I-817 Instructions Table of Changes

TABLE OF CHANGES – INSTRUCTIONS

Form I-817, Application for Family Unity Benefits

OMB Number: 1615-0005

01/02/2019

Reason for Revision: Extension, with updates to Privacy Notice

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 11/30/2019

Edition Date 11/07/2017

Current Page Number and Section	Current Text	Proposed Text
Page 14, USCIS Privacy Act Statement	[Page 14] USCIS Privacy Act Statement AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the Section 301 of the Immigration Act of 1990 (IMMACT 90) and Section 1504 of the Legal Immigration Family Equity Act Amendments (LIFE Act Amendments). PURPOSE: The purpose of this application is to request initial benefits under the Family Unity Program or to request an extension of such benefits. DHS/USCIS will use the information you provide to grant or deny the benefit. USCIS requests the applicant to provide their Social Security Number (SSN) to facilitate and expedite the adjudication of the applicant’s request. The SSN is used to establish and corroborate the applicant’s identity to complete a sufficient background check. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including the SSN and any requested evidence, may delay a final decision in your case or result in denial of your application. ROUTINE USES: DHS may share the information you provide on this application 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, 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 14] DHS Privacy Notice AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the Immigration Act of 1990 section 301 and the Legal Immigration Family Equity Act Amendments (LIFE Act) section 1504. PURPOSE: The primary purpose for providing the requested information on this application is to request initial benefits under the Family Unity Program, or to request an extension of such benefits. 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 application. ROUTINE USES: DHS may 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/ICE/CBP-001 - Alien File, Index, and National File Tracking System of Records, DHS/USCIS-007 - Benefits Information System, and DHS/USCIS-018 - Immigration Biometric and Background Check] and the published privacy impact assessment [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management 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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