Report of Medical Examination and Vaccination Record

ICR 201209-1615-001

OMB: 1615-0033

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2012-09-10
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
Supplementary Document
2012-09-07
IC Document Collections
IC ID
Document
Title
Status
20305 Modified
ICR Details
1615-0033 201209-1615-001
Historical Active 201107-1615-005
DHS/USCIS I-693
Report of Medical Examination and Vaccination Record
Revision of a currently approved collection   No
Regular
Approved with change 01/15/2013
Retrieve Notice of Action (NOA) 10/31/2012
Approved for two years only due to lack of GPEA compliance.
  Inventory as of this Action Requested Previously Approved
01/31/2015 36 Months From Approved 01/31/2013
565,180 0 800,000
1,412,950 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 and Nationality Act
  
None

Not associated with rulemaking

  77 FR 36285 06/18/2012
77 FR 55221 09/07/2012
No

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

  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 565,180 800,000 0 0 -234,820 0
Annual Time Burden (Hours) 1,412,950 2,000,000 0 0 -587,050 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There has been a decrease of 587,050 in burden hours from those previously reported for this information collection. This change can be attributed to a decrease in the number of respondents from 800,000 respondents to 565,180. The decrease in the number of respondents is based on updated FY 2011 statistical data and the resulting adjustment in agency estimates.

$33,910,800
No
No
No
No
No
Uncollected
Bosong Mayer 202 272-8356 [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.
10/31/2012


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