Information Collection

Withdrawal of URM Program Application or Declination of URM Program Placement Forms

IC 241922 under ICR 202607-0970-005 · OMB 0970-0550.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Withdrawal of URM Program Application or Declination of URM Program Placement Forms Withdrawal of URM Program Application or Declination of URM Program Placement Forms	Form
1 Withdrawal of URM Program Application or Declination of OMB #0970-0550_Withdrawal of URM Program App or Declination Forms - CLEAN_7.8.2026.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	1				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Refugee Arrivals Data System (RADS)

FR Citation: 87 FR 7178

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	-10	50
Annual IC Time Burden (Hours)	8	-2	10
Annual IC Cost Burden (Dollars)	0	0	0

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.

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