Annualized Cost Analysis:
Printing Cost $ 27,500
Collection and Processing Cost $ 48,000,000
Total Cost to Program $ 48,027,500
Fee Charge $ 0
Total Cost to Government $ 48,027,500
The estimated cost to the Government is $48,027,500. This figure is calculated by using the estimated number of respondents 800,000 x (1) number of response x (1.5 hours) per response (time required to collect and process information) x $40 (suggested average hourly rate for clerical, officer, and supervisory time with benefits). In addition, this figure includes the estimated overhead cost for printing, stocking, and distributing the form, which is $27,500.
The estimated annual public cost is $59,780,000. This estimate is based on the number of respondents 800,000 x 2.5 hours per response x $29.89 (average hourly rate).
15. There has been no increase or decrease in the estimated burden hours previously reported for this information collection.
USCIS is revising the Form I-693 (see table of changes). These revisions are being made in order to better organize the information requested on the form as well as to add fraud prevention elements (e.g. requiring the applicant’s identifying information on each page of the form). Minor updates or clarifications were also made to the form in response to past confusion over certain elements. In particular, the blanket waiver check box in Part 7 of the current form based on section 212(g)(2)(B) of the Act has been eliminated and language has been added in the form instructions to clarify that civil surgeons must sign with an original (not stamped) signature. Also, additional fields were added in Part 1 of the form for the civil surgeon to complete, regarding the documentation presented by the applicant to verify his or her identity. These fields were added as a fraud prevention measure to ensure that civil surgeons are checking applicants’ identification documents in accordance with the Centers for Disease Control and Prevention’s Technical Instructions.
16. USCIS does not intend to employ the use of statistics, or the publication thereof for this information collection.
17. USCIS will display the expiration date for OMB approval of this information collection.
18. The USCIS does not request an exception to the certification of this information collection.
Not Applicable.
In submitting this request for OMB approval, I certify that the requirements of the Privacy Act and OMB directives have been complied with including paperwork regulations, statistical standards or directives, and any other information policy directives promulgated under 5 CFR 1320.
_________________________ _________________
Sunday Aigbe Date
Chief
Regulatory Products Division,
Office of the Executive Secretariat,
U.S. Citizenship and Immigration Services,
Department of Homeland Security.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT |
| Author | ANDREA FLEET |
| Last Modified By | EXSO/RPD (Bo Mayer) |
| File Modified | 2011-09-29 |
| File Created | 2011-09-29 |