Information Collection

Work Sheet

IC 203678 under ICR 201611-1615-005 · OMB 1615-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-765WS Work Sheet	Form
I-765WS I-765 Work Sheet I765WS-FRM-AC21 Final-11012016.pdf	Form

IC Title:

Work Sheet

Agency IC Tracking Number:

I-765WS

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 274

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-765WS	I-765 Work Sheet	I765WS-FRM-AC21 Final-11012016.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: Electronic Immigration System-3 Automated Background Functions, DHS/USCIS-016

FR Citation: 76 FR 70735

Number of Respondents: 250,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	250,000	250,000
Annual IC Time Burden (Hours)	125,000	125,000
Annual IC Cost Burden (Dollars)	0	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.