Privacy Threshold Analysis

Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD ANALYSIS (PTA)
This form serves as the official determination by the DHS Privacy Office to
identify the privacy compliance requirements for all Departmental uses of
personally identifiable information (PII).
A Privacy Threshold Analysis (PTA) serves as the document used to identify
information technology (IT) systems, information collections/forms, technologies,
rulemakings, programs, information sharing arrangements, or pilot projects that involve
PII and other activities that otherwise impact the privacy of individuals as determined by
the Chief Privacy Officer, pursuant to Section 222 of the Homeland Security Act, and to
assess whether there is a need for additional Privacy Compliance Documentation. A PTA
includes a general description of the IT system, information collection, form, technology,
rulemaking, program, pilot project, information sharing arrangement, or other Department
activity and describes what PII is collected (and from whom) and how that information is
used and managed.
Please complete the attached Privacy Threshold Analysis and submit it to your
component Privacy Office. After review by your component Privacy Officer the PTA is sent
to the Department’s Senior Director for Privacy Compliance for action. If you do not have a
component Privacy Office, please send the PTA to the DHS Privacy Office:
Senior Director, Privacy Compliance
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
Tel: 202-343-1717
[email protected]
Upon receipt from your component Privacy Office, the DHS Privacy Office will review this
form and assess whether any privacy compliance documentation is required. If compliance
documentation is required – such as Privacy Impact Assessment (PIA), System of Records
Notice (SORN), Privacy Act Statement, or Computer Matching Agreement (CMA) – the DHS
Privacy Office or component Privacy Office will send you a copy of the relevant compliance
template to complete and return.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Privacy Threshold Analysis (PTA)

Specialized Template for
Information Collections (IC) and Forms
The Forms-PTA is a specialized template for Information Collections and Forms. This
specialized PTA must accompany all Information Collections submitted as part of the
Paperwork Reduction Act process (any instrument for collection (form, survey,
questionnaire, etc.) from ten or more members of the public). Components may use this PTA
to assess internal, component-specific forms as well.
Form Number:

Form I-601A

Form Title:
Component:

Application for Provisional Unlawful Presence Waiver
U.S. Citizenship and
Office:
Service Center
Immigration Services
Operations
(USCIS)

IF COVERED BY THE PAPERWORK REDUCTION ACT:
Collection Title:
Form I-601A, Application for Provisional Unlawful Presence Waiver
OMB Control
1615-0123
OMB Expiration
July 31, 2018
Number:
Date:
Collection status: Extension
Date of last PTA (if May 21, 2015
applicable):

Name:
Office:
Phone:

Name:

PROJECT OR PROGRAM MANAGER
Angela Lyons
Office of Field Operations
Title:
Adjudications Officer
(202) 615-6213
Email:
[email protected]
ov
COMPONENT INFORMATION COLLECTION/FORMS CONTACT
Evadne Hagigal

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Office:

Phone:

Regulatory Coordination
Division – PRA Compliance
Branch
(202) 272-0993

Title:

Management & Program
Analyst

Email:

[email protected].
gov

SPECIFIC IC/Forms PTA QUESTIONS
1. Purpose of the Information Collection or Form
a. Describe the purpose of the information collection or form. Please provide a
general description of the project and its purpose, including how it supports the DHS
mission, in a way a non-technical person could understand (you may use
information from the Supporting Statement).
If this is an updated PTA, please specifically describe what changes or upgrades are
triggering the update to this PTA.
2018 EXTENSION
Form I-601A, Application for Provisional Unlawful Presence Waiver, is set to expire on July
31, 2018. USCIS is filing for a PRA extension for Form I-601A. There were no changes to
the form information collection; however, this PTA Update is accounting for the
collection of identifying information that was not captured in the previously adjudicated
PTA (e.g., gender). This extension includes expanding the provisional I-601A waiver to
allow certain individuals with deportation orders to file Form I-212, Application for
Permission to Reapply for Admission into the United States After Deportation or Removal.
I-601A, Application for Provisional Unlawful Presence Waiver
Form I-601A is used by certain spouses, children, and parents of U.S. citizens (immediate
relatives) who are in the United States and are not eligible to apply for lawful permanent
resident (LPR) status while in the United States. The provisional unlawful presence
waiver, codified at 8 CFR 212.7(e), allows those individuals who are statutorily eligible
for an immigrant visa (immediate relatives, family-sponsored or employment-based
immigrants as well as Diversity Visa selectees); who only need a waiver of
inadmissibility for unlawful presence to apply for that waiver in the United States before
they depart for their immigrant visa interview.
The Department of Homeland Security (DHS) expanded the provisional unlawful
presence waiver program to include all individuals who are statutorily eligible for an
immigrant visa and who are relatives of U.S. citizens and lawful permanent residents
(LPRs) regardless of the type of immigrant category upon which they seek to immigrate.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

