Instructions For Supplement B, Declaration Of Law Enforcement Officer For Victim Of Trafficking In Persons (Form I-914b) (Page 4 of 4) in pdf

USCIS Privacy Act Statement

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

pursuant to Public Law 106 - 386, sections 107(e) and 1513(c) and 8 USC 1101(a)(15)(T).

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

established eligibility for temporary immigration benefits for which you are filing. The information you provide will be

used to grant or deny the benefit sought.

DISCLOSURE: The information you provide, including Social Security Number, is voluntary. However, failure to

provide the requested information, and any requested evidence, may delay a final decision or result in denial of your

benefit request.

ROUTINE USES: The information you provide in the application is confidential and protected from disclosure under

8 USC 1367. Your information will be used to determine eligibility, to investigate fraudulent claims, to enforce penalties

for false statements, to assist in the investigation and prosecution of trafficking and related crimes. The information will

be used by and disclosed to DHS personnel and contractors or other agents in accordance with approved routine uses,

as 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, which can be found at

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 law enforcement

agencies for this collection of information is estimated at 3 hours and 30 minutes per response, including the time for

reviewing instructions and completing and submitting the form. The public burden for the Form I-914 respondents who

will take the action of contacting a law enforcement agency to request that Form I-914, Supplement B, be completed is

estimated to require 15 minutes to make such a request to the agency. 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 Avenue NW,

Washington, DC 20529-2140. OMB No. 1615-0099. Do not mail your completed Form I-914, Supplement B to this

address.

Form I-914, Supplement B Instructions 02/27/17 Y

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Instructions For Supplement B, Declaration Of Law Enforcement Officer For Victim Of Trafficking In Persons (Form I-914b) Page 4