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pdfPAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/subagency
OMB Control Number
DHS-USCIS
0096
1615
___ ___
___ ___ - ___
___ ___ ___
Enter only items that change
Current record
New record
Agency form number (s)
G-1041/A
Annual reporting and recordkeeping hour
burden
Number of respondents
6,767
14,660
Total annual responses
6,767
14,660
Percent of these responses
collected electronically
Total annual hours
0
%
2,145
98.0
%
4,403
Difference
2,258
Explanation of difference
Addition of efile
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
0
0
Total annual costs (O&M)
0
0
Total annualized cost requested
25,376
1,080
Difference
-24,296
Explanation of difference
efiling eliminates out-of-pocket cost
Program change
Adjustment
Other changes**
USCIS added efiling as an option for the G-1041 and G-1041A. With this change, the estimated timeburden decrease for
efiling. The total estimated number of respondents for paper and efiling combined increased.
Signature of Senior Official or designee:
Date:
8/20/24
** This form cannot be used to extend an expiration date.
OMB 83-C
For OIRA Use
___________________________________
___________________________________
10/95
File Type | application/pdf |
File Title | Paperwork Reduction Act Submission (OMB 83-I) |
Subject | Paperwork Reduction Act Submission (OMB 83-I) |
Author | OMB |
File Modified | 2024-08-20 |
File Created | 1999-03-02 |