Information Collection

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

IC 20264 under ICR 202306-1615-006 · OMB 1615-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-191 Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	Form
I191-012-INS-REV-OMBReview-06272023.pdf	Instruction
I191-012-INS-REV-OMBReview-06272023.pdf	Instruction
I-191 Application for Relief under Former Section 212(c) of th I191-012-FRM-REV-OMBReview-06272023.pdf	Form
I-191 Application for Relief under Former Section 212(c) of th I191-012-FRM-REV-OMBReview-06272023.pdf	Form

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-191	Application for Relief under Former Section 212(c) of the Immigration and Nationality Act	I191-012-FRM-REV-OMBReview-06272023.pdf		Yes	No	Fillable Printable
Instruction			I191-012-INS-REV-OMBReview-06272023.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: DHS/USCIS-007 Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 118

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	118	2	116
Annual IC Time Burden (Hours)	163	-40	203
Annual IC Cost Burden (Dollars)	60,770	1,030	59,740

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.