DHS allows an applicant to show that his or her LPR spouses or parents, in addition to
U.S. citizen spouses or parents, may suffer extreme hardship if an applicant were denied
admission to the United States. Currently, the Immigration and Nationality Act allows a
showing of extreme hardship either to the applicant’s U.S. citizen spouse or parent or to
the LPR spouse or parent.
The National Benefits Center (NBC) and the Nebraska Service Center share processing
and adjudication of the Form I-601A.
USCIS USE OF FORM I-601A
USCIS will use the data collected on this form to determine whether the applicant is
eligible for a provisional waiver of the unlawful presence grounds of inadmissibility
under section 212(a)(9)(B)(v) of the Immigration and Nationality Act. Form I-601A
serves the purpose of standardizing the application; having the form also ensures that
applicants provide the necessary information required for USCIS to assess their
eligibility to participate in the new, streamlined waiver process and their eligibility for
the waiver itself. By allowing these individuals to apply for waivers in the U.S. and
making a provisional determination of waiver eligibility before the individuals must
depart the country for visa processing, USCIS provides a more predictable, transparent
process and improves processing times, minimizing the separation of U.S. citizens from
their families.
DEPARTMENT OF STATE USE OF FORM I-601A
USCIS informs the Department of State (DOS) of the decision (e.g., approval or denial) of
Form I-601A and the results of that decision impact how DOS adjudicates the immigrant
visa application. If USCIS approves the Form I-601A, it will inform the National Visa
Center (NVC) of its decision. If the NVC has received all required forms and documents
for the immigrant visa case, the NVC will schedule the immigrant visa interview at the
U.S. embassy or consulate designated on the application. The NVC will also notify the
applicant of the interview appointment date. The applicant will then need to depart the
United States to attend the immigrant visa interview at the designated location. If the
applicant fails to depart and attend the immigrant visa interview, the provisional
unlawful presence waiver will not take effect, and the approval may no longer be valid.
RELEVANT IT SYSTEM
Form I-601A is adjudicated in CLAIMS 3 and is stored in the applicant’s A-File.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

b. List the DHS (or component) authorities to collect, store, and use this information.
If this information will be stored and used by a specific DHS component, list the
component-specific authorities.
The authority to collect, store, and use the information requested on this form, and the
associated evidence, is set forth in the Immigration and Nationality Act Sections
212(a)(9)(B)(i)(I) and (II) and 212(a)(9)(B)(v).
2. Describe the IC/Form
a. Does this form collect any
Personally Identifiable
Information” (PII1)?
b. From which type(s) of
individuals does this form
collect information?
(Check all that apply.)

☒ Yes
☐No
☒ Members of the public
☐U.S. citizens or lawful permanent
residents
☒ Non-U.S. Persons.
☐DHS Employees
☐DHS Contractors
☐Other federal employees or contractors.

c. Who will complete and
submit this form? (Check
all that apply.)

☒ The record subject of the form (e.g., the
individual applicant).
☒ Legal Representative (preparer, attorney,
etc.). A preparer may complete the form on behalf
of the applicant.
☐Business entity.
If a business entity, is the only
information collected business contact
information?
☐Yes
☐No
☐Law enforcement.

