Application for Advance Permission to Return to Unrelinquished Domicile

Forms and Documents

Document Name	Status
Form I-191 Application for Advance Permission to Return to Unrelinquished Domicile Form	Modified
1615-0016 Form I-191 Supporting Statement 2013-6-24.docx Supporting Statement A	2013-06-25
Reference Citation 2013-2-26.doc Supplementary Document	2013-05-22
SORN BIS (9-29-2008).mht Supplementary Document	2013-05-22
privacy_pia_cis_claims3.pdf Supplementary Document	2013-05-22
30-Day Notice 5-22-2013.pdf Supplementary Document	2013-05-22
60-day notice 3-15-2013.pdf Supplementary Document	2013-05-22

IC Document Collections

IC ID	Document Title	Status
20264	Application for Advance Permission to Return to Unrelinquished Domicile Form	Modified

ICR Details

OMB Control No: 1615-0016	ICR Reference No: 201305-1615-003
Status: Historical Active	Previous ICR Reference No: 201102-1615-003
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-191
Title: Application for Advance Permission to Return to Unrelinquished Domicile
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: 08/15/2013
	Date Received in OIRA: 06/25/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved	08/31/2013
Responses	300	0	300
Time Burden (Hours)	300	0	75
Cost Burden (Dollars)	0	0	175,500

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Abstract: The information collected on this form is used by U.S. Citizenship and Immigration Services (USCIS) to determine whether the applicant is eligible for a discretionary relief under section 212(c) of the Immigration and Nationality Act.

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Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: US Code
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 16519	03/15/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 30320	05/22/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Application for Advance Permission to Return to Unrelinquished Domicile	I-191	Application for Advance Permission to Return to Unrelinquished Domicile

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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	300	300	0	0	0	0
Annual Time Burden (Hours)	300	75	0	0	225	0
Annual Cost Burden (Dollars)	0	175,500	0	0	-175,500	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: There has been an increase of 225 burden hours previously reported for this information collection. This change can be attributed to an increase in the time burden from 15 minutes (0.25 hours) to 60 minutes (1 hours). The previous estimated time burden was re-evaluated to better account for the time it would take an average respondent to review the instructions, gather necessary documentation and information, and complete the form and any statements, based on an adjustment in agency estimates. There are no changes to the information being collected.

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Annual Cost to Federal Government: $175,500

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

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Common Form ICR:  No

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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: 06/25/2013

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