SUPPORTING STATEMENT
Health and Human Services Statistical Data for
Refugee/Asylee Adjusting Status
(Form I-643)
OMB No. 1615-0070
Refugees and asylees, Cuban/Haitian Entrants under section 202 of Public Law 99-603, and Amerasians under Public Law 97-359, must use this form when applying for adjustment of status, with the U.S. Citizenship and Immigration Services (USCIS). USCIS will provide the data collected on this form to the Department of Health and Human Services (HHS).
The data collected on this form is used by HHS in submitting it’s annual report to Congress under section 413(a) of the Immigration and Nationality Act (Act). In addition, HHS uses this data to support internal planning and policy making, and material of general interest is released to the public. The areas of information covered on the form are: basic demographic characteristics, current address, cities of residence since entering the United States, household size and characteristics, employment history, education received, English language training and ability, and public assistance history. This type of information was selected as appropriate to comply with the goal to achieve economic self-sufficiency among refugees under section 412 (a)(1) of the Act.
The use of this form provides the most efficient means for collecting and processing the required data. In this case USCIS does not employ the use of information technology in collecting the information. However, this form has been designated for e-filing under the Business Transformation Project.
A review of USCIS’ Inventory Report revealed no duplication of effort, and there is no other similar information currently available which can be used for this purpose.
This collection of information does not have an impact on small businesses or other small entities.
If the information is not collected, the USCIS and HHS will not be able to comply with sections 412(a)(8) and 413(a) of the Act..
The special circumstances contained in item 7 of the Supporting Statement are not applicable to this information collection.
On May 21, 2009, USCIS published a 60-day notice in the Federal Register at 74 FR 23876. On August 5, 2009, USCIS published a 30-day notice in the Federal Register at 74 FR 39088. USCIS did not receive any comments for this information collection.
9. USCIS does not provide payments or gifts to respondents in exchange for a benefit sought.
10. There is no assurance of confidentiality.
11. There are no questions of a sensitive nature.
12. Annual Reporting Burden:
Number of Respondents 195,000
Number of Responses per each Respondent 1
Total Annual Responses 195,000
Hours per Response .916
Total Annual Reporting Burden 178,620
The projected hours per response for this collection of information were derived by first breaking the process into three basic components:
Learning about the Form: 10 Minutes
Completion of the Form: 10 Minutes
Assembling and Filing the Form: 35 Minutes
Total Hours per Response 55 Minutes
Total annual reporting burden hours is 178,620. This figure was derived by multiplying number of respondents (195,000) x frequency of response (1) x (.916) (55 minutes) per response.
13. There are no capital or start-up costs associated with this information collection.
Any cost burdens to respondents as a result of this collection are identified in question 14.
14. Annualized Cost Analysis:
Printing Cost $ 35,100
Collecting and processing 3,900,000
Total Cost to Program 3,935,100
Fee Charge, if any 0
Total Annual Cost to Government 3,935,100
The estimated cost of the program to the Government is $ 3,935,100. This figure is calculated by multiplying the estimated number of respondents (195,000) x 30 minutes (.50) (time required to distribute and collect the forms and forward to HHS) x $40 (Suggested average hourly rate for clerical, officer, and supervisory time and benefits). In addition, this figure includes the estimated overhead cost for printing, stocking, and sending forward this form to HHS which is $ 35,100.
15. There has been no increase or decrease in the annual burden hours for this information collection.
16. USCIS does not intend to employ the use of statistics or the publication
for this collection of information.
17. USCIS will display the expiration date for OMB approval of this information
collection.
18. USCIS does not request an exception to the certification of this information
collection.
Collection of Information Employing Statistical Methods.
Not Applicable.
Certification and Signature.
In submitting this request for OMB approval, I certify that the requirements of the Privacy Act and OMB directives have been complied with including paperwork regulations, statistical standards or directives, and any other information policy directives promulgated under 5 CFR 1320.
_______________________________________ ________________
Sunday Aigbe, Date
Chief,
Regulatory Products Division
U.S. Citizenship and Immigration Services.
| File Type | application/msword |
| File Title | Supporting Statement |
| Author | INS User |
| Last Modified By | user_template |
| File Modified | 2009-08-20 |
| File Created | 2009-08-20 |