Privacy Act Statement

USCIS Privacy Act Statement
Form I-243, Application for Removal

AUTHORITIES: The Immigration and Nationality Act, Section 250 [8 U.S.C. 1260]
authorizes USCIS to collect the information requested on this benefit application, and the
associated evidence.
PURPOSE: The primary purpose for providing the requested information on this form is to
request removal from the United States at the government’s expense due to distress, or need of
public aid from causes arising after your entry. The information you provide will be used to
grant your request.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the
requested information, and any requested evidence, may delay a final decision or result in denial
of your request.
ROUTINE USES: USCIS may disclose the information you provide on this benefit application
to other federal, state, local, and foreign government agencies and authorized organizations in
accordance with approved routine uses, as described in the associated published system of
records notices DHS/USCIS-001 - Alien File, Index, and National File Tracking System of
Records; DHS-USCIS-007 - Benefits Information System and the DHS/ICE-011 - Immigration
Enforcement Operational Records System (ENFORCE), which can be found at
www.dhs.gov/privacy. The information may also be made available, as appropriate for law
enforcement purposes or in the interest of national security.