Information Collection

Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status

IC 20384 under ICR 201210-1615-003 · OMB 1615-0070.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-643 Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status	Form and Instruction
I-643 Health and Human Services Statistical Data for Refugee/A I-643 Form and Instructions.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 207

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 and Instruction	I-643	Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status	I-643 Form and Instructions.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: USCIS Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 195,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	195,000	195,000
Annual IC Time Burden (Hours)	178,620	178,620
Annual IC Cost Burden (Dollars)	0	0

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.