Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 422-1 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)	Form	Modified	Available
Attachment D Non Research Determination.pdf	Supplementary Document	Uploaded 2020-06-10	Available
Attachment B - Published 60-day FRN-1.22.2020.pdf	Supplementary Document	Uploaded 2020-06-10	Available
0920-0006 Supporting Statement B DGMQ-6.4.2020.docx	Supporting Statement B	Uploaded 2020-06-10	Available
0920-0006 Supporting Statement A DGMQ-6.8.20.docx	Supporting Statement A	Uploaded 2020-06-10	Available
Attachment 1C 8 CFR 212.7 Waiver of certain grounds of excludability.pdf	Supplementary Document	Uploaded 2014-05-07	Available
Attachment 1B 42 CFR Part 34 Medical Examination of Aliens.pdf	Supplementary Document	Uploaded 2014-05-07	Available
Attachment 1A - 8 USC 1182.pdf	Supplementary Document	Uploaded 2014-05-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6595	Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)	Form	Modified
186935	Follow-up of Immigrants or Refugees with Class A Physical or Mental Condition	Instruction	Removed

ICR Details

OMB Control No: 0920-0006	ICR Reference No: 202006-0920-005
Status: Active	Previous ICR Reference No: 201703-0920-013
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0006
Title: Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/23/2020
	Date Received in OIRA: 06/23/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	12/31/2020
Responses	200	0	400
Time Burden (Hours)	33	0	100
Cost Burden (Dollars)	3,260	0	16,000

---

Abstract: The goal of this collection is to provide CDC with adequate information to fulfill its responsibilities with regard to the processing of applications for waivers of inadmissibility on health related grounds, specifically mental health disorders with associated harmful behaviors. The information collected is required under U.S. immigration law and regulation. This revision removes the follow-up information collection.

---

Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: Aliens and Nationality
   US Code: 42 USC 34 Name of Law: Public Health Service Medical Exam of Aliens
   PL: Pub.L. 212 - 7 8 Name of Law: CFR
  

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:
	85 FR 3693	01/22/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 37662	06/23/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up of Immigrants or Refugees with Class A Physical or Mental Condition
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)	4 422-1	STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY

---

ICR Summary of Burden

table that charts list 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	200	400	0	-200	0	0
Annual Time Burden (Hours)	33	100	0	-67	0	0
Annual Cost Burden (Dollars)	3,260	16,000	0	-12,740	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden is reduced due to the elimination of one form as CDC does not receive information about the evaluation report of an applicant who received a waiver.

---

Annual Cost to Federal Government: $72,634

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.     No

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: 06/23/2020

---