TABLE OF CHANGES –FORM/INSTRUCTION
Form G-639, Freedom of Information/Privacy Act Request
OMB Number: 1615-0102
05/27/2022
Reason for Revision: Revision (Converting to 1C format FRM combining with Instruction) Project Phase: OMBReview
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Page 1, What is the Purpose of Form G-639? |
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What Is the Purpose of Form G-639?
Use Form G-639 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 allows U.S. citizens or lawful permanent residents to:
1. Request access to information pertaining to themselves in Federal agency records; and
2. Correct or amend their records.
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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What Is the Purpose of Form G-639?
Use Form G-639 to request access to U.S. Citizenship and Immigration Services (USCIS) records under 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, if applicable. You may also use this form to request amendment or correction of records pertaining to you under the PA, if applicable.
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Your Options to Make a FOIA or PA Request with USCIS
You can make a FOIA or PA request:
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Request and Receive Records Faster Online
Our online FOIA and PA services are a more efficient way to request and receive records than by using Form G-639 to make a request.
When you make your request online, USCIS receives it immediately and we can deliver the response to you immediately after the records are processed.
You will also be able to:
Making your request online helps ensure your request contains the required information and reaches us immediately, rather than through a mailed postal delivery. Once you provide the information necessary to process your request, we will add it to the same first-in, first-out processing queue ordinarily used for all requests.
Once we release records you request online, you can use your online account to:
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Page 1, When May I Use Form G-639? |
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When May I Use Form G-639?
You may use Form G-639 to obtain access to USCIS records. You may also use this request to allow to another individual to access USCIS records pertaining to you.
Do not use Form G-639 for the following requests.
1. Status Inquires. Contact the USCIS office where the application or petition was filed or visit https://egov.uscis.gov to check your case status online. You may also 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.
2. Consular Notification of a Visa Petition Approval. Use Form I-824, Application for Action on an Approved Application or Petition, to request consular notification of visa petition approval.
3. Return of Original Documents. Use Form G-884, Request for the Return of Original Documents, to request the return of original documents.
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4. Naturalization Records Before September 27, 1906. Contact the clerk of court where the naturalization occurred to request naturalization records before September 27, 1906.
5. USCIS Manifest Arrivals Before December 1982. Contact the National Archives at https://www.archives.gov/contact to request information on USCIS manifest arrivals before December 1982.
6. Proof of Status for Non-Immigration Benefits. Contact the Federal agency responsible for the benefit (for example, Social Security benefit, Selective Service requirement) to obtain proof of status.
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 www.uscis.gov/foia.
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If You Make Your Request Using This Form
If you complete and submit this form, we will send all correspondence and any records we release through U.S. mail, requiring time for transit and receiving. Unless you specify another format, any records responsive to your request will be sent to you on a CD-ROM, so you will need to use a computer with an optical drive to view them. Alternately, if you request records online (www.uscis.gov/foia) using FIRST, you can download them without the need for equipment other than a computer, smartphone, or tablet that is connected to the internet.
Do not use Form G-639 for:
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Page 1, General Instructions |
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General Instructions
USCIS provides forms free of charge through the USCIS website. 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 asked that we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
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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 6. Additional Information or attach a separate sheet of paper. Type or print the Subject of Record’s 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. |
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General Instructions
USCIS provides forms free of charge through the USCIS website. 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 Contact Center at 1-800-375-5283 (TTY 1-800-767-1833) and ask that we mail a form to you. The USCIS Contact Center provides information in English and Spanish.
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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 the Subject of Record’s 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.
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Page 2, Specific Instructions |
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Specific Instructions
Form G-639 is divided into six parts. The following information will help you complete the request.
Providing the information requested on Form G-639 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.b. 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. Indicate whether you are the Subject of Record. If you answer “No,” indicating you are requesting access to another individual’s records, complete 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. - 3.c. Representative Role to the Subject of Record. Select the appropriate box to indicate your representative role to the Subject of the Record:
1. An attorney eligible to practice law in, and a member of good standing of, the bar of the highest courts of a state, possession, territory, commonwealth, or District of Columbia;
2. An accredited representative of a qualified religious, charitable, social service, or similar organization established in the United States, so recognized by the Department of Justice, Board of Immigration Appeals, in accordance with 8 CFR 292.2.; or
3. A family member or caretaker.
Proof of Parentage. If a parent is filing on behalf of a minor child, then he or she must submit proof of parentage. Proof of parentage may be in the form of a birth certificate, adoption decree, or similar document naming the requester as the legal parent. If a guardian is filing on behalf of his or her ward, he or she must submit proof of guardianship. The signature of the parent/guardian must be notarized or signed under penalty of perjury (6 CFR section 5.21(e)). Proof of parentage may be submitted under Part 6. Additional Information.
