Instructions For Notice Of Entry Of Appearance (Form G-28) (Page 4 of 4) in pdf

Part 5. Signature of Attorney or Accredited Representative

Item Numbers 1. - 3. The attorney or accredited representative and, if applicable, law student or law graduate must sign

and date the form in black ink.

Part 6. Additional Information

Use this section to provide additional information related to Part 3., Item Numbers 1.a. - 1.d. or to provide your U.S.

business address for purposes of receiving secure identity documents for your client (if your client has consented to your

receipt of such documents under Part 4.).

Warning

Individuals appearing as attorneys or accredited representatives (including law students and law graduates permitted to

appear under 8 CFR 292.1(a)(2)) are subject to the rules of Professional Conduct for Practitioners found in 8 CFR 292.3.

Freedom of Information/Privacy Act Requests

You may not use this form to request records under the Freedom of Information Act or the Privacy Act, Title 5 U.S. Code

sections 552 and 552a. You may find the procedures for requesting such records in 6 CFR Part 5 and at

DHS Privacy Act Statement

AUTHORITIES: The information requested on this form is collected pursuant to 8 C.F.R. section 292.4(a).

PURPOSE: The primary purpose for providing the requested information on this form is to establish your eligibility to

appear and act on behalf of an applicant, petitioner, or respondent. The information you provide will be used to designate

you as an attorney or accredited representative.

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information may

prevent your ability to represent an individual or entity.

ROUTINE USES: The information will be used by and disclosed to DHS personnel and contractors or other agents who

need the information. Additionally, DHS may share the information with other federal, state, local government agencies

and authorized organizations in accordance with approved routine uses, as described in the associated published system

of records notices [DHS-USCIS-001 - Alien File (A-File) and National File Tracking System (NFTS), DHS-USCIS-005

- Inter-Country Adoptions Security, DHS-USCIS-007 - Benefits Information System, DHS-USCIS-010 - Asylum

Information and Pre-Screening, and DHS-USCIS-015 - Electronic Immigration System-2 Account and Case Management

System of Records, which can be found at The information may also be made available, as

appropriate for law enforcement purposes or in the interest of national security.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection

of information, unless it displays a currently valid OMB control number. The public reporting burden for this collection

of information is estimated at 53 minutes per response, including the time for reviewing instructions and completing and

submitting the form. Send comments regarding this burden estimate or any other aspect of this collection of information,

including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination

Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No. 1615-0105.

Do not mail your completed Form G-28 to this address.

Form G-28 Instructions 05/05/16 Y

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