Freedom of Information/Privcy Act Request

Instructions for
Freedom of Information/Privacy Act Request
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form G-639

OMB No. 1615-0102
Expires 01/31/2015

What is the Purpose of This Request?
Use this request to obtain access to U. S. Citizenship and Immigration Services (USCIS) records as allowed by the
Freedom of Information Act (FOIA) at 5 U.S.C. 552 and the Privacy Act of 1974 (PA) at 5 U.S.C. 552a.
With certain exceptions, FOIA provides access to Federal agency records. PA permits U.S. citizens or lawful permanent
residents to gain access to information pertaining to themselves in Federal agency records; to have a copy made of all or
any part thereof; to correct or amend such records; and to permit individuals to make requests concerning what records
pertaining to themselves are collected, maintained, used, or disseminated. PA also prohibits disclosure of any person’s
records without his or her written consent, except under certain circumstances as prescribed by PA.

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When May I Use This Request?

An individual may use this request to obtain access to agency records or to access his or her own records, or he or she may
consent to another individual requesting access to those records.
Do not use Form G-639 for the following requests:

1. For status inquires. Contact the USCIS office where the application, petition, or request was filed or call our National
Customer Service Center at 1-800-375-5283;
2. For consular notification of a visa petition approval. Use Form I-824, Application for Action on an Approved
Application or Petition;
3. To request the return of original documents. Use Form G-884, Request for Return of Original Documents;
4. To request records of naturalization prior to September 27, 1906. Contact the clerk of court where the naturalization
occurred;
5. To request information on USCIS manifest arrivals prior to December 1982. Contact the National Archives; and
6. To obtain proof of status (for example, Social Security benefit, Selective Service requirement).

NOTE: Form G-639 is not required to make a FOIA/PA request; however, you must make all FOIA/PA requests in
writing.

General Instructions
USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you
do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that
we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each request must be properly signed and filed. For all signatures on this request, USCIS will not accept a
stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may
sign the request on your behalf. A legal guardian may also sign for a mentally incompetent person.
Filing Fee. No filing fee is required until you are notified by USCIS during processing of your request. (See the What Is
the Filing Fee section of these instructions.)
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Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific
Instructions section of these instructions.
Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application, petition, or request. If you submit original documents when not required, the documents
may remain a part of the record, and USCIS will not automatically return them to you.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and that
he or she is competent to translate from the foreign language into English.

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How To Fill Out Form G-639

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this request, use the space provided in Part 5. Additional
Information or attach a separate sheet of paper; type or print your name and Alien Registration Number (A-Number)
(if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer
refers; and sign and date each sheet.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None,” unless
otherwise directed.

Specific Instructions

Form G-639 is divided into five parts. The following information will help you complete the request.

NOTE: Providing the information requested on this request is voluntary. However, failure to provide complete and
specific information may delay processing of your request or create an inability for USCIS to locate the records or
information requested.
Part 1. Type of Request

Item Numbers 1.a. - 1.c. Select only one box in Part 1. that describes the type of records you are requesting.
NOTE: If you are filing this request on behalf of another individual, select the response as it would apply to that
individual.
Part 2. Requestor Information
Item Number 1. Select the appropriate box to indicate whether you are the Subject of Record. If you answer “No,”
indicating you are requesting access to another individual’s records, complete all information in Part 2. If you answer
“Yes,” indicating you are requesting access to your own records, skip Part 2. and proceed to Part 3. Description of
Records Requested.
Item Numbers 2.a. - 2.c. Requestor’s Full Name. Provide your full legal name in the spaces provided.
Item Numbers 3.a. - 3.i. Requestor’s Mailing Address. List your complete mailing address in the spaces provided.
You may list a valid residence, APO, In Care Of Name, or commercial address in the United States. You may list a Post
Office address (PO Box) if that is how you receive your mail. If your mail is sent to someone other than yourself, include
an “In Care Of Name” as part of your mailing address. If your mailing address is in a U.S. territory and it contains an
urbanization name, list the urbanization name in the “In Care Of Name” space provided.
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Item Numbers 4. - 6. Requestor’s Contact Information. Provide your daytime telephone number, mobile telephone
number (if any), and email address (if any).
Item Numbers 7.a. - 7.b. Requestor’s Certification. Sign and date the request. A stamped or typewritten name in place
of a signature is not acceptable.
Part 3. Description of Records Requested
You are not required to respond to every item in Part 3.; however, failure to provide complete and specific information
may delay processing of your request or create an inability for USCIS to locate the records or information requested.
NOTE: If you are filing this request on behalf of another individual, select the response as it would apply to that
individual.

