Application for Relief Under Former Section 212(c) of the Immigration and Nationality Act (INA)

Forms and Documents

Document Name	Status
Form I-191 Application for Relief under Former Section 212(c) of the Immigration and Nationality Act Form	Modified
I-191-012 REV Supporting Statement 20230627.docx Supporting Statement A	2023-06-27
I-191-012 REV 60-Day Public Comment Response Matrix 20230413.pdf Supplementary Document	2023-06-27
SORN 018 DHS_USCIS IBBC 20180731.pdf Supplementary Document	2020-11-02
I-191-012 30-Day 88 FR 29686 2023-09690.pdf Supplementary Document	2023-06-23
I-191-012 60FRN 2023-00004 88 FR 1087.pdf Supplementary Document	2023-06-23
I191-012-INS-TOC-REV-OMBReview-06272023.docx Supplementary Document	2023-06-27
I191-012-FRM-TOC-REV-OMBReview-06272023.docx Supplementary Document	2023-06-27
SORN 007 Benefits Info System 20191010.pdf Supplementary Document	2020-11-02
SORN 001 AFileIndexNFTS 2017 09 18.pdf Supplementary Document	2020-11-02
PIA-016(a) Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems.pdf Supplementary Document	2016-07-26
Reference Citation.docx Supplementary Document	2020-07-28

IC Document Collections

IC ID	Document Title	Status
20264	Application for Relief under Former Section 212(c) of the Immigration and Nationality Act Form	Modified

ICR Details

OMB Control No: 1615-0016	ICR Reference No: 202306-1615-006
Status: Received in OIRA	Previous ICR Reference No: 202011-1615-005
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-191
Title: Application for Relief Under Former Section 212(c) of the Immigration and Nationality Act (INA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/24/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2023
Responses	118	116
Time Burden (Hours)	163	203
Cost Burden (Dollars)	60,770	59,740

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Abstract: The information collected on this form is used by U.S. Citizenship and Immigration Services (USCIS) to determine whether the applicant is eligible for a discretionary relief under former section 212(c) of the Immigration and Nationality Act.

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Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: US Code
  

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:
	88 FR 1087	01/06/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 29686	05/08/2023
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	I-191	Application for Relief under Former Section 212(c) of the Immigration and Nationality Act

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ICR Summary of Burden

	Total Request	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	118	116	0	0	2	0
Annual Time Burden (Hours)	163	203	0	0	-40	0
Annual Cost Burden (Dollars)	60,770	59,740	0	0	1,030	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: With this Revision, there was a decrease in the total estimated annual hour burden. This result stems from a decrease in the annual hour burden due to the update including new condensed signature language in the Form and Instructions. The estimated annual cost burden increased due to an increase in the agency estimated number of respondents. There are no program changes.

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Annual Cost to Federal Government: $109,740

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: 07/24/2023

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