SUPPORTING STATEMENT
Case Assistance Form and Instructions (Ombudsman Form DHS-7001)
and
Ombudsman Case Assistance Online System (Ombudsman Form DHS-7001)
OMB No. 1601-0004
A. Justification:
1. The Citizenship and Immigration Services (CIS) Ombudsman was created under section 452 of the Homeland Security Act of 2002 (Public Law 107-296) to: (1) assist individuals and employers in resolving problems with the U.S. Citizenship and Immigration Services (USCIS); (2) to identify areas in which individuals and employers have problems in dealing with USCIS; and (3) to the extent possible, propose changes in the administrative practices of USCIS to mitigate problems. This form is used by an applicant who is experiencing problems with USCIS in the processing of an immigration benefit.
2. The information collected on this form will allow the CIS Ombudsman to identify issues to be handled in accordance with Section 452 of Public Law 107-296, such as: (1) a request for case assistance with, or for additional information about, an application or petition filed with USCIS (“case problem”); or (2) the identification of a systemic issue that may or may not pertain to an individual case which the individual, attorney or employer is seeking to bring to the attention of the CIS Ombudsman (“trend”).
For case problems, the CIS Ombudsman will refer case specific issues to the appropriate office within USCIS for further research and review.
For trends received, the CIS Ombudsman notes the systemic issue identified in the correspondence which may or may not be incorporated into future recommendations submitted to the Director of USCIS pursuant to section 452(d)(4) of Public Law 107-296.
3. The use of this form provides the most efficient means for collecting and processing the required data. The CIS Ombudsman is now employing the use of information technology in collecting and processing information by offering the option for electronic submission of the DHS Form 7001 through the Ombudsman Case Assistance Online System. Per PRA requirements, a fillable PDF version of the form is provided on the CIS Ombudsman’s website. The PDF form can be completed online, printed out and sent to the CIS Ombudsman’s office at the address indicated on the form. It is noted on the form that using the paper method can result in significant processing delays for the CIS Ombudsman’s office to provide the requested case assistance. After approval of the changes to the form, detailed in this supporting statement, the online form will be updated and posted on the CIS Ombudsman’s website at http://www.dhs.gov/case-assistance for electronic online submission.
4. A review of the DHS Forms Inventory Report revealed no duplication of effort, and there is no other similar information currently available which can be used for this purpose.
5. This information collection does not have an impact on small businesses or other small entities.
6. If this information is not collected the CIS Ombudsman will not be able to identify problem areas, propose changes, and assist individuals and employers experiencing problems during the processing of an immigration benefit with USCIS.
7. The special circumstances contained in item 7 of the supporting statement are not applicable to this information collection.
8. The CIS Ombudsman published a 60-day notice in the Federal Register on October 17, 2014 at 79 FR 62450 and a 30-day notice on January 14, 2015, at 80 FR 1928 requesting comments from the public. No comments were received from either of the notices requesting comments. The CIS Ombudsman has also reviewed the draft revised information collection and made additional minor amendments to ensure consistency and clarity between its online and paper versions.
9. The CIS Ombudsman does not provide payments or gifts to respondents in exchange for a benefit sought.
10. The assurance of confidentiality provided to the respondents for this information collection is provided by: (a) The CIS Ombudsman statute and mandate as established by Homeland Security Act Section 452; (b) the Privacy Impact Assessment for the Office of the Citizenship & Immigration Services Ombudsman (CISOMB) Virtual CIS Ombudsman System (March 19, 2010) and the (c) Systems of Records Notice: 9110-9B DEPARTMENT OF HOMELAND SECURITY, Office of the Secretary [Docket No. DHS-2009-0146] Privacy Act of 1974; Department of Homeland Security Citizenship and Immigration Services Ombudsman – 001 Online Ombudsman Form DHS -7001 System of Records. The DHS Privacy Office will receive the entire package of documents for this information collection to assure authorization for renewal of the collection.
The CIS Ombudsman Form DHS-7001 and the Ombudsman Case Assistance Online System is constructed in compliance with all applicable DHS Privacy Office, DHS OCIO (Office of the Chief Information Officer), DHS Records Management, and OMB regulations regarding data collection, use, storage, and retrieval. The proposed public use data collection system is therefore intended to be distributed for public use primarily by electronic means with limited paper distribution and processing of paper forms.
The CIS Ombudsman Form DHS-7001(PDF) and the Ombudsman Case Assistance Online System (Form DHS-7001) has been constructed in compliance with regulations and authorities under the purview of the DHS Privacy Office, DHS CIO, DHS Records Management, and OMB regulations regarding data collection, use, sharing, storage, information security and retrieval of information.
