Medical Examination for Immigrant or Refugee Applicant

ICR 201407-1405-004

OMB: 1405-0113

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2014-07-21
Supplementary Document
2011-08-04
Supplementary Document
2011-08-04
Supporting Statement A
2014-07-21
IC Document Collections
ICR Details
1405-0113 201407-1405-004
Historical Active 201105-1405-007
STATE/AFA
Medical Examination for Immigrant or Refugee Applicant
Revision of a currently approved collection   No
Regular
Approved without change 09/11/2014
Retrieve Notice of Action (NOA) 07/21/2014
State Department will provide more information and submit a request to OMB prior to implementing an electronic version of the information collection instruments.
  Inventory as of this Action Requested Previously Approved
09/30/2017 36 Months From Approved 09/30/2014
660,000 0 630,000
660,000 0 630,000
290,250,000 0 283,500,000

Forms for this collection are completed by panel physicians for refugees and aliens seeking immigrant visas to the U.S. The collection records medical information necessary to determine whether refugees or immigrant visa applicants have medical conditions affecting the public health and requiring treatment.

US Code: 8 USC 1101 Name of Law: Immigration and Nationality Act
  
None

Not associated with rulemaking

  79 FR 13730 03/11/2014
79 FR 42391 07/21/2014
No

  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 660,000 630,000 0 0 30,000 0
Annual Time Burden (Hours) 660,000 630,000 0 0 30,000 0
Annual Cost Burden (Dollars) 290,250,000 283,500,000 0 0 6,750,000 0
No
No
Burden changes due to increase in number of respondents.

$9,189,360
No
No
No
No
No
Uncollected
Sydney Taylor 202 663-3721 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/21/2014


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