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 Title:

Form I-914, Form I-914A, Form I-914B
Application for T Nonimmigrant Status (including Supplements A and
B)

Component:

U.S. Citizenship and
Immigration Services
(USCIS)

Office:

Office of Policy and
Strategy (OP&S)

IF COVERED BY THE PAPERWORK REDUCTION ACT:
Collection Title:
Click here to enter text.
OMB Control
Number:
Collection status:
Name:
Office:
Phone:

OMB No 1615-0099
Choose an item.

OMB Expiration
Date:
Date of last PTA (if
applicable):

July 31, 2016
Click here to enter
a date.

PROJECT OR PROGRAM MANAGER
Elizabeth Dallam
OP&S
Title:
Policy Analyst
202-272-2995
Email:
[email protected]
v
COMPONENT INFORMATION COLLECTION/FORMS CONTACT

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

Name:
Office:
Phone:

Click here to enter text.
Click here to enter text.
Title:
Click here to enter text.
Click here to enter text.
Email:
Click here to enter text.
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.
The form provides an opportunity for individuals to apply for temporary
immigration benefits available to victims of severe forms of trafficking in persons
and family members, subject to specific eligibility requirements.
Background
In October 2000, Congress created the “T” nonimmigrant status by passing the
Victims of Trafficking and Violence Protection Act (VTVPA). The legislation
strengthens the ability of law enforcement agencies to investigate and prosecute
human trafficking, and also offer protection to victims.
Human trafficking, also known as trafficking in persons, is a form of modern-day
slavery in which traffickers lure individuals with false promises of employment
and a better life. Traffickers often take advantage of poor, unemployed individuals
who lack access to social services. The T Nonimmigrant Status (T visa) is a set
aside for those who are or have been victims of human trafficking, protects victims
of human trafficking and allows victims to remain in the United States to assist in
an investigation or prosecution of human trafficking.
T Nonimmigrant Eligibility
To qualify for T nonimmigrant status the individual must:
• Be or have been a victim of severe trafficking in persons.
• Be physically present in the United States, American Samoa, or the
Commonwealth of the Northern Mariana Islands, or at a port of entry on
account of trafficking.
• Comply with any reasonable request from a law enforcement agency for
assistance in the investigation or prosecution of human trafficking.
• Demonstrate that you would suffer extreme hardship involving severe and
unusual harm if removed from the United States.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

• If under the age of 18 at the time of the victimization, or if unable to
cooperate with a law enforcement request due to physical or psychological
trauma, an individual may qualify for the T nonimmigrant visa without
having to assist in investigation or prosecution.
The individual must also be admissible to the United States or obtain a waiver of
admissibility.
Form I-914, Application for T Nonimmigrant Status
Individuals seeking T nonimmigrant status are required to submit a completed
Form I-914 and a personal statement explaining how they were a victim of
trafficking, and supplemental evidence demonstrating eligibility requirements.
Form I-914, Supplement A, Application for Immediate Family Member of T-1
Recipient:
Certain family members are eligible for a derivative T visa. To apply for a family
member, the applicant must file a Form I-914, Supplement A, Application for
Family Member of T-1 Recipient, at any time.
Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of
Trafficking in Persons
Supplement B serves as primary evidence that the individual is a victim of
trafficking and has complied with reasonable requests from law enforcement.
Once a T nonimmigrant visa is granted, the individual can apply for permanent
residence after three years or upon completion of the investigation of trafficking,
whichever is earlier.
Form I-914 is currently undergoing an extension with OMB. No changes have
occurred since the previous I-914 PTA.
Relevant IT System and protections
The Form I-914 is processed in CLAIMS 3. All USCIS employees who come in contact
with 8 USC 1367 protected information is required to complete the VAWA:
Confidentiality and Immigration Relief training on an annual basis.
The statutory confidentiality protections at 8 U.S.C. § 1367 generally prohibit the
disclosure or use of any information about applicants for, and beneficiaries of,
certain victim-based immigration benefits, including T nonimmigrant status, U
nonimmigrant status, or relief under the Violence Against Women Act (VAWA).
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Prior to making information disclosures, CIS employees are required to consult
the individuals A-file or run a query in the Central Index System (CIS), or through
the CIS function in the Person Centric Query System. CIS and PCQS includes an
alert message to indicate that an individual is protected by 8 U.S.C. § 1367. The
message reads: 8 USC 1367 Protected Information–Disclosure and Use Restrictions
Apply. Any record in CIS and PCQS that displays this banner must be handled as
Section 1367 Information in accordance with the law and DHS policy.
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 information requested on this benefit application, and the associated
evidence, is collected pursuant to Public Law 106-386, sections 107(e) and 1513(c)
and 8 USC 1101(a)(15)(T), 1184(o); 1182 (d)(13) and the implementing
regulations found at 8 CFR 214.11.

