Information Collection

Application for Civil Surgeon Designation

IC 192797 under ICR 201307-1615-004 · OMB 1615-0114.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0114 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-910 Application for Civil Surgeon Designation Application for Civil Surgeon Designation	Form
I910-INS-OMBReview-07302013.pdf	Instruction
Draft I-910 webpage.docx	Other-Web Page
I-910 Application for Civil Surgeon Designation I910-FRM-WIP-05032013.pdf	Form

IC Title:

Application for Civil Surgeon Designation

Agency IC Tracking Number:

I-910

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 212

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-910	Yes	No	Fillable Printable
Instruction		Yes	No	Printable Only
Other-Web Page		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: United States Citizenship and Immigration Services Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 923

Number of Respondents for Small Entity: 450

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	923	0	-277	1,200
Annual IC Time Burden (Hours)	1,708	785	-277	1,200
Annual IC Cost Burden (Dollars)	0	0	-738,000	738,000

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.

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