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Freedom of Information/Privacy Act Request (United States)

This form is for Freedom of Information or Privacy Act for the United States. The form provided here is simply a sample of what the actual Form G-639 looks like.

Department of Homeland Security
U.S. Citizenship and Immigration Services

G-639, Freedom of Information/Privacy Act Request

NOTE: The completion of this form is optional. Any written format for Freedom of Information or Privacy Act requests is acceptable.

START HERE - Please type or print in black ink. Read instructions before completing this form.

1. Type of Request: (Check appropriate box.)

____ Freedom of Information Act (FOIA). (Complete all items except Number 6.)

____ Privacy Act (PA). (Number 6 must be completed in addition to all other applicable items.)

____ Amendment. (PA only. Number 5 must be completed in addition to all other applicable items.)

2. Requester Information.

Name of Requester (Last, First and Middle Names): _______________________________

Date (mm/dd/yyyy) _______________________________

Daytime Telephone: _______________________________

Address (Street Number and Name): _______________________________

Apt. Number: ____________

City: _______________________________

State: _______________________________

Zip Code: _______________________________

By my signature, I consent to the following:
Pay all costs incurred for search, duplication and review of materials up to $25.00, when applicable. (See Instructions.)

Signature of requester: _______________________________

____ Deceased Subject - Proof of death must be attached. (Obituary, Death Certificate or other proof of death required.)


3. Consent to Release Information. (Complete if name is different from Requester). (Numbers 7 and 8 must be completed.)

Print Name of Person Giving Consent: _______________________________

Signature of Person Giving Consent: (Original signature required.) _______________________________

By my signature, I consent to the following (Check applicable boxes.):

____ Allow the Requester named in Number 2 above:

____ All of my records, or

____ A portion of my records. (If a portion, specify what part, i.e. copy of application.)

_______________________________

(Consent is required for records of U. S. citizens (USC) and Lawful Permanent Residents (LPR).

4. Information needed to search for record(s).

Specific information, document(s) or record(s) desired: (Identify by name, date, subject matter and location of information.)

_______________________________

Purpose: (Optional: You are not required to state the purpose of your request. However, doing so may assist USCIS to locate the records needed to respond to your request.)

5. Data Needed on Subject of Record. (If data marked with an asterisk (*) is not provided, records may not be located.)

* Family Name: _______________________________

Given Name: _______________________________

Middle Name: _______________________________

* Other names used, if any: _______________________________

* Name at time of entry into the U.S.: _______________________________

I-94 Admissions #: _______________________________

* Alien Registration Number: _______________________________

* Petition or Claim Receipt #: _______________________________

* Country of Birth: _______________________________

* Date of Birth (mm/dd/yyyy) _______________________________

Names of other family members that may appear on requested record(s) (i.e., Spouse, Daughter, Son):

Father's First Name _______________________________

Middle _______________________________

Last _______________________________


Mother's First Name _______________________________

Middle _______________________________

Last (Include Maiden Name) _______________________________


Country of Origin: (Place of Departure) _______________________________

Port-of-Entry Into the U.S.: _______________________________

Date of Entry: _______________________________

Manner of Entry: (Air, Sea, Land) _______________________________

Mode of Travel: (Name of Carrier) _______________________________

U.S. Social Security Number: _______________________________

Name on Naturalization Certificate: _______________________________

Certificate #: _______________________________

Naturalization Date: _______________________________

Address on Date of Naturalization: _______________________________

Court and Location: _______________________________

6. Verification of Subject's Identity: (See Instructions for explanation. Check one box.)

____ In-Person With ID

____ Notarized Affidavit of Identity

____ Other (Specify) _______________________________

7. Signature of Subject of Record:

(Original signature required) _______________________________

Date: _______________________________

Telephone No.: _______________________________

8. Notary:
(Normally needed from persons who are the subject of the record sought or for a sworn declaration under penalty of perjury. See below.)

Subscribed and sworn to before me this _______________________________

Day of _______________________________

in the Year ___________

Signature of Notary _______________________________

My Commission Expires on _______________________________

OR

NOTE: If a declaration is provided in lieu of a notarized signature, it must state at a minimum the following: (Include Notary Seal or Stamp in the appropriate space below.)

Executed outside U.S.

If executed outside the United States: ''I declare (certify, verify, or state) under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

Signature: _______________________________

(Seal/Stamp)

Executed in U.S.

If executed within the United States, its territories, possessions or commonwealths: ''I declare (certify, verify or state) under penalty of perjury that the foregoing is true and correct.

Signature: _______________________________

(Seal/Stamp)


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INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

NOTE: Please read all Instructions carefully before completing this form. Applicants making false statements are subject to criminal penalties (Pub.L. 93-579.99 Stat. [5 U.S.C. 552a(i)(3)]).

Are There Cases When You Should Not Use This Form?

Do not use this form:

1. To determine the status of pending applications. For status inquires, write to the USCIS office where the application was filed or call our National Customer Service Center at 1-800-375 5283.

2. For consular notification of a visa petition approval, use Form I-824 (Application for Action on an Approved Application or Petition).

3. For the return of original documents, use Form G-884 (Request for Return of Original Documents).

4. For records of naturalization prior to September 27, 1906, write to the clerk of court where naturalization occurred.

5. For information on USCIS manifest arrivals prior to December 1982, write to the National Archives.

6. To obtain proof of status (i.e., Social Security benefit, Selective Service requirement).

How Can You Obtain Copies of Records From USCIS?

