Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

Forms and Documents

Document Name	Status
Form I-914B Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
Form I-914A Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
Form I-914 Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
I-914 SS -EXT ( 30-Day-8-30-2018).docx Supporting Statement A	2018-10-12
Refrence Citation.doc Supplementary Document	2018-10-10
SORN - Benefits.pdf Supplementary Document	2018-10-10
SORN - A-File.pdf Supplementary Document	2018-10-10
PIA-CLAIMS 3.pdf Supplementary Document	2018-10-10
PTA, USCIS - Form I-914, 20171018, PRIV final.pdf Supplementary Document	2018-10-09
Published 30-Day FRN (10-3-2018).docx Supplementary Document	2018-10-09
Published 60-Day FRN (6-26-2018).docx Supplementary Document	2018-10-09

IC Document Collections

IC ID	Document Title	Status
225155	Biometrics Processing	Modified
211477	Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
211476	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
21015	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified

ICR Details

OMB Control No: 1615-0099	ICR Reference No: 201810-1615-004
Status: Historical Active	Previous ICR Reference No: 201702-1615-002
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-914
Title: Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
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: 04/15/2019
	Date Received in OIRA: 01/31/2019
Terms of Clearance: Approved for two years only due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2019
Responses	4,253	0	3,992
Time Burden (Hours)	6,284	0	5,870
Cost Burden (Dollars)	0	0	0

---

Abstract: The information on all three parts of the form will be used to determine whether applicants meet the eligibility requirements for benefits. This application incorporates information pertinent to eligibility under the Victims of Trafficking and Violence Protection Act (VTVPA), Public Law 106-386, and a request for employment.

---

Authorizing Statute(s): PL: Pub.L. 106 - 386 107(e) Name of Law: Victims of Trafficking and Violence Protection Act
  

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 29812	06/26/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 49938	10/03/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons	I-914A	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons	I-914	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons	I-914B	Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Biometrics Processing

---

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	4,253	3,992	0	261	0	0
Annual Time Burden (Hours)	6,284	5,870	0	414	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The total estimated annual hour burden has increased from 5,870 hours to 6,206 hours. This increase is due to: a) an increase in the estimated time burden for completing Form I-914, and b) an increase in the estimated time burden for completing Form I-914, Supplement A.

---

Annual Cost to Federal Government: $205,720

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: 01/31/2019

---