In accordance with the Privacy Act of 1974, the Department of Homeland Security is giving notice that it proposes to renew the Department of Homeland Security system of records notice titled, “Department of Homeland Security Citizenship and Immigration Services Ombudsman – Ombudsman Form DHS -7001 and Ombudsman Case Assistance Online System of Records.” This system of records will continue to ensure the efficient and secure processing of information to aid the CIS Ombudsman in providing assistance to individuals, employers, and their representatives in resolving problems with USCIS; identify areas in which individuals, employers, and their representatives have problems working with USCIS; and to the extent possible, propose changes to mitigate problems, pursuant to 6 U.S.C. Section 272. This system will continue to be included in the Department of Homeland Security’s inventory of record systems.
11. There are no questions of a sensitive nature.
12. Annual Reporting Burden:
a. Number of Respondents 8,800 b. Number of Responses 1
c. Total Annual Responses 8,800
d. Hours per Response 1
e. Total Annual Reporting Burden 8,800
The projected hours per response for this collection of information were derived by first breaking the process into three basic components:
Learning about the Law and the Form: 20 Minutes
Completion of the Form: 30 Minutes
Assembling and Filing the Form: 10 Minutes
Total Hours per Response 1 Hour
Total annual reporting burden hours is 8,800. This figure was derived by multiplying the number of respondents (8,800) x frequency of response (1) x hours per response (1 hour).This is an increase of 6,200 over the 2,600 total annual reporting burden hours established in 2011. This is due to the increased use of the online system and from the Ombudsman’s outreach activities informing and educating the public about the online form and system.
The estimated annual public cost is $279,787. This figure is calculated by multiplying the number of respondents 8,800 x 1 hour (1.0) per response x $31.80 average hourly rate (see table below).
Type of Respondent |
Form Name (Form Number) |
No. of Respondents |
No. of Responses per Respondent |
Avg. Burden per Response (in hours) |
Total Annual Burden (in hours) |
Avg. Hourly Wage Rate |
Total Annual Respondent Cost |
Individuals or households |
|
8,800 |
1 |
1 |
8,800 |
*$31.80 |
$279,787 |
Total |
|
8,800 |
|
|
8,800 |
|
$279,787 |
* The above Average Hourly Wage Rate is the May 2014 Bureau of Labor Statistics average wage for “All Occupations” of $22.71 times the wage rate benefit multiplier of 1.4 (to account for fringe benefits) equaling $31.80. The selection of “All Occupations” was chosen as the expected respondents for this collection could be expected to be from any occupation.
13. There are no capital or start-up costs associated with this information collection. Any cost burdens to respondents as a result of this collection are identified in question 14.
14. Annualized Cost Analysis:
a. Printing Cost $ 0
b. Collecting and Processing $ 362,000
c. Total Cost to Program $ 362,000
d. Fee Charge $ 0
e. Total Annual Cost to Government $ 362,000
The estimated cost to the Government is $362,000. This figure is calculated by multiplying the estimated number of respondents 8,800 x 1 hour (1.0) (time required to collect and process information) x $40 (Suggested average hourly rate for clerical, officer, and supervisory time with benefits). Note: the estimated overhead cost for printing, stocking, and distributing the form which was $2,500 is now $0 as respondents can now download the PDF form for free or use the online system to submit their information.
15. There has been an increase of 6,200 in the estimated annual burden hours previously reported for this information collection. The increase in burden hours is a reflection of agency estimates.
There is no change in the information being collected, however there have been cosmetic changes to the form including punctuation, formatting, sequencing of information, and text changes to make the form more understandable and streamlined for use by respondents. The number of response fields has been reduced from 13 to 12 and arranged in a way that streamlines completion, submission and processing of the form. The title of the form has changed from “Case Problem Submission Worksheet (CIS Ombudsman Form DHS-7001)” to “Case Assistance Form (CIS Ombudsman Form DHS-7001).”
The name of the system has changed from “Virtual Ombudsman System” to “Ombudsman Case Assistance Online”.
The following narrative explains the changes made on the form and the corresponding instructions:
The ORIGINAL Form DHS-7001 had the sections arranged in the following order:
1- Name: Please identify the individual or employer encountering difficulties with USCIS (applicant/beneficiary/petitioner)
2- Contact Information: Please provide information on the individual or employer encountering difficulties with USCIS (applicant/ beneficiary /petitioner).
3- Date of Birth.
4- Country of Birth and Citizenship.
5- Alien Registration Number (A-Number); The A-number appears in the following format: A123-456-789.
6- Person Preparing This Form: Please indicate who is completing this form.
7- Applications/Petitions Filed: List all applications and/or petitions pending with USCIS related to your case inquiry.
8- Type of Immigration Benefit: Please provide the type of immigration benefit sought from USCIS.
