Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)

[NCEZID] Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act

OMB: 0920-0006

IC ID: 6595

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) 0920-0006
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4.422-1 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY Attachment C CDC Form 4.422-1.pdf Yes No Fillable Printable
Form and Instruction 0920-0006 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY - Revised 21JUL2025 4.422 Form_July 2025 Clean.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

09-02-0102: Alien Mental Waiver Program  51 FR 42461

200 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 0 0 0 200
Annual IC Time Burden (Hours) 33 0 0 0 0 33
Annual IC Cost Burden (Dollars) 3,260 0 0 0 0 3,260

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