Application for Replacement Naturalization/Citizenship Document

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form N-565 Application for Replacement Naturalization/Citizenship Document	Form and Instruction	New	Available
Form N-565 Application for Replacement Naturalization/Citizenship Document	Form	Modified	Available
N-565-83C-Supporting Statement-Fee Rule.docx	Supporting Statement A	Uploaded 2019-11-27	Available
N-565 83C.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2019-11-08	Available
SORN 018 DHS_USCIS IBBC 20180731.pdf	Supplementary Document	Uploaded 2018-12-18	Available
privacy-pia-056-uscis-eliseappendixaupdate-may17,2016.pdf	Supplementary Document	Uploaded 2018-07-01	Available
privacy-pia-016a-uscis-claims3-march25,2016.pdf	Supplementary Document	Uploaded 2018-07-01	Available
privacy-pia-071-uscis-myuscisaccountexperience-dec15,2017.pdf	Supplementary Document	Uploaded 2018-12-18	Available
SORN 007 Benefits Info Sys 2016 10 19.pdf	Supplementary Document	Uploaded 2018-07-01	Available
SORN 001 AFileIndexNFTS 2017 09 18.pdf	Supplementary Document	Uploaded 2018-12-18	Available
N-565 Reference Citation.docx	Supplementary Document	Uploaded 2018-07-01	Available
N565-INS-TOC-2019FeeRule-10302019.docx	Supplementary Document	Uploaded 2019-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238510	Application for Replacement Naturalization/Citizenship Document	Form and Instruction	New
234544	Biometrics Processing		Unchanged
20426	Application for Replacement Naturalization/Citizenship Document	Form	Modified

ICR Details

OMB Control No: 1615-0091	ICR Reference No: 201911-1615-022
Status: Historical Inactive	Previous ICR Reference No: 201806-1615-009
Agency/Subagency: DHS/USCIS	Agency Tracking No: N-565
Title: Application for Replacement Naturalization/Citizenship Document
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/21/2019
	Date Received in OIRA: 11/27/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021	10/31/2021
Responses	55,380	0	55,380
Time Burden (Hours)	69,225	0	69,225
Cost Burden (Dollars)	3,392,025	0	3,392,025

---

Abstract: This form is used by USCIS to determine an applicant's eligibility for a replacement document that was lost, mutilated or destroyed, or if the applicant's name was changed by marriage or by court order after the original document was issued. Additionally, this form is used by a naturalized citizen applicant who desires to obtain a special certificate of recognition as a citizen of the United States by a foreign country.

---

Authorizing Statute(s): US Code: 8 USC 1454 Name of Law: U.S. 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 44294	08/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 60888	11/27/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Biometrics Processing
Application for Replacement Naturalization/Citizenship Document	N-565	Application for Replacement Naturalization/Citizenship Document
Application for Replacement Naturalization/Citizenship Document	N-565	Application for Replacement Naturalization/Citizenship Document (e-File)

---

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: USCIS is now accounting for a separate time burden estimate for paper filed Form N-565s versus e-filed Form N-565s. This change is reflected in Question 12 above, as well as in the table at Question 15. The estimated average time burden per response for e-filing is .917 hours, as compared to 1.33 hours for a paper filing, which results in a lower annual hour burden for e-filing than for paper filing. The estimated total annual hour burden for this information collection decreased from 69,225 to 65,451 as a result of a decrease in the estimated annual hour burden for e-filers. There is no change to the estimated cost burden to respondents for this collection of information.

---

Annual Cost to Federal Government: $17,721,600

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: 11/27/2019

---