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Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)
Application for Waiver of Inadmissibility Under Immigration and Nationality Act
OMB: 0920-0006
IC ID: 6595
OMB.report
HHS/CDC
OMB 0920-0006
ICR 201405-0920-005
IC 6595
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0006 can be found here:
2024-01-19 - Reinstatement with change of a previously approved collection
2020-06-23 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-02-0102: Alien Mental Waiver Program
FR Citation:
51 FR 42461
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
33
0
0
0
0
33
Annual IC Cost Burden (Dollars)
16,000
0
0
0
0
16,000
Documents for IC
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.