83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Homeland Security/USCIS

0040
1615
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Enter only items that change
Current record

New record

Agency form number (s)

I-765

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

The Emergency Stopgap USCIS Stabilization Act (RIN 1615-AC73) designated Form I-765 for premium processing service
(filed on Form I-907, OMB Control Number 1615-0048) for a fee of $1,500. The Form I-765 Instructions were updated with
new language about how to determine whether a classification or category is available for premium processing.
Signature of Senior Official or designee:

Date:

02/23/2022
** This form cannot be used to extend an expiration date.

OMB 83-C

For OIRA Use
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10/95