DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information on this form, and
any additional supporting information that may be requested, may delay a final decision or result in disqualification of your
interpreter.
ROUTINE USES: The information you provide on this benefit application 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
[DHS/USCIS/ICE/CBP-001 - Alien File, Index, and National File Tracking System of
Records], which
system of records notices
can be found at The information may also be made available, as appropriate for law enforcement purposes or
in the interest of national security.
Page 2 of 2
Form G-1256 08/10/15