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Privacy Act Notice
AUTHORITIES: The information requested on this immigration benefit application form, and
the associated evidence, is collected under Immigration and Naturalization Act (INA) sections
101 and 244. INA section 264(f) (8 USC 1304(f)) also provides the Secretary of Homeland
Security with the authority to collect Social Security number (SSN) information for aliens who
will be submitting this form .
PURPOSE: The primary purpose for obtaining the requested information on this benefit form is
to determine whether the applicant have established eligibility for Temporary Protected Status
(TPS) if you have not yet been granted TPS. This form and the information requested is also
used to determine whether current TPS beneficiaries who are filing for TPS re-registration are
continuing to maintain TPS eligibility. If you do not currently have TPS, DHS will use the
information you provide to grant or deny the benefit you are seeking. If you have TPS and are
filing for re-registration, DHS will use the information provided to determine whether you are
continuing to maintain TPS eligibility or whether to deny your TPS re-registration and withdraw
your existing TPS.
ROUTINE USES: Consistent with TPS confidentiality requirements in 8 CFR Section 244.16
and other relevant legal authorities, DHS may share the information you provide on this benefit
form, including supporting documentation you provide, 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 of Records and DHS/USCIS-007 - Benefits
Information System] which you can find at www.dhs.gov/privacy. DHS may also share the
information, as appropriate, for law enforcement purposes or in the interest of national security.
DISCLOSURE: The information you provide, including your SSN, is voluntary. However,
failure to provide the requested information, and any other information that DHS may later
request for purposes of adjudicating your application, may delay a final decision or result in
denial of your application.