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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/subagency
OMB Control Number
DHS/USCIS
0043
1615
___ ___
___ ___ - ___
___ ___ ___
Enter only items that change
Current record
New record
Agency form number (s)
I-821
Annual reporting and recordkeeping hour
burden
Number of respondents
0043
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**
Add ability for respondents to include the location for which their application is submitted under instead of providing the detail
freestyle as currently done
Signature of Senior Official or designee:
[email protected]
hs.gov
Digitally signed by
[email protected]
DN: [email protected]
Date: 2017.09.08 11:45:54 -04'00'
** This form cannot be used to extend an expiration date.
OMB 83-C
Date:
9/8/2017
For OIRA Use
___________________________________
___________________________________
10/95
| File Type | application/pdf |
| File Title | Paperwork Reduction Act Submission (OMB 83-I) |
| Subject | Paperwork Reduction Act Submission (OMB 83-I) |
| Author | OMB |
| File Modified | 2017-09-08 |
| File Created | 1999-03-02 |