Information Collection

Application for Civil Surgeon Designation

IC 192797 under ICR 202206-1615-002 · OMB 1615-0114.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0114 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-910 Application for Civil Surgeon Designation	Form
Form I-910 Application for Civil Surgeon Designation Application for Civil Surgeon Designation	Form
i-910instr.pdf	Instruction
i-910instr.pdf	Instruction
I-910 Application for Civil Surgeon Designation i-910.pdf	Form
I-910 Application for Civil Surgeon Designation i-910.pdf	Form

IC Title:

Application for Civil Surgeon Designation

Agency IC Tracking Number:

I-910

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 8 CFR 212

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	I-910				Yes	No	Fillable Printable
Instruction					Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: United States Citizenship and Immigration Services Benefits Information System

FR Citation: 81 FR 72069

Number of Respondents: 470

Number of Respondents for Small Entity: 450

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	470	470
Annual IC Time Burden (Hours)	940	940
Annual IC Cost Burden (Dollars)	24,205	24,205

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.

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