I-601A 83C Signed

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Homeland Security, U.S. Citizenship and Immigration Services
Enter only items that change
Current record

0123
1615
___ ___
___ ___ - ___
___ ___ ___

New record

Agency form number (s)

I-601A

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

Per the previous 83C approved by OMB on December 15, 2017. When submitting the change to OMB, USCIS’ request
inadvertently neglected to include a request to change the identical terminology on the form. Therefore, the form and the
instructions are now inconsistent. USCIS is submitting this request to remedy the inconsistency.
Signature of Senior Official or designee:

JOHN R RAMSAY JR

Digitally signed by JOHN R
RAMSAY JR
Date: 2019.05.21 16:33:16 -04'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

05/21/2019

For OIRA Use
___________________________________
___________________________________

10/95