Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request (Page 3 of 7) in pdf

Item Numbers 7.a. - 7.b. Requestor’s Certification. Sign and date the request. A stamped or typewritten name in place

of a signature is not acceptable.

Part 3. Description of Records Requested

You are not required to respond to every item in Part 3. However, failure to provide complete and specific information

may delay processing of your request or create an inability for USCIS to locate the records or information requested.

NOTE: If you are filing this request on behalf of another individual, select the response as it would apply to that

individual.

Item Number 1. Purpose. This optional information, if provided, may assist USCIS in locating the records you seek.

Item Numbers 2.a. - 2.c. Full Name of the Subject of Record. Provide the full legal name of the Subject of Record in

the spaces provided.

Item Numbers 3.a. - 3.c. Other Names Used by the Subject of Record. Provide other names you have used since

birth, including any nicknames, aliases, and your maiden name (if applicable). If you need extra space to complete this

section, use the space provided in Part 5. Additional Information.

Item Numbers 4.a. - 4.c. Full Name of the Subject of Record at Time of Entry into the United States. If your name

has changed since your entered the United States, provide the full name that you used at the time of entry into the United

States.

Item Number 5. Form I-94 Number Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or

USCIS issued you a Form I-94, Arrival-Departure Record, provide your Form I-94 number and date that your authorized

period of stay expires or expired (as shown on Form I-94). The Form I-94 number also is known as the Departure

Number on some versions of Form I-94.

NOTE: If you were admitted to the United States by CBP at an airport or seaport after April 30, 2013, you may have

been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. You may visit the CBP website at

to obtain a paper version of an electronic Form I-94. CBP does not charge a fee for this service. Some

travelers admitted to the United States at a land border, airport, or seaport, after April 30, 2013 with a passport or travel

document, who were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form I-94 from the CBP

website without charge. If your Form I-94 cannot be obtained from the CBP website, it may be obtained by filing Form

I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a

fee for this service.

Item Number 6. Alien Registration Number (A-Number) (if any). An Alien Registration Number, otherwise known as

an “A-Number,” is typically issued to persons who apply for, or are granted, certain immigration benefits. In addition to

USCIS, CBP, U.S. Immigration and Customs Enforcement (ICE), Executive Office for Immigration Review (EOIR), and

the U.S. Department of State (DOS) may also issue an A-Number to certain aliens. If you were issued an A-Number, type

or print it in the spaces provided. If you do not have an A-Number, or if you cannot remember it, leave this space blank.

Item Number 7. USCIS Online Account Number (if any). If you have previously filed an application, petition, or

request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)),

provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account

Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,

or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice

issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be

found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The

USCIS Online Account Number is not the same as an A-Number.

Item Number 8. Application, Petition, or Request Receipt Number. Provide the USCIS receipt number that

corresponds to any application, petition, or request you previously filed with USCIS.

Form G-639 Instructions 04/17/17 N

Page 3 of 7

Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request Page 3

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