Select the appropriate box to provide further information regarding your representative role to the subject of the record.
Item Numbers 4.a. - 4.c. Requestor’s Full Name. Provide your full legal name in the spaces provided.
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Item Numbers 5.a. - 5.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 6. - 8. Requestor’s Contact Information. Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
Item Numbers 9.a. - 9.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 prevent USCIS from locating the records or information requested.
Item Number 1. Purpose. State the purpose of your request. 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. - 4.c. Other Names Used by the Subject of Record. Provide other names the Subject of Record has used since birth, including any nicknames, aliases, and maiden name (if applicable). If you need extra space to complete this section, use the space provided in Part 6. Additional Information.
Item Numbers 5.a. - 5.c. Full Name of the Subject of Record at Time of Entry into the United States. If his or her name has changed since he or she entered the United States, provide the full name he or she used at the time of entry into the United States.
Item Numbers 6.a. - 6.b. Form I-94, Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or USCIS issued him or her a Form I-94, Arrival-Departure Record, provide his or her Form I-94 number and date that his or her authorized period of stay expires or expired (as shown on your Form I-94). The Form I-94 number also is known as the Departure Number on some versions of Form I-94.
NOTE: If he or she was admitted to the United States by CBP at an airport or seaport after April 30, 2013, CBP may have issued him or her an electronic Form I-94 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 you cannot obtain his or her Form I-94 from the CBP website, you may obtain it by filing Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a fee for this service. See the USCIS website at www.uscis.gov/I-102 for more information.
Passport and Travel Document Numbers. If he or she used a passport or travel document to travel to the United States, enter either the passport or travel document information in the appropriate space on the request, even if the passport or travel document is currently expired.
Item Number 7. 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 he or she was issued an A-Number, type or print it in the spaces provided. If he or she does not have an A-Number, or if he or she does not remember it, leave this space blank.
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Item Number 8. USCIS Online Account Number (if any). If he or she has previously filed an application or petition using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number he or she was issued by the system. He or she can find his or her USCIS Online Account Number by logging in to his or her account and going to the profile page. If he or she previously filed certain applications or petitions on a paper form through a USCIS Lockbox facility, he or she may have received a USCIS Online Account Access Notice issuing him or her a USCIS Online Account Number. He or she may find his or her USCIS Online Account Number at the top of the notice. The USCIS Online Account Number is not the same as an A-Number. If he or she was issued a USCIS Online Account Number, enter it in the space provided.
Item Number 9. Application or Petition Receipt Number. Provide the USCIS receipt number that corresponds to any application or petition he or she previously filed with USCIS.
Item Numbers 10.a. - 13. Information About Family Members that May Appear on Requested Records. Provide the family member’s full name and his or her relationship to the Subject of Record 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 6. Additional Information.
Item Numbers 14.a. - 15.d. Parents’ Names for the Subject of Record. Provide the full names of his or her father and mother in the spaces provided. If applicable, include his or her mother’s maiden name.
Item Number 16. Describe the records you are seeking. If you need additional space, use the space provided in Part 6. Additional Information.
Part 4. Verification of Identity and Subject of Record Consent
If you are the Subject of Record and requesting records about yourself, you must verify your identity by providing the information requested in addition to Item Numbers 1.a. - 4.i. You must also sign your request and have your signature notarized OR submitted under penalty of perjury in Item Number 8.a. or 8.b.
If you are NOT the Subject of Record but are requesting records on behalf of that individual, you must still provide a statement from the individual verifying his or her identity and certifying the individual’s agreement that USCIS may release his or her records to you. Again, you may fulfill these requirements by completing Item Numbers 1.a. - 4.i. and having the individual complete Item Numbers 8.a. or 8.b.
If the Subject of Record is deceased, select Item Number 8.c. and attach appropriate proof of death, such as an obituary or a death certificate with your request.
