Form I-360 83C

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS, U.S. Citizenship and Immigration Services

0020
1615
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Enter only items that change
Current record

New record

Agency form number (s)

Form I-360, Petition for Amerasian,
Widow(er), or Special Immigrant
Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

Request a change in publication date from July 23, 2016, (as approved by OMB on March 14, 2016) to publish the new edition
of I-360 on Monday, August 29, 2016. The delay in publication is due to operational issues.
Signature of Senior Official or designee:

HEATHER L YOUNG

Digitally signed by HEATHER L YOUNG
DN: c=US, o=U.S. Government, ou=Department of Homeland Security, ou=USCIS,
ou=People, cn=HEATHER L YOUNG, 0.9.2342.19200300.100.1.1=0269871124.USCIS
Date: 2016.07.15 14:40:55 -04'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

July 15, 2016

For OIRA Use
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