Annual Certification of Regional Center

Instructions for Annual Certification of Regional Center
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-924A

OMB No. 1615-0061
Expires 07/31/2022

What Is the Purpose of Form I-924A?
This form is used by approved regional centers to certify and demonstrate their continued eligibility for the regional center
designation. Each approved regional center must file Form I-924A, Annual Certification of Regional Center, for each
Federal fiscal year (October 1 through September 30) on or before December 29 of the calendar year in which the Federal
fiscal year ended.

Draft
Not for
Production
07/27/2020
An Approved Regional Center

With a designated letter dated:

Must file an initial Form I-924A:

On/before September 30

On/before December 29 of the same calendar year

On/after October 1

On/before December 29 of the following calendar year

Failure to file Form I-924A in a timely manner for each Federal fiscal year in which the regional center has been
designated to participate in the Immigrant Investor Program will result in the issuance of a notice of intent to terminate the
participation of the regional center in the program. Such failure may ultimately result in the termination of the approval
and designation of the regional center. U.S. Citizenship and Immigration Services (USCIS) will review each certification
and will notify the regional center should the certification be inadequate.

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 order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS
Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each form must be properly signed and filed. For all signatures on this form, USCIS will not accept a
stamped or typewritten name in place of a signature.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original, handwritten signature
valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten, ink
signature.
Filing Fee. Each form must be accompanied by the appropriate filing fee. (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 What Evidence
Must You Submit and/or Specific Instructions sections of these Instructions.

Form I-924A Instructions 07/23/20 

Page 1 of 10

Biometric Services Appointment. USCIS may require that you appear for an interview or provide biometrics
(fingerprints, photograph, and/or signature) at any time to verify your identity, obtain additional information, and conduct
background and security checks, including a check of criminal history records maintained by the Federal Bureau of
Investigation (FBI), before making a decision on your form. After USCIS receives your form and ensures it is complete,
we will inform you if you need to attend a biometric services appointment. If an appointment is necessary, the notice
will provide you the location of your local or designated USCIS Application Support Center (ASC) and the date and time
of your appointment or, if you are currently overseas, instruct you to contact a U.S. Embassy, U.S. Consulate, or USCIS
office outside the United States to set up an appointment.
If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:
1. You provided or authorized all information in the form;

Draft
Not for
Production
07/27/2020

2. You reviewed and understood all of the information contained in, and submitted with, your form; and
3. All of this information was complete, true, and correct at the time of filing.

If you fail to attend your biometric services appointment, USCIS may deny your form.

Copies. You should 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 or petition. If USCIS requests an original document from you, it will be returned to you after
USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed after we receive them.
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. The certification must also include the
translator’s signature, printed name, the signature date, and the translator’s contact information.
How To Fill Out Form I-924A

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this form, use the space provided in Part 11. Additional
Information or attach a separate sheet of paper. Type or print the name of the regional center entity at the top of each
attached 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 the new commercial
enterprise does not serve as a vehicle for investment into other job creating entities and the question asks for
information about those entities), 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, “Aggregate Non-EB-5 Capital Investment”), type or print
“None” unless otherwise directed.

Specific Instructions
Part 1. Information About the Regional Center
Item Numbers 1. - 4. Information About the Regional Center Entity. Provide the name of the regional center entity,
the name of the regional center (if different from the regional center entity), regional center identification number, and the
receipt number for the Form I-924 filing. The regional center entity is the legal entity previously designated as a regional
center in order to promote economic growth through investment in a limited geographic area.

