OMB Form 83-C

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS-USCIS

0122
1615
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Enter only items that change
Current record

New record

Agency form number (s)

No Form Number

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

The change request is to identify two distinct processes within the collection identified as USCIS ELIS, Control Number
1615-0122. Please see the separate document "Supporting Information for Change Request to OMB Control Number
1615-0122" for explanation.
Signature of Senior Official or designee:

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

For OIRA Use
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10/95