Citizenship and Immigration Services Ombudsman Request for Case Assistance Form (DHS Form 7001)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DHS-7001 Case Assistance Form	Form and Instruction	Modified	Available
Form DHS-7001 CIS Ombudsman Case Assistance Form	Form and Instruction	Modified	Repair queued
DHS Request for Case Assistance Form 7001.pdf	Supplementary Document	Uploaded 2022-03-28	Available
1601-0004 30 Day FRN.pdf	Supplementary Document	Uploaded 2022-03-16	Available
PIA CISOMB - CAADI 20210217.pdf	Supplementary Document	Uploaded 2022-02-07	Available
PIA CISOMB - CAADI 20210217.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
2021-23342.pdf	Supplementary Document	Uploaded 2021-12-16	Available
2021-23342.pdf	Supplementary Document	Uploaded 2021-12-16	Repair queued
2021-27250.pdf	Supplementary Document	Uploaded 2021-12-16	Available
2021-27250.pdf	Supplementary Document	Uploaded 2021-12-16	Repair queued
Supporting_Statement_A_1601_0004_ revised 09062022.docx	Supporting Statement A	Uploaded 2022-09-08	Available
Supporting_Statement_A_1601_0004_ revised 120721.docx	Supporting Statement A	Uploaded 2021-12-10	Repair queued
CISOMB Virtual Ombudsman PIA 20100319 - final signed.doc	Supplementary Document	Uploaded 2011-09-19	Available
CISOMB Virtual Ombudsman PIA 20100319 - final signed.doc	Supplementary Document	Uploaded 2011-09-19	Repair queued
SORN (Published).pdf	Supplementary Document	Uploaded 2010-07-22	Available
SORN (Published).pdf	Supplementary Document	Uploaded 2010-07-22	Repair queued
PRA DHS 7001 Citations.doc	Supplementary Document	Uploaded 2007-11-08	Available
PRA DHS 7001 Citations.doc	Supplementary Document	Uploaded 2007-11-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
44790	CIS Ombudsman Case Assistance Form	Form and Instruction	Modified	Case Assistance Form
44790	CIS Ombudsman Case Assistance Form	Form and Instruction	Modified

ICR Details

OMB Control No: 1601-0004	ICR Reference No: 202109-1601-002
Status: Active	Previous ICR Reference No: 201807-1601-001
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: Citizenship and Immigration Services Ombudsman Request for Case Assistance Form (DHS Form 7001)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/15/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/28/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2025	36 Months From Approved	09/30/2022
Responses	18,000	0	12,000
Time Burden (Hours)	18,000	0	12,000
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will be used by the Citizenship and Immigration (CIS) Ombudsman to identify problem areas, propose changes, and assist individuals experiencing problems during the processing of an immigration benefit with U.S. Citizenship and Immigration Services (USCIS)

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Authorizing Statute(s): PL: Pub.L. 107 - 296 452 Name of Law: The Homeland Security Act of 2002
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 71517	12/16/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 12480	03/04/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CIS Ombudsman Case Assistance Form	DHS-7001	Case Assistance Form

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ICR Summary of Burden

table that charts list 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	18,000	12,000	0	0	6,000	0
Annual Time Burden (Hours)	18,000	12,000	0	0	6,000	0
Annual Cost Burden (Dollars)	0	0	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: There has been an increase of 3,324 in the estimated annual burden hours previously reported for this information collection. The increase in burden hours reflects agency estimates. There is no change in the information being collected, however there have been cosmetic changes to the form including punctuation, formatting, and text changes to make the form more understandable and streamlined for use by respondents.

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Annual Cost to Federal Government: $1,231,200

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

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Common Form ICR:  No

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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: 02/28/2022

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