2. Describe the IC/Form
a. Does this form collect any
Personally Identifiable
Information” (PII 1)?

b. From which type(s) of
individuals does this form
collect information?
(Check all that apply.)

c. Who will complete and
submit this form? (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.

☒ The record subject of the form (e.g., the
individual applicant).
☒ Legal Representative (preparer, attorney,
etc.).
☐ Business entity.

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

d. How do individuals
complete the form? Check
all that apply.

If a business entity, is the only
information collected business contact
information?
☐ Yes
☐ No
☒ Law enforcement.
☐ DHS employee or contractor.
☐ Other individual/entity/organization that is
NOT the record subject. Please describe.
Click here to enter text.

☒ 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.
Form I-914 or I-914A collects the following information regarding principal
applicants and family members:
• Full Name
• Home and SafeAddress
• Telephone Number
• Alien Registration Number
• Date And Place of Birth
• Country of Citizenship
• Gender and Marital Status
• Email Address
• Social Security Number
• I-94 Number
• Place and Date of Last Entry
• Passport Number, Place and Date of Issue
• Current Immigrant Status
• Entries and exits from the United States
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

•
•
•
•

Criminal and Immigration History
Medical information/medical records
Victimization status and circumstances
Signature

For Principal Applicants, Form I-914 also collects:
• Law Enforcement Agency and Office, Address, Phone Number, Case Number
For Family Members, Form I-914A also collects:
• Name of Former Spouse, Date Marriage Ended, Where and How Marriage
Ended
• Address and Country where Want Notification of Approval Sent
Form I-914 and Form I-914A collect the following preparer information:
• Name
• Firm Name
• Address
• Phone number
• Fax Number
• Email Address
• Signature
•
Form I-914 collects the following interpreter information:
• Language Used
• Name
• Phone Number
• Signature
Form I-914B also collects the following additional information:
• Name of Certifying Official
• Title and Division/Office of Certifying Official
• Agency Type
• Fax Number
• Case Status
• Certifying Agency Category
• FBI or SID 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

Statement of Trafficking Claim
Assessment of Applicant’s Cooperation
Full Name, Relationship and Involvement in Trafficking of Any Family
Members
• Signature of Law Enforcement Officer
• Signature of Certifying Officer
Signature of Supervisor
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:
•
•
•

g. List the specific authority to collect SSN or these other SPII elements.
INA 264(f) (8 U.S.C. 1304(f)), states, “ Notwithstanding any other provision of law,
the Attorney General is authorized to require any alien to provide the alien's social
security account number for purposes of inclusion in any record of the alien
maintained by the Attorney General or the Service.”
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.
The SSN and other information collected is used to identify the applicant and
adjudicate the application. The SSN is recorded by USCIS CLAIMS 3 Database. USCIS
collects SSNs (applicant, fiancé and spouse) in certain forms and enters them into
CLAIMS 3 and associated systems in conjunction with other information to verify
the identity of the applicant, fiancé, spouse, to determine the applicant’s eligibility
for certain benefits.
i. Are individuals
☒ Yes. Please describe how notice is provided.
provided notice at the
USCIS provides applicants with notice via a
Privacy Act Statement which is included on the
time of collection by
form instructions.
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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 (Does the records
subject have notice of
the collection or is
form filled out by
third party)?

☐ No.

3. How will DHS store the IC/form responses?
a. How will DHS store
☐ Paper. Please describe.
the original,
The Forms I-914 and I-914B will be kept in the
completed IC/forms?
applicant’s A-file.
☒ Electronic. Please describe the IT system that will
store the data from the form.
Data from the form will be stored in CLAIMS 3
and NFTS (for A-file tracking purposes).
☐ 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?
c. How would a user
search the
information
submitted on the
forms, i.e., how is the
information
retrieved?

☒ Manually (data elements manually entered). Please
describe.
USICS personnel input the data manually into
the appropriate systems.
☐ Automatically. Please describe.
Click here to enter text.
☒ By a unique identifier. 2 Please describe. If
information is retrieved by personal identifier, please
submit a Privacy Act Statement with this PTA.
The information is retrieved using the
applicant’s Alien Registration Number.
☐ By a non-personal identifier. 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

USCIS is working with NARA to update and
consolidate the current retention schedules N1563-04-03 and N1-566-08-12. Under the proposed
update to retention schedules for CLAIMS 3, the
system will delete and destroy records from 15 to
50 years from the date of the last completed
action.
The I-914 is also stored in the A-file and treated as
permanent material(N1-566-08-11).
e. How do you ensure
The system owner is responsible for ensuring the
that records are
records are deleted in accordance with a
retention schedule.
disposed of or deleted
in accordance with
A-Files are transferred to the National Archives
the retention
and Records Administration 100 years from the
schedule?
applicant’s date of birth.
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.
Information may be shared within DHS (e.g., Immigration and Customs
Enforcement) in compliance with confidentiality provisions in 8 USC 1367.
d. What is the records
retention
schedule(s)? Include
the records schedule
number.

