G-1295 Toc

TABLE OF CHANGES

Form G-1295, DNA Collection Consent Form (Rapid Test)

OMB Number: 1615-0132

05/13/2019

Reason for Revision: Extension

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 05/31/2019

Edition Date 05/05/2016

Current Page Number and Section	Current Text	Proposed Text
Page 2 USCIS Privacy Act Statement	[Page 2] USCIS Privacy Act Statement AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act (INA) section 101(42) and 8 CFR parts 204.2(D)(2)(vi) and 207. PURPOSE: The samples collected for the Rapid DNA pilot will only be used to evaluate the effectiveness of the Rapid DNA prototype equipment. Separate samples will be collected and sent to an American Association of Blood Banks (AABB) accredited laboratory. DISCLOSURE: The information you provide is voluntary and participation in the Rapid DNA pilot is voluntary. Refusal to sign the lab DNA consent form will have no impact on your pending refugee case. ROUTINE USES: The Department of Homeland Security (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 described in the associated published system of records notices [DHS-USCIS-001 - Alien File, Index, and National File Tracking System of Records] 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 2] DHS Privacy Notice AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act (INA) section 101(a)(42) and 8 CFR part 207. PURPOSE: The samples collected by USCIS for the Rapid DNA pilot will only be used to evaluate the effectiveness of the Rapid DNA prototype equipment. Separate samples will be collected and sent to an American Association of Blood Banks (AABB) accredited laboratory. USCIS does not retain DNA samples after collection, but will receive the results of the DNA analyzation from the laboratory. DISCLOSURE: The information you provide is voluntary and participation in the Rapid DNA pilot is voluntary. Refusal to sign the lab DNA consent form will have no impact on your pending refugee case. 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 described in the associated published system of records notices [DHS-USCIS-001 - Alien File, Index, and National File Tracking System of Records and DHS/USCIS-017 Refugee Case Processing and Security Screening Information System of Records] and approved privacy impact assessments [DHS/S&T/PIA-024 Rapid DNA System and DHS/USCIS/PIA-068 Refugee Case Processing and Security Vetting], 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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