83c

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

DHS USCIS

0131
1650
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Enter only items that change
Current record

New record

Agency form number (s)

G-1450; pay.gov

Annual reporting and recordkeeping hour
burden
Number of respondents
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**

Currently, this form does not clearly state USCIS no refund policy. This update provides clarifying language and resources to
users of USCIS' no refund policy and requires users to certify that they pay the exact fee amount. Finally, this update reflects
the recent office name change from the USCIS Customer Service Center to the USCIS Contact Center.
Signature of Senior Official or designee:

Date:

10/30/2018
** This form cannot be used to extend an expiration date.

OMB 83-C

For OIRA Use
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10/95