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Authorization for Release of Information (Form SAP-2)
ICR 202609-0970-007 · OMB 0970-0278 · Object 172739500.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Authorization for Release of Information (Form SAP-2) |
| Conversion State | complete |
Extracted Text
New Sponsor application <ARI> An official website of the United States government An official website of the United States government An official website of the United States government An official website of the United States government An official website of the United States government An official website of the United States government Here’s how you know Here’s how you know Here’s how you know Here’s how you know Here’s how you know Here’s how you know Sponsor Application for Family Sponsor Application for Family ac : x : B kg 1 Unification MENU Unification Section 2: This section has not been Background started. becomes . 1 1 About the child (children) Unification : Authori ation Sponsor Application for Family Unification z 2 MENU : Authori ation Sponsor Application for Family Unification z 2 MENU : Authori ation 2 Sponsor Application for Family MENU Unification z : Authori ation 2 z This section has not been This section has not been This section has not been This section has not been This section has not been started. started. started. started. started. Y ou must complete this Y ou must complete this Y ou must complete this Y ou must complete this x Authori ation E isting Y ou must complete this section before you can proceed section before you can proceed section before you can proceed section before you can proceed section before you can proceed with the application. with the application. with the application. with the application. with the application. 1 of 5 2 of 5 Carefully read this Authorization 3 of 5 4 of 5 I Authori e any federal, state, or local I Understand that my biometric and I Understand that this information will agreement and accompanying Privacy criminal ustice agency federal, state, biographical information, including become the property of the ORR and Notice, then provide your typed local, or private child welfare agency my fingerprints, is shared with may be reviewed by its employees, electronic signature. federal immigration agency or any Federal, state or local law grantees, contractors, and delegates. I other sources of information, such as enforcement agencies and may be also understand that the ORR may I Authori e any investigator, special schools, courts, treatment providers, used consistent with their authorities, share this information with the agent, employee, contractor, grantee probation parole officers, mental including with the U.S. Department of employees and contractors of other or other duly accredited health professionals, or other Homeland Security (DHS) and with Federal agencies. representative working on behalf of references, to release information the U.S. Department of Justice (DOJ) the Office of Refugee Resettlement about any criminal history, child to investigate my criminal history I Understand that ORR will offer me a (ORR) conducting my background abuse and neglect charges or through the National Criminal fingerprint appointment within seven investigation or sponsorship concerns, mental health issues, Information Center. I also understand (7) business days of receipt of a assessment to obtain information for substance abuse, domestic violence, that DHS cannot use my information signed copy of this document and a the purposes of assessing my ability or any other psychosocial information for immigration enforcement actions, valid form of identification, unless to provide appropriate care and gathered about me either verbally or including placement in detention, circumstances beyond ORR’s control placement of a child and for providing in writing. removal, referral for a decision prevent ORR from offering an whether to initiate removal appointment within that timeframe. I Child’s first name z j Child’s date of birth / / mm dd yyyy , 1 2 About you the ; / post release services, as needed, or + Add another child ; ; z Child’s last name z sources of information pertaining to proceedings, unless I have been make reasonable efforts to process applicable. me to release such information upon convicted of a serious felony, am my fingerprints within ten (10) request of the investigator, special pending charges for a serious felony, business days of receipt of a set of agent, employee, contractor, grantee, or I have been directly involved in or legible prints, unless circumstances or other duly accredited associated with any organization beyond ORR’s control prevent representative of the ORR. involved in human trafficking. g Y A our first name I, Raul Miguel Castillo, agree to the j and affirm under penalty of per ury 1 accurate to the best of my knowledge. Y our signature Please type your name below to indicate household or caregiver for a child, as our name submitting. this authorization is true and further understand that ORR will Y Background information before that the information contained in proceedings, or initiation of removal ac Please review your Section 1: Authorization Agreement. I declare I Authori e custodians of records and B k your electronic signature. B k ac fingerprints from being processed ree and continue within that timeframe. Submit I Understand that the information ? See Frequently Asked Need Help Q B k uestions or contact your Case Manager. ac Last name Family Reunification Packet |V ersion 1 g 3 A ree and continue FRP-2 Authorization for Release of n / / Informatio our date of birth / / mm dd yyyy ? See Frequently Asked Need Help Q uestions or contact your Case Manager. Revised 12 28 2022 released by any custodian of my I Hereby Relinquish any claim or right records and any other sources of under the laws of the United States information about me is for official against the federal government, its use by the U.S. Government, its employees, grantees, contractors, or employees, grantees, contractors, and delegates, for the legally authorized other delegated personnel, for the use of any information gathered purposes stated above, and may be during a search of my criminal history, disclosed by the U.S. Government only child welfare information, any as authorized by law. information contained in my ? See Frequently Asked Need Help Q uestions or contact your Case Manager. Family Reunification Packet |V ersion 1 3 FRP-2 Authorization for Release of n / / Informatio Revised 12 28 2022 sponsorship application and Family Reunification Packet Y |V ersion 1 3 supporting documentation, and any information gathered from any verbal FRP-2 Authorization for Release of our country of citizenship n / / Informatio - Select - 1 Revised 12 28 2022 or written sources regarding this See Consolidated Appropriations Act, sponsorship application. I hereby 2023, Pub. L. 117-328, Division F, Title II, § relinquish any claim or previous 217. Please note that DHS is restricted agreement with any federal, state, from using this information through O Proof of identity Upload your government issued ID. Y RR National C C all local, or private agency that would bar September 31, 2023. the ORR or the agency's official enter delegate from obtaining the 1 (800) 203-7001 requested information. List A or two or more selections from B k ac List documents are acceptable. O RR National C C all enter g A B k ree and continue ac 1 (800) 203-7001 ? Q g See Frequently Asked Need Help List A (upload one) A uestions or contact your Case Manager. List A document selection ? - Select Family Reunification Packet |V ersion 1 3 Q ree and continue See Frequently Asked Need Help uestions or contact your Case Manager. FRP-2 Authorization for Release of O List n / / Informatio R Family Reunification Packet Revised 12 28 2022 |V ersion 1 3 FRP-2 Authorization for Release of n / / Informatio B (upload two) Revised 12 28 2022 List B document 1 selection - Select - O Y our previously used name(s) List other names you have used, such as your name before you were married or maternal last names (separate with commas) Delete Y our previous name When you stopped using this name month year - Select - - Select - + Add another name Y our place of birth Please copy from your birth certificate Country - Select - State - Select - City . Your addresses 1 3 Y our current address Street address City State - Select - Zip code Address start date month year - Select - - Select - Y our past addresses Where have you lived the past 5 ? years Previous address Delete Country - Select - Street address City State - Select - Zip code Address start date month year - Select - - Select - Address end date month year - Select - - Select - + Add another address ? Need Help See Frequently Asked uestions or contact your Case Manager. v Sa e for later Submit for C ase Manager review Family Reunification Packet |V ersion 1 3 FRP-2 Authorization for Release of n / / Informatio Revised 12 28 2022 O C C all enter 1 (800) 203-7001 O RR National C C all enter 1 (800) 203-7001 Previous name Q RR National RR National C C all enter 1 (800) 203-7001 O RR National C C all enter 1 (800) 203-7001 ou may present one selection from B. If you present selections from List B, at least on selection must contain a photograph. Expired Authorization becomes 5 of 5 my background as a member of the Sponsor Y Section 1: Section 2 Delete . MENU Section 1 Child (children) information Child Sponsor Application for Family z 2 E isting round MENU