1

Personally identifiable information means any information that permits the identity of an individual to be directly or indirectly inferred, including
any other information which is linked or linkable to that individual regardless of whether the individual is a U.S. citizen, lawful permanent resident,
visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☐DHS employee or contractor.
☒ Other individual/entity/organization that is
NOT the record subject. Please describe.
An interpreter may also complete the form on
behalf of the applicant.
d. How do individuals
complete the form? Check
all that apply.

☒ Paper.
☒ Electronic. (ex: fillable PDF)
☐Online web form. (available and submitted via
the internet)
Provide link:

e. What information will DHS collect on the form? List all PII data elements on the
form. If the form will collect information from more than one type of individual,
please break down list of data elements collected by type of individual.
There are no new data elements being collected as a result of this 2018 extension.
However, there were data elements that were not accounted for on the previous PTA
adjudication. The list below contains a full inventory of PII collected by type of
individual.
Information about the Applicant:
 Alien Number
 Social Security number
 USCIS Online Account Number
 Full name
 Other names used
 U.S. mailing address
 U.S. physical address
 Gender
 Date of birth
 City or town of birth
 Country of birth
 Country of citizenship/nationality
 Parents’ names
 Information about last entry into the United States (date of entry, port-of-entry
city/town, state, and current immigration status)
 Information about previous entries into the United States (port-of-entry
city/town, state, date of entry, and current immigration status)
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

















Information about immigration history or criminal history (Receipt number for
Form I-212)
Ethnicity
Race
Height
Weight
Eye color
Hair color
Information about applicant’s immigrant visa case (DOS Diversity Visa case
number, Diversity Visa Program Selectee’s full name, Receipt number, DOS
Consular case number, petitioner name, petitioner’s company or organization
name)
Information about applicant’s qualifying relative(s) (full name, relationship to
applicant)
Statement from applicant why USCIS should approve the application
Daytime telephone number
Mobile telephone number
Email address
Signature

Evidence submitted by Applicant:
 Biometrics (photographs and fingerprints)
 Statement and evidence of extreme hardship (e.g. documents containing
information on health, financial status, education)
 Personal considerations (e.g., separation of spouse/child); special factors (e.g.,
cultural religious, language and/or ethnic obstacles)
 Other forms of evidence (e.g., petition approval notice)
 Evidence of Fee Payment (e.g., Department of State Immigrant Visa Processing
Fee Receipt)
 Evidence of relationship to qualifying relative (e.g., copies of: marriage certificate,
birth certificate, documentation of termination of previous marriage; legal name
change document; adoption paperwork; U.S. passport; FS-240, Report of Birth
Abroad of a Citizen of the U.S.; relatives Legal Permanent Resident (LPR) card or
other evidence of LPR status)
Information about the Interpreter:
 Full name
 Organization name
 Mailing address
 Daytime telephone number
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy






Mobile telephone number
Email address
Certification of fluency
Signature

Information about the Preparer/Attorney/BIA-Accredited Representative:
 Full name
 Business name
 Mailing address
 Daytime telephone number
 Mobile telephone number
 Email address
 Signature
 G-28 ID number
 Attorney State Bar number
 Attorney or Accredited Representative USCIS Online Account Number
f. Does this form collect Social Security number (SSN) or other element that is
stand-alone Sensitive Personally Identifiable Information (SPII)? Check all that
apply.
☒ Social Security number
☐ DHS Electronic Data Interchange
Personal Identifier (EDIPI)
☒ Alien Number (A-Number)
☐ Social Media Handle/ID
☐ Tax Identification Number
☐ Known Traveler Number
☒ Visa Number
☐ Trusted Traveler Number (Global
☐ Passport Number
Entry, Pre-Check, etc.)
☐ Bank Account, Credit Card, or other
☐ Driver’s License Number
financial account number
☐ Biometrics
☒ Other. Please list: USCIS Online
Account number
g. List the specific authority to collect SSN or these other SPII elements.
The Immigration and Nationality Act, 264(f) (8 U.S.C. 1304(f)) allows USCIS to collect the
SSN and other SPII to adjudicate the Form I-601A.
h. How will this information be used? What is the purpose of the collection?
Describe why this collection of SPII is the minimum amount of information
necessary to accomplish the purpose of the program.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