☒ Yes, information is shared external to DHS with other federal agencies, state/local
partners, international partners, or non-governmental entities. Please describe.
Section 1367 Information may be shared amongst sworn officers and
employees of DHS, DOJ, and DOS for legitimate Department, bureau, or
agency purposes. Furthermore, USCIS shares information with the Human
Smuggling and Trafficking Center (HSTC) to analyze human trafficking
information to advance and support U.S. counter-human trafficking efforts
by federal law enforcement entities and relevant policy makers. The data is
used to produce analytical products and law enforcement targeting profiles,
where permitted. Analytical products based on USCIS-provided human
trafficking information may be disseminated outside DHS if the products
comply with the statistical exception noted in the HSTC MOA and where
USCIS has reasonable opportunity to review, correct, and approve the
analysis based on its data.
☐ No. Information on this form is not shared outside of the collecting office.

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

Please include a copy of the referenced form and Privacy Act Statement (if
applicable) with this PTA upon submission.

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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 REVIEW
(TO BE COMPLETED BY COMPONENT PRIVACY OFFICE)
Component Privacy Office Reviewer:

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

Catherine Catanzaro Shorten
August 26, 2016
October 5, 2017

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

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 Privacy Office recommendation is to designate Form I-914 and its
supplements as privacy sensitive with coverage under the following privacy
compliance documents:
• DHS/USCIS-001 - Alien File, Index, and National File Tracking System of
Records
• DHS/USCIS-007 - Benefits Information System
• DHS/USCIS/PIA-016a - CLAIMS 3 and Associated Systems
The forthcoming Special Protected Class PIA will provide added coverage and will
assess the privacy risks involved in collecting PII from applicants who are protected
under 8 U.S.C. 1367.

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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 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

1151364
October 18, 2017
October 18, 2020

DESIGNATION

Privacy Sensitive IC or
Form:

Yes If “no” PTA adjudication is complete.

DHS IC/Forms Review:

DHS PRIV has approved this ICR/Form.

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

Date IC/Form Approved October 16, 2017
by PRIV:
IC/Form PCTS Number:
Privacy Act
New e(3) statement is required.
Statement:
The submitted PN is adequate
PTA:
CLAIMS 3 PTA is adequate
PIA:
System covered by existing PIA
If covered by existing PIA, please list:
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Forthcoming Special Protected Immigrant PIA; DHS/USCIS/PIA-016
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 for Form I-914 and
associated supplemental forms. Individuals seeking T nonimmigrant status are required to
submit a completed Form I-914 and a personal statement explaining how they were a
victim of trafficking, and supplemental evidence demonstrating eligibility requirements.
The DHS Privacy Office (PRIV) finds that Form I-914 is a privacy sensitive information
collection and a PIA is required because it collects PII from members of the public. PRIV
finds that the forthcoming Special Protected Immigrant PIA will assess the privacy risks
involved in collecting PII from applicants who are protected by 8 U.S.C. 1367
confidentiality requirements. PRIV agrees with USCIS Privacy that interim coverage is
provided by the CLAIMS 3 PIA as USCIS works to finalize the SPC PIA.

PRIV finds that a SORN is required because Form I-914 collects information that is then
retrieved by a unique identifier. Form I-914 is covered by DHS/USCIS/ICE/CBP-001 A-File
SORN because the information collected is maintained in an applicant’s A-File as they pass
through the immigration process. DHS/USCIS-007 Benefits Information System (BIS) SORN
covers the electronic processing and decisional information of Form I-914 in CLAIMS 3.

This PTA contemplates information sharing between USCIS, the DOJ, and DOS. This sharing
is permitted under Routine Use J of the BIS SORN. This sharing is compatible with the
purpose of the BIS SORN to support national security by providing information that
combats human trafficking.

PRIV finds that a privacy notice is required because Form I-914 collects PII from Non-US
persons that is then entered into a system of records. PRIV finds the privacy notice
submitted by USCIS is adequate but recommends that it should specify that the individuals
who fill out this form are not subject to all of the routine uses described in the relevant
SORNs.
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