Privacy Threshold Analysis

Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD ANALYSIS (PTA)
This form serves as the official determination by the DHS Privacy Office to
identify the privacy compliance requirements for all Departmental uses of
personally identifiable information (PII).
A Privacy Threshold Analysis (PTA) serves as the document used to identify
information technology (IT) systems, information collections/forms, technologies,
rulemakings, programs, information sharing arrangements, or pilot projects that involve
PII and other activities that otherwise impact the privacy of individuals as determined by
the Chief Privacy Officer, pursuant to Section 222 of the Homeland Security Act, and to
assess whether there is a need for additional Privacy Compliance Documentation. A PTA
includes a general description of the IT system, information collection, form, technology,
rulemaking, program, pilot project, information sharing arrangement, or other Department
activity and describes what PII is collected (and from whom) and how that information is
used and managed.
Please complete the attached Privacy Threshold Analysis and submit it to your
component Privacy Office. After review by your component Privacy Officer the PTA is sent
to the Department’s Senior Director for Privacy Compliance for action. If you do not have a
component Privacy Office, please send the PTA to the DHS Privacy Office:
Senior Director, Privacy Compliance
The Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
Tel: 202-343-1717
[email protected]
Upon receipt from your component Privacy Office, the DHS Privacy Office will review this
form and assess whether any privacy compliance documentation is required. If compliance
documentation is required – such as Privacy Impact Assessment (PIA), System of Records
Notice (SORN), Privacy Act Statement, or Computer Matching Agreement (CMA) – the DHS
Privacy Office or component Privacy Office will send you a copy of the relevant compliance
template to complete and return.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Privacy Threshold Analysis (PTA)

Specialized Template for
Information Collections (IC) and Forms
The Forms-PTA is a specialized template for Information Collections and Forms. This
specialized PTA must accompany all Information Collections submitted as part of the
Paperwork Reduction Act process (any instrument for collection (form, survey,
questionnaire, etc.) from ten or more members of the public). Components may use this PTA
to assess internal, component-specific forms as well.
Form Number:
Form Title:

I-290B
Notice of Appeal of Motion (OMB No. 1615-0095)

Component:

U.S. Citizenship and
Immigration Services
(USCIS)

Office:

Service Center
Operations (SCOPS)

IF COVERED BY THE PAPERWORK REDUCTION ACT:
Form I-290B, Notice of Appeal of Motion
Collection Title:
OMB Control
Number:
Collection status:

Name:
Office:
Phone:

1615-0095
Revision

OMB Expiration
Date:
Date of last PTA (if
applicable):

January 31, 2017
November 16, 2016

PROJECT OR PROGRAM MANAGER
Deborah Blacksten
Administrative Appeals
Title:
Supervisory Management &
Office
Program Analyst
[email protected]
703-224-4530
Email:
.gov

COMPONENT INFORMATION COLLECTION/FORMS CONTACT
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Name:
Office:

Phone:

Kerstin Jager
Regulatory Coordination
Title:
Management Program
Division- PRA Compliance
Analyst
Branch
[email protected]
202-213-4211
Email:
SPECIFIC IC/Forms PTA QUESTIONS

1. Purpose of the Information Collection or Form
a. Describe the purpose of the information collection or form. Please provide a
general description of the project and its purpose, including how it supports the DHS
mission, in a way a non-technical person could understand (you may use
information from the Supporting Statement).
If this is an updated PTA, please specifically describe what changes or upgrades are
triggering the update to this PTA.
Form I-290B Update
Form I-290B is for both motions to the USCIS office that last issued the decision (field
offices, service centers, and the AAO) and appeals to the AAO.USCIS is submitting the
updated Form I-290B PTA to document the following changes:



The collection of Attorney and Accredited Representative Information (not new
collection, but was not documented on previously adjudicated PTA)
The Form I-290B data is not stored in USCIS ELIS

Form I-290B, Notice of Appeal or Motion
Form I-290B, Notice of Appeal or Motion, is used to file an appeal or motion on any decision
under the immigration laws , except for appeals of Form I-130, Petition for Alien Relative, and
Form I-360, Petition for Amerasian, Widow(er), or Special Immigrant, (widow(er) only)
denials in which the Board of Immigration Appeals (BIA) has appellate jurisdiction.
The appeal or motion must be filed with USCIS in accordance with the regulation at 8.C.F.R
Sections 103.3 and 103.5. Form I-290B must be filed within 30 calendar days after service of
the decision. If the decision is mailed, the form must be filed within 33 calendar days. If the
appeal relates to a revocation of an immigrant petition approval, the appeal must be filed
within 15 calendar days after service of the decision, 18 calendar days if the decision was
mailed. The date of service is normally the date of the decision.
Late filed appeals that do not meet the requirements of a motion to reopen or reconsider may
be rejected. Late filed motions may be rejected.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