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Item Number 1. Purpose. This optional information, if provided, may assist USCIS in locating the records you seek.
Item Numbers 2.a. - 2.c. Full Name of the Subject of Record. Provide the full legal name of the Subject of Record in
the spaces provided.
Item Numbers 3.a. - 3.c. Other Names Used by the Subject of Record. Provide other names you have used since
birth, including any nicknames, aliases, and your maiden name (if applicable). If you need extra space to complete this
section, use the space provided in Part 5. Additional Information.
Item Numbers 4.a. - 4.c. Full Name of the Subject of Record at Time of Entry into the United States. If your name
has changed since your entered the United States, provide the full name that you used at the time of entry into the United
States.
Item Number 5. Form I-94 Number Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or
USCIS issued you a Form I-94, Arrival-Departure Record, provide your Form I-94 number and date that your authorized
period of stay expires or expired (as shown on Form I-94). The Form I-94 number also is known as the Departure
Number on some versions of Form I-94.
NOTE: If you were admitted to the United States by CBP at an airport or seaport after April 30, 2013, you may have
been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. You may visit the CBP Web site at
www.cbp.gov/i94 to obtain a paper version of an electronic Form I-94. CBP does not charge a fee for this service. Some
travelers admitted to the United States at a land border, airport, or seaport, after April 30, 2013 with a passport or travel
document, who were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form I-94 from the CBP
Web site without charge. If your Form I-94 cannot be obtained from the CBP Web site, it may be obtained by filing Form
I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a
fee for this service.
Item Number 6. Alien Registration Number (A-Number) (if any). An Alien Registration Number, otherwise known as
an “A-Number,” is typically issued to persons who apply for, or are granted, certain immigration benefits. In addition to
USCIS, CBP, U.S. Immigration and Customs Enforcement (ICE), Executive Office for Immigration Review (EOIR), and
the U.S. Department of State (DOS) may also issue an A-Number to certain aliens. If you were issued an A-Number, type
or print it in the spaces provided. If you do not have an A-Number, or if you cannot remember it, leave this space blank.
Item Number 7. Application, Petition, or Request Receipt Number. Provide the USCIS receipt number that
corresponds to any application, petition, or request you previously filed with USCIS.
Item Numbers 8.a. - 11. Information About Family Members that May Appear on Requested Records. Provide
your family member’s full name and his or her relationship to you for any individual that may appear on the requested
records (for example, a spouse or children). If you need extra space to complete this section, use the space provided in
Part 5. Additional Information.
Item Numbers 12.a. - 13.d. Parents’ Names for the Subject of Record. Provide the full names of your father and
mother in the spaces provided. If applicable, include your mother’s maiden name.
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Part 4. Verification of Identity and Subject of Record Consent
If you request records about yourself (in other words, you are the Subject of Record), you are required to verify your
identity by providing your full name, your current address, your date of birth, and your place of birth in Item Numbers
1.a. - 4., as requested in this section. You must also sign this request, and you must either have your signature notarized
or submitted under penalty of perjury, which you can do by completing either Item Number 8.a. or 8.b. in this section. If
you request records about another individual (in other words, the other individual is the Subject of Record) and on behalf
of that individual, you are still required to provide a statement from the individual verifying his or her identity, as well
as certifying the individual’s agreement that USCIS may release his or her records to you. Again, you can fulfill these
requirements by completing Item Numbers 1.a. - 4. and then having the individual complete either Item Number 8.a. or
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NOTE: If you are requesting records about another individual and your request is not on behalf of that individual, you
may use the space provided in Part 5. Additional Information to provide additional information that you want USCIS
to consider in processing your request. For example, if the Subject of Record is deceased, you may use this section to
provide that information, and you should also attach appropriate proof of death, such as an obituary or a death certificate.
If you believe that the disclosure of the Subject of Record’s information would further a public interest recognizable under
the FOIA, you may also use Part 5. Additional Information to assert and explain the public interest, and you should
attach any documentation in support of your position.
Item Numbers 1.a. - 1.c. Full Name of the Subject of Record. Provide the full legal name of the Subject of Record in
the spaces provided. If you are completing this request using a computer, this information will automatically complete
based on your responses in Item Numbers 2.a. - 2.c. of Part 3.
Item Numbers 2.a. - 2.i. Mailing Address for the Subject of Record. Provide the current address of the Subject of
Record in the spaces provided. You may list a valid residence, APO, In Care Of Name, or commercial address in the
U.S. You may list a Post Office address (PO Box) if that is how the Subject of Record receives mail. If the mail is sent
to someone other than the Subject of Record, include an “In Care Of Name” as part of the mailing address. If the mailing
address is in a U.S. territory and it contains an urbanization name, list the urbanization name in the “In Care Of Name”
space provided.
Item Number 3. Date of Birth. Provide the date of birth of the Subject of Record in mm/dd/yyyy format in the space
provided.
Item Number 4. Country of Birth. Provide the name of the country where the Subject of Record was born. Provide the
name of the country as it was named when the Subject of Record was born, even if the country’s name has changed or the
country no longer exists.
Item Numbers 5. - 7. Contact Information for the Subject of Record. Provide the daytime telephone number, mobile
telephone number (if any), and email address (if any) for the Subject of Record. Providing this information is optional.
Item Numbers 8.a - 8.c. Signature and Notarized Affidavit or Declaration of the Subject of Record. Select only one
box. The Subject of Record MUST provide a signature in Item Number 8.a. Notarized Affidavit of Identity OR Item
Number 8.b. Declaration Under Penalty of Perjury, regardless if you submit this request yourself or another individual
completes this request on your behalf. If the Subject of Record is deceased, read Item Number 8.c. and attach proof of
death.
NOTE: Appropriate consent from the Subject of Record is established by submitting Form G-639 with required
information and signatures or an authorizing letter with verification of identity for the Subject of Record. You may also
use U.S. Department of Justice (DOJ) Form 361, Certification of Identity, to verify identity for the Subject of Record.
Form DOJ-361 is available online at www.fbi.gov/foia/u.s.-department-of-justice-form-361-certification-of-identity.
If you are a parent or legal guardian submitting Form G-639 on behalf of a child or other individual, you must also
establish your own identity as the child’s or other individual’s parent or legal guardian.

