I-910-005-rev-sptstmt

SUPPORTING STATEMENT FOR

APPLICATION FOR CIVIL SURGEON DESIGNATION

OMB Control No.: 1615-0114

COLLECTION INSTRUMENT(S): I-910

A. Justification

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Section 212(a)(1) of the Immigration and Nationality Act (INA) renders individuals inadmissible if the individual is afflicted with the statutorily specified diseases or medical conditions. In order to establish that the individual is admissible when seeking adjustment of status to that of lawful permanent resident (and in certain cases other aliens seeking an immigration benefit), the individual must submit Form I-693, Report of Medical Examination and Vaccination Record, that is completed by a USCIS-designated physician, or “civil surgeon.” The statutory and regulatory bases for civil surgeons and the medical examination of aliens is contained in section 232 of the INA, 8 C.F.R. 232.2, and 42 C.F.R. Part 34. To be designated as a civil surgeon, the physician has to demonstrate that he or she is a licensed physician with no less than 4 years of professional experience. Civil surgeons are currently designated by USCIS.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

This information collection is required to determine whether a physician meets the statutory and regulatory requirements for civil surgeon designation. For example, all documents are reviewed to determine whether the physician has a currently valid medical license and whether the physician has had any disciplinary action taken against him or her by the medical licensing authority of the U.S. state(s) or U.S. territories in which he or she practices. If the Application for Civil Surgeon Designation (Form I-910) is approved, the physician is included in USCIS’s public Civil Surgeon Locator and is authorized to complete Form I-693 (OMB Control Number 1615-0033) for an applicant’s adjustment of status.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

The Form I-910 is available online from www.uscis.gov/forms for completion. The form cannot be submitted electronically at this time. Although a respondent can complete and save the application electronically, the form must be printed and submitted to USCIS by mail.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

The information collected via Form I-910 is used specifically to determine if a respondent meets the requirements set forth to be designated as a civil surgeon; there is no other collection of information that has the necessary information to adjudicate this issue. There is no duplication of information collection via another form.

5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.

This information collection impacts physicians who can be a small business. USCIS has made every effort to minimize the impact on the respondents by reducing the information collection to the minimal amount possible to adjudicate the request.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

If the information is not collected, USCIS will be unable to adjudicate requests by physicians for civil surgeon designation and assess applicant credentials effectively. The information collection enables USCIS to effectively adjudicate requests made by physicians for civil surgeon designation and ensures that physicians serving USCIS and its applicants meet the statutory and regulatory requirements governing civil surgeon designation.

7. Explain any special circumstances that would cause an information collection to be conducted in a manner:

• Requiring respondents to report information to the agency more often than quarterly;

• Requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it;

• Requiring respondents to submit more than an original and two copies of any document;

• Requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years;

• In connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study;

• Requiring the use of a statistical data classification that has not been reviewed and approved by OMB;

• That includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or

• Requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information's confidentiality to the extent permitted by law.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

8. If applicable, provide a copy and identify the data and page number of publication in the Federal Register of the agency’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years - even if the collection of information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

On February 03, 2020 USCIS published a 60-day notice in the Federal Register at 85 FR 5979. USCIS did receive one comment after publishing that notice. USCIS did make clarifying edits to the form instructions as a result of the comment. The comment and response can be seen in the comment matrix file titled “85FR5979_60-day_PublicCommentMatrix.”

On May 04, 2020, USCIS published a 30-day notice in the Federal Register at 85 FR 26488. USCIS did not receive comments.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

USCIS does not provide any payment for benefit sought.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation or agency policy.

There is no assurance of confidentiality.

This collection is covered under the following Privacy Impact Assessment:

• DHS/USCIS/PIA-064 myUSCIS, and

• DHS/USCIS/PIA-067 Civil Surgeon Designation.

The collection is covered under the following System of Records Notices:

• DHS/USCIS-007 Benefits Information System, October 19, 2016 81 FR 72069.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

USCIS asks questions of a sensitive nature regarding criminal convictions and professional disciplinary actions.  This information is necessary to assess the respondent’s eligibility for designation as a civil surgeon.