Form I-924A Instructions 07/23/20 

Page 2 of 10

Item Numbers 5.a. - 5.f. Regional Center Mailing Address. Provide the mailing address where the regional center
entity can receive a printed notice from USCIS. If the mailing address of the regional center entity is different from its
physical address, provide the physical address of the regional center entity in the space provided in Part 11. Additional
Information.
Item Numbers 6. - 9. Regional Center Contact Information. Provide the daytime telephone number, fax number,
email address, and website address for the regional center entity.
Part 2. Information About the Managing Company or Agency (if different from the regional center entity)
A “managing company or agency” is any entity, agent, individual, group, or other organization, which is not a principal
(as that term is defined in Part 4. of the Specific Instructions section) of the regional center entity, that is or will be
involved in the management, oversight, or administration of the regional center.

Draft
Not for
Production
07/27/2020

Item Number 1. Name of the Managing Company or Agency. Provide the name of the managing company or agency.
Item Numbers 2.a. - 2.f. Managing Company or Agency Mailing Address. Provide the mailing address of the
managing company or agency.
Item Numbers 3. - 6. Contact Information for Managing Company or Agency. Provide the daytime telephone
number, fax number, email address, and website address for the regional center’s managing company or agency.
NOTE: If more than one managing company or agency is associated with the regional center, provide the above
information for all other managing companies or agencies in the space provided in Part 11. Additional Information.
Part 3. Reporting Period for the Regional Center Activity

Item Numbers 1. - 2. Reporting Period. Indicate whether you are filing this form for a single Federal fiscal year or for
a series of Federal fiscal years. Confirm the period of time the form is meant to cover regarding reporting for the regional
center.
Part 4. Information About the Organizational Structure, Ownership, and Control of Regional Center Entity
A “principal” is any person or legal entity or organization (for example, a corporation, limited liability company,
partnership, or governmental entity) that is an owner of the regional center entity, that is in a position of executive
managerial authority over the regional center entity, or that is otherwise in a position to control, influence, or direct the
management or policies of the regional center.
Item Numbers 1.a. - 11. Information About the Owners of the Regional Center Entity. For those persons that hold
an ownership interest in the regional center entity, provide each person’s full legal name, date of birth, country of birth,
social security number, the percentage of ownership held in the regional center entity, and the current position/title held
within the regional center entity. All such principals are required to provide a copy of a valid government-issued photo
identification document and should provide a social security number. If the principal is an entity or organization, such as
a limited liability company or partnership, provide the entity’s legal name, Federal Employer Identification Number, and
the name of all persons having ownership, control or a beneficial interest in that entity or organization. Also provide the
date of birth, country of birth, percentage of ownership and the position held of all persons having ownership, control, or a
beneficial interest in the entity or organization. For each owner, provide any other names and aliases used, as well as their
mailing address, telephone number, email address, and website address.
Item Numbers 12.a. - 12.i. Mailing Address for the Principal Owner of the Regional Center Entity. Provide the
principal’s mailing address.
Item Numbers 13. - 16. Contact Information for the Principal Owner of the Regional Center Entity. Provide the
principal’s current daytime telephone number, fax number, and email address. Provide the principal’s website address.
NOTE: If there are multiple principals with ownership interest in the regional center entity, provide the information
requested in the space provided in Part 11. Additional Information.

Form I-924A Instructions 07/23/20 

Page 3 of 10

Item Numbers 17.a. - 26. Information About Principal Non-Owner of the Regional Center Entity. Provide the full
legal name of each person who is a principal of, but does not hold an ownership interest in, the regional center entity,
as well as their date of birth, country of birth, social security number, and their current position/title held within the
regional center entity. All such principals are required to provide a copy of a valid government-issued photo identification
document and should provide a social security number. If the principal is an entity or organization, such as a limited
liability company or partnership, provide the entity’s legal name, Federal Employer Identification Number, and the name
of all persons having ownership, control, or a beneficial interest in that entity or organization. Also provide the date of
birth, country of birth, percentage of ownership interest, and the position held of all persons having ownership, control, or
a beneficial interest in the entity or organization. For each principal, provide any other names and aliases used, as well as
their mailing address, telephone number, email address, and website address.

