G-1041a Ins Toc

TABLE OF CHANGES – INSTRUCTIONS

Form G-1041A, Instructions for Genealogy Records Request

OMB Number: 1615-0096

02/11/2019

Reason for Revision: Include changes to Privacy Act Statement

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 05/31/2019

Edition Date 12/23/16 N

Current Page Number and Section	Current Text	Proposed Text
Page 5, USCIS Privacy Act Statement	[Page 5] USCIS Privacy Act Statement AUTHORITIES:  The information requested on this historical records request, and the associated evidence, is collected pursuant to 8 CFR section 103.38 through 103.41. PURPOSE:  The primary purpose for providing the requested information on this request form is to assist USCIS with identifying and obtaining copies of the requested USCIS historical records.   DISCLOSURE:  The information you provide is voluntary.  However, failure to provide the requested information, and any requested evidence, prevents USCIS from processing your request. ROUTINE USES:  Information provided may be used by and disclosed to DHS personnel and contractors or other agents who need the information to assist in activities related to your request.  The information may be shared in accordance with approved routine uses, as described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System of Records] which can be found at www.dhs.gov/privacy.	[Page 5] DHS Privacy Notice AUTHORITIES:  The information requested on this historical records request, and the associated evidence, is collected under 8 CFR parts 103.38 through 103.41. PURPOSE:  The primary purpose for providing the requested information on this request form is to assist USCIS with identifying and obtaining copies of the requested USCIS historical records.    DISCLOSURE:  The information you provide is voluntary.  However, failure to provide the requested information, and any requested evidence, prevents USCIS from processing your request. ROUTINE USES:  DHS may share the information you provide on this form with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses, as described in the associated published system of records notice [DHS/USCIS-001 Alien File, Index, and National File Tracking System of Records] and as described in the published privacy impact assessment [DHS/USCIS/PIA-017(a) Microfilm Digitization Application 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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