Information Collection

Request for Fee Waiver

IC 194028 under ICR 201505-1615-003 · OMB 1615-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0116 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i-912p.pdf	Other-Poverty Guidelines
I-912 INSTRUCTIONS Place Holder.docx	Instruction
I-912 Request for Fee Waiver I-912 FORM Place Holder.docx	Form

IC Title:

Request for Fee Waiver

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 103

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Poverty Guidelines			i-912p.pdf	Yes	No	Printable Only
Form	I-912	Request for Fee Waiver	I-912 FORM Place Holder.docx	Yes	No	Fillable Printable
Instruction			I-912 INSTRUCTIONS Place Holder.docx	Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: USCIS Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 502,216

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	502,216	102,216	400,000
Annual IC Time Burden (Hours)	587,593	119,593	468,000
Annual IC Cost Burden (Dollars)	1,883,310	1,883,310	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.