Draft
Not for
Production
07/27/2020

Item Numbers 27.a. - 27.i. Mailing Address for the Principal Non-Owner of the Regional Center Entity. Provide
the principal non-owner’s mailing address.
Item Numbers 28. - 31. Contact Information for the Principal Non-Owner of the Regional Center Entity. Provide
the principal non-owner’s current daytime telephone number, fax number, email address, and website address.
NOTE: If there are multiple principal non-owners in the regional center entity, provide the information requested in the
space provided in Part 11. Additional Information.
Part 5. Information About the Regional Center’s Operations

Item Numbers 1. - 5. Aggregate Capital Investment and Job Creation. Provide the following information, in
aggregate, from all sponsored projects:
1. EB-5 investor capital invested through the regional center;
2. Non-EB-5 capital invested through the regional center;

3. Fees, profits, surcharges, or other remittances that have been paid to the regional center or any of its principals,
managing companies or agencies, or agents through the new commercial enterprises into which EB-5 investors have
invested capital;
4. New direct, indirect, and/or induced jobs created through the regional center; and

5. Jobs maintained for EB-5 purposes through the regional center by investment into “troubled businesses.”
NOTE: When reporting job creation, the numbers should reflect the aggregate direct, indirect, and/or induced jobs that
have actually been created by all sponsored projects to date, regardless of whether any petitioners have independently
claimed credit for such jobs on any Form I-526, Immigrant Petition by Alien Investor or Form I-829, Petition by Investor
to Remove Conditions. This calculation should employ the same economic methodology identified when the project was
first submitted to USCIS with Form I-924, Application For Regional Designation Center Under the Immigrant Investor
Program, with an exemplar project or a Form I-526 petition. In cases where a current project is different than what was
contemplated in Form I-924 or Form I-526, the job creation calculation should employ the intended methodology for
related Form I-829.
Where utilized job creation methodologies use inputs of expenditures, revenues, and/or direct jobs, the reported aggregate
jobs created should be the result of those job creating inputs to date. Include a description which explains the prorated
inputs and job creation calculations in relation to the total jobs expected to result from the project.
If there is more than one project sponsored through a regional center or if a particular project’s jobs were not all created
during the Federal fiscal year covered by the form, use the space provided in Part 11. Additional Information to report
the number of jobs created by Federal fiscal year for each sponsored project.
Item Numbers 6. - 17. Industries and Resulting Aggregate Capital Investment and Job Creation. Provide the
following information about the regional center operations:
1. Each industry that has been the focus of EB-5 capital investments sponsored through the regional center;
2. North American Industry Classification System (NAICS) code for each industry;
Form I-924A Instructions 07/23/20 

Page 4 of 10

3. Aggregate amount of EB-5 capital investment for each industry;
4. Aggregate amount of non-EB-5 capital investment for each industry;
5. Aggregate number of direct, indirect, and/or induced jobs created for each industry; and
6. Aggregate number of jobs maintained for EB-5 purposes through investment into “troubled businesses” for each
industry.
Part 6. Information About the New Commercial Enterprise
For each new commercial enterprise associated with the regional center that has received EB-5 investor capital, provide
the following information.

Draft
Not for
Production
07/27/2020

Item Number 1. Name of the New Commercial Enterprise. Provide the name of the new commercial enterprise and
the industry category title.
Item Number 2. New Commercial Enterprise Federal Employer Identification Number. Provide the Federal
Employer Identification Number of the new commercial enterprise.
Item Numbers 3.a. - 3.f. New Commercial Enterprise Mailing Address. Provide the mailing address of the new
commercial enterprise. If the mailing address of the new commercial enterprise is different from its physical address,
provide the physical address of the new commercial enterprise in the space provided in Part 11. Additional Information.
Item Numbers 4. - 10. Other Information. Provide the following information about the new commercial enterprise. If
the regional center oversees more than one new commercial enterprise, provide the requested information for each new
commercial enterprise:
1. Industries that have been the focus of EB-5 capital investment;
2. NAICS code for each industry;

