Form 83-i

PAPERWORK REDUCTION ACT SUBMISSION
Please read the instructions before completing this form. For additional forms or assistance in completing this form, contact your agency's
Paperwork Clearance Officer. Send two copies of this form, the collection instrument to be reviewed, the Supporting Statement, and any
additional documentation to: Office of Information and Regulatory Affairs, Office of Management and Budget,
Docket Library, Room 10102, 725 17th Street NW, Washington, DC 20503.
2. OMB CONTROL NUMBER

1. AGENCY/SUBAGENCY ORIGINATING REQUEST

Department of Justice, Executive Office for Immigration Review
a.

1125

0003

b. NONE

4. TYPE OF REVIEW REQUESTED (X one)

3. TYPE OF INFORMATION COLLECTION (X one)
(For b. - f., note Item A2 of Supporting Statement instructions)

a. REGULAR SUBMISSION

a. NEW COLLECTION

b. EMERGENCY - APPROVAL REQUESTED BY:

b. REVISION OF A CURRENTLY APPROVED COLLECTION

c. DELEGATED

c. EXTENSION OF A CURRENTLY APPROVED COLLECTION
d. REINSTATEMENT, WITHOUT CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

5. SMALL ENTITIES
Will this information collection have a significant economic
impact on a substantial number of small entities?

e. REINSTATEMENT, WITH CHANGE, OF A PREVIOUSLY
APPROVED COLLECTION FOR WHICH APPROVAL HAS EXPIRED

6. REQUESTED EXPIRATION DATE

YES

NO

a. THREE YEARS FROM APPROVAL DATE

f. EXISTING COLLECTION IN USE WITHOUT AN OMB CONTROL
NUMBER

b. OTHER:

7. TITLE

Fee Waiver Request
8. AGENCY FORM NUMBER(S) (if applicable)

EOIR-26A
9. KEYWORDS

Fee, Waiver, Immigration, Immigration Judge, Board of Immigration Appeals
10. ABSTRACT

The information on the fee waiver request form is used by the Board of Immigration Appeals and the Immigration Judges to determine whether the
requisite fee for an application, motion or appeal will be waived due to an individual's inability to pay.

12. OBLIGATION TO RESPOND (X one)

11. AFFECTED PUBLIC (Mark primary with "P" and all others that apply with "X")

P

a. INDIVIDUALS OR HOUSEHOLDS
b. BUSINESS OR OTHER FOR-PROFIT

X

c. NOT-FOR-PROFIT INSTITUTIONS

d. FARMS

a. VOLUNTARY

e. FEDERAL GOVERNMENT

b. REQUIRED TO OBTAIN OR RETAIN BENEFITS

f. STATE, LOCAL OR TRIBAL GOVERNMENT

c. MANDATORY

13. ANNUAL REPORTING AND RECORDKEEPING HOUR BURDEN
a. NUMBER OF RESPONDENTS
b. TOTAL ANNUAL RESPONSES
(1) Percentage of these responses collected electronically
c. TOTAL ANNUAL HOURS REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

EXPLANATION OF
DIFFERENCE:

5,499
5,499
0.00 %
5,499
8,614
-3115

14. ANNUALIZED COST TO RESPONDENTS (In thousands of dollars)
b. TOTAL ANNUAL COSTS (O&M)
c. TOTAL ANNUALIZED COST REQUESTED
d. CURRENT OMB INVENTORY
e. DIFFERENCE (+, -)
f.

less rcvd

15. PURPOSE OF INFORMATION COLLECTION (Mark primary with
a. APPLICATION FOR BENEFITS

16. FREQUENCY OF RECORDKEEPING OR REPORTING (X all that apply)
a. RECORDKEEPING

e. PROGRAM PLANNING
OR MANAGEMENT

b. PROGRAM EVALUATION
c. GENERAL PURPOSE STATISTICS
d. AUDIT

17. STATISTICAL METHODS
Does this information collection employ
statistical methods?

OMB FORM 83-I, 10/95

NO

b. THIRD PARTY DISCLOSURE

c. REPORTING:

f. RESEARCH
g. REGULATORY OR
COMPLIANCE

(1) On Occasion

(2) Weekly

(3) Monthly

(4) Quarterly

(5) Semi-Annually

(6) Annually

(7) Biennially

(8) Other (Describe) as needed

18. AGENCY CONTACT (Person who can best answer questions regarding the content of this
submission)
a. NAME (Last, First, Middle Initial)

Baptista, Christina
YES

0.00
0.00

(2) Adustment (+, -)

"P" and all others that apply with "X")

P

EXPLANATION OF DIFFERENCE:
(1) Program change (+, -)

(1) Program change (+, -)
(2) Adustment (+, -)

$0.00
0.00
0.00
0.00
0.00

a. TOTAL CAPITAL/STARTUP COSTS

CHRISTINA BAPTISTA

Digitally signed by CHRISTINA BAPTISTA
Date: 2021.04.22 10:22:47 -04'00'

b. TELEPHONE NUMBER (Include
area code)

(703) 305-0992
Adobe Professional 8.0

OMB CONTROL NUMBER

1125

0003

TITLE

Fee Waiver Request

19. CERTIFICATION FOR PAPERWORK REDUCTION ACT SUBMISSIONS
a. PROGRAM OFFICIAL CERTIFICATION (Internal DoD Use Only)
(1) Signature

CHRISTINA BAPTISTA

(2) Date

Digitally signed by CHRISTINA BAPTISTA
Date: 2021.04.22 10:24:17 -04'00'

4/22/21

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies
with 5 CFR 1320.9.
NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of the
instructions. The certification is to be made with reference to those regulatory provisions as set forth in the
instructions.
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 (see note in Item 19 of the instructions);
(i) If applicable, it uses effective and efficient statistical survey methodology; and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain the reason in
Item 18 of the Supporting Statement.

b. SENIOR OFFICIAL OR DESIGNEE CERTIFICATION
(1) Signature

CHRISTINA BAPTISTA
OMB FORM 83-I (BACK), 10/95

(2) Date

Digitally signed by CHRISTINA BAPTISTA
Date: 2021.04.22 10:24:49 -04'00'

4/22/21

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