Information Collection

Application for Civil Surgeon Designation

IC 192797 under ICR 201610-1615-039 · OMB 1615-0114.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0114 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-910 Application for Civil Surgeon Designation	Form
I910-INS-WIP-2016 FeeRule-83C-10012016.pdf	Instruction
I-910 Application for Civil Surgeon Designation I910-FRM-OMBReview-04062016.pdf	Form

IC Title:

Application for Civil Surgeon Designation

Agency IC Tracking Number:

I-910

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 212

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-910	Application for Civil Surgeon Designation	I910-FRM-OMBReview-04062016.pdf		Yes	No	Fillable Printable
Instruction			I910-INS-WIP-2016 FeeRule-83C-10012016.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: United States Citizenship and Immigration Services Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 725

Number of Respondents for Small Entity: 450

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	725	725
Annual IC Time Burden (Hours)	1,450	1,450
Annual IC Cost Burden (Dollars)	3,625	3,625

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.