Affidavit of Support Under Section 213A of the Act

Forms and Documents

Document Name	Status
Form I-864W Affidavit of Support Under Section 213A of the Act Form	Modified
Form I-864EZ Affidavit of Support Under Section 213A of the Act Form	Modified
I864W-INS-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864W-FRM-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864EZ-INS-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864EZ-FRM-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864A-INS-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864A-FRM-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864-INS-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
I864-FRM-TOC-OMB REV-05042015.docx Supplementary Document	2015-06-26
Reference_-_71_FR_35732,_35739[1].doc Supplementary Document	2015-03-10
Reference_-_Dep_of_State_Foreign_Affairs_Manual_Volume_9_ý_Visas[1].pdf Supplementary Document	2015-03-10
Reference_-_USCIS_memo_(Consolidation_of_Policy_of_USCIS_Form_I-864)[1].pdf Supplementary Document	2015-03-10
Section 213A.doc Supplementary Document	2015-03-10
30-day FRN I-864.pdf Supplementary Document	2015-03-31
60-day FRN I-864.pdf Supplementary Document	2015-03-25
SupportingStatement 1615-0075 072014.doc Supporting Statement A	2015-07-02
SORN Immigration Benefits System.docx Supplementary Document	2015-03-30
PIA USCIS Benefits Processing other than PNRSA.pdf Supplementary Document	2015-03-30

IC Document Collections

IC ID	Document Title	Status
41275	Affidvit of Support Under Section 213A of the Act Instruction	Modified
204187	Affidavit of Support Under Section 213A of the Act Form	Modified
204186	Affidavit of Support Under Section 213A of the Act Form	Modified
204184	Affidavit of Support Under Section 213A of the Act Instruction	Modified

ICR Details

OMB Control No: 1615-0075	ICR Reference No: 201503-1615-001
Status: Historical Active	Previous ICR Reference No: 201209-1615-003
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-864
Title: Affidavit of Support Under Section 213A of the Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/02/2015
	Date Received in OIRA: 03/31/2015
Terms of Clearance: Approved for two years only due to lack of GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	07/31/2015
Responses	756,300	0	756,300
Time Burden (Hours)	3,265,650	0	3,265,650
Cost Burden (Dollars)	132,177,500	0	0

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Abstract: The forms are mandated by law for a petitioning relative to submit an affidavit on their relative's behalf. The executed form creates a contract between the sponsor and any entity that provides means-tested benefits.

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Authorizing Statute(s): US Code: 8 USC 1183a Name of Law: Immigration Nationality Act
  

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:
	80 FR 4297	01/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 17061	03/31/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Affidvit of Support Under Section 213A of the Act	I-864	Affidavit of Support Under Section 213A of the Act
Affidavit of Support Under Section 213A of the Act	I-864W	Intending Immigrant's Affidavit of Support Exemption
Affidavit of Support Under Section 213A of the Act	I-864EZ	Affiavit of Support of Support Under Section 213A of the Act
Affidavit of Support Under Section 213A of the Act	I-864A	Contract Between Sponsor and Household Member

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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	756,300	756,300	0	0	0	0
Annual Time Burden (Hours)	3,265,650	3,265,650	0	0	0	0
Annual Cost Burden (Dollars)	132,177,500	0	0	0	132,177,500	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: $30,393,200

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: 03/31/2015

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