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

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. This revision removes the follow-up information collection.

The latest form for [NCEZID] Statement in Support of Application for Waiver of Inadmissibility Under Immigration and Nationality Act expires 2023-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 4.422-1 Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction
Attachment F Privacy Impact Assessment.pdf Supplementary Document
Attachment D Human Research Determination.pdf Supplementary Document
Supporting Statement B 2023.docx Supporting Statement B
Supporting Statement A 2023.docx Supporting Statement A
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.pdf Supplementary Document
Attachment A1 8 USC 1182.pdf Supplementary Document
Application for Waiver of Inadmissibility Under Immigration and Nationality Act (Form 4-422-1) Form and Instruction

All Historical Document Collections

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

OMB Details

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

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 4 422-1

STATEMENTS IN SUPPORT OF APPLICATION FOR WAIVER OF INADMISSIBILITY

Fillable Printable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.