Information Collection

Application for Significant Public Benefit Entrepreneur

IC 218313 under ICR 201712-1615-007 · OMB 1615-0136.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0136 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-941 Application for Significant Public Benefit Entrepreneur	Form
I941-INS-EP NPRM-OMBReview-01172017.pdf	Instruction
IER Implementation Webpage (DEC2017)LZ (2).docx	Instruction
I-941 Application for Significant Public Benefit Entrepreneur I941-FRM-EP NPRM-OMBReview-01172017.pdf	Form

IC Title:

Application for Significant Public Benefit Entrepreneur

Agency IC Tracking Number:

I-941

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 212

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-941	Application for Significant Public Benefit Entrepreneur	I941-FRM-EP NPRM-OMBReview-01172017.pdf	Yes	No	Fillable Printable
Instruction			I941-INS-EP NPRM-OMBReview-01172017.pdf	Yes	No	Printable Only
Instruction			IER Implementation Webpage (DEC2017)LZ (2).docx	Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: Alien File, Index, and National File Tracking SORN

FR Citation: 76 FR 43233

Number of Respondents: 2,940

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	2,940	2,940
Annual IC Time Burden (Hours)	13,818	13,818
Annual IC Cost Burden (Dollars)	1,440,600	1,440,600

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.