I-765 Worksheet

Application for Employment Authorization

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0040 can be found here:

Documents and Forms

Document Name Document Type
Form I-765WS I-765 Worksheet Form and Instruction
I-765WS Form I-765 Worksheet I765WS-FRM-Comp-OMBReview-05222018.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	I-765 Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 274

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	I-765WS	Form I-765 Worksheet	I765WS-FRM-Comp-OMBReview-05222018.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: Electronic Immigration System-3 Automated Background Functions, DHS/USCIS-016	FR Citation: 76 FR 70735

Number of Respondents: 41,912	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	41,912	-208,088	250,000
Annual IC Time Burden (Hours)	20,956	-104,044	125,000
Annual IC Cost Burden (Dollars)	0	0	0

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.