Fee
Waiver Additional Information
The
collection of information on fee waiver requests is covered
by the Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et
seq.),
as amended; OMB No. 1615-0116; Expires 10/31/2012.
Any
personally identifiable information (PII) that is
collected, used, maintained, and/or disseminated through
fee waiver requests is covered by the Privacy Act of 1974
(5 U.S.C. 552a), as amended.
USCIS
Privacy Act Statement
AUTHORITIES:
Section 286 of the Immigration and Nationality Act, as
amended and 8 C.F.R. 103.7(c) authorize USCIS to collect
the information and associated evidence on this form.
PURPOSE:
The primary purpose for providing the requested
information on this form is to determine if you have
established eligibility for a fee waiver for the
associated immigration benefit for which you are filing.
DISCLOSURE:
The information you provide is voluntary. However,
failure to provide the requested information may delay a
final decision or result in the denial of the fee waiver
request and rejection of your application or petition
based on non-payment of the fee.
ROUTINE
USES:
The information you provide on this form may be shared
with other Federal, State, local and foreign government
agencies in accordance with approved routine uses, as
described in the associated published system of records
notice [DHS/USCIS/ICE/CBP-001 - Alien File, Index, and
National File Tracking and DHS-USCIS-007 - Benefits
Information System of Records], 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.
Paperwork
Reduction Act
An
agency may not conduct or sponsor an information
collection, and a person is not required to respond to a
collection of information unless it displays a currently
valid OMB control number. The public reporting burden for
this collection of information is estimated at 1 hour and
10 minutes per response, including the time for reviewing
instructions and completing and submitting the form. 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. 1615-0116. Do
not mail your completed Form I-912 to this address.
This
page can be found at http://www.uscis.gov/[new
quick link]
Last
updated: 04/19/2013
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