I-821 Ins Toc

TABLE OF CHANGES – INSTRUCTIONS

Form I-821, Application for Temporary Protected Status

OMB Number: 1615-0043

11/19/2018

Reason for Revision: Privacy Notice update to Extension, no change.

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 03/31/2019

Edition Date 04/11/2018

Current Page Number and Section	Current Text	Proposed Text
Pages 16-17, USCIS Privacy Act Statement	[Page 16] USCIS Privacy Act Statement AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA section 101 and 244. INA section 264(f) (8 U.S.C. 1304(f)) also provides the Secretary of Homeland Security with the authority to collect Social Security number (SSN) information. PURPOSE: The primary purpose for providing the requested information on this application is to determine if you have established eligibility for TPS. DHS will use the information you provide to grant or deny the 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 or result in denial of your application. [Page 17] ROUTINE USES: DHS may share the information you provide on this application, 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-007 - Benefits Information System and DHS/USCIS-001 - Alien File, Index] 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 16] DHS Privacy Notice AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA sections 101 and 244. PURPOSE: The primary purpose for obtaining the requested information on this application is to determine whether you have established eligibility for TPS, if you have not yet been granted TPS. DHS will use the information you provide to grant or deny the 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 denial of your application. [Page 17] ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this application 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, DHS/USCIS-007 - Benefits Information System, and DHS/USCIS-018 Immigration Biometric and Background Check System] and the published privacy impact assessment [DHS/USCIS/PIA-056 USCIS Electronic Immigration 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.

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