Signed 83-C for 1651-0107

PAPERWORK REDUCTION ACT
CHANGE WORKSHEET
Agency/Subagency

OMB control number

DHS/CBP

1

6

5

1

0

1

0

7

Enter only items that change
Current record
New record
Agency form number(s)

Annual reporting and recordkeeping hour
burden
Number of respondents
Total annual responses
Percent of these responses
collected electronically

%

%

Total annual hours

0

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)

0.00

Total annualized cost requested

0.00
0.00

Difference
Explanation of difference
Program change
Adjustment
Other changes**

Change to form limited to an update to the form fee. Previous fee of $585.00 changed to current fee of $695.00. Updated fee found at top (line
#1) of page 2. Update was necessitated by a USCIS final rule and will begin on 04/01/2024.
Signature of Senior Official or designee:

Dale Johnson, Branch Chief, Office of Field Operations
**This form cannot be used to extend an expiration date.
OMB FORM 83-C, 10/95

Date:

For OIRA Use

03/18/2024

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