CIS OMBudsman Case Assistance Form

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1601-0004 can be found here:

Documents and Forms

Document Name Document Type
cisomb_dhsform7001_instructions_AUG_2014_V24.pdf Instruction
DHS Form 7001 Citizenship and Immigration Services Ombudsman OMBUDSMAN DHS Form 7001_FINAL.pdf Form
DHS Form 7001 Citizenship and Immigration Services Ombudsman 1601-0004 (DHS Form 7001) OCA 2015 company screenshots.pdf Form

Information Collection (IC) Details

IC Title:	CIS Ombudsman Case Assistance Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			cisomb_dhsform7001_instructions_AUG_2014_V24.pdf	Yes	No	Fillable Printable
Form	DHS Form 7001	Citizenship and Immigration Services Ombudsman	OMBUDSMAN DHS Form 7001_FINAL.pdf	Yes	No	Fillable Printable
Form	DHS Form 7001	Citizenship and Immigration Services Ombudsman	1601-0004 (DHS Form 7001) OCA 2015 company screenshots.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,000	3,200	8,800
Annual IC Time Burden (Hours)	12,000	3,200	8,800
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.