Application for Benefits Under the Family Unity Program

Forms and Documents

Document Name	Status
Form I-817 Application for Family Unity Benefits Form	Modified
Form I-817 - Supporting Statement - 2015 (c).doc Supporting Statement A	2015-06-30
SORN.htm Supplementary Document	2015-06-24
PIA.pdf Supplementary Document	2015-06-24
I817-INS-TOC-OMBReview-09142015.docx Supplementary Document	2015-10-02
I817-FRM-TOC-OMBReview-09142015.docx Supplementary Document	2015-10-02
Reference citations.doc Supplementary Document	2015-06-24
Published 30-Day Notice.docx Supplementary Document	2015-06-17
Published 60-Day Notice.docx Supplementary Document	2015-06-17

IC Document Collections

IC ID	Document Title	Status
217204	Biometric Processing	New
20230	Application for Family Unity Benefits Form	Modified

ICR Details

OMB Control No: 1615-0005	ICR Reference No: 201506-1615-002
Status: Historical Active	Previous ICR Reference No: 201301-1615-010
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-817
Title: Application for Benefits Under the Family Unity Program
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: 10/05/2015
	Date Received in OIRA: 06/30/2015
Terms of Clearance: Approved for only two years due to lack of GPEA compliance. This form can be completed but not submitted electronically.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	10/31/2015
Responses	5,114	0	2,384
Time Burden (Hours)	8,106	0	4,768
Cost Burden (Dollars)	313,233	0	0

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Abstract: The information collected will be used to determine whether the applicant meets the eligibility requirements for benefits under 8 CFR 245A, Subpart C. If the applicant fully demonstrates eligibility, the application will be approved, and USCIS will issue an employment authorization document and approval notice to the applicant.

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Authorizing Statute(s): US Code: 8 USC 1255a Name of Law: U.S. 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:
	80 FR 17765	04/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 33276	06/11/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Family Unity Benefits	I-817	Application for Family Unity Benefits
Biometric Processing

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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	5,114	2,384	0	2,730	0	0
Annual Time Burden (Hours)	8,106	4,768	0	3,338	0	0
Annual Cost Burden (Dollars)	313,233	0	0	0	313,233	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: There is an increase of annual hour burden from 4,768 to 8,106, a total increase of 3,338. This is due to an increase of the agency's estimation of the number of respondents for the form.

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Annual Cost to Federal Government: $1,331,740

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: 06/30/2015

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