Application for Benefits Under the Family Unity Program

Forms and Documents

Document Name	Status
Form I-817 Application for Benefits Under the Family Unity Program Form	Modified
SORN.htm Supplementary Document	2011-11-09
PIA.pdf Supplementary Document	2011-11-09
PTA USCIS-Form I-817 20111024 PRIV final.pdf Supplementary Document	2011-11-09
Reference citations.doc Supplementary Document	2011-11-09
Published 30-Day Notice 11-8-11.doc Supplementary Document	2011-11-09
60 Day Notice Published 8-12-11.doc Supplementary Document	2011-11-09
Supp Statement 11-9-11.doc Supporting Statement A	2011-11-09

IC Document Collections

IC ID	Document Title	Status
20230	Application for Benefits Under the Family Unity Program Form	Modified

ICR Details

OMB Control No: 1615-0005	ICR Reference No: 201111-1615-001
Status: Historical Active	Previous ICR Reference No: 201008-1615-036
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Application for Benefits Under the Family Unity Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/28/2012
	Date Received in OIRA: 11/29/2011
Terms of Clearance: Approved for one year only due to lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	36 Months From Approved	02/29/2012
Responses	1,750	0	1,750
Time Burden (Hours)	3,500	0	3,500
Cost Burden (Dollars)	910,000	0	910,000

---

Abstract: The information collected will be used to determine whether the applicant meets the eligibility requirements for benefits under 8 CFR 245A, Subpart C. If the applicant fully demonstrates eligibility, the application will be approved, and USCIS will issue an employment authorization document and approval notice to the applicant.

---

Authorizing Statute(s): US Code: 8 USC 1255a Name of Law: U.S. Code
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 50237	08/12/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 69274	11/08/2011
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Application for Benefits Under the Family Unity Program	I-817	Application for Family Unity Benefits

---

ICR Summary 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	1,750	1,750	0	0	0	0
Annual Time Burden (Hours)	3,500	3,500	0	0	0	0
Annual Cost Burden (Dollars)	910,000	910,000	0	0	0	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:

---

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 11/29/2011

---