NOTE: If your request is NOT on behalf of the individual whose records you seek, you may use the space provided in Part 6. Additional Information to provide additional information you want USCIS to consider in processing your request. You should also attach any documentation in support of your request. For example, if you believe disclosure of the Subject of Record’s information would further a public interest recognizable under FOIA, you may use Part 6. to explain the public interest and 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 appear based on your responses in Part 3., Item Numbers 2.a. - 2.c.
Item Number 2. Date of Birth. Provide the date of birth (mm/dd/yyyy) of the subject of record.
Item Number 3. Country of Birth. Provide the country of birth of the subject of record.
Item Numbers 4.a. - 4.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.
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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 6.a. OR Item Number 6.b., regardless if you submit this request for yourself or on behalf of another individual. If the Subject of Record is deceased, select Item Number 6.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 at www.justice.gov/oip/forms/cert_ind.pdf. 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. Processing Information
Item Number 1. Select the box next to any of the circumstances that apply to your request. USCIS may consider your request for expedited processing if any of these circumstances apply.
Item Number 2. If you have a pending Immigration Court hearing, submit a copy of one of the following documents with your Form G-639: I-862, Notice to Appear; Form I-122, Order to Show Cause; Form I-863, Note of Referral to Immigration Judge, or a written notice of continuation of a future scheduled hearing before the immigration judge.
Part 6. Additional Information
Item Numbers 1.a. - 7.d. If you need extra space to provide any additional information within this request, use the space provided in Part 6. Additional Information. If you need more space than what is provided in Part 6., you may make copies of Part 6. to complete and file with your request, or attach a separate sheet of paper. Type or print the Subject of Record’s 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.
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Page 5, What Is the Filing Fee? |
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What Is the Filing Fee?
There is no filing fee for Form G-639.
Processing Fees
Please do not send any fees payment at the time of your request. After receiving your FOIA request, USCIS will contact you if any fees are required.
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 FOIA/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 costs for searches, duplication, and/or review is more than $14, and by submitting Form G-639, you as the requestor agree to pay for fees up to $25. If total anticipated fees are more than $250, or you have failed to pay for fees in the past, USCIS may request an advance deposit. Also, USCIS will not process any Form G-639 until the requestor pays all unpaid fees from any of their prior requests.
NOTE: The processing fees are not refundable, regardless of any action USCIS takes on this request. DO NOT MAIL CASH. You must submit all fees in the exact amounts.
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Payments by Check or Money Order
Use the following guidelines when you prepare your check or money order for the Form G-639 processing fees:
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 Treasury of the United States.
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.
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, we will re-submit the payment to the financial institution one time. If the check is returned as unpayable a second time, we will reject your Form G-639 and charge you a returned check fee.
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Page 6, Where To File? |
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Where To File?
Please see our website at www.uscis.gov/G-639 or visit the USCIS Contact Center at www.uscis.gov/contactcenter for the most current information about where to file this request. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
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Page 6, Processing Information |
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Processing Information
Requests for More Information. We may request that you provide more information or evidence to support your request. 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.
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Page 6, USCIS Forms and Information |
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USCIS Forms and Information
You can get USCIS forms and immigration-related information on the USCIS Internet website at www.uscis.gov. 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
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Read the Entire Form and Complete as Much as Possible
The information USCIS requests in this form helps us locate the records and information you request.
You are not required to respond to every item, but if you do not provide enough information we may:
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Page 1, Part 1. Type of Request
Page 4, Part 5. Processing Information |
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START HERE - Type or print in black ink.
Part 1. Type of Request
Select only one box.
NOTE: If you are filing this request on behalf of another individual, respond as it would apply to that individual.
1.a. Freedom of Information Act (FOIA)/Privacy Act (PA) 1.b. Amendment of Record (PA only)
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[Form G-639, Page 4, Part 5. Processing Information]
1. Indicate if any of these circumstances apply to your request (Select all that apply).
[] Circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to the life or physical safety of the individual.
[] An urgency to inform the public about an actual or alleged Federal government activity, if made by a person primarily engaged in disseminating information.
[] The loss of substantial due process rights.
[] A matter of widespread and exceptional media interest in which there exists possible questions about the government's integrity which affects public confidence.
Submit a certified, detailed statement regarding the basis for your request with your Form G-639.
2. Do you have a pending Immigration Court hearing date? Yes No
If you answered “Yes” to Item Number 2., submit a copy of one of the following documents with your Form G-639: I-862, Notice to Appear; Form I-122, Order to Show Cause; Form I-863, Note of Referral to Immigration Judge, or submit a written notice of continuation of a future scheduled hearing before the immigration judge.
