FRM N648 Ext 30day Supporting Statement ver4__6FEB2017

SUPPORTING STATEMENT FOR

Medical Certification for Disability Exceptions

OMB Control No.: 1615-0060

COLLECTION INSTRUMENT(S): Form N-648

A. Justification

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Section 312(a) of the Immigration and Nationality Act (the Act) requires applicants for naturalization to demonstrate a knowledge and understanding of the form of government and history of the United States. Section 312(b)(1) of the Act allows an exception in the case of persons who, because of a physical or developmental disability or mental impairment, are unable to comply with the requirements of section 312(a) of the Act. In order to determine whether applicants for the above named exception to the section 312 requirements are qualified to receive that benefit, the U.S. Citizenship and Immigration Services (USCIS) regulations at 8 CFR 312.2(b)(2) require them to submit a Medical Certification for Disability Exceptions, Form N-648 from a licensed health care provider (medical or osteopathic doctor or clinical psychologist), affirming the existence of a medical condition warranting the exception, as part of their application for naturalization.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

USCIS uses the Form N-648 to substantiate a claim for an exception to the requirements of section 312(a) of the Act. Only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States are authorized to certify Form N-648. By certifying the form, the doctor states that an applicant filing an Application for Naturalization, Form N-400, is unable to complete the English and/or civics requirements because of a physical or developmental disability or mental impairment(s).

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

The use of this form currently provides the most efficient means for collecting and processing the required data. USCIS provides this application to the public via the USCIS Internet Web site at www/uscis.gov/n-648. This form can be downloaded, completed and saved electronically, but cannot be e-filed at this time. Due to the partial GPEA compliance of allowing for accessing, completing and saving the form electronically, USCIS respectfully requests a minimum 2-year approval.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

A search of USCIS automated forms tracking system was accomplished and revealed no duplication. There is no similar data collected.

5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.

This collection of information does not impact small businesses or other small entities. This form is completed by individuals seeking an exception and, while they may engage the services of medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States, those activities are a normal part of the medical professionals' function and no unnecessary burden is placed upon them due to the collection activities associated with this form.

Under 8 CFR 1320.3(c)(4), for the purposes of the definition of ten or more persons, persons do not include contractors engaged by a respondent for the purpose of complying with the collection of information. Medical professionals providing medical certifications fall under the category of contractors engaged by the respondents to comply with this information collection, and may not be considered respondents or persons impacted by this information collection for purposes of the Paperwork Reduction Act.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

If the information is not collected, the adjudicating officer will be unable to determine whether the applicant is qualified for the exception.

7. Explain any special circumstances that would cause an information collection to be conducted in a manner:

• Requiring respondents to report information to the agency more often than quarterly;

• Requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it;

• Requiring respondents to submit more than an original and two copies of any document;

• Requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years;

• In connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study;

• Requiring the use of a statistical data classification that has not been reviewed and approved by OMB;

• That includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or

• Requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information's confidentiality to the extent permitted by law.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2). There are no special circumstances applicable to this information collection.

8. If applicable, provide a copy and identify the data and page number of publication in the Federal Register of the agency’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years - even if the collection of information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

On September 20, 2016, USCIS published a 60-day notice in the Federal Register at 81 FR 64474. USCIS received 3 comments after publishing that notice, 2 of which mentioned the outdated information regarding the DMS-IV codes for medical conditions. USCIS appreciates the feedback and has updated the language in the form to update the information on the medical codes.

There was one comment regarding the time burden to consider multiple doctor's visits. USCIS feels that the time burden is appropriate as it allows time for filing out the form and additional time for a doctor's visit. This form is requesting information about an existing condition that would preclude them from establishing the language and civics requirements.

A more detailed discussions is available in the Support Statement Appendix A: Form N-648 60-day Comment Matrix.

On February6, 2017, USCIS published a 30-day notice in the Federal Register at 82 FR 9389. USCIS has not yet received public comments.

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9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

USCIS does not provide any payment for benefit sought.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation or agency policy.

There is no assurance of confidentiality.

The system of record notices associated with this information collection are:

• DHS/USCIS-001 - Alien File, Index, and National File Tracking System of Records, November 21, 2013, 78 FR 69864.
  
