Instructions Table of Changes

G639-INS-TOC-30 day-02282017.docx

Freedom of Information/Privacy Act Request

Instructions Table of Changes

OMB: 1615-0102

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TABLE OF CHANGES – INSTRUCTIONS

Form I-639, Freedom of Information/Privacy Act Request

OMB Number: 1615-0102

2/28/2017

Reason for Revision: Working Group edits and Standard Language updates

Current Page Number and Section

Current Text

Proposed Text

Page 1,

What is the Purpose of This Request?

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.

[Page 1]

What Is the Purpose of Form G-639?

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;
Have a copy made of all or any part thereof;
Correct or amend such records; and
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.

Page 1,

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.

[Page 1]

When May I Use Form G-639?

You may use this request to obtain access to agency records. You may also use this request to consent to another individual accessing agency records pertaining to you.

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, call our National Customer Service Center at 1-800-375-5283, or check the Case Status Online: https://egov.uscis.gov/casestatus/landing.do. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

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 before September 27, 1906. Contact the clerk of court where the naturalization occurred;

5. To request information on USCIS manifest arrivals before 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 and in accordance with the applicable statutory and regulatory requirements under the FOIA and PA. For information about filing an electronic FOIA/PA request, please visit the USCIS FOIA website at: https://www.uscis.gov/about-us/freedom-information-and-privacy-act-foia/uscis-freedom-information-act-and-privacy-act

Page 1,

General Instructions

USCIS provides forms free of charge through the USCIS Website. 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.

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.

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.)

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.

[Page 1]

General Instructions

How To Fill Out Form G-639

1. Type or print legibly in black ink.

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 type or print “N/A,” unless otherwise directed. If your answer to a question which requires a numeric

response is zero or none type or print “None,” unless otherwise directed.

[Deleted by WG]

Page 2,

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.

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.

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 Website 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 Website without charge. If your Form I-94 cannot be obtained from the CBP Website, 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.

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 8.b.

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.

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.

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.

[Page 2]

Specific Instructions

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

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 Numbers 2.a. - 2.c. Requestor’s Full Name. Provide your full legal name in the spaces provided.

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.

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 Number 7. USCIS Online Account Number (if any). If you have previously filed an application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions, or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not the same as an A-Number.

Item Number 8. 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 9.a. - 12. 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 13.a. - 14.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.

Item Number 15. Description of Records Sought. Provide a description of the records you are seeking. If you need additional space, use the space provided in Part 5. Additional Information.

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.. 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 8.b.

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 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. Deceased Subject of Record and attach proof of death.

Part 5. Additional Information

Item Numbers 1.a.-6.d. 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.

We recommend that you print or save a copy of your completed request to review in the future and for your records.

Expedite Requests

Requests will be given expedited treatment whenever it is determined that they involve:

1. Circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to the life or physical safety of an individual;

2. An urgency to inform the public about an actual or alleged Federal government activity, if made by a person primarily engaged in disseminating information;

3. The loss of substantial due process rights; or

4. A matter of widespread and exceptional media interest in which there exists possible questions about the government’s integrity which affect public confidence. Requests for expedited processing based upon this category must be submitted to the Senior Director of FOIA Operations, the Privacy Office, U.S. Department of Homeland Security, 245 Murray Lane SW STOP -0655, Washington, DC 20598-0655.

Page 5,

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.

[Page 3]

Fees

Please do not remit any fees payment at the time of your request. After receipt of your FOIA request, USCIS will contact you if any fees are required.

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Use the following guidelines when you prepare your checks or money orders for payment of any applicable FOIA fees (as noted above, please do not remit any fees payment at this time):

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.

Page 6,

Where to File?

Please see our Website 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.

[Page 4]

Where to File?

[Page 5]

Address Change

A requestor who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address, go to the USCIS Website at www.uscis.gov/addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because the Lockbox does not process change of address requests.

Page 6,

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.

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.

[Page 5]

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 may not establish a basis for your records access and USCIS may reject or deny your request.

Requests for More Information. We may request that you provide more information to support your request.

Page 6,

USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS Website 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.

[Page 6]

USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS Website 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 the Forms Request line 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.

Page 6,

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.

[Page 6]

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Page 6,

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.

[Page 6]

USCIS Privacy Act Statement

AUTHORITIES: The Freedom of Information Act, 5 U.S.C. Section 552, and the Privacy Act of 1974, 5 U.S.C. Section 552a, together with the Department of Homeland Security implementing regulations found in volume 6 of the Code of Federal Regulations (CFR), authorize USCIS to collect the information and associated evidence requested on this form.

PURPOSE: The primary purpose for providing the information requested on this form is to provide essential information that the USCIS FOIA/PA office uses to conduct a thorough search for responsive records, to verify the record subject’s identity, and when applicable, to confirm that consent for the release of privacy protected information has been provided when required. The information you provide will be used to grant or deny this request.

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay USCIS’ ability to provide responsive records or result in USCIS’s inability to locate documents you have requested.

ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and foreign government agencies and authorized organizations in accordance with approved routine uses, as described in the associated published system of records notices [DHS/USCIS-001-DHS Freedom of Information Act and Privacy Act Record System which can be found at https://www.dhs.gov/system-records-notices-sorns]. The information may also be made available, 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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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	TABLE OF CHANGE – FORM I-687
Author	jdimpera
File Modified	0000-00-00
File Created	2021-01-22