Application for Benefits Under the Family Unity Program

Forms and Documents

Document Name	Status
Form I-817 Application for Family Unity Benefits Form	Modified
SS 1615-0005 Form I-817-SS (8-2017)-clean.doc Supporting Statement A	2017-09-11
Reference citation-3.pdf Supplementary Document	2017-08-04
Reference citation-2.pdf Supplementary Document	2017-08-04
Reference citation-1.pdf Supplementary Document	2017-08-04
PIA-IDDMP.pdf Supplementary Document	2017-07-03
PIA-CLAIMS 3.pdf Supplementary Document	2017-07-03
SORN - USCIS Benefits.doc Supplementary Document	2017-07-03
SORN - A-File.docx Supplementary Document	2017-07-03
I817-INS-TOC-05312017.docx Supplementary Document	2017-07-03
I817-FRM-TOC-05312017.docx Supplementary Document	2017-07-03
Published 30-Day FRN (6-29-17).docx Supplementary Document	2017-07-03
Published 60-Day FRN (4-10-17).docx Supplementary Document	2017-07-03

IC Document Collections

IC ID	Document Title	Status
217204	Biometric Processing	Modified
20230	Application for Family Unity Benefits Form	Modified

ICR Details

OMB Control No: 1615-0005	ICR Reference No: 201706-1615-002
Status: Historical Active	Previous ICR Reference No: 201610-1615-009
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-817
Title: Application for Benefits Under the Family Unity Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/07/2017
	Date Received in OIRA: 10/31/2017
Terms of Clearance: Approved for two years only due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved	11/30/2017
Responses	2,716	0	5,114
Time Burden (Hours)	4,305	0	8,106
Cost Burden (Dollars)	166,355	0	313,233

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Abstract: The information collected will be used to determine whether the applicant meets the eligibility requirements for benefits under 8 CFR 245A, Subpart C. If the applicant fully demonstrates eligibility, the application will be approved, and USCIS will issue an employment authorization document and approval notice to the applicant.

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Authorizing Statute(s): US Code: 8 USC 1255a Name of Law: U.S. Code
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 17273	04/10/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 29578	06/29/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Biometric Processing
Application for Family Unity Benefits	I-817	Application for Family Unity Benefits

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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	2,716	5,114	0	0	-2,398	0
Annual Time Burden (Hours)	4,305	8,106	0	0	-3,801	0
Annual Cost Burden (Dollars)	166,355	313,233	0	0	-146,878	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: There is an estimated decrease in the annual hour burden from 8,106 to 4,305; a estimated total decrease of 3,801. This is due to a decrease in the agency’s estimation of the number of respondents for the form.

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Annual Cost to Federal Government: $930,230

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

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Common Form ICR:  No

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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: 10/31/2017

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