Application for Significant Public Benefit Entrepreneur and Instructions for Data Reporting Supplement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form I-941 Application for Significant Public Benefit Entrepreneur	Form	Modified	Available
OMB 83C I-941 Final.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-08	Available
I-941 SS 2017 07-11-17(clean).doc	Supporting Statement A	Uploaded 2017-07-11	Available
citations.docx	Supplementary Document	Uploaded 2016-08-25	Available
PIA 016.pdf	Supplementary Document	Uploaded 2016-08-25	Available
DHS USCIS SORN 007.docx	Supplementary Document	Uploaded 2016-08-05	Available
DHS USCIS SORN 001.docx	Supplementary Document	Uploaded 2016-08-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223185	Biometric Processing		Unchanged
218313	Application for Significant Public Benefit Entrepreneur	Form	Modified

ICR Details

OMB Control No: 1615-0136	ICR Reference No: 201712-1615-007
Status: Historical Active	Previous ICR Reference No: 201706-1615-007
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-941
Title: Application for Significant Public Benefit Entrepreneur and Instructions for Data Reporting Supplement
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/08/2017
	Date Received in OIRA: 12/08/2017
Terms of Clearance: This information collection approval is effective as of December 1, 2017.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	01/31/2019	01/31/2019
Responses	5,880	0	5,880
Time Burden (Hours)	17,258	0	17,258
Cost Burden (Dollars)	1,440,600	0	1,440,600

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Abstract: USCIS is submitting this request because DHS is proposing to require an alien seeking entrepreneur parole under its proposed rule, "Significant Public Benefit Parole for Entrepreneurs," to file Form I-941 and, when applicable, Form I-941A, to demonstrate that he or she meets the eligibility criteria for entrepreneur parole based on significant public benefit. Based on his or her grant of parole, the alien's dependent spouse and children will also be eligible to request this parole.

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Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: INA - Inadmissable Aliens
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1625-AC04	Final or interim final rulemaking	82 FR 31887	07/11/2017

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31887	07/11/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31887	07/11/2017
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Significant Public Benefit Entrepreneur	I-941	Application for Significant Public Benefit Entrepreneur
Biometric Processing

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ICR Summary of Burden

table that charts list 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	5,880	5,880	0	0	0	0
Annual Time Burden (Hours)	17,258	17,258	0	0	0	0
Annual Cost Burden (Dollars)	1,440,600	1,440,600	0	0	0	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:

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Annual Cost to Federal Government: $3,777,900

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.     Yes

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: 12/08/2017

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