Change Request

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS/USCIS

0047
1615
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Enter only items that change
Current record

New record

Agency form number (s)

I-9

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

DHS requests a modification to the Terms of Clearance in the July 7, 2017 Notice of action. DHS requests that the effective
date of the form IER-related revisions to Form I-9 be changed to December 1, 2017. DHS will allow employers to continue to
use Form I-9 (Rev. 7/17/17 N).
Signature of Senior Official or designee:

john.r.ramsay@usci
s.dhs.gov

Digitally signed by
[email protected]
DN: [email protected]
Date: 2018.02.13 10:19:22 -05'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

For OIRA Use
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10/95