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START HERE - Type or print in black ink.
Part 1. Specify the Nature of your Request
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NOTE: On this form, the individual to whom a record pertains is described as the subject of record.
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1. Select Type of Request
Select the box that indicates the nature of your request, and the type of records you are requesting. If you need extra space to complete this section, use the space provided in Part 5. Additional Information.
[] A. Information from your own immigration record; [] B. Information from another person’s immigration record; [] C. USCIS business, operational, or policy records; [] D. An amendment or correction of your record under the Privacy Act; [Fillable field] [] E. An amendment or correction of another person’s immigration record on their behalf under the Privacy Act; [Fillable field] or [] F. Other records in USCIS custody. [Fillable field]
If you selected Item B. or E in Item Number 1., complete Part 4. Third-Party Requestor, along with other pertinent sections of this form.
If you selected Item A., C., D., or F. in Item Number 1., do not complete Part 4. Third-Party Requestor section of this form.
2. Request Specific Documents
If you request specific documents, USCIS will usually be able to process your request faster than if you a request a large set of records, such as an entire A-File.
Select the types of records you are requesting, if applicable, from this list of commonly requested records:
[] Apprehensions, and Date of Apprehension (mm/dd/yyyy) [] Birth certificate [] I-94, with Date of Entry (mm/dd/yyyy) [] Passport [] Other Arrival/Departure documents into the U.S., with Date of Entry (mm/dd/yyyy) [] I-129, Petition for a Nonimmigrant Worker [] I-90, Application to Replace Permanent Resident Card (Green Card) [] I-130, Petition for Alien Relative [] I-140, Immigrant Petition for Alien Workers [] I-485, Application to Register Permanent Residence or Adjust Status [] I-751, Petition to Remove Conditions on Residence [] N-400, Application for Naturalization [] Labor certification issued by the U.S. Department of Labor [] Naturalization certificate [] Proof of Lawful Permanent Resident (LPR) status [] Record of removal from the U.S., with Date of Removal (mm/dd/yyyy) [] Other (Explain): [Fillable field]
If you need extra space to complete this section, use the space provided in Part 5. Additional Information.
3. Qualifications for Expedited Processing
Select any of the following circumstances if applicable to your request:
[] Circumstances in which the lack of expedited processing could reasonably be expected to pose an imminent threat to the life or physical safety of an individual.
[] An urgency to inform the public about an actual or alleged Federal government activity, if made by a person primarily engaged in disseminating information.
[] The loss of substantial due process rights.
[] A matter of widespread and exceptional media interest in which there are 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.
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4. Statement Requesting Expedited Processing
To receive expedited processing, you must further explain why you are requesting it. In Part 5. Additional Information, type or print a detailed statement explaining your selection in Item Number 3.
5. Information Pertaining to an Upcoming Immigration Court Proceeding
If the subject of record has an upcoming immigration court proceeding, USCIS may be able to process the request on an accelerated track. Select the box if the following circumstance applies to your request.
[] The subject of record has a date scheduled for an immigration court proceeding.
If selected, include a copy of one of the following forms, as issued by the U.S. Department of Homeland Security or U.S. Department of Justice, with your request:
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Page 1, Part 2. Requestor Information
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Pages 2-3, Part 3. Description of Records Requested
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Page 3, Part 4. Verification of Identity and Subject of Record Consent
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Page 3, Specific Instructions |
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Part 2. Requestor Information
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1. Are you the Subject of Record for this request? Yes No
If you answered "Yes" to Item Number 1., skip to Part 3. If you answered "No" to Item Number 1., provide the information requested in Part 2., Item Numbers 2.a. - 3.c.
Requestor's Full Name
4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name
Requestor's Mailing Address
5.a. In Care Of Name (if any) 5.b. Street Number and Name 5.c. Apt./Ste./Flr. 5.d. City or Town 5.e. State 5.f. ZIP Code 5.g. Province 5.h. Postal Code 5.i. Country
Requestor's Contact Information
6. Requestor's Daytime Telephone Number
7. Requestor's Mobile Telephone Number (if any)
8. Requestor's Email Address (if any)
Requestor's Certification
By my signature, I consent to pay all costs incurred for search, duplication, and review of documents up to $25. (See the What Is the Filing Fee section in the Form G-639 Instructions for more information.)
