Sworn Statement of Refugee Applying for Admission to the United States

Forms and Documents

Document Name	Status
Form G-646 Sworn Statement of Refugee Applying for Admission to the United States Form and Instruction	Modified
Supporting Statement A 161500097 G-646 2014-11-1.doc Supporting Statement A	2014-11-26
PIA G-646.pdf Supplementary Document	2014-11-26
SORN G-646.docx Supplementary Document	2014-11-26
30-day FRN pub 2014-10 G-646.pdf Supplementary Document	2014-11-24
60-day FRN pub 2014-3-27 1615-0097 G-646.pdf Supplementary Document	2014-11-24
G-646 Reference Citation.doc Supplementary Document	2014-11-26

IC Document Collections

IC ID	Document Title	Status
20432	Sworn Statement of Refugee Applying for Admission to the United States Form and Instruction	Modified

ICR Details

OMB Control No: 1615-0097	ICR Reference No: 201411-1615-007
Status: Historical Active	Previous ICR Reference No: 201206-1615-001
Agency/Subagency: DHS/USCIS	Agency Tracking No: G-646
Title: Sworn Statement of Refugee Applying for Admission to the United States
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/24/2014
	Date Received in OIRA: 11/26/2014
Terms of Clearance: This collection is approved for two years only due to lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved	12/31/2014
Responses	75,000	0	75,000
Time Burden (Hours)	24,975	0	24,975
Cost Burden (Dollars)	0	0	0

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Abstract: This form provides the grounds for admissibility to the United States as they apply to refugees. The information collected allows DHS to make admissibility determinations for refugees.

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Authorizing Statute(s): US Code: 8 USC 1157 Name of Law: United States Code
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 17171	03/27/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 60489	10/07/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Sworn Statement of Refugee Applying for Admission to the United States	G-646	Sworn Statement of Refugee Applying for Admission to the United States

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ICR Summary of Burden

	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	75,000	75,000	0	0	0	0
Annual Time Burden (Hours)	24,975	24,975	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,513,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/26/2014

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