Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

Forms and Documents

Document Name	Status
Form Supplement B Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	New
Form I-914 Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified
SORN.mht Supplementary Document	2014-04-28
PIA.pdf Supplementary Document	2014-04-28
Refrence Cite.doc Supplementary Document	2014-04-28
Published 30-Day Notice - 2014-4-2.docx Supplementary Document	2014-04-28
Published 60-Day Notice - 2014-1-24.docx Supplementary Document	2014-04-28
I-914 Supporting Statement 4-3-2014 (c).DOC Supporting Statement A	2014-04-28

IC Document Collections

IC ID	Document Title	Status
211477	Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	New
211476	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Instruction	New
21015	Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons Form	Modified

ICR Details

OMB Control No: 1615-0099	ICR Reference No: 201403-1615-001
Status: Historical Active	Previous ICR Reference No: 201201-1615-008
Agency/Subagency: DHS/USCIS	Agency Tracking No: Form I-914
Title: Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
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: 07/29/2014
	Date Received in OIRA: 05/28/2014
Terms of Clearance: Approved for two years only due to lack of GPEA compliance. This form is electronically fillable but not fileable.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	36 Months From Approved	07/31/2014
Responses	1,200	0	1,200
Time Burden (Hours)	1,725	0	1,725
Cost Burden (Dollars)	0	0	0

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Abstract: The information on all three parts of the form will be used to determine whether applicants meet the eligibility requirements for benefits. This application incorporates information pertinent to eligibility under the Victims of Trafficking and Violence Protection Act (VTVPA), Public Law 106-386, and a request for employment.

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Authorizing Statute(s): PL: Pub.L. 106 - 386 107(e) Name of Law: Victims of Trafficking and Violence Protection Act
  

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:
	79 FR 4168	01/24/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 18572	04/02/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons	I-914	Application for T Nonimmigrant Status
Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons	Supplement B	Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

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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	1,200	1,200	0	0	0	0
Annual Time Burden (Hours)	1,725	1,725	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: There has been no increase or decrease in the burden. However, the time burden was previously combined, and with this submission the ICs and corresponding time burden have been separated in the system.

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Annual Cost to Federal Government: $48,000

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: 05/28/2014

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