I-912 Ins Toc Ext+pn

TABLE OF CHANGES – INSTRUCTIONS

Form I-912, Instructions for Request for Fee Waiver

OMB Number: 1615-0116

1/02/2018

Reason for Revision: I-912 Extension, update to PAS

Current Page Number and Section	Current Text	Proposed Text
Pages 10-11, USCIS Privacy Act Statement	[Page 10] USCIS Privacy Act Statement AUTHORITIES: The information requested on this request, and the associated evidence, is collected under the Immigration and Nationality Act, section 286, and 8 CFR 103.7(c). PURPOSE: The primary purpose for providing the requested information on this request is to determine if you have established eligibility for the immigration benefit for which you are filing. The Department of Homeland Security (DHS) will use the information you provide to grant or deny the immigration benefit you are seeking. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay a final decision in your case or result in denial of your request and rejection of your application or petition based on non-payment of the filing fee. [Page 11] ROUTINE USES: DHS may share the information you provide on this request 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-007 - Benefits Information System and DHS-USCIS-001 - Alien File, Index, and National File Tracking System of Records] 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.	[Page 10] DHS Privacy Notice AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act sections 286 and 8 CFR 103.7(c). 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 in which you are filing. The Department of Homeland Security (DHS) uses the information you provide to grant or deny the immigration benefit you are seeking. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in the denial of your fee waiver and rejection of your application or petition. [Page 11] ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence 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 and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003(b) Integrated Digitization Document Management Program, DHS/USCIS/PIA-015 Computer Linked Application Information Management System, DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System, and DHS/USCIS/PIA-056 USCIS Electronic Information System] which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.

1