12. Provide estimates of the hour burden of the collection of information. The statement should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

• If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

		A	B	C (=AxB)	D	E (=CxD)	F	(=ExF)
Type of Respondent	Form Name / Form Number	#. of Respondents	#. of Responses per Respondent	# of Responses	Avg. Burden per Response (in hours)	Total Annual Burden (in hours)	Avg. Hourly Wage Rate*	Total Annual Respondent Cost
Business or other for-profit	Application for Civil Surgeon Designation / Form I-910	470	1	470	2	940	$148.09	$139,205
Total				470		940		$139,205

* The above Average Hourly Wage Rate is the May 2018 Bureau of Labor Statistics average wage for Physicians and Surgeons of $101.43 times the wage rate benefit multiplier of 1.46 (to account for benefits provided) equaling $148.09.

13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

• The cost estimate should be split into two components: (a) a total capital and start-up cost component (annualized over its expected useful life); and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

• If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.

• Generally, estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995; (2) to achieve regulatory compliance with requirements not associated with the information collection; (3) for reasons other than to provide information or keep records for the government; or, (4) as part of customary and usual business or private practices.

There are no start-up, maintenance, and operating costs associated with this collection of information. For informational purposes, there is a $785 fee charge associated with the filing of this information collection. There is no fee for an application from a medical officer in the U.S. Armed Forces or civilian physician employed by the U.S. Government, who examines members and veterans of the Armed Forced and their dependents at a military, Department of Veterans Affairs, or U.S. Government facility in the United States.

This information collection may impose some out-of-pocket costs on respondents in addition to the time burden for the form’s preparation.

For form preparation, legal services, translators, and document search and generation, USCIS estimates the average cost of this information collection may vary widely, from as little as $20 to $1000 per respondent. USCIS estimates that the average cost for these activities is $515 and approximately 10% of the total respondent population may incur this cost. The total cost to respondents would generate as follows: 470 respondents x 10% of the population = 47 respondents, multiplied by the average cost per response of $515= $24,205.

14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

USCIS establishes its fees using an activity-based costing model to assign costs to an adjudication based on its relative adjudication burden and use of USCIS resources. Fees are established at an amount that is necessary to recover these assigned costs, plus an amount to recover unassigned overhead (which includes the suggested average hourly rate for clerical, officer, and managerial time with benefits) and immigration benefits provided for free. USCIS uses the fee associated with an information collection as a reasonable measure of the collection’s costs to USCIS, since these fees are based on resource expenditures related to the benefit in question. In addition, this figure includes the estimated overhead cost for printing, stocking, distributing and processing of this form.

The estimated cost of the program to the Government is calculated by using the estimated number of respondents (470) x filing fee charge ($785.00). The total cost to the Federal government is $368,950.00.

15. Explain the reasons for any program changes or adjustments reporting in Items 13 or 14 of the OMB Form 83-I.

Data collection Activity/Instru-ment (in hours)	Program Change (hours currently on OMB Inventory)	Program Change (New)	Difference	Adjustment (hours currently on OMB Inventory)	Adjustment (New) [new minus current]	Difference
I-910				1,076	940	(136)
Total(s)				1,076	940	(136)

There is a decrease of 136 hours in the estimated annual hour burden, which resulted from a decrease in the estimated number of respondents to this collection of information. Although the form for this information collection has been modified to collect additional address and interpreter information from applicants and the instructions have been revised for greater clarity, the modifications did not necessitate an increase in the estimated hour burden per response.

Data collection Activity/Instru-ment (in dollars)	Program Change (cost currently on OMB Inventory)	Program Change (New)	Difference	Adjustment (cost currently on OMB Inventory)	Adjustment (New) [new minus current]	Difference
I-910				$26,459	$24,205	($2,254)
Total(s)				$26,459	$24,205	($2,254)

There is an overall decrease in the estimated cost to the respondents associated with this collection. USCIS has updated its estimate of the cost that a respondent may incur when responding to this information collection, while the estimated number of respondents for this collection of information has decreased.

16. For collections of information whose results will be published, outline plans for tabulation, and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

This information collection will not be published for statistical purposes.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

USCIS will display the expiration date for OMB approval of this information collection.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submission,” of OMB 83-I.

USCIS does not request an exception to the certification of this information collection.

B. Collections of Information Employing Statistical Methods.

There is no statistical methodology involved with this collection.

7