USCIS collects this SPII to identify the applicant. The required information assists the
Immigration Services Officer in verifying identity, validating immigration history, and
determining the applicant’s eligibility for the benefit sought (physical presence in the
United States, if applicant is at least 17 years old at the time of filing, and has an
immigrant visa case pending with DOS).
i. Are individuals
☒ Yes. Please describe how notice is provided.
provided notice at the
USCIS provides a Privacy Notice to the individual
time of collection by
on the form instructions prior to collecting any
DHS (Does the records
information.
subject have notice of
☐No.
the collection or is
form filled out by
third party)?
3. How will DHS store the IC/form responses?
a. How will DHS store
☒ Paper. Please describe.
the original,
The Form I-601A is stored in the applicant’s A-File
completed IC/forms?
(A-File).
☒ Electronic. Please describe the IT system that will
store the data from the form.
Data from Form I-601A is stored in the ComputerLinked Application Information Management
System (CLAIMS 3).
☐Scanned forms (completed forms are scanned into
an electronic repository). Please describe the
electronic repository.
Click here to enter text.
b. If electronic, how
does DHS input the
responses into the IT
system?

☒ Manually (data elements manually entered).
Please describe.
Data from the form will be uploaded manually to
CLAIMS 3 by USCIS Lockbox Operations.
☐Automatically. Please describe.
Click here to enter text.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

c. How would a user
search the
information
submitted on the
forms, i.e., how is the
information
retrieved?

☒ By a unique identifier.2 Please describe. If
information is retrieved by personal identifier, please
submit a Privacy Act Statement with this PTA.
CLAIMS 3:
Information can be retrieved by name, date of
birth, A-Number, Receipt number, or combination
of the above data elements.
☐By a non-personal identifier. Please describe.

d. What is the records
retention
schedule(s)? Include
the records schedule
number.

Click here to enter text.
Form I-601A: N1-85-96-01 covers the adjudicative
decision of Form I-601A. Records are retained in
Receipt Files for five (5) years. When time to purge the
record, an A-File is created for petitions for which visa
numbers are not available, and for which no A-File
currently exists.
CLAIMS 3: DAA-0566-2016-0009 covers CLAIMS 3
records. Data is destroyed 50 years after the last
completed action.
A-File: N1-566-08-11 covers A-File records as
permanent value.

e. How do you ensure
The system owner is responsible for ensuring the
that records are
records are deleted in accordance with a retention
disposed of or deleted schedule.
in accordance with
the retention
schedule?
f. Is any of this information shared outside of the original program/office? If yes,
describe where (other offices or DHS components or external entities) and why.
What are the authorities of the receiving party?
☐Yes, information is shared with other DHS components or offices. Please describe.
Click here to enter text.

2

Generally, a unique identifier is considered any type of “personally identifiable information,” meaning any information that permits the identity
of an individual to be directly or indirectly inferred, including any other information which is linked or linkable to that individual regardless of
whether the individual is a U.S. citizen, lawful permanent resident, visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☒ Yes, information is shared external to DHS with other federal agencies, state/local
partners, international partners, or non-governmental entities. Please describe.
Once USCIS approves a Form I-601A, it will inform the NVC of its decision. If the NVC
has received all required forms and documents for an immigration case, the NVC will
schedule the immigrant visa interview at the U.S. embassy or consulate designated on
the form and notify the applicant of the interview appointment date.
☐No. Information on this form is not shared outside of the collecting office.

Please include a copy of the referenced form and Privacy Act Statement (if
applicable) with this PTA upon submission.
PRIVACY THRESHOLD REVIEW
(TO BE COMPLETED BY COMPONENT PRIVACY OFFICE)
Component Privacy Office Reviewer:

Amanda Hoffmaster

Date submitted to component Privacy
Office:
Date submitted to DHS Privacy Office:

January 25, 2018

Have you approved a Privacy Act
Statement for this form? (Only
applicable if you have received a
waiver from the DHS Chief Privacy
Officer to approve component Privacy
Act Statements.)