Form I-290B may be used in the following circumstances:
1. To file an appeal with the AAO;
2. To file a motion to reconsider a decision of USCIS (i.e., the AAO, a field office or service
center);
3. To file a motion to reopen a decision of USCIS (i.e., the AAO, a field office or service
center); or
4. To appeal certain denials of U.S. Immigration and Customs Enforcement (ICE) Form I-17,
Petition for Approval of School for Attendance by Nonimmigrant Student.
When a decision on a petition is appealed or a request for a motion is made, the affected party
(e.g., petitioner/applicant or an authorized official of a petitioning employer) must sign Form
I-290B and if applicable, sign and submit Form G-28, Notice of Entry of Appearance as
Attorney or Representative. In the case of self-petitioners and applicants for certain waivers,
the self-petitioner or waiver applicant may sign the Form I-290B.
Applicants currently use paper applications or petitions and must submit the Form I-290B to
the appropriate location.
Relevant Information Technology
Data for all paper applications or petitions are entered into CLAIMS 3. After the data is
entered, all paper forms, including Form I-290B, are stored in the A-files and Receipt Files as
a part of USCIS official records. Currently CLAIMS 3 supports the adjudication of this form.
There is no electronic filing of Form I-290B
b. List the DHS (or component) authorities to collect, store, and use this information.
If this information will be stored and used by a specific DHS component, list the
component-specific authorities.

The information and evidence requested on this form is collected under § 103 of the
Immigration and Nationality Act, as amended, and 8 CFR §§ 103.3 and 103.5.

2. Describe the IC/Form
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

a. Does this form collect any
Personally Identifiable
Information” (PII1)?

☒ Yes

b. From which type(s) of
individuals does this form
collect information?
(Check all that apply.)

☒ Members of the public
☒ U.S. citizens or lawful permanent
residents
☒ Non-U.S. Persons.

☐No

☐DHS Employees
☐DHS Contractors
☐Other federal employees or contractors.
c. Who will complete and
submit this form? (Check
all that apply.)

☒ The record subject of the form (e.g., the
individual applicant).
☒ Legal Representative (preparer, attorney,
etc.).
☒ Business entity.
If a business entity, is the only
information collected business contact
information?
☐Yes
☒ No
☐Law enforcement.
☐DHS employee or contractor.
☐Other individual/entity/organization that is
NOT the record subject. Please describe.
Click here to enter text.

d. How do individuals
complete the form? Check
all that apply.

☒ Paper.
☒ Electronic. (ex: fillable PDF)

1

Personally identifiable information means any information that permits the identity of an individual to be directly or indirectly inferred, including
any other information which is linked or linkable to that individual regardless of whether the individual is a U.S. citizen, lawful permanent resident,
visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

☐Online web form. (available and submitted via
the internet)
Provide link:
e. What information will DHS collect on the form? List all PII data elements on the
form. If the form will collect information from more than one type of individual,
please break down list of data elements collected by type of individual.
Information Collected from the Attorney/Accredited Representative (if any)



Attorney State Bar (if applicable)
Attorney or Accredited Representative USCIS Online Account Number

Information Collected About the Applicant or Petitioner












Full Name
Alien Registration Number (A-Number, if applicable)
USCIS Online Account Number (if applicable)
In Care Of Name
Mailing Address
Daytime Telephone Number
Mobile Telephone Number (if any)
Email Address (if any)
Statement and Certification
Signature
Date of Signature

Information About the Appeal or Motion








USCIS Form for the application or petition that is the subject of This Appeal or Motion
Receipt Number for the Application or Petition
Requested Nonimmigrant or Immigrant Classification
Specific Classification Requested (if applicable)
Date of Adverse Decision
Office That Issued the Adverse Decision
Basis for the Appeal Or Motion Request

Information Collected from the Interpreter



Full Name
Business or Organization Name (if any)

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy









Mailing Address
Daytime Telephone Number
Mobile Telephone Number (if any)
Email Address (if any)
Certification
Signature
Date of Signature

