Application for Civil Surgeon Designation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0114 can be found here:

Documents and Forms

Document Name Document Type
Form I-910 Application for Civil Surgeon Designation Form
I910-INS-OMBReview-05102016.pdf Instruction
I-910 Application for Civil Surgeon Designation I910-FRM-OMBReview-04062016.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Civil Surgeon Designation	Agency IC Tracking Number:	I-910

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 212

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-910	Application for Civil Surgeon Designation	I910-FRM-OMBReview-04062016.pdf		Yes	No	Fillable Printable
Instruction			I910-INS-OMBReview-05102016.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: United States Citizenship and Immigration Services Benefits Information System	FR Citation: 73 FR 56596

Number of Respondents: 725	Number of Respondents for Small Entity: 450

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	725	-198	923
Annual IC Time Burden (Hours)	1,450	-258	1,708
Annual IC Cost Burden (Dollars)	3,625	3,625	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.