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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Withdrawal of URM Program Application or Declination of URM Program Placement Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Withdrawal of URM Program Application or Declination of URM Program Placement Forms	OMB #0970-0550_Withdrawal of URM Program App or Declination Forms - CLEAN_7.8.2026.docx		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 %

	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

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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