Application for Status as a Temporary Resident Under Section 245A of the Immigration and Nationality Act

Forms and Documents

Document Name	Status
Form Form I-687 Application for Status as a Temporary Resident Under Section 245A of the Immigration and Nationality Act; Form	Modified
privacy_pia_cis_claims3.pdf Supplementary Document	2015-01-27
SORN 78 FR 69864.htm Supplementary Document	2015-01-27
Supporting Statement A 1615-0090 I-687 1-26-15.doc Supporting Statement A	2015-01-27
I-687 30-Day Notice 79 FR 68283 11-14-14.pdf Supplementary Document	2015-01-26
I-687 60-Day Notice.pdf Supplementary Document	2015-01-26
Reference Citation.doc Supplementary Document	2012-08-22
NWIRP Final Settlement.pdf Supplementary Document	2010-07-29
Court Order -- CSS-Newmann Abandonment Foreign Filer Order.pdf Supplementary Document	2010-07-29

IC Document Collections

IC ID	Document Title	Status
20425	Application for Status as a Temporary Resident Under Section 245A of the Immigration and Nationality Act; Form	Modified
203833	Biometrics Processing	Modified

ICR Details

OMB Control No: 1615-0090	ICR Reference No: 201501-1615-005
Status: Historical Active	Previous ICR Reference No: 201208-1615-006
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-687
Title: Application for Status as a Temporary Resident Under Section 245A of the Immigration and Nationality Act
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 with change	Conclusion Date: 03/30/2015
	Date Received in OIRA: 01/28/2015
Terms of Clearance: Approved for only two years due to partial GPEA compliance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	03/31/2015
Responses	60	0	60
Time Burden (Hours)	70	0	70
Cost Burden (Dollars)	11,250	0	0

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Abstract: This information collection will now be used to apply to U.S. Citizenship and Immigration Services (USCIS) for benefits pursuant to the terms and conditions of certain settlement agreements.

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Authorizing Statute(s): US Code: 8 USC 1255a 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 45829	08/06/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68283	11/14/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Status as a Temporary Resident Under Section 245A of the Immigration and Nationality Act;	Form I-687, Form I-687	Application for Status as a Temporary Resident Under Section 245A of the INA ,   NWIRP Class Member Worksheet
Biometrics Processing

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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	60	60	0	0	0	0
Annual Time Burden (Hours)	70	70	0	0	0	0
Annual Cost Burden (Dollars)	11,250	0	0	11,250	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: $36,450

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: 01/28/2015

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