Information Collection

I-765 Worksheet

IC 203678 under ICR 202011-1615-009 · OMB 1615-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-765WS I-765 Worksheet	Form and Instruction
I-765WS Form I-765 Worksheet I765WS-016-FRM-OSUP NPRM-RIN 1615-AC40.pdf	Form and Instruction
I-765WS Form I-765 Worksheet I765WS-016-FRM-OSUP NPRM-RIN 1615-AC40.pdf	Form and Instruction

IC Title:

I-765 Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 274

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	I-765WS	Form I-765 Worksheet	I765WS-016-FRM-OSUP NPRM-RIN 1615-AC40.pdf		Yes	No	Fillable Printable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: Electronic Immigration System-3 Automated Background Functions, DHS/USCIS-016

FR Citation: 76 FR 70735

Number of Respondents: 307,697

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	307,697	5,697	302,000
Annual IC Time Burden (Hours)	153,849	2,849	151,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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