9.a. Requestor's Signature 9.b. Date of Signature (mm/dd/yyyy)
[Form G-639, Part 3. Description of Records Requested, Pages 2]
7. Alien Registration Number (A-Number) (if any)
[Page 3, Specific Instructions]
Item Number 7. 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 he or she was issued an A-Number, type or print it in the spaces provided. If he or she does not have an A-Number, or if he or she does not remember it, leave this space blank.
[Form G-639, Part 4. Verification of Identity and Subject of Record Consent, Page 3]
2. Date of Birth (mm/dd/yyyy)
3. Country of Birth
[Form G-639, Part 3. Description of Records Requested, Pages 2-3]
9. Application or Petition Receipt Number
6.b. Passport or Travel Document Number
[Page 3, Specific Instructions]
Passport and Travel Document Numbers. If he or she used a passport or travel document to travel to the United States, enter either the passport or travel document information in the appropriate space on the request, even if the passport or travel document is currently expired.
6.a. Form I-94 Arrival-Departure Record Number
If U.S. Customs and Border Protection (CBP) or USCIS issued him or her a Form I-94, Arrival-Departure Record, provide his or her Form I-94 number and date that his or her authorized period of stay expires or expired (as shown on your Form I-94). The Form I-94 number also is known as the Departure Number on some versions of Form I-94.
NOTE: If he or she was admitted to the United States by CBP at an airport or seaport after April 30, 2013, CBP may have issued him or her an electronic Form I-94 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 you cannot obtain his or her Form I-94 from the CBP website, you may obtain it by filing Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a fee for this service. See the USCIS website at www.uscis.gov/I-102 for more information.
[Form G-639, Part 3. Description of Records Requested, Pages 2-3]
While you are not required to respond to every Item Number in Part 3., failure to provide complete and specific information may delay processing of your request or prevent U.S. Citizenship and Immigration Services (USCIS) from locating the records or information requested.
1. State the purpose of your request.
NOTE: This field is optional. However, providing this information may assist USCIS in locating the records and information needed to respond to your request.
Full Name of the Subject of Record
2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name
Other Names Used by the Subject of Record (if any)
Provide all other names the Subject of Record has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 6. Additional Information.
3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name
4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name
Full Name of the Subject of Record at Time of Entry into the United States
5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name
Other Information About the Subject of Record
8. USCIS Online Account Number (if any)
[New]
Parents' Names for the Subject of Record
Father
14.a. Family Name (Last Name) 14.b. Given Name (First Name) 14.c. Middle Name
[Page 3]
Mother
15.a. Family Name (Last Name) 15.d. Maiden Name (if applicable) 15.b. Given Name (First Name) 15.c. Middle Name
Information About Family Members that May Appear on Requested Records
For example, provide the requested information about a spouse or children. If you need extra space to complete this section, use the space provided in Part 6. Additional Information.
Family Member 1
10.a. Family Name (Last Name) 10.b. Given Name (First Name) 10.c. Middle Name
11. Relationship
Family Member 2
12.a. Family Name (Last Name) 12.b. Given Name (First Name) 12.c. Middle Name
13. Relationship
16. Describe the records you are seeking. If you need additional space, use the space provided in Part 6. Additional Information.
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[Page X]
Part 2. Provide Information to Identify the Subject of Record
The individual to whom a record pertains is described as the subject of record. The more information you provide about the subject of record, the better USCIS can identify the records you are requesting.
[Delete]
Subject of Record’s Identifying Information
1. Alien Registration Number (A-Number):
USCIS issues Alien Registration Numbers, otherwise known as an “A-Number,” to persons who apply for, or are granted, certain immigration benefits. U.S. Customs and Border Protection (CBP) or U.S. Immigration and Customs Enforcement (ICE) may also issue A-Numbers. If the subject of record was issued an A-Number(s), type or print it in the spaces provided. If they do not have an A-Number, or do not remember it, leave this space blank.
[A-Number] [Additional A-Number] [Additional A-Number]
2. Date of Birth (mm/dd/yyyy)
3. Country of Birth
Provide the name of the country where the subject of record was born. If the country’s name has changed or the country no longer exists, list the country as it was named when the subject of record was born.
[Fillable field]
4. Receipt Number
Provide the USCIS receipt number that corresponds to any request the subject of record filed with USCIS.