3. Aggregate amount of EB-5 capital investment;

4. Aggregate amount of non-EB-5 capital investment;

5. Aggregate number of direct, indirect, and/or induced jobs created;

6. Aggregate number of jobs that have been maintained for EB-5 purposes through investments into “troubled
businesses”; and
7. Indicate whether the new commercial enterprise will serve as a vehicle for investment into job creating entities that
have or will create or maintain jobs for EB-5 purposes.
Item Numbers 11. - 18. Job Creating Entity. If any new commercial enterprise serves as a vehicle for investment into
other job creating entities, provide the following information for each job creating entity:
1. Name of each job creating entity;
2. Federal Employer Identification Number of each job creating entity;
3. Mailing address and physical address of each job creating entity;
4. Industries of each job creating entity;
5. Aggregate amount of EB-5 capital investment for each job creating entity;
6. Aggregate amount of non-EB-5 capital investment for each job creating entity;
7. Aggregate number of jobs created for each job creating entity; and
8. Aggregate number of jobs maintained for EB-5 purposes through investment into “troubled businesses” for each job
creating entity.

Form I-924A Instructions 07/23/20 

Page 5 of 10

NOTE: When providing the requested job creation data, please refer to NOTE in Part 5. in the Specific Instructions
section for reporting job creation contained in the note to Part 5. above. Additionally, if the reported jobs were not all
created during the Federal fiscal year covered by the form, use the space provided in Part 11. Additional Information to
report the number of jobs created by Federal fiscal year.
Part 7. Petitions Filed by EB-5 Investors
Item Numbers 1. - 2. Immigrant Petition by Alien Investor (Form I-526). Provide the name of each new commercial
enterprise associated with the regional center that has received EB-5 investment capital and the total number of approved,
denied, and revoked Form I-526 petitions filed by EB-5 investors for each new commercial enterprise. If you need extra
space to complete this section, use the space provided in Part 11. Additional Information.

Draft
Not for
Production
07/27/2020

Item Numbers 3. - 4. Petition by Investor to Remove Conditions (Form I-829). Provide the name of each new
commercial enterprise associated with the regional center that has received EB-5 investment capital and the total number
of approved and denied Form I-829 petitions filed by EB-5 investors for each new commercial enterprise. If you need
extra space to complete this section, use the space provided in Part 11. Additional Information.
NOTE: In certain instances, in order to verify the aggregate data provided in this form, USCIS may require case-specific
data relating to individual EB-5 petitions and the job creation and allocation methodologies used by a regional center.
Part 8. Statement, Contact Information, Certification, and Signature of the Authorized Individual
This form must be signed and filed by an authorized individual of the regional center. An “authorized individual” of the
regional center is a principal of the entity previously designated to participate in the Immigrant Investor Program with the
executive managerial authority to complete and execute this form.
Item Numbers 1.a. - 8.b. Select the appropriate box to indicate whether you read this form yourself or whether
you had an interpreter assist you. If someone assisted you in completing the form, select the box indicating that you
used a preparer. Further, you must sign and date this form and provide your title or position held within the regional
center entity, daytime telephone number, mobile telephone number (if any), and email address (if any). Every form
MUST contain the signature of the authorized individual. A stamped or typewritten name in place of a signature is not
acceptable.
Part 9. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1.a. - 7.b. If you used anyone as an interpreter to read the Instructions and questions on this form to you
in a language in which you are fluent, the interpreter must fill out this section; provide his or her name, the name and
address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone
number (if any), and his or her email address (if any). The interpreter must sign and date the form.
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Form, if Other Than the
Authorized Individual of the Regional Center
Item Numbers 1.a. - 8.b. This section must contain the signature of the person who completed your form, if other
than you, the authorized individual of the regional center. If the same individual acted as your interpreter and your
preparer, that person should complete both Part 9. and Part 10. If the person who completed this form is associated
with a business or organization, that person should complete the business or organization name and address information.
Anyone who helped you complete this form MUST sign and date the form. A stamped or typewritten name in place of a
signature is not acceptable. If the person who helped you prepare your form is an attorney or accredited representative,
he or she may also need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited
Representative, along with your form.

