Application for Replacement Naturalization/Citizenship Document

Forms and Documents

Document Name	Status
Form N-565 Application for Replacement Naturalization/Citizenship Document - Electronic Form and Instruction	New
Form N-565 Application for Replacement Naturalization/Citizenship Document - Paper Form	Modified
N-565-009-83C signed.pdf Justification for No Material/Nonsubstantive Change	2020-01-16
SORN 018 DHS_USCIS IBBC 20180731.pdf Supplementary Document	2018-12-18
privacy-pia-056-uscis-eliseappendixaupdate-may17,2016.pdf Supplementary Document	2018-07-01
privacy-pia-016a-uscis-claims3-march25,2016.pdf Supplementary Document	2018-07-01
privacy-pia-071-uscis-myuscisaccountexperience-dec15,2017.pdf Supplementary Document	2018-12-18
SORN 007 Benefits Info Sys 2016 10 19.pdf Supplementary Document	2018-07-01
SORN 001 AFileIndexNFTS 2017 09 18.pdf Supplementary Document	2018-12-18
N-565 Reference Citation.docx Supplementary Document	2018-07-01
N-565-SS-83C-20200116.docx Supporting Statement A	2020-01-16

IC Document Collections

IC ID	Document Title	Status
239294	Application for Replacement Naturalization/Citizenship Document - Electronic Form and Instruction	New
234544	Biometrics Processing	Unchanged
20426	Application for Replacement Naturalization/Citizenship Document - Paper Form	Modified

ICR Details

OMB Control No: 1615-0091	ICR Reference No: 202001-1615-005
Status: Historical Active	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: Approved without change	Conclusion Date: 06/09/2020
	Date Received in OIRA: 03/18/2020
Terms of Clearance:

	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)	65,451	0	69,225
Cost Burden (Dollars)	3,392,025	0	3,392,025

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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.

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Authorizing Statute(s): US Code: 8 USC 1454 Name of Law: U.S. Code
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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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

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

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

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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	55,380	55,380	0	0	0	0
Annual Time Burden (Hours)	65,451	69,225	0	0	-3,774	0
Annual Cost Burden (Dollars)	3,392,025	3,392,025	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: There is a decrease of 3,774 hours in the estimated annual hour burden for this collection of information. This is the result of the decrease from 1.33 hours to 0.917 hours in the estimated hour burden per response for the version of the form that can be electronically filed. There is no change in the estimated annual cost burden for this collection of information.

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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? No

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Common Form ICR:  No

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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: 03/18/2020

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