Privacy Threshold Analysis – IC/Form

April 19, 2018
☒ Yes. Please include it with this PTA
submission.
☐No. Please describe why not.
Click here to enter text.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Component Privacy Office Recommendation:
Please include recommendation below, including what existing privacy compliance
documentation is available or new privacy compliance documentation is needed.
The USCIS Office of Privacy recommends designating Form I-601A as a privacy sensitive
form with coverage under the following:
PIA


DHS/USCIS/PIA-016(a) Computer Linked Application Information Management
System (CLAIMS 3) and Associated Systems, which covers the processing and
adjudication of Form I-601A.

SORN
 DHS-USCIS-001 Alien File, Index, and National File Tracking System, which covers
the physical and electronic immigration files, including A-Files and Receipt Files.
 DHS/USCIS-007 Benefits Information System, which covers the collection, use, and
storage of data elements USCIS collects about benefit requestors, beneficiaries, legal
representatives, interpreters, and preparers.
PRIVACY THRESHOLD ADJUDICATION
(TO BE COMPLETED BY THE DHS PRIVACY OFFICE)
DHS Privacy Office Reviewer:

Kameron Cox

PCTS Workflow Number:
Date approved by DHS Privacy Office:
PTA Expiration Date

1161909
April 25, 2018
April 25, 2021

DESIGNATION
Privacy Sensitive IC or
Form:

Yes If “no” PTA adjudication is complete.

Determination:

☐PTA sufficient at this time.
☐Privacy compliance documentation determination in progress.
☐New information sharing arrangement is required.
☐DHS Policy for Computer-Readable Extracts Containing SPII
applies.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☒ Privacy Act Statement required.
☒ Privacy Impact Assessment (PIA) required.
☒ System of Records Notice (SORN) required.
☐Specialized training required.
☐Other. Click here to enter text.
DHS IC/Forms Review:

DHS PRIV has approved this ICR/Form.

Date IC/Form Approved April 19, 2018
by PRIV:
IC/Form PCTS Number: Click here to enter text.
Privacy Act
Statement:
Privacy Notice is sufficient
PTA:
CLAIMS 3 PTA is sufficient
PIA:
System covered by existing PIA
If covered by existing PIA, please list: DHS/USCIS/PIA-016a Computer
Linked Application Information Management System (CLAIMS 3) and
Associated Systems
SORN:
System covered by existing SORN
If covered by existing SORN, please list: DHS/USCIS/ICE/CBP-001 Alien
File, Index, and National File Tracking System of Records, September 18,
2017, 82 FR 43556
DHS/USCIS-007 Benefits Information System, October 19, 2016 81 FR
72069
DHS Privacy Office Comments:
Please describe rationale for privacy compliance determination above.
USCIS is submitting this PTA to renew compliance documentation regarding Form I-601A,
Application for Provisional Unlawful Presence Waiver. The purpose of the Form I-601A is for
certain immigrant visa applicants who are relatives of U.S. citizens or Lawful Permanent
Residents to request a provisional waiver of the unlawful presence grounds of
inadmissibility before departing the United States to appear at a U.S. Embassy or Consulate
for an immigrant visa interview.
The DHS Privacy Office (PRIV) agrees with USCIS Privacy that Form I-601A is a privacy
sensitive information collection. PRIV further agrees that DHS/USCIS/PIA-016(a) CLAIMS
3 assesses the privacy impacts of processing and storing Form I-601A in that system.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIV finds that SORN coverage is required because Form I-601A collects information that
is later retrieved by unique identifier. PRIV concludes that DHS/USCIS/ICE/CBP-001 Alien
File covers the collection of applicant information for the purposes of administering
immigration benefits. DHS/USCIS-007 BIS SORN covers the collection of adjudicative and
decisional data not stored in an applicant’s A-file.
Form I-600 contemplates information sharing with the Department of State (DOS). This
sharing is compatible with routine use O of the A-File SORN and routine use I of the BIS
SORN, which permit USCIS to share information with DOS in the processing of applications
for benefits under the INA.
PRIV finds that a Privacy Notice is required to accompany the Form I-601A because it
collects information from Non-US Persons.

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