9- Reason for Inquiry: Please indicate if any of the options apply. Provide a description in section 10;
10- Description: Describe the difficulties experienced with USCIS. Attach additional pages if needed.
11- Prior Actions Taken: Check all that apply: Please describe the response USCIS provided and attach any relevant correspondence.
12- Consent: If you are the beneficiary of an immigration petition, consent of the individual who submitted the petition on your behalf is required. The petitioner must sign.
13- Attorney or Accredited Representative: Please complete this section if you are an attorney, a representative of an organization, an accredited representative, or anyone else preparing this form on behalf of the individual or employer encountering difficulties with USCIS.
The AMENDED Form DHS-7001 has the sections arranged in the following order:
1. Name: Please identify the name of the individual or employer (applicant/ beneficiary/petitioner) encountering or difficulties with USCIS. Do not enter the attorney/law firm's name here.
2. Date of Birth: Country of Birth: Country of Citizenship:
3. Alien Registration Number (A-Number); The A-number appears in the following format: A123-456-789.
4. Contact Information: Please provide the contact information of the individual or employer (applicant/beneficiary/petitioner) encountering difficulties with USCIS. Please include the primary E-Mail address for the Ombudsman to provide updates.
5. Applications/Petitions Filed: List all applications and/or petitions pending with USCIS related to your case inquiry.
6. Type of Immigration Benefit Sought: Please provide the type of immigration benefit sought from USCIS.
7. Reason for Inquiry/Case Assistance Request: Check all that apply. Provide a description in section 8 and add documentation related to your inquiry.
8. Description of your Case Problem: Describe the difficulties experienced with USCIS including all responses USCIS provided. Attach relevant correspondence concerning actions taken to resolve the issue before submitting with the Ombudsman's Office including: receipt notices; requests for evidence; decisions; notices and any other correspondence from USCIS about your case. Attach additional pages if needed.
9. Prior Actions Taken to Remedy the Problem:
Check all that apply and provide the additional information requested for each selection in the space provided. Note that if selecting Option a "Visited USCIS My Case Status at www.uscis.gov", you must indicate what additional actions (b through g) were taken to remedy the problem before submitting the form to the Ombudsman
a. Visited USCIS My Case Status at www.uscis.gov.and
b. Contacted the National Customer Service Center (NCSC) for information and/or assistance regarding this case at their toll-free number 1-800-375-5283. Provide referral number (also referred to as an SRMT Number):
c. Attended an InfoPass Appointment with USCIS.
Provide InfoPass Confirmation Number:
d. Sent an E-mail to USCIS. Provide date E-Mail sent: Provide USCIS E-mail address:
e. Contacted a U.S. Government Department or Agency for assistance. Provide name and contact information:
f. Contacted a U.S. Congressional Representative for assistance. Provide name and contact information:
g. Other. Please describe
10. Person Preparing This Form:
Please indicate who is completing this form
11. Attorney or Accredited Representative:
Please complete this section if you are an attorney, a representative of an organization, an accredited representative, or anyone else preparing this form on behalf of the individual or employer encountering difficulties with USCIS. Please attach a copy of your Form G-28
12. Consent: Please note that if you are the beneficiary of an immigration petition, consent of the individual or employer that submitted the petition on your behalf is required. The petitioner must sign.
The instructions have been updated to reflect the electronic submission options as detailed in the previous paragraphs.
Instructions for electronic submission will be posted on the CIS Ombudsman website at www.dhs.gov/cisombudsman.The electronic version of the form will be developed by DHS OCIO (Office of the Chief Information Officer) based upon the approved version of the amended Form DHS-7001 as described herein.
There is no change in the terms of clearance from the previously approved collection have been addressed by updates to the: (a) Privacy Impact Assessment for the Office of the Citizenship & Immigration Services Ombudsman (CISOMB) Virtual Ombudsman System (March 19, 2010); and the (b) Systems of Records Notice: 9110-9B DEPARTMENT OF HOMELAND SECURITY, Office of the Secretary [Docket No. DHS-2009-0146] Privacy Act of 1974; Department of Homeland Security Citizenship and Immigration Services Ombudsman – 001 Virtual Ombudsman System (March 2010) to reflect the name change to Online Ombudsman Form DHS -7001 System of Records.
16. CIS Ombudsman does not intend to employ the use of statistics or the publication thereof for this collection of information.
17. CIS Ombudsman will display the expiration date for OMB approval of this information collection.
18. CIS Ombudsman does not request an exception to the certification of this information collection.
Collection of Information Employing Statistical Methods.
This ICR does not contain surveys, censuses, or employ statistical methods.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | PRA Supplemental Information |
| Subject | DHS Form 7001 |
| Author | rgm |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |