Privacy Act Statement

PAS USCIS-N-300 20150910, PVY FINAL.PDF

Application to File Declaration of Intention

Privacy Act Statement

OMB: 1615-0078

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USCIS Privacy Act Statement
N-300

AUTHORITIES: The information requested on this benefit application, and the associated
evidence, is collected pursuant to Section 334 of the Immigration and Naturalization Act 8
U.S.C. 1445, as amended INA § 101.
PURPOSE: The primary purpose for providing the requested information on this form is to
notify USCIS, and certain states, that you intend to become a Unites States Citizen.
DISCLOSURE: The information you provide on this form and submit to USCIS is voluntary.
However, certain states may require the completion of this form prior to engaging in any
business with you. Failure to complete this form does not make you ineligible for USICS
benefits, but may prevent you from engaging in business with the state.
ROUTINE USES: The information you provide on this benefit application may be shared with
other federal, state, local, and foreign government agencies and authorized organizations in
accordance with approved routine uses, as described in the associated published system of
records notices [DHS-USCIS-001 - Alien File (A-File) and National File Tracking System
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.

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File Typeapplication/pdf
File TitlePrivacy Act Statement Template
AuthorCarterJL3
File Modified2015-09-10
File Created2015-09-10

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