Form I-924A Instructions 07/23/20 

Page 6 of 10

Part 11. Additional Information
Item Numbers 1. - 7.d. If you need extra space to provide any additional information within this form, use the space
provided in Part 11. Additional Information. If you need more space than what is provided in Part 11., you may make
copies of Part 11. to complete and file with your form, or attach a separate sheet of paper. Type or print the regional
center entity’s name 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 form to review in the future and for
your records.

Draft
Not for
Production
07/27/2020

What Evidence Must You Submit?

Each regional center must provide USCIS with updated information to demonstrate the regional center is continuing to
promote economic growth, improved regional productivity, job creation, or increased domestic capital investment in the
approved geographic area. Such information must be submitted to USCIS on an annual basis, on a cumulative basis, and/
or as otherwise requested by USCIS, using Form I-924A.
You must submit all evidence requested in these Instructions with your form. If you fail to submit required evidence,
USCIS may reject or deny your form for failure to submit requested evidence or supporting documents in accordance with
8 CFR 103.2(b)(1) and these Instructions.
If you fail to completely fill out your Form I-924A, USCIS may reject your form. USCIS will issue a notice of intent to
terminate the participation of the regional center in the Immigrant Investor Program if a regional center fails to submit the
required information or upon a determination that the regional center no longer serves the purpose of promoting economic
growth, including increased export sales, improved regional productivity, job creation, and increased domestic capital
investment, in accordance with 8 CFR 204.6(m)(6) and these Instructions.

What Is the Filing Fee?

The filing fee for Form I-924A is $4,465.

NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this form. DO NOT MAIL CASH.
You must submit all fees in the exact amounts.
Payments by Check or Money Order
Use the following guidelines when you prepare your check or money order for the Form I-924A filing:
1. The check or money order 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 check or money order 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 Paying by Check. If you send USCIS a check, we 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.

Form I-924A Instructions 07/23/20 

Page 7 of 10

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 your
check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the check is
returned as unpayable, we may reject your application.
How To Check If the Fees Are Correct
Form I-924A’s filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS
fees change periodically, you can verify that the fee is correct by following one of the steps below.
1. Visit the USCIS website at www.uscis.gov, select “FORMS,” and check the appropriate fee; or

Draft
Not for
Production
07/27/2020

2. Visit the USCIS Contact Center at www.uscis.gov/contactcenter to get answers to your questions and connect with a
live USCIS representative. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf
or hard of hearing) call: 1-800-767-1833.

Where To File?

Please see our website at www.uscis.gov/I-924A or visit the USCIS Contact Center at www.uscis.gov/contactcenter to
connect with a USCIS representative for the most current information about where to file this form. The USCIS Contact
Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Address Change

You must notify USCIS of any change to the mailing address of the regional center entity. For information on filing a
change of address, go to the USCIS website at www.uscis.gov/addresschange or reach out to the USCIS Contact Center
at www.uscis.gov/contactcenter for help. The USCIS Contact Center provides information in English and Spanish. 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. If you send notification of an address change to the EB-5 Program mailbox at:
USCIS.ImmigrantInvestorProgram@dhs.gov, you must still notify USCIS as explained at
www.uscis.gov/addresschange.

