Privacy Act Statement

Draft Privacy Act Statement for Non-Immigrant Checkout Letter (ICE Form G-146)

PRIVACY ACT STATEMENT

AUTHORITY: U.S. Immigration and Customs Enforcement (ICE) is authorized to collect this information by and through the following authorities: sections 101, 222(g), 212(a)(9)B(i)(I) and (II), 214(a)(1), and 217(a)(7) of the Immigration and Nationality Act; and 8 C.F.R. § 215.8(a)(1) and 235.1(f)(1)(ii).

PURPOSE: The purpose of the form is to verify that an alien voluntarily departed the United States pursuant to an order from an Immigration Judge; or to document that an alien did not depart the United States for a valid reason; or to obtain contact information from those with knowledge of the alien’s whereabouts.

ROUTINE USES: Information provided on this form may be used as necessary and is authorized to be used by the routine uses published in the Alien File (A-file), Index, and National File Tracking System of Records Notice (SORN) (78 FR 69864, November 21, 2013). Further, the information on this form may be disclosed as generally permitted under the Privacy Act of 1974, 5 U.S.C. § 552a(b).

DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the requested information may result in ICE being unable to confirm that an alien voluntarily departed the United States or did not depart for a valid reason. Failure to disclose the information on this form may also result in ICE being unable to locate an alien.