Report of Medical Examination and Vaccination Record

ICR 202108-1615-004

OMB: 1615-0033

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-09-08
Supporting Statement A
2021-09-07
Supplementary Document
2019-02-05
Supplementary Document
2019-02-05
Supplementary Document
2019-02-05
Supplementary Document
2019-02-05
Supplementary Document
2019-02-05
Supplementary Document
2021-08-31
Supplementary Document
2021-08-31
IC Document Collections
IC ID
Document
Title
Status
20305 Modified
ICR Details
1615-0033 202108-1615-004
Received in OIRA 201901-1615-011
DHS/USCIS I-693
Report of Medical Examination and Vaccination Record
Revision of a currently approved collection   No
Emergency 09/08/2021
09/08/2021
  Requested Previously Approved
6 Months From Approved 07/31/2022
667,000 667,000
2,001,000 1,667,500
329,331,250 329,331,250

The information on the application will be used by USCIS in considering eligibility for adjustment of status under 8 CFR part 209, 8 CFR 210.5, 245.5 and 245a.3.
USCIS seeks emergency processing under 5 CFR 1320.13 of changes to Form I-693, Report of Medical Examination and Vaccination Record, that will require civil surgeons conducting immigration medical examinations to document whether a noncitizen applying for certain immigration benefits has completed the COVID-19 vaccine series, as applicable. USCIS is modifying Form I-693 and its Instructions in response to updates to the Centers for Disease Control and Prevention (CDC) Technical Instructions for Civil Surgeons (Technical Instructions). The Technical Instructions update requires civil surgeons to document whether an immigrant for whom they conduct an immigration medical examination has completed the COVID-19 vaccine series. The updated Technical Instructions are effective October 1, 2021.

US Code: 8 USC 1255 Name of Law: Immigration and Nationality Act
  
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Report of Medical Examination and Vaccination Record I-693 Report of Medical Examination and Vaccination Record

  Total Request 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 667,000 667,000 0 0 0 0
Annual Time Burden (Hours) 2,001,000 1,667,500 0 0 333,500 0
Annual Cost Burden (Dollars) 329,331,250 329,331,250 0 0 0 0
No
No
USCIS is updating Form I-693 and its Instructions to allow for documentation of COVID-19 vaccination and associated guidance to civil surgeons and applicants. There is an increase in the estimated annual hour burden to respondents as a result of this change. USCIS estimates an increase of 0.5 hours per response across the entire respondent population.

$42,130,634
No
    Yes
    Yes
No
No
No
No
Kerstin Jager 214 489-8022 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/08/2021


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