Follow-up of Immigrants or Refugees with Class A Physical or Mental Condition

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0006 can be found here:

Documents and Forms

Document Name Document Type
0006_Attachment 2B_CDC4 422-1aForm.doc Instruction
0006_Attachment 2A_ revform cdc 4 422-1-2008.doc Attachment 2A revform IC Document

Information Collection (IC) Details

IC Title:	Follow-up of Immigrants or Refugees with Class A Physical or Mental Condition	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0006_Attachment 2B_CDC4 422-1aForm.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-02-0102: Alien Mental Waiver Program	FR Citation: 51 FR 42461

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 2A revform	0006_Attachment 2A_ revform cdc 4 422-1-2008.doc	07/11/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.