I-612 Instructions TOCs

TABLE OF CHANGES – INSTRUCTIONS

Form I-612, Application for Waiver of the Foreign Residence Requirement (Under Section 212(e) of the INA, as Amended)

OMB Number: 1615-0030

03/20/2019

Reason for Revision: Extension and PN language update

Legend for Proposed Text:

• Black font = Current text

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Expires 04/30/2019

Edition Date 04/24/2017

Current Page Number and Section	Current Text	Proposed Text
[Page 7] USCIS Privacy Act Statement	USCIS Privacy Act Statement AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA section 212(e) and 8 CFR 212.7(e). PURPOSE: The primary purpose for providing the requested information on this application is to apply for a waiver of the two year foreign residence requirement. The information you provide will be used to grant or deny the waiver sought. DISCLOSURE: The information you provide, is voluntary. However, failure to provide the requested information, including your Social Security number, may delay a final decision or result in denial of your waiver. ROUTINE USES: The information you provide on this application may be shared with other Federal, state, local, and foreign government agencies and authorized organizations in accordance with approved routine uses, as described in the associated published system of record notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System of Records and DHS/USCIS-007 - Benefits Information System, which you can find at www.dhs.gov/privacy]. The information may also be made available, as appropriate, for law enforcement purposes or in the interest of national security.	DHS Privacy Notice AUTHORITIES: The information requested on this waiver, and the associated evidence, is collected under the Immigration and Nationality Act section 212(e) and 8 CFR S. 212.7(c). PURPOSE: The primary purpose for providing the requested information on this waiver is to apply for a waiver of the two year foreign residence requirement. 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 denial of your waiver. ROUTINE USES: DHS may share the information you provide on this waiver 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/ICE/CBP-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-016(a) Computer Linked Application Information Management System and Associated Systems] 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.

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