Processing Information
Form I-924A Processing. Once USCIS accepts your form, we will check it for completeness. If you do not completely
fill out Form I-924A, USCIS may reject your form. If USCIS determines that the regional center no longer serves the
purpose of promoting economic growth, improved regional productivity, job creation, or increased domestic capital
investment in the approved geographic area, USCIS will issue a notice of intent to terminate the participation of the
regional center in the Immigrant Investor Program. If the regional center fails to overcome the grounds alleged in the
notice of intent to terminate, USCIS will terminate the approval and designation of the regional center.
Requests for More Information. USCIS may request that you provide more information or evidence to support your
form. We may also request that you provide the originals of any copies you submit. If we request an original document
from you, it will be returned to you after USCIS determines it no longer needs your original.
Requests for Interview. We may request that you, as the authorized individual, appear at a USCIS office for an interview
based on your form. At the time of any interview or other appearance at a USCIS office, we may require that you, as the
authorized individual, provide your biometrics to verify your identity and/or update background and security checks.

Form I-924A Instructions 07/23/20 

Page 8 of 10

Decision. The decision on Form I-924A involves a determination of whether you have established eligibility for the
continued designation you are seeking. USCIS will notify you of the decision in writing.

USCIS Forms and Information
To ensure you are using the latest version of this form, 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 USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in
English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Draft
Not for
Production
07/27/2020

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at
www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to
set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for
you.

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-924A, we
will deny your Form I-924A 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 Compliance Review and Monitoring

By signing this form, you have stated under penalty of perjury (28 U.S.C. section 1746) that all information and
documentation submitted with this form are complete, true, and correct. You also authorize the release of any information
from the records associated with the regional center that USCIS may need to determine the regional center’s continued
eligibility for designation, and consent to USCIS verifying such information.
DHS has the authority to verify any information you submit to establish continued eligibility for regional center
designation at any time. USCIS’ legal authority to verify this information is in 8 U.S.C. sections 1103, 1155 and 1357;
the Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 1993, Pub. L.
No. 102-395, section 610, 106 Stat 1828, 1874 (1992) (as amended); and 8 CFR Part 103, 204, 205, and 287. To ensure
compliance with applicable laws and authorities, USCIS may verify information before or after your case is decided.
Agency verification methods may include, but are not limited to: review of public records and information; contact
through written correspondence, the Internet, facsimile, other electronic transmission, or telephone; unannounced physical
site inspections of residences and locations of employment; and interviews. USCIS will use information obtained through
verification to assess your compliance with the laws and to determine continued eligibility for regional center designation.
Subject to the restrictions under 8 CFR 103.2(b)(16) and/or 8 CFR 204.6(m)(6), USCIS will provide you with an
opportunity to address any adverse or derogatory information that may result from a USCIS compliance review,
verification, or site visit after a formal decision is made on your case or after the agency has initiated an adverse action
which may result in revocation or termination of an approval.

Form I-924A Instructions 07/23/20 

Page 9 of 10

DHS Privacy Notice
AUTHORITIES: The information requested on this form, and the associated evidence, is collected under Immigration
and Nationality Act, sections 101, 103, and 203 (as amended) and the Departments of Commerce, Justice, and State, the
Judiciary, and Related Agencies Appropriation Act, 1993 Pub. L. No. 102-395, section 610, 106 Stat 1828, 1874 (1992)
(as amended).
PURPOSE: The primary purpose for collecting the requested information on this form is to determine the regional
center’s continued eligibility for regional center designation. DHS uses the information you provide to determine
continued eligibility for regional center designation.

Draft
Not for
Production
07/27/2020

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may adversely impact continued
eligibility for regional center designation.
ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence 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-001 - Alien File, Index, and National
File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments,
which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement
purposes or in the interest of national security.

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 Office of Management and Budget (OMB) control number. The public
reporting burden for this collection of information is estimated at 14 hours per response, for initial and amendment filings,
including the time for reviewing instructions, gathering the required documentation and information, completing the form,
preparing statements, attaching necessary documentation, and submitting the form. The time burden for participating in
compliance reviews, when required, is 24 hours for the review and 16 hours for the site visit. 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. 1615-0061. Do not mail your completed Form I-924A
to this address.

Form I-924A Instructions 07/23/20 

Page 10 of 10