Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form I-914B Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)	Form	New	Available
Form I-914B Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)	Form	Modified	Available
Form I-914A Application for Family Member of T-1 Recipient	Form	Modified	Available
Form I-914 Application for T Nonimmigrant Status	Form	Modified	Available
Place Holder - T Nonimmigrant Rule .docx	Supplementary Document	Uploaded 2015-01-15	Repair queued
I914-INS-TOC-WIP-TRule-08122013.doc	Supplementary Document	Uploaded 2015-01-15	Available
I914B-INS-TOC-WIP-TRule-06182013.doc	Supplementary Document	Uploaded 2015-01-15	Available
I914B-FRM-TOC-WIP-TRule-06132013.doc	Supplementary Document	Uploaded 2015-01-15	Repair queued
I914A-FRM-TOC-WIP-TRule-06182013.doc	Supplementary Document	Uploaded 2015-01-15	Available
I914-FRM-TOC-WIP-TRule-07022013.doc	Supplementary Document	Uploaded 2015-01-15	Repair queued
Reference Cite.docx	Supplementary Document	Uploaded 2015-01-15	Available
Reference Cite.doc	Supplementary Document	Uploaded 2015-01-15	Available
SORN - USCIS A-FILE.docx	Supplementary Document	Uploaded 2015-01-15	Available
SORN - USCIS Benefits Information System.docx	Supplementary Document	Uploaded 2015-01-15	Available
PIA - CLAIMS 3.pdf	Supplementary Document	Uploaded 2015-01-15	Available
Supporting Statement 1615-0099 I-914 2014-4-10.docx	Supporting Statement A	Uploaded 2015-01-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214658	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)	Form	New	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)
214658	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)	Instruction	New
214657	Biometric Processing		New
211477	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)	Form	Modified	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)
211477	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)	Instruction	Modified
211476	Application for Family Member of T-1 Recipient	Form	Modified	Application for Family Member of T-1 Recipient
21015	Application for T Nonimmigrant Status	Form	Modified	Application for T Nonimmigrant Status
21015	Application for T Nonimmigrant Status	Instruction	Modified

ICR Details

OMB Control No: 1615-0099	ICR Reference No: 201411-1615-012
Status: Historical Inactive	Previous ICR Reference No: 201403-1615-001
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-914, I-914A, I-914B
Title: Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/30/2015
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/26/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/21/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	6 Months From Approved	01/31/2017
Responses	1,200	0	1,200
Time Burden (Hours)	1,725	0	1,725
Cost Burden (Dollars)	0	0	0

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Abstract: The information on all three parts of the form will be used to determine whether applicants meet the eligibility requirements for benefits. This application incorporates information pertinent to eligibility under the Victims of Trafficking and Violence Protection Act (VTVPA), Public Law 106-386, and a request for employment.

Emergency Justfication: To meet regulatory requirements.

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Authorizing Statute(s): PL: Pub.L. 106 - 386 107(e) Name of Law: Victims of Trafficking and Violence Protection Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1615-AA59	Final or interim final rulemaking	78 FR 22222	01/01/1801

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 6209	02/03/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Application for Family Member of T-1 Recipient	I-914A	Application for Family Member of T-1 Recipient
Application for T Nonimmigrant Status	I-914	Application for T Nonimmigrant Status
Biometric Processing
Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)	I-914B	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Contact by Respondent to Law Enforcement)
Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)	I-914B	Declaration of Law Enforcement Officer for Victim of trafficking in Persons (Law Enforcement Officer completion activity)

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The total estimated annual hour burden has increased from 1,725 hours to 4,711 hours. This increase is due to: a) an increase in the estimated number of respondents for the I-914 based on an adjustment in agency estimate; b) an increase in the estimated number of respondents for the I-914 Supplement A based on an adjustment in agency estimate; c) an increase in the estimated number of respondents for the I-914 Supplement B based on an adjustment in agency estimate; d) an increase in the estimated burden per response for the I-914 Supplement B, from 30 minutes and 3 hours and 30 minutes based on a program change due to agency discretion; e) and the inclusion of the biometric processing burden for this collection which was not captured at the time of the last submission.

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Annual Cost to Federal Government: $143,000

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: 01/21/2015

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