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Part 5. Additional Information
If you need extra space to provide any additional information within this request, use the space provided in Part 5.
Additional Information. If you need more space than what is provided in Part 5., you may make copies of Part 5. to
complete and file with your request, or attach a separate sheet of paper. Include your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign
and date each sheet.
Expedite Requests
Requests to have your Form G-639 expedited, or processed ahead of other previously received requests, are reviewed on
a case-by-case basis. To seek expedited processing, you must submit a typed or printed statement explaining in detail
the basis for requesting expedited processing, and your statement must include a certification that this information is
complete, true, and correct to the best of your knowledge and belief.

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You must establish that one of the following situations exists in order to receive expedited treatment of your FOIA/PA
request:
1. Reasonably expected circumstances pose an imminent threat to the life or physical safety of an individual; or
2. There is an urgency to inform the public about an actual or alleged Federal government activity made by a person
primarily engaged in disseminating information.

What is the Filing Fee?

No filing fee for Form G-639 is required until you are notified by USCIS during the processing of your request.
NOTE: When requested, the filing fee is not refundable, regardless of any action USCIS takes on this request. DO NOT
MAIL CASH. You must submit all fees in the exact amounts.
Except for commercial requestors, the first 100 pages of reproduction and the first two hours of search time are provided
without charge. Thereafter, requests processed under PA may incur fees of 10 cents per page for duplication. Other costs
for searches and duplication are charged at the actual direct cost.
Fees are charged if the combined cost for searches, duplication, and/or review is more than $14, and by submitting Form
G-639, you agree to pay for fees up to $25.  If the total anticipated fees are more than $250, or you have failed to pay fees
in the past, USCIS may request an advance deposit. Also, USCIS will not process any Form G-639 until all unpaid fees
from prior requests are paid.
Use the following guidelines when you prepare your checks or money orders for the Form G-639 filing fees:
1. The checks or money orders must be drawn on a bank or other financial institution located in the United States and
must be payable in U.S. currency; and
2. Make the checks or money orders payable to U.S. Department of Homeland Security.
NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”
Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it into an electronic funds
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your
account for the amount of the check. The debit from your account will usually take 24 hours and your bank will show it
on your regular account statement.
You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS
cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If
USCIS cannot complete the EFT because of insufficient funds, we may try to make the transfer two additional times.
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Where to File?
Please see our Web site at www.uscis.gov/G-639 or call our National Customer Service Center at 1-800-375-5283 for the
most current information about where to file this request. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Processing Information
Initial Processing. Once USCIS accepts your request we will check it for completeness. If you do not completely fill out
this request, you will not establish a basis for your records access and USCIS may reject or deny your request.

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Requests for More Information. We may request that you provide more information or evidence to support your
request. We may also request that you provide the originals of any copies you submit.
Decision. The decision on Form G-639 involves a determination of whether you have provided the information required
for USCIS to process your records access request. USCIS will notify you of the decision in writing.

USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS Web site at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order
USCIS forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling
the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form G-639, we
will deny your Form G-639 and may deny any other immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this request, and the associated evidence, is collected under 5 U.S.C.
552 and 552a.
PURPOSE: The primary purpose for providing the requested information on this request is to enable USCIS to locate
applicable records and to respond to requests made under the Freedom of Information Act (FOIA) and Privacy Act (PA).
USCIS will use the information you provide to grant or deny the records access you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay processing of your request or create an inability for USCIS to locate the records or
information requested.
ROUTINE USES: DHS may share the information you provide on this request with other Federal, state, local, and
foreign government agencies and authorized organizations. DHS follows approved routine uses described in the
associated published system of records notices [DHS-USCIS-007 - Benefits Information System, DHS-USCIS-001- Alien
File, Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS may also
share the information, as appropriate, for law enforcement purposes or in the interest of national security.

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Paperwork Reduction Act
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of
information, unless it displays a currently valid OMB control number. The public reporting burden for this collection of
information is estimated at 15 minutes per response, including the time for reviewing instructions, gathering the required
documentation and information, completing the request, preparing statements, attaching necessary documentation,
and submitting the request. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory
Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No.
1615-0102. Do not mail your completed Form G-639 to this address.

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