Instructions For Annual Certification Of Regional Center (Form I-924a) (Page 9 of 9) in pdf

USCIS Privacy Act Statement

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

Immigration and Nationality Act, sections 101, 103, and 203 (as amended) and the Departments of Commerce, Justice,

and State, the Judiciary, and Related Agencies Appropriation Act, 1993 Pub. L. No. 102-395, section 610, 106 Stat 1828,

1874 (1992) (as amended).

PURPOSE: The primary purpose for collecting the requested information on this form is to determine the regional

center’s continued eligibility for regional center designation. DHS will use the information you provide to determine

continued eligibility for regional center designation. The identifying information requested on this form relating

to the principals of the regional center and the owners of associated new commercial enterprises will allow DHS to

perform standard background checks with law enforcement agencies. These background checks may reveal derogatory

information that may result in the termination of the regional center’s designation.

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

any requested evidence, may adversely impact continued eligibility for regional center designation.

ROUTINE USES: DHS may share the information you provide on this form 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 Office of Management and Budget (OMB) control number. The public

reporting burden for this collection of information is estimated at 14 hours per response, for initial and amendment filings,

including the time for reviewing instructions, gathering the required documentation and information, completing the

form, preparing statements, and attaching necessary documentation, 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. 1615-0061. Do not mail your completed Form I-924A

to this address.

Form I-924A Instructions 12/23/16 N

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Instructions For Annual Certification Of Regional Center (Form I-924a) Page 9