83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Homeland Security, U.S. Citizenship and Immigration Services
Enter only items that change
Current record

0124
1615
___ ___
___ ___ - ___
___ ___ ___

New record

Agency form number (s)

I-821D

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**

USCIS requests a technical correction to ensure the respondent and burden changes approved by OMB OIRA on 10/25/22
correctly match the information in USG internal information systems. No changes to the form and instructions are being
proposed.
Signature of Senior Official or designee:

Date:

06/22/2023
** This form cannot be used to extend an expiration date.

OMB 83-C

For OIRA Use
___________________________________
___________________________________

10/95