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Form I-361 - Instructions For Affidavit Of Financial Support And Intent To Petition For Legal Custody Of Public Law 97-359 Amerasian Page 6

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-361, we will

deny your Form I-361 and may deny any other immigration benefit the beneficiary seeks. In addition, you will face severe

penalties provided by law and may be subject to criminal prosecution.

USCIS will not accept this affidavit if more than a year has elapsed from the date of execution.

USCIS Privacy Act Statement

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

Immigration and Nationality Act, section 101.

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

established eligibility for the immigration benefit for which you are filing. 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 in your request or result in denial of your affidavit.

ROUTINE USES: DHS may share the information you provide on this affidavit 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 can be found at DHS may also

share the information, as appropriate, for law enforcement purposes or in the interest of national security.

Form I-361 Instructions 09/11/15 N

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Form I-361 - Instructions For Affidavit Of Financial Support And Intent To Petition For Legal Custody Of Public Law 97-359 Amerasian Page 6