Application for Relief Under Former Section 212(c) of the Immigration and Nationality Act (INA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form I-191 Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	Form	Modified	Available
I-191 30-day 20180831 83 FR 44643.pdf	Supplementary Document	Uploaded 2018-09-04	Available
I-191 60-day 20180514.pdf	Supplementary Document	Uploaded 2018-08-06	Available
I-191 SS DHS PRA 20180904.docx	Supporting Statement A	Uploaded 2018-09-04	Available
SORN_78FR69864_21NOV2013.pdf	Supplementary Document	Uploaded 2016-07-26	Repair queued
SORN_73FR56596_29SEP2008.pdf	Supplementary Document	Uploaded 2016-07-26	Available
PIA-016(a) Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems.pdf	Supplementary Document	Uploaded 2016-07-26	Available
Reference Citation 2013-2-26.doc	Supplementary Document	Uploaded 2013-05-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
20264	Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	Form	Modified

ICR Details

OMB Control No: 1615-0016	ICR Reference No: 201808-1615-001
Status: Historical Active	Previous ICR Reference No: 201611-1615-006
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-191
Title: Application for Relief Under Former Section 212(c) of the Immigration and Nationality Act (INA)
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: 09/26/2018
Terms of Clearance: Approved for two years only for partial GPEA compliance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/28/2019
Responses	240	0	600
Time Burden (Hours)	360	0	900
Cost Burden (Dollars)	30,300	0	75,750

---

Abstract: The information collected on this form is used by U.S. Citizenship and Immigration Services (USCIS) to determine whether the applicant is eligible for a discretionary relief under former section 212(c) of the Immigration and Nationality Act.

---

Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: US Code
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 22286	05/14/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 44643	08/31/2018
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	I-191	Application for Relief under Former Section 212(c) of the Immigration and Nationality Act

---

ICR Summary of Burden

table that charts list 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	240	600	0	0	-360	0
Annual Time Burden (Hours)	360	900	0	0	-540	0
Annual Cost Burden (Dollars)	30,300	75,750	0	0	-45,450	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: The estimated hour burden for this collection of information has decreased as a result of the decrease in the estimated number of respondents from 600 to 240. The estimated cost burden for this collection of information has decreased as a result of the decrease in the estimated number of respondents 600 to 240. There are no changes to the form; the Privacy Notice in the Instructions was updated.

---

Annual Cost to Federal Government: $223,200

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

---

Common Form ICR:  No

---

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: 09/26/2018

---