OMB control number

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

OMB 0920-0006 ยท HHS/CDC.

OMB 0920-0006

The goal of this collection is to provide CDC with adequate information to fulfill its responsibilities with regard to the processing of applications for waivers of inadmissibility on health-related grounds, specifically mental health disorders with associated harmful behaviors. The information collected is required under U.S. immigration law and regulation. CDC uses the information collected in 0920-0006 to review waiver applications for prospective immigrants and refugees to the United States. CDC assists DHS/USCIS in determining whether or not a prospective immigrant or refugee with a Class A health designation, specifically those mental health disorders with associated harmful behavior, may be admitted into the United States. Non-Substantive Change Request is submitted to make minor format changes including email and mailing addresses. There is no anticipated change to the approved burden hours.

The latest form for [NCEZID] Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act expires 2027-03-31 and is listed under ICR 202507-0920-015.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-0006 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY - Revised 21JUL2025Form and Instruction
Form 4.422-1 STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITYForm and Instruction
Form 4.422-1 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1)Form and Instruction
Change Request Memo_4.422_July 2025.docxJustification for No Material/Nonsubstantive Change
Attachment F Privacy Impact Assessment.pdfSupplementary Document
Attachment D Human Research Determination.pdfSupplementary Document
Attachment D Human Research Determination.pdf Supplementary Document
Supporting Statement B 2023.docxSupporting Statement B
Supporting Statement B 2023.docxSupporting Statement B
Supporting Statement A 2023.docxSupporting Statement A
Supporting Statement A 2023.docxSupporting Statement A
Attachment A3 8 CFR 212.7 Waiver of certain grounds of excludability.pdfSupplementary Document
Attachment A3 8 CFR 212.7 Waiver of certain grounds of excludability.pdf Supplementary Document
Attachment A2 42 CFR Part 34 Medical Examination of Aliens.pdfSupplementary Document
Attachment A2 42 CFR Part 34 Medical Examination of Aliens.pdf Supplementary Document
Attachment A1 8 USC 1182.pdfSupplementary Document
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202507-0920-015 No material or nonsubstantive change to a currently approved collection 2025-07-23
202401-0920-001 Reinstatement with change of a previously approved collection 2024-01-19 Approved without change
202006-0920-005 Revision of a currently approved collection 2020-06-23 Approved without change
201703-0920-013 Extension without change of a currently approved collection 2017-04-27 Approved without change
201405-0920-005 Extension without change of a currently approved collection 2014-05-22 Approved without change
201107-0920-006 Revision of a currently approved collection 2011-07-25 Approved without change
200810-0920-002 Extension without change of a currently approved collection 2008-10-17 Approved without change
200512-0920-002 Extension without change of a currently approved collection 2005-12-20 Approved without change
200203-0920-004 Revision of a currently approved collection 2002-03-22 Approved without change
199809-0920-003 Reinstatement without change of a previously approved collection 1998-09-30 Approved without change
199509-0920-004 Reinstatement without change of a previously approved collection 1995-09-25 Approved without change
199204-0920-002 Revision of a currently approved collection 1992-04-10 Approved without change
198902-0920-005 Revision of a currently approved collection 1989-02-22 Approved without change
198603-0920-001 Revision of a currently approved collection 1986-03-31 Approved without change
198503-0920-004 No material or nonsubstantive change to a currently approved collection 1985-03-04 Approved with change
198404-0920-001 Reinstatement with change of a previously approved collection 1984-04-09 Approved without change
198105-0920-003 No material or nonsubstantive change to a currently approved collection 1981-05-30 Approved with change
198104-0920-001 Revision of a currently approved collection 1981-04-07 Approved without change
198102-0920-007 No material or nonsubstantive change to a currently approved collection 1981-02-27 Approved with change
198012-0920-005 No material or nonsubstantive change to a currently approved collection 1980-12-10 Approved with change
197802-0920-003 No material or nonsubstantive change to a currently approved collection 1978-02-28 Approved with change
197504-0920-001 Extension without change of a currently approved collection 1975-04-28 Approved without change