Case Assistance Form (Ombudsman Form DHS-7001) and Instructions (Form DHS-7001)

Forms and Documents

Document Name	Status
30 day FRN 1601-0004 7-17-18.pdf Supplementary Document	2018-07-31
60 day FRN 1601-0004 4-24-18.pdf Supplementary Document	2018-07-31
PTA CISOMB - Form 7001 - Ombudsman Case Assistance Online System 20150309 PRIV FINAL.pdf Supplementary Document	2015-07-22
Supporting_Statement_A_1601_0004_ 07-31-18.docx Supporting Statement A	2018-07-31
1601-0004_30 Day FRN Published.pdf Supplementary Document	2015-06-02
CISOMB Virtual Ombudsman PIA 20100319 - final signed.doc Supplementary Document	2011-09-19
1601-0004_60 day FRN Published.pdf Supplementary Document	2015-06-02
SORN (Published).pdf Supplementary Document	2010-07-22
PRA DHS 7001 Citations.doc Supplementary Document	2007-11-08

IC Document Collections

IC ID	Document Title	Status
44790	CIS Ombudsman Case Assistance Form Instruction	Modified

ICR Details

OMB Control No: 1601-0004	ICR Reference No: 201807-1601-001
Status: Active	Previous ICR Reference No: 201410-1601-001
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: Case Assistance Form (Ombudsman Form DHS-7001) and Instructions (Form DHS-7001)
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: 02/13/2019
	Date Received in OIRA: 07/31/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	02/28/2019
Responses	12,000	0	8,800
Time Burden (Hours)	12,000	0	8,800
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will be used by the Citizenship and Immigration (CIS) Ombudsman to identify problem areas, propose changes, and assist individuals experiencing problems during the processing of an immigration benefit with U.S. Citizenship and Immigration Services (USCIS)

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Authorizing Statute(s): PL: Pub.L. 107 - 296 452 Name of Law: The Homeland Security Act of 2002
  

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 17833	04/24/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 33244	07/17/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
CIS Ombudsman Case Assistance Form	DHS Form 7001 , DHS Form 7001	Citizenship and Immigration Services Ombudsman ,   Citizenship and Immigration Services Ombudsman

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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	12,000	8,800	0	0	3,200	0
Annual Time Burden (Hours)	12,000	8,800	0	0	3,200	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: There has been an increase of 3,200 in the estimated annual burden hours previously reported for this information collection. The increase in burden hours is a reflection of agency estimates. There is no change in the information being collected, however there have been cosmetic changes to the form including punctuation, formatting, and text changes to make the form more understandable and streamlined for use by respondents

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Annual Cost to Federal Government: $547,200

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: 07/31/2018

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