Application for Replacement Naturalization/Citizenship Document

Forms and Documents

Document Name	Status
Form N-565 Application for Replacement Naturalization/Citizenship Document Form	Modified
SORN 018 DHS_USCIS IBBC 20180731.pdf Supplementary Document	2018-12-18
N-565-30-Day_20181127_83_FR_60888.pdf Supplementary Document	2018-12-18
N-565 60day 20180830 83 FR 44294.pdf Supplementary Document	2018-12-18
privacy-pia-056-uscis-eliseappendixaupdate-may17,2016.pdf Supplementary Document	2018-07-01
privacy-pia-016a-uscis-claims3-march25,2016.pdf Supplementary Document	2018-07-01
privacy-pia-071-uscis-myuscisaccountexperience-dec15,2017.pdf Supplementary Document	2018-12-18
SORN 007 Benefits Info Sys 2016 10 19.pdf Supplementary Document	2018-07-01
SORN 001 AFileIndexNFTS 2017 09 18.pdf Supplementary Document	2018-12-18
2017-1-19ChangeGenderDesignation-PM-602-0141.pdf Supplementary Document	2018-07-01
N-565 Reference Citation.docx Supplementary Document	2018-07-01
N-565 30-day 20180626 83 FR 29811.pdf Supplementary Document	2018-07-01
N-565 60day 20180131.pdf Supplementary Document	2018-07-01
PTA USCIS - N-565 20181119 PRIV Final-adjudicated.pdf Supplementary Document	2018-12-18
N565-INS-TOC-REV-30Day-11052018.docx Supplementary Document	2018-12-18
N565-FRM-TOC-REV-30Day-11052018.docx Supplementary Document	2018-12-18
N-565-Supporting Statement-Final-20190128.docx Supporting Statement A	2019-04-19

IC Document Collections

IC ID	Document Title	Status
234544	Biometrics Processing	New
20426	Application for Replacement Naturalization/Citizenship Document Form	Modified

ICR Details

OMB Control No: 1615-0091	ICR Reference No: 201806-1615-009
Status: Historical Active	Previous ICR Reference No: 201805-1615-004
Agency/Subagency: DHS/USCIS	Agency Tracking No: N-565
Title: Application for Replacement Naturalization/Citizenship Document
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/21/2019
	Date Received in OIRA: 06/28/2019
Terms of Clearance: This collection is approved for only two years due to non-compliance with the Government Paperwork Elimination Act.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	36 Months From Approved	10/31/2019
Responses	55,380	0	27,954
Time Burden (Hours)	69,225	0	25,606
Cost Burden (Dollars)	3,392,025	0	3,424,365

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Abstract: This form is used by USCIS to determine an applicant's eligibility for a replacement document that was lost, mutilated or destroyed, or if the applicant's name was changed by marriage or by court order after the original document was issued. Additionally, this form is used by a naturalized citizen applicant who desires to obtain a special certificate of recognition as a citizen of the United States by a foreign country.

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Authorizing Statute(s): US Code: 8 USC 1454 Name of Law: U.S. 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:
	83 FR 44294	08/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 60888	11/27/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Replacement Naturalization/Citizenship Document	N-565, N-565	Application for Replacement Naturalization/Citizenship Document ,   Application for Replacement Naturalization/Citizenship Document (E-file)
Biometrics Processing

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ICR Summary 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	55,380	27,954	0	27,690	-264	0
Annual Time Burden (Hours)	69,225	25,606	0	32,397	11,222	0
Annual Cost Burden (Dollars)	3,392,025	3,424,365	0	0	-32,340	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated total annual hour burden for this information collection increased as a result of an increase in the estimated average time burden per response from .916 hours to 1.33 hours. USCIS revised this information collection to include additional data elements and additional instructions, which resulted in an increase in the estimated time to review instructions, complete the form, and gather necessary evidence. USCIS also made a programmatic change to require submission of biometrics by respondents to this information collection, which added an additional time burden per response. The estimated total annual cost burden to respondents decreased as a result of a decrease in the estimated number of respondents for this information collection. USCIS previously reported an estimate of 27,954 respondents and is now reporting an estimate of 27,690 respondents. There is no additional cost burden as a result of the biometrics requirement.

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Annual Cost to Federal Government: $17,721,600

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: 06/28/2019

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