Request for Fee Waiver

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
I912-INS-TOC-EXT+PN-30Day-01022018.docx	Supplementary Document	Uploaded 2018-02-21	Available
I-912 30day FRN 20180119.pdf	Supplementary Document	Uploaded 2018-02-21	Available
I-912 SS 20180221.docx	Supporting Statement A	Uploaded 2018-02-21	Available
privacy-pia-056-uscis-eliseappendixaupdate-may17,2016.pdf	Supplementary Document	Uploaded 2017-12-29	Available
privacy-pia-015-cis-claims4-sept5,2008.pdf	Supplementary Document	Uploaded 2017-12-29	Available
privacy-pia-016a-uscis-claims3-march25,2016.pdf	Supplementary Document	Uploaded 2017-12-29	Available
privacy-pia-003b-uscis-iddmp-feb28,2017.pdf	Supplementary Document	Uploaded 2017-12-29	Available
SORN 007 Benefits Info Sys 2016 10 19.pdf	Supplementary Document	Uploaded 2017-12-29	Available
SORN 001 AFileIndexNFTS 2013 11 21.html	Supplementary Document	Uploaded 2017-12-29	Available
PTA, USCIS - Form I-912, 20170728, PRIV final.pdf	Supplementary Document	Uploaded 2017-12-29	Repair queued
I-912 60d FRN 20171011.pdf	Supplementary Document	Uploaded 2017-12-29	Available
Reference Citation.doc	Supplementary Document	Uploaded 2012-10-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204681	8 CFR 103.7(d) Director's exception request		Modified
204680	DACA-related I-765 Fee Exemption Request		Removed
204678	Non-form Request for Fee Waiver	Instruction	Modified
194028	Request for Fee Waiver	Other-Poverty Guidelines	Modified

ICR Details

OMB Control No: 1615-0116	ICR Reference No: 201712-1615-011
Status: Historical Active	Previous ICR Reference No: 201506-1615-006
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-912
Title: Request for Fee Waiver
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: 03/13/2018
	Date Received in OIRA: 03/01/2018
Terms of Clearance: Approved for two years only due to lack of GPEA compliance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	04/30/2018
Responses	602,528	0	505,000
Time Burden (Hours)	704,958	0	590,850
Cost Burden (Dollars)	2,259,480	0	1,893,750

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Abstract: The collection of information on Form I-912 is necessary in order for U.S. Citizenship and Immigration Services (USCIS) to make a determination that the applicant is unable to pay the application fee for certain immigration benefits.

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Authorizing Statute(s): US Code: 8 USC 1103 Name of Law: United States 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 47234	10/11/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 2814	01/19/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
DACA-related I-765 Fee Exemption Request
Request for Fee Waiver	I-912	Request for Fee Waiver
8 CFR 103.7(d) Director's exception request
Non-form Request for Fee Waiver

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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	602,528	505,000	0	0	97,528	0
Annual Time Burden (Hours)	704,958	590,850	0	0	114,108	0
Annual Cost Burden (Dollars)	2,259,480	1,893,750	0	0	365,730	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: The change in the total hour burden estimate and the total cost burden estimate is due to a change in the estimated number of respondents for the form. There are no substantive changes to the form or instructions.

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Annual Cost to Federal Government: $28,206,076

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: 03/01/2018

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