Information Collection

Application for Employment Authorization for Abused Nonimmigrant Spouse

IC 223940 under ICR 201805-1615-007 · OMB 1615-0137.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0137 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
I765V-INS-REV-30Day-11142017.pdf www.uscis.gov/i-765v	Instruction
I-765V Application for Employment Authorization for Abused Noni I765V-FRM-REV-30Day-11142017.pdf www.uscis.gov/i-765v	Form

IC Title:

Application for Employment Authorization for Abused Nonimmigrant Spouse

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 274a.2(b)(1) 8 CFR 103.2(b)(9) 8 CFR 103.16 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			I765V-INS-REV-30Day-11142017.pdf	www.uscis.gov/i-765v	Yes	No	Printable Only
Form	I-765V	Application for Employment Authorization for Abused Nonimmigrant Spouse	I765V-FRM-REV-30Day-11142017.pdf	www.uscis.gov/i-765v	Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: DHS/USCIS/ICE/CBP-001-Alien File, Index, and National File Tracking

FR Citation: 78 FR 69864

Number of Respondents: 500

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	-500	1,000
Annual IC Time Burden (Hours)	1,875	-1,125	3,000
Annual IC Cost Burden (Dollars)	125,000	-130,000	255,000

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.