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⚠️ Notice: This information collection may be referencing outdated material.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
I910-005-INS-Revision-30 Day-04202020.pdf Instruction
I-910 Application for Civil Surgeon Designation I910-005-FRM-Revision-30 Day-04202020.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: Voluntary

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	I910-005-FRM-Revision-30 Day-04202020.pdf		Yes	No	Fillable Printable
Instruction			I910-005-INS-Revision-30 Day-04202020.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: 81 FR 72069

Number of Respondents: 470	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	470	-68	538
Annual IC Time Burden (Hours)	940	-136	1,076
Annual IC Cost Burden (Dollars)	24,205	-2,254	26,459

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.