I693-009-EMG-Supporting Statement

SUPPORTING STATEMENT FOR

Report of Medical Examination and Vaccination Record

OMB Control No.: 1615-0033

COLLECTION INSTRUMENT(S): Form I-693

A. Justification

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Certain immigration benefits, such as adjustment of status to that of a lawful permanent resident under section 245 of the Immigration and Nationality Act (Act) require establish that they are admissible to the United States, including being admissible on health-related grounds. The health-related grounds of inadmissibility are found in section 212(a)(1)(A) of the Act. In addition, section 232(b) of the Act requires that medical officers of the U.S. Public Health Service (PHS) certify any physical or mental defect or disease observed in arriving aliens. When PHS medical officers are not available, U.S. Citizenship and Immigration Services (USCIS) has the authority to designate private physicians to serve as civil surgeons. Because PHS medical officers have not been available for many years, USCIS has been designating private physicians to serve as civil surgeons, in accordance with section 232(b) of the Act.

Section 212(a)(1)(A) of the Act states that the health-related grounds of inadmissibility are determined according to the regulations prescribed by the Secretary of Health and Human Services. The applicable U.S. Department of Health and Human Services (HHS) regulations are found at 42 CFR Part 34. The corresponding USCIS regulations are found at 8 CFR Part 232. In addition, civil surgeons are responsible for certifying to USCIS the information necessary to determine whether applicants seeking immigration benefits while in the United States, such as adjustment of status, are inadmissible on health-related grounds. The Report of Medical Examination and Vaccination Record, Form I-693, is used by civil surgeons to report the results of the medical examination to USCIS.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

The information on the Report of Medical Examination and Vaccination Record, Form I-693, will be used by USCIS when considering the eligibility for adjustment of status under 8 CFR 209.1(c), 209.2(d), 210.2(d), 245.5 and 245a.3(d)(4); and for V nonimmigrant status under 8 CFR 214.15(f). The information on the Report of Medical Examination and Vaccination Record, Form I-693, will be used by EOIR in considering the eligibility for immigration benefits in removal proceedings.  The information on the Report of Medical Examination and Vaccination Record, Form I-693, may also be used by CBP in determining admissibility at a port of entry. 

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

This form can be downloaded, completed and saved electronically, but cannot be e-filed at this time. This form is the most efficient means for USCIS to collect the required data until full automation can be achieved. USCIS provides this application to the public via the USCIS Internet Web site at www.uscis.gov/i-693. This information collection is partially compliant with the Government Paperwork Elimination Act by allowing for electronic access, completion, and saving of the form.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

No other similar information is currently available which can be used for this purpose. In addition, USCIS has examined whether the information is collected by other DHS components or Federal agencies from which USCIS could obtain the information, and no viable source was found. The law and regulations require a separate and distinct medical examination and a report to be completed in association with the application for adjustment of status. An examination and medical report prepared for other purposes is not sufficient for USCIS’s needs in adjudicating applications. This is because routine physical examinations, or other medical examinations not performed specifically for immigration purposes, do not typically cover all of the health conditions required to determine admissibility under section 212(a)(1)(A) of the Act. Further, the assessment of medical conditions for immigration purposes must be conducted according to HHS regulations, as stated above, including the Technical Instructions for the Medical Examination of Aliens in the United States (Technical Instructions).¹ The Report of Medical Examination and Vaccination Record, Form I-693 covers all medical conditions relevant to the admissibility determination and corresponds with the Technical Instructions to ensure that the specific medical conditions that may impact admissibility are properly assessed in the medical examination.

5. If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.

This collection of information does not have an impact on small businesses or other small entities. This form is completed by applicants required to establish that they are not inadmissible to the United States based on health-related grounds. While the applicants may engage the services of a doctor, those activities are a normal part of the doctor/small business function. No unnecessary burden is placed upon the applicant or doctor due to the information collected on this form.

Under 5 CFR 1320.3(b)(1), burden means the total time, effort, or financial resources expended by persons to maintain, retain, or disclose or provide information to or for a Federal Agency. Under 5 CFR 1320.3(c)(4), for purposes of the definition of ten or more persons, contractors engaged by a respondent for the purpose of complying with the collection of information are not included as persons. Medical professionals providing medical certifications are generally paid for their services either by the alien or a third party, and thus are considered contractors engaged by the respondents to comply with this information collection. Therefore, they do not fall under the category of persons with the associated burden described above.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

If the required information is not collected, USCIS will not be able to correctly determine the eligibility of an applicant for lawful permanent resident status, creating a potential public health risk or denying the applicant an immigration benefit to which he or she may be legally entitled.

7. Explain any special circumstances that would cause an information collection to be conducted in a manner:

• Requiring respondents to report information to the agency more often than quarterly;

• Requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it;

• Requiring respondents to submit more than an original and two copies of any document;

• Requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years;

• In connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study;

• Requiring the use of a statistical data classification that has not been reviewed and approved by OMB;

• That includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or

• Requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information's confidentiality to the extent permitted by law.

