Application to Determine Returning Resident Status

Forms and Documents

Document Name	Status
Form DS-117 Application to Determine Returning Resident Status Form and Instruction	Modified
DS-117 Legal Authorities.doc Supplementary Document	2019-12-11
Final - 30-Day DS-117 Supporting Statement.docx Supporting Statement A	2019-12-11

IC Document Collections

IC ID	Document Title	Status
14917	Application to Determine Returning Resident Status Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0091	ICR Reference No: 201912-1405-003
Status: Active	Previous ICR Reference No: 201701-1405-013
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application to Determine Returning Resident Status
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: 05/11/2020
	Date Received in OIRA: 12/11/2019
Terms of Clearance: Previous TOC apply. The agency will update travel.state.gov (TSG) with guidancae on how to submit this collection and supporting documentation via email to the relevant U.S. Embassy or Consulate. Prior to resubmission of this ICR, the agency will update question #3 of the supporting statement to include describing the instruction verbiage used on TSG.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	36 Months From Approved	05/31/2020
Responses	4,400	0	4,400
Time Burden (Hours)	2,200	0	2,200
Cost Burden (Dollars)	0	0	0

---

Abstract: Form DS-117 is used by consular officers to determine the eligibility of an alien applicant for special immigrant status as an returning resident because he or she remained out of the United States for more than one year because of circumstances outside of his or her control.

---

Authorizing Statute(s): US Code: 8 USC 1101 Name of Law: Immigration and Nationality 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:
	84 FR 31655	07/02/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 67504	12/10/2019
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
Application to Determine Returning Resident Status	DS-117	Application to Determine Returning Resident Status

---

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	4,400	4,400	0	0	0	0
Annual Time Burden (Hours)	2,200	2,200	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $130,856

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? No

---

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: 12/11/2019

---