USCIS Privacy Act Statement
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under Sections 207 and
209 of the Immigration and Nationality Act, as amended, as well as 8 CFR 207.3.
PURPOSE: The primary purpose for providing the requested information on this application is for a refugee who has been found
inadmissible to the United States for reasons such as a criminal conviction or certain health conditions to apply for a waiver of such
inadmissibility on grounds of humanitarian reasons, family unity or national interest. DHS will use the information you provide to
grant or deny the waiver.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any
requested evidence, may delay a final decision or result in denial of the waiver.
ROUTINE USES: DHS may share the information you provide on this application with other Federal, state, local, and foreign
government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system
of records notices [DHS/USCIS-007 - Benefits Information System and DHS/USCIS-001 - Alien File, Index, and National File
Tracking System of Records] which you can find at DHS may also share the information, 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 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. 1615-0069. Do not mail your application to this address.
Form I-602 (Rev. 12/19/16) Y Page 4