Supplement 2 TOC

TABLE OF CHANGES – FORM

Form I-600A/I-600 Supplement 2, Consent to Disclose Information

OMB Number: 1615-0028

05/28/2020

Reason for Revision: Fee Rule Final Rule

Project Phase: G-1056

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 12/31/2021

Edition Date 12/21/2019

Current Page Number and Section	Current Text	Proposed Text
New	[Page 1] START HERE – Type or print in black ink. [New] Notice The Privacy Act protects information that U.S. Citizenship and Immigration Services (USCIS) may have concerning your Form I-600A, Application for Advance Processing of an Orphan Petition, or Form I-600, Petition to Classify Orphan as an Immediate Relative. See 5 U.S.C. 552a. USCIS generally may not disclose this information without your consent. If you want USCIS to be able to disclose this information, you may give this consent by signing Form I-600A/I-600, Supplement 2. You are not required to submit Form I-600A/I-600, Supplement 2, to file Form I-600A or Form I-600. This supplement does not cover your attorney or accredited representative. In order for USCIS to share information with an individual who is your legal representative, you must submit Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States. Provide information below about the individual or entity that you are authorizing USCIS to disclose information to. This could include your home study preparer, the agency that reviewed and approved your home study, your primary adoption service provider, or any other individual or entity (other than your attorney or accredited representative) to whom USCIS may disclose information. For more information about home study preparers and primary adoption service providers, see the Instructions for Form I-600 and Form I-600A. Pursuant to the Privacy Act, 5 USC 552a, and to assist USCIS in adjudicating Form I-600A and/or Form I-600, I (we), the undersigned applicants/petitioners filing Form I-600A and/or Form I-600, consent to the disclosure of any record pertaining to me (us), which appears in any system of records maintained by the U.S. Department of Homeland Security (DHS), or which USCIS may obtain as a result of collecting my (our) biometrics information, to the following individual or entity: 1. Name of Individual or Entity 2. Point of Contact (contact person within the entity) (if any) 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 4. Daytime Telephone Number (with area/country code) 5. Mobile Telephone Number (if any) 6. Email Address (if any) [Page 2] I (We) understand that, by signing this supplement, I am (we are) authorizing USCIS to provide the individual or entity named above with copies of notices sent to me (us) about this case and discuss my (our) case with the individual or entity named in this supplement. I (We) also understand that an adoption service provider, home study preparer, and home study reviewer can only provide adoption services and cannot act as my (our) representative before USCIS with respect to my (our) case unless the adoption service provider/home study preparer is authorized to do so under 8 CFR 292. I (We) also understand that the adoption service provider, home study preparer, and home study reviewer cannot provide any other legal services unless the adoption service provider/home study preparer is authorized to do so under the law governing the provision of legal services in the country or state in which the legal service is provided. 7. Your Printed Name 8. Your Signature Date of Signature (mm/dd/yyyy) 9. Your Spouse’s Printed Name (if you are married) 10. Your Spouse’s Signature Date (mm/dd/yyyy)	[Page 1] START HERE – Type or print in black ink. Answer all questions fully and accurately.  If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed.  If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have?” or “How many times have you departed the United States?”), type or print “None” unless otherwise directed. [no change] Provide information below about the individual or entity that you are authorizing USCIS to disclose information to. This could include your home study preparer, the agency that reviewed and approved your home study, your primary adoption service provider, or any other individual or entity (other than your attorney or accredited representative) to whom USCIS may disclose information. For more information about home study preparers and primary adoption service providers, see the Instructions for Form I-600A and Form I-600. [no change] 1. Name of Individual or Entity 2. Point of Contact (contact person within the entity) 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 4. Daytime Telephone Number (with area/country code) 5. Mobile Telephone Number 6. Email Address [No change]

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