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

USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS website at

where you can obtain

the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order USCIS

forms by calling the Forms Request Line at 1-800-870-3676. You may also obtain forms and information by calling the

USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:

1-800-767-1833.

USCIS Privacy Act Statement

AUTHORITIES: The Freedom of Information Act, 5 U.S.C. Section 552, and the Privacy Act of 1974, 5 U.S.C. Section

552a, together with the Department of Homeland Security implementing regulations found in volume 6 of the Code of

Federal Regulations (CFR), authorize USCIS to collect the information and associated evidence requested on this form.

PURPOSE: The primary purpose for providing the information requested on this form is to provide essential information

that the USCIS FOIA/PA office uses to conduct a thorough search for responsive records, to verify the record subject’s

identity, and when applicable, to confirm that consent for the release of privacy protected information has been provided

when required. The information you provide will be used to grant or deny this request.

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

any requested evidence, may delay USCIS’ ability to provide responsive records or result in USCIS’s inability to locate

documents you have requested.

ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and

foreign government agencies and authorized organizations in accordance with approved routine uses, as described in the

associated published system of records notices [DHS/USCIS-001-DHS Freedom of Information Act and Privacy Act

Record System which can be found at https:// 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 15 minutes per response, including the time for reviewing instructions, gathering the required

documentation and information, completing the request, preparing statements, attaching necessary documentation,

and submitting the request. 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.

1615-0102. Do not mail your completed Form G-639 to this address.

Form G-639 Instructions 04/17/17 N

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Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request Page 7