Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request (Page 5 of 7) in pdf

Item Numbers 8.a - 8.c. Signature and Notarized Affidavit or Declaration of the Subject of Record. Select only one

box. The Subject of Record MUST provide a signature in Item Number 8.a. Notarized Affidavit of Identity OR Item

Number 8.b. Declaration Under Penalty of Perjury, regardless if you submit this request yourself or another individual

completes this request on your behalf. If the Subject of Record is deceased, read Item Number 8.c. Deceased Subject of

Record and attach proof of death.

NOTE: Appropriate consent from the Subject of Record is established by submitting Form G-639 with required

information and signatures or an authorizing letter with verification of identity for the Subject of Record. You may also

use U.S. Department of Justice (DOJ) Form 361, Certification of Identity, to verify identity for the Subject of Record.

Form DOJ-361 is available online at

If you are a parent or legal guardian submitting Form G-639 on behalf of a child or other individual, you must also

establish your own identity as the child’s or other individual’s parent or legal guardian.

Part 5. Additional Information

Item Numbers 1.a. - 6.d. If you need extra space to provide any additional information within this request, use the

space provided in Part 5. Additional Information. If you need more space than what is provided in Part 5., you may

make copies of Part 5. to complete and file with your request, or attach a separate sheet of paper. Include your name and

A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your

answer refers; and sign and date each sheet.

We recommend that you print or save a copy of your completed request to review

in the future and for your records.

Expedite Requests

Requests to have your Form G-639 expedited, or processed ahead of other previously received requests, are reviewed on

a case-by-case basis. To seek expedited processing, you must submit a typed or printed statement explaining in detail

the basis for requesting expedited processing, and your statement must include a certification that this information is

complete, true, and correct to the best of your knowledge and belief.

Requests will be given expedited treatment whenever it is determined that they involve:

1. Circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to

the life or physical safety of an individual;

2. An urgency to inform the public about an actual or alleged Federal government activity, if made by a person primarily

engaged in disseminating information;

3. The loss of substantial due process rights; or

4. A matter of widespread and exceptional media interest in which there exists possible questions about the government’s

integrity which affect public confidence. Requests for expedited processing based upon this category must be

submitted to the Senior Director of FOIA Operations, the Privacy Office, U.S. Department of Homeland Security, 245

Murray Lane SW STOP -0655, Washington, DC 20598-0655.

Fees

Please do not remit any fees payment at the time of your request. After receipt of your FOIA request, USCIS will contact

you if any fees are required.

Except for commercial requestors, the first 100 pages of reproduction and the first two hours of search time are provided

without charge. Thereafter, requests processed under PA may incur fees of 10 cents per page for duplication. Other costs

for searches and duplication are charged at the actual direct cost.

Form G-639 Instructions 04/17/17 N

Page 5 of 7

Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request Page 5