Application for Significant Public Benefit Entrepreneur

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form I-941 Application for Significant Public Benefit Entrepreneur Form
I941-INS-IER FR-OMBReview-12222017.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

Information Collection (IC) Details

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:

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-IER FR-OMBReview-12222017.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 %

	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

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.