Supplement A to Form I-539 (Filing Instructions for V Nonimmigrant Status)

Forms and Documents

Document Name	Status
Published 60-day notice 2014-8-13.docx Supplementary Document	2014-12-22
SORN - CLAIMS.doc Supplementary Document	2014-12-17
PIA.pdf Supplementary Document	2014-12-17
Reference Citation.doc Supplementary Document	2014-12-17
Published 30-day notice 2014-11-19.docx Supplementary Document	2014-12-17
Supporting Statement - I-539A.doc Supporting Statement A	2014-12-17

IC Document Collections

IC ID	Document Title	Status
20227	Supplement A to Form I-539 (Filing Instructions for V Nonimmigrant Status) Other-Instruction - I-539A	Modified

ICR Details

OMB Control No: 1615-0004	ICR Reference No: 201411-1615-003
Status: Historical Active	Previous ICR Reference No: 201108-1615-004
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-539A
Title: Supplement A to Form I-539 (Filing Instructions for V Nonimmigrant 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: 03/11/2015
	Date Received in OIRA: 12/23/2014
Terms of Clearance: USCIS should consider transferring this information collection to the request for the I-539 form (1615-0003).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	200	0	200
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	17,000	0	17,000

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Abstract: This form is needed to accompany the I-539 in order to explain and provide instructions for the V nonimmigrant classification. This form will be used by nonimmigrants to apply for an extension of stay, a change to another nonimmigrant classification, or for obtaining V nonimmigrant classification.

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Authorizing Statute(s): US Code: 8 USC 1184 Name of Law: Immigration and Nationality 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 47471	08/13/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68902	11/19/2014
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Supplement A to Form I-539 (Filing Instructions for V Nonimmigrant Status)

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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	200	200	0	0	0	0
Annual Time Burden (Hours)	100	100	0	0	0	0
Annual Cost Burden (Dollars)	17,000	17,000	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:

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Annual Cost to Federal Government: $8,100

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

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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: 12/23/2014

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