This information collection is conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

8. If applicable, provide a copy and identify the data and page number of publication in the Federal Register of the agency’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years - even if the collection of information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

USCIS is requesting OMB approval of this collection of information under 5 CFR 1320.13 Emergency Processing. 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, as applicable. The updated Technical Instructions are effective October 1, 2021. This effective date does not allow USCIS to complete the PRA form revision process before Form I-693 must be available for civil surgeons to comply with the new CDC requirement.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

USCIS does not provide any payment for benefit sought.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation or agency policy.

There is no assurance of confidentiality.

The information collected via this instrument is covered by the Privacy Impact Assessment:

• DHS/USCIS/PIA-003 Integrated Digitization Document Management Program (IDDMP), and

• DHS/USCIS/PIA-067 USCIS Civil Surgeon Designation.

The information is also covered in the System of Records Notices:

• DHS/USCIS/ICE/CBP-001 Alien File, Index, and National File Tracking System of Records, and

• DHS-USCIS-007 Benefits Information System.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

Some of the information requested on this form is of a sensitive nature. The form includes information as to whether an applicant has been diagnosed with tuberculosis, syphilis, or other communicable diseases or suffers from a physical or mental disorder, drug abuse or addiction. These questions are required to obtain information that must be reviewed to determine whether an applicant has or does not have a condition that may make him or her ineligible for adjustment of status on public health-related grounds under 8 CFR 209.1(c), 209.2(d), 210.2(d), 245.5 and 245a.3(d)(4); or for V nonimmigrant status under 8 CFR 214.15(f).

12. Provide estimates of the hour burden of the collection of information. The statement should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

• If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

		A	B	C (=AxB)	D	E (=CxD)	F	(=ExF)
Type of Respondent	Form Name / Form Number	#. of Respondents	#. of Responses per Respondent	# of Responses	Avg. Burden per Response (in hours)	Total Annual Burden (in hours)	Avg. Hourly Wage Rate*	Total Annual Respondent Cost
Individuals or Households	Report of Medical Examination and Vaccination Record – Form I-693	667,000	1	667,000	3	2,001,000	$39.52	$79,079,520
Total				667,000		2,001,000		$79,079,520

* The above Average Hourly Wage Rate is the May 2020 Bureau of Labor Statistics average wage for All Occupations of $27.07 times the wage rate benefit multiplier of 1.46 (to account for benefits provided) equaling $39.52. The selection of “All Occupations” was chosen because respondents to this collection could be expected from any occupation.

13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

• The cost estimate should be split into two components: (a) a total capital and start-up cost component (annualized over its expected useful life); and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

• If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.

• Generally, estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995; (2) to achieve regulatory compliance with requirements not associated with the information collection; (3) for reasons other than to provide information or keep records for the government; or, (4) as part of customary and usual business or private practices.

There are no capital or start-up costs associated with this information collection. There is no fee associated with Form I-693.

This information collection may impose some out-of-pocket costs on certain respondents in addition to the time burden provided under Question 12 above.  Applicants may incur costs to obtain immigration medical examinations and mail the completed Form I-693 to USCIS. USCIS estimates the average cost of the medical examinations may vary widely, from as little as $20 to $1000 per respondent (from vaccinations to additional medical evaluations and testing that may be required based on the health conditions of the applicant).  USCIS estimates that the average cost to respondents is $493.75. The estimated cost to respondents for out-of-pocket costs is 667,000 respondents multiplied by the average cost per response of $493.75, which equals $329,331,250.00.

14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

Annualized Cost Analysis:

1. Printing Cost $ 109,634

2. Collection and Processing Cost $ 42,021,000

3. Total Annual Cost to the Government $ 42,130,634

Government Cost

The estimated cost to USCIS, which is covered by fee receipts, is $42,130,634. This figure is calculated by using the estimated number of respondents 667,000 x (1) number of response x (1.5 hours) per response (time required to collect and process information) x $42 (suggested average hourly rate for clerical, officer, and supervisory time with benefits), which equals $42,021,000. In addition, this figure includes the estimated overhead cost for printing, stocking, and distributing the form, which is $109,634.

15. Explain the reasons for any program changes or adjustments reporting in Items 13 or 14 of the OMB Form 83-I.

Data collection Activity/ Instrument	Program Change (hours currently on OMB Inventory)	Program Change (New)	Difference	Adjustment (hours currently on OMB Inventory)	Adjustment (New)	Difference
I-693				1,667,500	2,001,000	333,500
Total(s)	0	0	0	1,667,500	2,001,000	333,500

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.

There are no changes to the estimated annual cost burden to respondents as a result of this change.

16. For collections of information whose results will be published, outline plans for tabulation, and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

This information collection will not be published for statistical purposes.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

USCIS will display the expiration date for OMB approval of this information collection.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submission,” of OMB 83-I.

USCIS does not request an exception to the certification of this information collection.

B. Collections of Information Employing Statistical Methods.

There is no statistical methodology involved with this collection.

1 Provided by the Centers for Disease Control and Prevention, a component agency of HHS. The Technical Instructions are available online at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.

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