Special Immigrant Visa Biodata Form

Forms and Documents

Document Name	Status
Form DS-0234 Special Immigrant Visa Biodata Form Form	Modified
Legal Authorities for DS-234.docx Supplementary Document	2019-03-29
Final - Supporting Statement DS 234.docx Supporting Statement A	2019-03-29

IC Document Collections

IC ID	Document Title	Status
200665	Special Immigrant Visa Biodata Form Form	Modified

ICR Details

OMB Control No: 1405-0203	ICR Reference No: 201903-1405-004
Status: Active	Previous ICR Reference No: 201602-1405-003
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Special Immigrant Visa Biodata Form
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: 01/03/2020
	Date Received in OIRA: 03/29/2019
Terms of Clearance: Prior to re-submission of this ICR, the agency will provide a briefing to OIRA on the collection and consult with OIRA on ways to ensure this collection is 1) conducted efficiently with minimal burden to respondents; and 2) provides clear instructions to respondents regarding the intent of sensitive information collected in this IC.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2021	36 Months From Approved	01/31/2020
Responses	14,000	0	12,000
Time Burden (Hours)	3,500	0	4,000
Cost Burden (Dollars)	0	0	0

---

Abstract: The information in this collection will aid DOS/PRM partners to arrange travel, select a resettlement site and prepare for services needed by Iraqi or Afghan citizens who worked with the U.S. Government or contractor, obtained a Special Immigrant Visa (SIV) because of this employment, and elected refugee resettlement benefits.

---

Authorizing Statute(s): PL: Pub.L. 110 - 161 525 Name of Law: Consolidated Appropriations Act
   PL: Pub.L. 110 - 181 1244(g) Name of Law: The Refugee Crisis in Iraq Act
   PL: Pub.L. 109 - 163 1059 Name of Law: National Defense Authorization 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 63697	12/11/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 12012	03/29/2019
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Special Immigrant Visa Biodata Form	DS-0234	Special Immigrant Visa Biodata Form

---

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	14,000	12,000	0	2,000	0	0
Annual Time Burden (Hours)	3,500	4,000	0	-500	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Estimated Number of Responses: 14,000 (The Department has increased the number of Special Immigrant Visas issued since the last noticed was published. The previously estimated number was 12,000.)

---

Annual Cost to Federal Government: $248,605

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.     No

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: 03/29/2019

---