I-765V-008 INS TOCs

TABLE OF CHANGES – INSTRUCTIONS

Form I-765V, Application for Employment Authorization for Abused Nonimmigrant Spouse

OMB Number: 1615-0137

03/07/2022

Reason for Revision: Extension

Project Phase: OMBReview

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 07/31/2022

Edition Date 07/31/2020

Current Page Number and Section	Current Text	Proposed Text
Page 11, DHS Privacy Notice	[Page 11] DHS Privacy Notice AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA section 106 and VAWA 2005 section 814(c), which extends employment authorization eligibility to battered spouses of nonimmigrants admitted under INA section 101(a)(15) subparagraph (A), (E)(iii), (G), or (H). PURPOSE: The primary purpose for providing the requested information on this application is to determine your employment eligibility. The information is used to approve or deny your request for an Employment Authorization Document. 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 the denial of your application. ROUTINE USES: The information you provide in the application is confidential and protected from disclosure under 8 USC 1367. 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 follow approved routine uses described in the associated published system of records notices [DHS­USCIS-001 - Alien File, Index, and National File Tracking System of Records and DHS-USCIS-007 – Benefit Information System] and the published privacy impact assessment [DHS/USCIS/PIA-016(a) Computer Linked Application Information management System and Associated Systems] 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.	[Page 11] DHS Privacy Notice AUTHORITIES: The information requested on this application, and the associated evidence, is collected pursuant to Section 106 of the Immigration and Nationality Act (INA), as amended and Section 814(c) of the Violence Against Women Act of 2005, which extends employment authorization eligibility to battered spouses of nonimmigrants admitted under subparagraph (A), (E)(iii), (G), or (H) of section 101(a)(15) of the Act. PURPOSE: The primary purpose for providing the requested information on this application is to determine your employment eligibility. The information is used to approve or deny your request for an Employment Authorization Document. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay a final decision or result in the denial of your benefit request. ROUTINE USES: The information will be used by and disclosed to DHS personnel and contractors or other agents in accordance with approved routine uses, as 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 Benefit Information System, and DHS/USCIS-018 Immigration Biometric and Background Check] and published privacy impact assessment [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System and Associated Systems], which you can find at www.dhs.gov/privacy. This information may also be made available, as appropriate, for law enforcement purposes or in the interest of national security.

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