Information collected from Preparers










Full Name
Business or Organization Name (if any)
Mailing Address
Daytime Telephone Number
Mobile Telephone Number (if any)
Email Address (if any)
Statement and Certification
Signature
Date of Signature

f. Does this form collect Social Security number (SSN) or other element that is
stand-alone Sensitive Personally Identifiable Information (SPII)? Check all that
apply.
☐ Social Security number
☐ DHS Electronic Data Interchange
Personal Identifier (EDIPI)
☒ Alien Number (A-Number)
☐ Social Media Handle/ID
☐ Tax Identification Number
☐ Known Traveler Number
☐ Visa Number
☐ Trusted Traveler Number (Global
☐ Passport Number
Entry, Pre-Check, etc.)
☐ Bank Account, Credit Card, or other
☐ Driver’s License Number
financial account number
☐ Biometrics
☒ Other. Please list:
 Receipt number
g. List the specific authority to collect SSN or these other SPII elements.
The information and evidence requested on this form is collected under § 103 of the
Immigration and Nationality Act, as amended, and 8 CFR §§ 103.3 and 103.5.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

h. How will this information be used? What is the purpose of the collection?
Describe why this collection of SPII is the minimum amount of information
necessary to accomplish the purpose of the program.
Form I-290B is used to file an appeal with the Administrative Appeals Office (AAO); or a
motion with the USCIS office that issued the latest decision in the case (including a field
office, service center, or the AAO). Over fifty immigration benefit types are eligible for an
appeal or motion using this form. This information is necessary to correctly identify: the
applicant or petitioner; any attorney, representative, interpreter, or preparer; the applicable
immigration benefit request that is the subject of the appeal or motion; and the specific basis
of the appeal or motion.
i.

Are individuals
provided notice at the
time of collection by
DHS (Does the records
subject have notice of
the collection or is
form filled out by
third party)?

☒ Yes. Please describe how notice is provided.
USCIS includes a Privacy Notice on the form instructions
☐No.

3. How will DHS store the IC/form responses?
a. How will DHS store
☒ Paper. Please describe.
the original,
Paper records are stored in the A-files or Receipt
completed IC/forms?
files
☒ Electronic. Please describe the IT system that will
store the data from the form.
Form I-290B data is stored in USCIS CLAIMS 3 after
the data is entered into the system
☐Scanned forms (completed forms are scanned into
an electronic repository). Please describe the
electronic repository.
Click here to enter text.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

b. If electronic, how
does DHS input the
responses into the IT
system?

☒ Manually (data elements manually entered). Please
describe.
Information is manually entered into the IT
system during the intake process.
☐Automatically. Please describe.
Click here to enter text.

c. How would a user
search the
information
submitted on the
forms, i.e., how is the
information
retrieved?

☒ By a unique identifier.2 Please describe. If
information is retrieved by personal identifier, please
submit a Privacy Act Statement with this PTA.

d. What is the records
retention
schedule(s)? Include
the records schedule
number.

Form I-290B: N1-85-96-01; if filed with the Form I539: DAA-0566-2017-0009
Destroy 2-6 years after adjudicative decision

e. How do you ensure
that records are
disposed of or deleted
in accordance with
the retention
schedule?

System information is searched via any of the
following methods: Name (First, Last), Receipt
Number, A-File Number or Company Name

A-File: N1-566-08-11
Permanent
CLAIMS 3: DAA-0566-2016-0009
Destroy 50 years after last completed action. (Last
action may include: adjudication date/address
change)
The system owner is responsible for ensuring the records
are deleted in accordance with the approved records
retention schedule.

2

Generally, a unique identifier is considered any type of “personally identifiable information,” meaning any information that permits the identity
of an individual to be directly or indirectly inferred, including any other information which is linked or linkable to that individual regardless of
whether the individual is a U.S. citizen, lawful permanent resident, visitor to the U.S., or employee or contractor to the Department.
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

f. Is any of this information shared outside of the original program/office? If yes,
describe where (other offices or DHS components or external entities) and why.
What are the authorities of the receiving party?
☒ Yes, information is shared with other DHS components or offices. Please describe.
 Form I-290B may be used as an appeal with the Administrative Appeals Office
(AAO)
 Form I-290B may be used as a motion with the Field Office, Service Center, or
the AAO
 Form I-290B may be used by Immigration and Customs Enforcement (ICE)
Form I-17 Petition for Appeal of School for Attendance by Nonimmigrant
Student with the ICE Student and Exchange Visitor Program

☐ Yes, information is shared external to DHS with other federal agencies, state/local
partners, international partners, or non-governmental entities. Please describe.
☐ No. Information on this form is not shared outside of the collecting office.

Please include a copy of the referenced form and Privacy Act Statement (if
applicable) with this PTA upon submission.

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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

PRIVACY THRESHOLD REVIEW
(TO BE COMPLETED BY COMPONENT PRIVACY OFFICE)
Component Privacy Office Reviewer:

Nina Robinson

Date submitted to component Privacy
Office:
Date submitted to DHS Privacy Office:

February 13, 2018

Have you approved a Privacy Act
Statement for this form? (Only
applicable if you have received a
waiver from the DHS Chief Privacy
Officer to approve component Privacy
Act Statements.)

