I854ab Ins Toc

TABLE OF CHANGES – INSTRUCTIONS

Form I-854AB, Inter-Agency Alien Witness and Informant Record and Adjustment of Status

OMB Number: 1615-0049

04/24/2019

Reason for Revision: PN update.

Legend for Proposed Text:

• Black font = Current text

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Expires 07/31/2019

Edition Date 07/13/2017

Current Page Number and Section	Current Text	Proposed Text
Pages 5-6, USCIS Privacy Act Statement	[Page 5] USCIS Privacy Act Statement AUTHORITIES: 8 U.S.C. section 1101(a)(15)(S) authorizes USCIS to collect the information and the associated evidence for this application. PURPOSE: The primary purpose for providing the requested information on these forms are to obtain S nonimmigrant status after assisting a law enforcement agency as a witness or informant. DHS will use the information you provide to grant or deny the benefit sought. [Page 6] DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information and any requested evidence, may delay a final decision in your case or result in denial of your form for S nonimmigrant status for the alien. ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, foreign government agencies, and authorized organizations 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. DHS may also make the information available, as appropriate for law enforcement purposes or in the interest of national security.	[Page 5] DHS Privacy Notice AUTHORITY: The information requested on these forms, and the associated evidence, is collected under 8 U.S.C. section 1101(a)(15)(S). PURPOSE: The primary purpose for providing the requested information on these forms are to obtain either S nonimmigrant status or adjustment of status after assisting a law enforcement agency as a witness or informant. DHS uses the information you provide to grant or deny the immigration benefit you are seeking. [Page 6] 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 form. ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on these forms 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 of Records] and published privacy impact assessment [DHS/USCIS/PIA-013-01 Fraud Detection and National Security Directorate] 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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