Application for Replacement Naturalization/Citizenship Document

Forms and Documents

Document Name	Status
Form N-565 Application for Replacement Naturalization/Citizenship Document Form	Modified
OMB-83C N-565.pdf Justification for No Material/Nonsubstantive Change	2016-06-02
N565-INS-TOC-SL-04142016.docx Supplementary Document	2016-06-02
N565-FRM-TOC-SL-04132016 PM.docx Supplementary Document	2016-06-02

IC Document Collections

IC ID	Document Title	Status
20426	Application for Replacement Naturalization/Citizenship Document Form	Modified

ICR Details

OMB Control No: 1615-0091	ICR Reference No: 201606-1615-001
Status: Historical Active	Previous ICR Reference No: 201502-1615-015
Agency/Subagency: DHS/USCIS	Agency Tracking No: N-565
Title: Application for Replacement Naturalization/Citizenship Document
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/21/2016
	Date Received in OIRA: 06/03/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	05/31/2017	05/31/2017
Responses	29,298	0	29,298
Time Burden (Hours)	26,836	0	26,836
Cost Burden (Dollars)	3,589,005	0	3,589,005

---

Abstract: This form is used by USCIS to determine an applicant's eligibility for a replacement document that was lost, mutilated or destroyed, or if the applicant's name was changed by marriage or by court order after the original document was issued. Additionally, this form is used by a naturalized citizen applicant who desires to obtain a special certificate of recognition as a citizen of the United States by a foreign country.

---

Authorizing Statute(s): US Code: 8 USC 1454 Name of Law: U.S. Code
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 64612	10/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 9742	02/24/2015
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Application for Replacement Naturalization/Citizenship Document	N-565	Application for Replacement Naturalization/Citizenship Document

---

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	29,298	29,298	0	0	0	0
Annual Time Burden (Hours)	26,836	26,836	0	0	0	0
Annual Cost Burden (Dollars)	3,589,005	3,589,005	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:

---

Annual Cost to Federal Government: $10,107,810

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

---

Common Form ICR:  No

---

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: 06/03/2016

---