February 20, 2018
☒ Yes. Please include it with this PTA
submission.
☐No. Please describe why not.
Click here to enter text.

The USCIS Office of Privacy recommendation is to designate the Form I-290B as a privacy
sensitive form with coverage under the following compliance documentation:
PIA




DHS/USCIS/PIA-016 Computer Linked Application Information Management
System (CLAIMS 3) and Associated Systems, which covers the collection, use,
and storage of data elements collected on the Form I-290B and stored in CLAIMS
3
DHS/USCIS/PIA-062 Administrative Appeals Office Case Management System,
which covers the collection and use of data elements collected on the Form I290B to file an appeal or motion with the Administrative Appeals Office (AAO)

SORN
 DHS/USCIS/ICE/CBP-001- Alien File, Index, and National File Tracking System of
Records, which covers the storage of paper forms in the A-File and Receipt File
 DHS-USCIS-007 Benefits Information System, which covers attorney/accredited
representative, preparers, interpreters, and petitioner

PRIVACY THRESHOLD ADJUDICATION
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

(TO BE COMPLETED BY THE DHS PRIVACY OFFICE)
DHS Privacy Office Reviewer:

Kameron Cox

PCTS Workflow Number:
Date approved by DHS Privacy Office:
PTA Expiration Date

1158351
February 27, 2018
February 27, 2021

DESIGNATION
Privacy Sensitive IC or
Form:

Yes If “no” PTA adjudication is complete.

Determination:

☐PTA sufficient at this time.
☐Privacy compliance documentation determination in progress.
☐New information sharing arrangement is required.
☐DHS Policy for Computer-Readable Extracts Containing SPII
applies.
☒ Privacy Act Statement required.
☒ Privacy Impact Assessment (PIA) required.
☒ System of Records Notice (SORN) required.
☐Specialized training required.
☐Other. Click here to enter text.

DHS IC/Forms Review:

Choose an item.

Date IC/Form Approved Click here to enter a date.
by PRIV:
IC/Form PCTS Number: Click here to enter text.
Privacy Act
Current Privacy Notice is sufficient
Statement:
PTA:
CLAIMS 3 PTA is Sufficient
PIA:
System covered by existing PIA
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Privacy Office
U.S. Department of Homeland Security
Washington, DC 20528
202-343-1717, [email protected]
www.dhs.gov/privacy

If covered by existing PIA, please list: DHS/USCIS/PIA-062
Administrative Appeals Office Case Management System
DHS/USCIS/PIA-016(a) Computer Linked Application Information
Management System (CLAIMS 3) and Associated Systems
SORN:
System covered by existing SORN
If covered by existing SORN, please list: DHS/USCIS/ICE/CBP-001 Alien
File, Index, and National File Tracking System of Records, September 18,
2017, 82 FR 43556
DHS/USCIS-007 Benefits Information System October 19, 2016 81 FR
72069
DHS Privacy Office Comments:
Please describe rationale for privacy compliance determination above.
USCIS is submitting this PTA to document changes to Form I-290B, Notice of Appeal
or Motion, which is used to file an appeal or motion on any decision under the
immigration laws, except for appeals of Form I-130, Petition for Alien Relative, and
Form I-360, Petition for Amerasian, Widow(er), or Special Immigrant, (widow(er)
only) denials in which the Board of Immigration Appeals (BIA) has appellate
jurisdiction.
The DHS Privacy Office (PRIV) agrees with USCIS Privacy that Form I-290B is a
privacy sensitive information collection and a PIA is required because it collects PII
from members of the public. PRIV finds that DHS/USCIS/PIA-062 AAO Case
Management System assesses the risks of filing an appeal on the form I-290B and
DHS/USCIS/PIA-016(a) discusses the system on which the Form I-290B is processed.
PRIV finds that a SORN is required because Form I-290B collects information that is
then retrieved by a unique identifier. PRIV concurs with USCIS Privacy that
DHS/USCIS/ICE/CBP-001 Alien File SORN covers the collection of information of
paper and electronic benefit forms and supplemental evidence for the purposes of
adjudicating immigration benefits. DHS/USCIS-007 BIS SORN provides coverage for
the use and storage of decisional data that accompanies the Form I-290B.
PRIV concludes that a Privacy Act Statement is required because Form I-290B
collects information from both US Persons and non US Persons that is then entered
into a system of records. PRIV recommends the title of the Privacy Notice submitted
by USCIS is changed to “Privacy Act Statement.”

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