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Instructions For Form I-212 - Application For Permission To Reapply For Admission Into The United States After Deportation Or Removal Page 18

USCIS Privacy Act Statement

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

Immigration and Nationality Act section 212(a)(9)(A) or (C).

PURPOSE: The primary purpose for providing the requested information on this application is to obtain consent from

the Secretary to reapply for admission to the United Sates before you can lawfully return to the United States. DHS and

DOJ will use the information you provide to grant or deny the immigration benefit you are seeking.

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

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

of your application.

ROUTINE USES: DHS and DOJ 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

and DOJ may also make the information 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 this collection

of information is estimated at 2 hours per response, including the time for reviewing instructions, gathering the required

documentation and information, completing the application, preparing statements, attaching necessary documentation,

and submitting the application. The collection of biometrics, if 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. 1615-0018. Do not mail your

completed Form I-212 to this address.

Form I-212 Instructions 12/23/16 N

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Instructions For Form I-212 - Application For Permission To Reapply For Admission Into The United States After Deportation Or Removal Page 18