A. [Receipt Number] B. [Additional Receipt Number] C. [Additional Receipt Number]
[Delete]
Subject of Record
5. Subject of Record’s Name
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
6. Additional Names Used
If applicable, list any additional names the subject of record has used, including any nicknames, aliases, and maiden name, in Item Number 8. If the subject’s name has changed since they entered the United States, indicate the name used at the time of entry in Item Number 9. If you need extra space to complete this section, use the space provided in Part 5. Additional Information.
A. Additional Name 1 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
B. Additional Name 2 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
C. Additional Name 3 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
7. Name Used Upon Entry to the United States
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) [delete]
Subject of Record’s Mailing Address and Contact Information
8. List the subject’s contact information. You may list a valid residence, Army Post Office (APO), Fleet Post Office (FPO), or commercial address in the United States. You may list a post office address (PO Box) if that is how the subject receives their mail.
Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country Telephone Number Email Address
9. Subject of Record’s Father
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) [] Father’s Name is unknown.
10. Subject of Record’s Mother
Family Name (Last Name) Maiden Name, or previous last names Given Name (First Name) Middle Name (if applicable) [] Mother’s Name is unknown.
11. Additional Family Members that May Appear on Requested Records
Provide the family member’s full name and their relationship to the subject of record for any individual that may appear on the requested records, for example, a spouse or children.
A. Name 1
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Relationship
B. Name 2
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Relationship
C. Name 3 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Relationship
If you need extra space to complete this section, use the space provided in Part 5. Additional Information.
12. Avoiding Redaction of Records Mentioning Additional Persons
To protect the privacy of each person mentioned in records we release, we redact their information unless you provide:
Include these documents with this Form G-639 and complete pertinent sections of Part 5. Additional Information.
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Page 2, Part 3. Description of Records Requested
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Page 5, What Is the Filing Fee? |
[Page 2]
Part 3. Description of Records Requested
[G-639 Instructions, What Is the Filing Fee?, Page 5]
Please do not send any fees payment at the time of your request. After receiving your FOIA request, USCIS will contact you if any fees are required.
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 FOIA/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 costs for searches, duplication, and/or review is more than $14, and by submitting Form G-639, you as the requestor agree to pay for fees up to $25. If total anticipated fees are more than $250, or you have failed to pay for fees in the past, USCIS may request an advance deposit. Also, USCIS will not process any Form G-639 until the requestor pays all unpaid fees from any of their prior requests.
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[Page X]
Part 3. Certification of Request and Consent to Release, Amend, or Correct Records
Requestor Consent to Pay Potential Fees
USCIS will contact you with instructions if any fees are required. Please do not send any payment at the time of your request.
In accordance with Department of Homeland Security Regulations, your request constitutes an agreement to pay any fees that may be chargeable up to $25.00. We may charge fees for searching for records at the respective clerical, professional, and/or managerial rates of $4.00/$7.00/$10.25 per quarter hour, and for duplication of copies at the rate of $.10 per copy. We do not charge for the first 100 copies and two hours of search time, and the remaining combined charges for search and duplication must exceed $14.00 before we will charge you any fees. Search and processing fees are not applicable for Privacy Act requests. 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. USCIS will not process any Form G-639 until you pay all fees from prior requests.
[] I, the requestor, consent to pay all costs incurred for search, duplication, and review of documents up to $25.
Declaration that the Request is True and Complete
If you are the subject of record and requesting records about yourself or requesting a correction or amendment of your records, you must verify your identity by providing the information requested in Part 2., Item Number 7. You MUST also sign your request below and have your signature notarized OR submitted under penalty of perjury.
Sign and date the request. A stamped or typewritten name in place of a signature is not acceptable.
I certify, swear, or affirm, under penalty of perjury under the laws of the United States of America, that the information in this request is complete, true, and correct.
1. Signature of Requestor Date of Signature (mm/dd/yyyy)
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Page 2, Part 2. Requestor Information
And
Page 3, Part 4. Verification of Identity and Subject of Record Consent
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[Page 2]
Part 4. Verification of Identity and Subject of Record Consent
Provide the information requested in Item Numbers 1.a. - 7. In addition, the Subject of Record MUST sign in Item Numbers 8.a. - 8.c.
Full Name of the Subject of Record
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
Other Information for the Subject of Record
2. Date of Birth (mm/dd/yyyy)
3. Country of Birth
Mailing Address for the Subject of Record
4.a. In Care Of Name (if any) 4.b. Street Number and Name 4.c. Apt./Ste./Flr. 4.d. City or Town 4.e. State 4.f. ZIP Code 4.g. Province 4.h. Postal Code 4.i. Country
Contact Information for the Subject of Record
NOTE: Providing this information is optional.
