Request for Fee Waiver

Forms and Documents

Document Name	Status
Form I-912 Request for Fee Waiver Form	Modified
I-912_83C_PCInjunction_072020.pdf Justification for No Material/Nonsubstantive Change	2020-09-03
Public Charge Emergency Memo_Final_09012020 2.pdf Supplementary Document	2020-09-03
I-912-012_83C_PCINJ_SPTSMT.docx Supporting Statement A	2020-09-03
DHS USCIS PIA-016 CLAIMS3.pdf Supplementary Document	2019-10-07
DHS USCIS PIA-003a IDDMP.pdf Supplementary Document	2019-10-07
I912-012-INS-TOC-PCINJ-09022020.docx Supplementary Document	2020-09-03
DHS USCIS PIA-056 ELIS.pdf Supplementary Document	2019-10-04
DHS USCIS PIA-015 CLAIMS4.pdf Supplementary Document	2019-10-04
DHS USCIS SORN 007 20161019.pdf Supplementary Document	2019-10-04
DHS USCIS ICE CBP SORN 001 20170918.pdf Supplementary Document	2019-10-04
Reference Citation.doc Supplementary Document	2012-10-31

IC Document Collections

IC ID	Document Title	Status
238166	DACA-Related I-765 Fee Exemption Request	Modified
204681	8 CFR 103.7(d) Director's exception request	Modified
194028	Request for Fee Waiver Form	Modified

ICR Details

OMB Control No: 1615-0116	ICR Reference No: 202009-1615-004
Status: Historical Active	Previous ICR Reference No: 201910-1615-006
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-912
Title: Request for Fee Waiver
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: 09/03/2020
	Date Received in OIRA: 09/03/2020
Terms of Clearance: Previous terms of clearance are still in effect.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021	10/31/2021
Responses	350,128	0	350,128
Time Burden (Hours)	815,649	0	815,649
Cost Burden (Dollars)	1,312,980	0	1,312,980

---

Abstract: The collection of information on Form I-912 is necessary in order for U.S. Citizenship and Immigration Services (USCIS) to make a determination that the applicant is unable to pay the application fee for certain immigration benefits.

---

Authorizing Statute(s): US Code: 8 USC 1103 Name of Law: United States Code
  

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:
	83 FR 49120	09/28/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26137	06/05/2019
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Request for Fee Waiver	I-912	Request for Fee Waiver
8 CFR 103.7(d) Director's exception request
DACA-Related I-765 Fee Exemption Request

---

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	350,128	350,128	0	0	0	0
Annual Time Burden (Hours)	815,649	815,649	0	0	0	0
Annual Cost Burden (Dollars)	1,312,980	1,312,980	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: $14,012,886

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: 09/03/2020

---