Information Collection

Request for Fee Waiver

IC 194028 under ICR 201210-1615-005 · OMB 1615-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0116 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
I-912P pdf 07222011_LJN .pdf	Other-Poverty Guidelines
I912-INS-OMBReview-05032013 (4).pdf	Instruction
I-912 Request for Fee Waiver I912-FRM-30Day-10092012.pdf	Form

IC Title:

Request for Fee Waiver

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 103

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Poverty Guidelines			I-912P pdf 07222011_LJN .pdf	Yes	No	Printable Only
Form	I-912	Request for Fee Waiver	I912-FRM-30Day-10092012.pdf	Yes	No	Fillable Printable
Instruction			I912-INS-OMBReview-05032013 (4).pdf	Yes	No	Printable Only

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: 400,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400,000	315,000	85,000
Annual IC Time Burden (Hours)	468,000	368,890	99,110
Annual IC Cost Burden (Dollars)	0	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.