5. Daytime Telephone Number 6. Mobile Telephone Number (if any) 7. Email Address (if any)
[Page 4]
Signature of the Subject of Record
Select only one box.
NOTE: The Subject of Record MUST provide a signature in Item Number 8.a. OR Item Number 8.b. If the Subject of Record is deceased, select Item Number 8.c. and attach an obituary, death certificate, or other proof of death.
8.c. [] Deceased Subject of Record
[New]
[Form G-639, Part 2. Requestor Information, Page 1]
Representative Role to the Subject of Record
Select your representative role to the Subject of the Record.
2.a. An Attorney 2.b. An Accredited Representative of a Qualified Organization 3.b. I am requesting information on behalf of someone who is deceased. 3.a. I am requesting information on behalf of my child or a minor I have guardianship over.
2.c. A Family Member
Select the appropriate box to provide further information regarding your representative role to the Subject of the Record.
3.c. I am requesting information on behalf of someone for whom I have power of attorney.
[new]
[Form G-639, Part 4. Verification of Identity and Subject of Record Consent, Page 4]
8.b. [] Declaration Under Penalty of Perjury
By my signature, I consent to USCIS releasing the requested records to the requestor (if applicable) named in Part 2. If filing this request on my own behalf, I also consent to pay all costs incurred for search, duplication, and review of documents up to $25. (See the What Is the Filing Fee section in the Form G-639 Instructions for more information.)
I certify, swear, or affirm, under penalty of perjury under the laws of the United States of America, that the information in this request is complete, true, and correct.
Signature of Subject of Record Date of Signature (mm/dd/yyyy)
8.a. [] Notarized Affidavit of Identity
IMPORTANT: Do NOT sign and date below until the notary public provides instructions to you.
By my signature, I consent to USCIS releasing the requested records to the requestor (if applicable) named in Part 2. If filing this request on my own behalf, I also consent to pay all costs incurred for search, duplication, and review of documents up to $25. (See the What Is the Filing Fee section in the Form G-639 Instructions for more information.)
Signature of Subject of Record Date of Signature (mm/dd/yyyy) Subscribed and sworn to before me on this______day of________in the year________.
Signature of Notary Daytime Telephone Number My Commission Expires on (mm/dd/yyyy)
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[Page X]
Part 4. Third-Party Requestor
[Delete]
1. Third-Party Requestor Identifying Information
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
2. Third-Party Requestor Mailing Address and Contact Information
In Care Of Name (if any) Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country Telephone Number Email Address
3. Third-Party Requestor’s Relationship to the Subject of Record
What is the relationship of the subject of record to the third-party requestor?
If you are requesting information or amendment or correction of records on behalf of the subject of record (select only one for Items A. – F.):
[] A. I am an attorney or accredited representative, acting on behalf of the subject of record [] B. I am requesting information about someone who is deceased; [] C. I am requesting information on behalf of my child or a minor for whom I am a legal guardian [] D. Other (Explain): [Fillable field]
If you are requesting information about a subject of record with whom you have no relationship:
[] E. I am requesting as a member of the media
[] F. Other (Explain): [Fillable field]
If you selected Item B. in Item Number 3., provide proof they are deceased, with a death certificate, obituary, photograph of a funeral memorial or monument; or screen print from the Social Security Death Index; or probate documents filed in court. This is not required if they were born more than 100 years before you submit this form.
4. If you selected Item C. in Item Number 3., you must provide proof of parentage/guardianship, such as a birth certificate, adoption decree, or similar document naming the requestor as the legal parent or guardian. You must also provide:
A. Parent/Guardian’s Family Name (Last Name) Parent/Guardian’s Given Name (First Name) Parent/Guardian’s Middle Name (if applicable) B. Parent/Guardian’s Date of Birth (mm/dd/yyyy) C. Parent/Guardian’s Country of Birth [Fillable field]
Consent by Subject of Record to Release Records to a Third-Party Requestor or Allow Amendment or Correction of Records by a Third-Party Requestor
USCIS generally requests that third-party requestors prove they have the subject of the record’s consent to receive the records. Alternately, third-party requestors must prove the subject of record is deceased, or otherwise demonstrate that the requested records are subject to release, such as when there is no privacy interest in the records, or if there is a public interest in the records that outweighs the subject’s privacy interests. Consent by the subject of record is generally not requested if the subject of record’s birthdate is more than 100 years before the submission of this request. Third party requestors who are seeking amendment or correction of records pertaining to the subject of record must demonstrate that they have the subject of record’s consent and that they are acting on behalf of the subject of record.
