Refugee/Asylee Adjusting Status

Forms and Documents

Document Name	Status
Form I-643 Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction	Modified
PIA USCIS Benefits Processing.pdf Supplementary Document	2012-10-24
SORN Immigration Benefits System.docx Supplementary Document	2012-10-24
PUBLIC Law 99-603 Section 202.docx Supplementary Document	2012-10-24
Section 412 (a)(1).doc Supplementary Document	2012-10-24
INA Section 413(a).docx Supplementary Document	2012-10-24
Public Law 97-359.pdf Supplementary Document	2012-10-24
30-day FRN Pub 2012-10-18 1615-0070 I-643.pdf Supplementary Document	2012-10-24
60-day FRN 1615-0070 Pub 2012-6-23.pdf Supplementary Document	2012-10-24
Supporting Statement 1615-0070 I-643 2012-10-24.doc Supporting Statement A	2012-10-24

IC Document Collections

IC ID	Document Title	Status
20384	Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status Form and Instruction	Modified

ICR Details

OMB Control No: 1615-0070	ICR Reference No: 201210-1615-003
Status: Historical Active	Previous ICR Reference No: 201008-1615-001
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-643
Title: Refugee/Asylee Adjusting Status
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2013
	Date Received in OIRA: 10/31/2012
Terms of Clearance: Approved for only two years due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2013
Responses	195,000	0	195,000
Time Burden (Hours)	178,620	0	178,620
Cost Burden (Dollars)	0	0	0

---

Abstract: 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).

---

Authorizing Statute(s): PL: Pub.L. 99 - 603 202 Name of Law: Cuban/Haitian Entrants
   US Code: 8 USC 1522 Name of Law: U.S. Code
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 38650	06/28/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 64119	10/18/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Health amd Human Services Statistical Data for Refugee/Asylee Adjusting Status	I-643	Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	195,000	195,000	0	0	0	0
Annual Time Burden (Hours)	178,620	178,620	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,935,100

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/31/2012

---