Affidavit of Support Under Section 213A of the Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form I-864 Affidavit of Support Under Section 213A of the Act	Form	Modified	Available
Form I-864W Intending Immigrant's Affidavit of Support Exemption	Form	New	Available
Form I-864EZ Affiavit of Support of Support Under Section 213A of the Act	Form	New	Repair queued
Form I-864A Contract Between Sponsor and Household Member	Form	New	Available
I864-INS-TOC-OMBReview-03132013.docx	Supplementary Document	Uploaded 2013-03-21	Available
30-day FRN 1615-0075 pub 2012-9-26.pdf	Supplementary Document	Uploaded 2012-09-26	Available
60-d FRN 1615-0075 pub 2012-6-1.pdf	Supplementary Document	Uploaded 2012-09-25	Available
Supporting Statement 1615-0075 I-864 OMB 2-7-13 USCIS response 2013-3-21.doc	Supporting Statement A	Uploaded 2013-03-21	Available
SORN Immigration Benefits System.docx	Supplementary Document	Uploaded 2012-09-25	Repair queued
PIA USCIS Benefits Processing other than PNRSA.pdf	Supplementary Document	Uploaded 2012-09-25	Available
Section 213A.doc	Supplementary Document	Uploaded 2012-09-25	Available
Reference_-_USCIS_memo_(Consolidation_of_Policy_of_USCIS_Form_I-864)[1].pdf	Supplementary Document	Uploaded 2012-09-25	Available
Reference_-_Dep_of_State_Foreign_Affairs_Manual_Volume_9_�_Visas[1].pdf	Supplementary Document	Uploaded 2012-09-25	Available
Reference_-_71_FR_35732,_35739[1].doc	Supplementary Document	Uploaded 2012-09-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
41275	Affidvit of Support Under Section 213A of the Act	Form	Modified	Affidavit of Support Under Section 213A of the Act
41275	Affidvit of Support Under Section 213A of the Act	Instruction	Modified
204187	Affidavit of Support Under Section 213A of the Act	Instruction	New
204187	Affidavit of Support Under Section 213A of the Act	Form	New	Intending Immigrant's Affidavit of Support Exemption
204186	Affidavit of Support Under Section 213A of the Act	Instruction	New
204186	Affidavit of Support Under Section 213A of the Act	Form	New	Affiavit of Support of Support Under Section 213A of the Act
204184	Affidavit of Support Under Section 213A of the Act	Instruction	New
204184	Affidavit of Support Under Section 213A of the Act	Form	New	Contract Between Sponsor and Household Member

ICR Details

OMB Control No: 1615-0075	ICR Reference No: 201209-1615-003
Status: Historical Active	Previous ICR Reference No: 201107-1615-009
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-864
Title: Affidavit of Support Under Section 213A of the Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/22/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/27/2012
Terms of Clearance: Approved for two years only due to lack of GPEA compliance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2013
Responses	756,300	0	756,300
Time Burden (Hours)	3,265,650	0	3,265,650
Cost Burden (Dollars)	0	0	0

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Abstract: The forms are mandated by law for a petitioning relative to submit an affidavit on their relative's behalf. The executed form creates a contract between the sponsor and any entity that provides means-tested benefits.

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Authorizing Statute(s): US Code: 8 USC 1183a Name of Law: Immigration Nationality Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 32658	06/01/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 59204	09/26/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Affidavit of Support Under Section 213A of the Act	I-864A	Contract Between Sponsor and Household Member
Affidavit of Support Under Section 213A of the Act	I-864EZ	Affiavit of Support of Support Under Section 213A of the Act
Affidavit of Support Under Section 213A of the Act	I-864W	Intending Immigrant's Affidavit of Support Exemption
Affidvit of Support Under Section 213A of the Act	I-864	Affidavit of Support Under Section 213A of the Act

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ICR Summary of Burden

table that charts list 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	756,300	756,300	0	0	0	0
Annual Time Burden (Hours)	3,265,650	3,265,650	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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:

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Annual Cost to Federal Government: $31,710,626

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

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Common Form ICR:  No

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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: 09/27/2012

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