To provide consent, complete one of the following options:
Option 1: Declaration Under Penalty of Perjury
[] I, the subject of record, consent to USCIS releasing my records to a third-party requestor and/or allowing amendment or correction of my records by a third-party requestor, as named in Part 4.
[deleted]
Signature of Subject of Record Date of Signature (mm/dd/yyyy)
Option 2: Notarized Affidavit of Identity
IMPORTANT: Do NOT sign and date below until the notary public provides you with instructions.
By my signature, I consent to USCIS releasing my records to a third-party requestor and/or allowing amendment or correction of the requested records to the third-party requestor, as named in Part 4.
6. Signature of Subject of Record 7. Date of Signature (mm/dd/yyyy) 8. Subscribed and Sworn to Before Me on (mm/dd/yyyy)
9. Signature of Notary 10. Notary’s Telephone Number 11. My Commission Expires on (mm/dd/yyyy)
If you need extra space to complete this section, use the space provided in Part 5. Additional Information.
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Page 5, Part 6. Additional Information |
[Page 5]
Part 6. Additional Information
If you need extra space to provide any additional information within this request, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Type or print the Subject of Record's name and his or her 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.
1.a. Subject of Record's Family Name (Last Name) 1.b. Subject of Record's Given Name (First Name) 1.c. Subject of Record's Middle Name
2. Subject of Record's A-Number (if any)
3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number 4.d.
5.a. Page Number 5.b. Part Number 5.c. Item Number 5.d.
6.a. Page Number 6.b. Part Number 6.c. Item Number 6.d.
7.a. Page Number 7.b. Part Number 7.c. Item Number 7.d.
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[Page X]
Part 5. Additional Information
If you need extra space to provide any additional information within this request, use the space below. You may also make copies of this page to complete this request or attach a separate sheet of paper.
If you attach additional paper:
1. Subject of Record's Family Name (Last Name) Subject of Record's Given Name (First Name)
Subject of Record's Middle Name
2. Subject of Record's A-Number (if any)
3.A. Page Number B. Part Number C. Item Number D.
4.A. Page Number B. Part Number C. Item Number D.
5.A. Page Number B. Part Number C. Item Number D.
6.A. Page Number B. Part Number C. Item Number D.
7.A. Page Number B. Part Number C. Item Number
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Page 6, DHS Privacy Notice
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[Page 6]
DHS Privacy Notice
AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Freedom of Information Act (FOIA), 5 U.S.C. Section 552, and the Privacy Act of 1974 (PA), 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).
PURPOSE: The primary purpose for providing the requested information on this form is to request access to information under the FOIA and/or PA. DHS uses the information you provide to grant or deny the information request you are seeking.
[Page 7]
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay access to information or result in denial of your information request.
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/ALL-001 DHS FOIA and Privacy Act Record System and DHS/ALL-037 E-Authentication Records System of Records] and the published privacy impact assessments [DHS/USCIS/PIA-077 FOIA Immigration Records System (FIRST) and DHS/ALL/PIA-038 FOIA/PA Information Processing System], 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.
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[Page X]
DHS Privacy Notice
AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Freedom of Information Act (FOIA), 5 U.S.C. Section 552, and the Privacy Act of 1974 (PA), 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).
PURPOSE: The primary purpose for providing the requested information on this form is to request access to information under the FOIA and/or PA, or amendment or correction of records under the PA. DHS uses the information you provide to grant or deny the information request you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay access to information or result in denial of your information or amendment request.
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/ALL-001 DHS FOIA and Privacy Act Record System and DHS/ALL-037 E-Authentication Records System of Records] and the published privacy impact assessments [DHS/USCIS/PIA-077 FOIA Immigration Records System (FIRST) and DHS/ALL/PIA-038 FOIA/PA Information Processing System], 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.
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Page 7, Paperwork Reduction Act |
[Page 7]
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 40 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No. 1615-0102. Do not mail your completed Form G-639 to this address.
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[Page X]
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 40 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; 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 |
| Author | Ketchum, Joshua A |
| File Modified | 0000-00-00 |
| File Created | 2022-06-24 |