  

• DHS/USCIS-007 Benefits Information System, October 16, 2016, 81 FR 72069.
  
  

The privacy impact assessment associated with this information collection is:

• DHS/USCIS/PIA-015 USCIS Computer Linked Application Information Management System (CLAIMS 4), September 5, 2008.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

12. Provide estimates of the hour burden of the collection of information. The statement should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

• If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

Type of Respondent	Form Name / Form Number	No. of Respondents	No. of Responses per Respondent	No. of Responses	Avg. Burden per Response (in hours)	Total Annual Burden (in hours)	Avg. Hourly Wage Rate*	Total Annual Respondent Cost
Individuals and households	Medical Certification for Disability Exceptions (Form N-648)	17,302	1	1	2	34,604	*$32.52	$1,125,322
Total		17,302				34,604		$1,125,322

*  The above Average Hourly Wage Rate is the May 2015 Bureau of Labor Statistics average wage for “All Occupations” of $23.23 times the wage rate benefit multiplier of 1.4 (to account for fringe benefits) equaling $32.52. The selection of “All Occupations” (for example) was chosen as the expected respondents for this collection could be expected to be from any occupation.

13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

• The cost estimate should be split into two components: (a) a total capital and start-up cost component (annualized over its expected useful life); and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

• If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.

• Generally, estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995; (2) to achieve regulatory compliance with requirements not associated with the information collection; (3) for reasons other than to provide information or keep records for the government; or, (4) as part of customary and usual business or private practices.

There is no fee charge associated with this collection.

USCIS estimates that respondents will incur an estimated out of pocket cost of $3.75 average postage cost associated with the submission of the completed package to USCIS. Postage to mail completed package (17,302 x $3.75 average postage) = $64,883.

This information collection may impose some out-of-pocket costs on respondents in addition to the time burden for the form’s preparation. Some respondents may incur expenses to obtain supporting records. For form preparation, legal services, translators, and document search and generation, USCIS estimates the average cost of this information collection may vary widely, from as little as $20 to $1000 per respondent. USCIS estimates that the average cost for these activities is $490 and that an average of 10% of the total respondent population may incur this cost. The total cost to respondents would be generated as follows: [17,302] respondents x 10% of the population x [$490] the average cost per response of = $847,798.

As a result, the estimated total cost to respondents is approximately $912,681 [$64,883 postage + $847,798 out-of-pocket costs]. The estimated cost per respondent is $912,681 / 17,302 = $52.75.

14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

Annualized Cost Analysis:

1. Printing Cost $ 1,190

2. Collection and Processing Cost $5,813,472

3. Total Cost to Government $5,814,662
   
   

Government Cost

The estimated cost to the Government is $5,814,662. This figure is calculated by multiplying the estimated number of respondents (17,302) x (1) number of annual responses x ($336) the estimated cost per N-648 receipt, plus ($1,190) the printing costs.

15. Explain the reasons for any program changes or adjustments reporting in Items 13 or 14 of the OMB Form 83-I.

(From Question 12 above)

	Program Change			Adjustment
Information Collection Instrument	Current OMB-Approved Hours Burden	New Hours Burden	Difference	Current OMB-Approved Burden Hours	New Hours Burden	Difference
N-648				34,604	0	0
Total(s)				34,604	0	0

There is no change in the burden hours associated with this collection. There is no change in the information being collected.

(From Question 13 above)

	Program Change			Adjustment
Information Collection Instrument	Current OMB-Approved Burden Cost	New Cost Burden	Difference	Current OMB-Approved Burden Cost	New Cost Burden	Difference
N-648				$847,798	$912,681	+$64,833
Total(s)				$$847,798	$912,681	+$64,833

There is an increase of $64,833 in the estimated total annual cost burden associated with this information collection. This increase is the result of accounting for the postage costs as part of the out-of-pocket costs those respondents may incur as described under item 13 above.

16. For collections of information whose results will be published, outline plans for tabulation, and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

The USCIS does not intend to employ the use of statistics or the publication thereof for this collection of information.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

USCIS will display the expiration date for OMB approval of this information collection.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submission,” of OMB 83-I.

USCIS does not request an exception to the certification of this information collection.

B. Collections of Information Employing Statistical Methods.

There is no statistical methodology involved with this collection.

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