Instructions For Form I-821 - Application For Temporary Protected Status (Page 17 of 18) in pdf

Instructions For Form I-821 - Application For Temporary Protected Status Page 17

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA

section 101 and 244. INA section 264(f) (8 U.S.C. 1304(f)) also provides the Secretary of Homeland Security with the

authority to collect Social Security number (SSN) information.

PURPOSE: The primary purpose for providing the requested information on this application is to determine if you have

established eligibility for TPS. DHS will use the information you provide to grant or deny the benefit you are seeking.

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 your application.

ROUTINE USES: DHS may share the information you provide on this application, including supporting documentation

you provide, 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] 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 Office of Management and Budget (OMB) control number. The public

reporting burden for this collection of information is estimated at 2 hours and 25 minutes per response, including the time

for reviewing instructions, gathering the required documentation and information, completing the application, attaching

necessary documentation, and submitting the application. The collection of biometrics, where required, is estimated to

require 1 hour and 10 minutes. 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.

1615-0043. Do not mail your completed Form I-821 to this address.

Form I-821 Instructions 10/19/17 N

Page 17 of 18

Instructions For Form I-821 - Application For Temporary Protected Status Page 17