83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS/USCIS

0043
1615
___ ___
___ ___ - ___
___ ___ ___
Enter only items that change
Current record

New record

Agency form number (s)

I-821

Annual reporting and recordkeeping hour
burden
Number of respondents

0043

Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours
Difference
Explanation of difference
Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)
Total annualized Capital/Startup costs
Total annual costs (O&M)
Total annualized cost requested
Difference
Explanation of difference
Program change
Adjustment
Other changes**

Add ability for respondents to include the location for which their application is submitted under instead of providing the detail
freestyle as currently done
Signature of Senior Official or designee:

john.r.ramsay@uscis.d
hs.gov

Digitally signed by
john.r.ramsay@uscis.dhs.gov
DN: cn=john.r.ramsay@uscis.dhs.gov
Date: 2017.09.08 11:45:54 -04'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

9/8/2017

For OIRA Use
___________________________________
___________________________________

10/95