Persons requesting a search for access to USCIS records under the Freedom of Information or Privacy Acts may submit the completed application or a letter to a USCIS office listed on our internet website at www.uscis.gov.

NOTE: Before submitting your request to your local USCIS office, visit our website at www.uscis.gov and click on InfoPass to determine the office's filing procedures. See Page 3 of these instructions on how to use InfoPass to make an appointment at your USCIS office.

If you do not know where to mail your request, send it to the following address:
USCIS National Record Center
FOIA Division
P.O. Box 648010
Lee Summit, MO 64064-5570

Requests may be submitted in person or by mail. If an application is mailed, the envelope should be clearly marked ''Freedom of Information'' or ''Privacy Act Request.''

What Information Is Needed to Search for USCIS Records?

NOTE: Failure to provide complete and specific information as requested in Number 4 of the form may result in a delay in processing or USCIS' inability to locate the record(s) or information requested. You may access www.uscis.gov for a description of DHS/USCIS systems of records.

Verification of Identity in Person.

Requesters appearing in person for access of their records may identify themselves by showing a document bearing a photograph (such as an Permanent Residence Card, Form I-551, Naturalization Certificate or passport) or two items that bear their name and address (such as a driver's license and voter registration card).

Verification of Identity by Mail.

Requesters wanting access of their records should identify themselves by name, current address, date and place of birth, and alien registration or employee identification number.

A notarized example of their signature or sworn declaration under penalty of perjury must also be provided. (This Form G-639 or a U.S. Department of Justice Form 361, Certification of Identity, may also be used.)

Verification of Identity of Parents, Guardians, Children or Other Persons.

Parents or legal guardians must establish their own identity as parents or legal guardians and the identity of the child or other person being represented.

Authorization or Consent.

Other parties requesting nonpublic information about an individual usually must have the consent of that person on Form G-639 or by an authorizing letter, together with appropriate verification of identity of the record subject. A notarized or sworn declaration is required from a record subject who is a lawful permanent resident or U.S. citizen, and for access to certain Legalization files.

Can Your Request Be Expedited?

To have your case processed ahead of other requests received previously, you must show a compelling need for your request to be expedited.

How Do You Show a Compelling Need?

A requester who seeks expedited processing must explain in detail the basis of the need and should submit a statement certified to be true and correct to the best of his or her knowledge and belief. The requester must also establish that one of the following situations exists:

1. Circumstances in which the lack of expedited processing could reasonably be expected to pose an imminent threat to the life or physical safety of an individual, or

2. An urgency to inform the public about an actual or alleged federal government activity, if made by a person primarily engaged in disseminating information.

Fees.

No fees are required until you are notified by USCIS during the processing of your request.

Except for commercial requesters, the first 100 pages of reproduction and two hours of search time will be provided without charge. Thereafter, for requests processed under the Privacy Act, there may be a fee of ten cents per page for photocopy duplication.

Other costs for searches and duplication will be charged at the actual direct cost.

Fees will only be charged if the aggregate amount of fees for searches, copy and/or review is more than $14.00. If the total anticipated fees amount to more than $250.00, or the same requester has failed to pay fees in the past, an advance deposit may be requested.

NOTE: If a fee for a prior request is outstanding, we will not honor future requests until all fees are paid.

Fee waivers or reductions may be sought for a request that clearly will benefit the public and is not primarily in the personal or commercial interest of the requester. Such requests should include a justification.

When Must You Submit the Fee?

Do not send money with this request. When USCIS instructs you to do so, submit the fees in the exact amount.

Payment may be in the form of a check or U. S. postal money order. If the form is submitted from outside the United States, remittance may be made on a bank international money order or foreign draft drawn on a financial institution based in the United States, made payable in U.S. currency to the "United States Treasury."

A requester residing in the U.S. Virgin Islands should make the remittance payable to the Commissioner of Finance of the Virgin Islands, and, if residing in Guam, to the Treasurer, Guam." Do not send cash at any time.

A charge of $30.00 will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn. Every remittance will be accepted subject to collection.

Routine Uses.

Information will be used to comply with requests for information under Title 5 U.S. Code 552 and 552a. Information provided to other agencies may be for referrals, consultations and/or to answer subsequent inquiries concerning specific requests.

Effect of Not Providing Requested Information.

Providing the information requested on this form is voluntary. However, failure to furnish the information may result in our inability to comply with a request when compliance will violate other policies or laws.

General Information.

The Freedom of Information Act (5 U.S.C. 552) allows requesters to have access to Federal agency records, except those exempted by the Act.

Privacy Act Statement.

Authority to collect this information is contained in Title 5 U.S. Code 552 and 552a. The purpose of the collection is to enable USCIS to locate applicable records and to respond to requests made under the Freedom of Information and Privacy Acts.

Privacy Act of 1974. (5 U.S.C. 552a).

With certain exceptions, the Privacy Act of 1974 permits persons (U.S. citizens or permanent resident aliens) to gain access to information pertaining to themselves in Federal agency records, to have a copy made of all or any part thereof, to correct or amend such records, and to permit individuals to make requests concerning what records pertaining to themselves are collected, maintained, used or disseminated. The Act also prohibits disclosure any person's records without their written consent, except under certain circumstances as prescribed by the Privacy Act.

USCIS Forms and Information.

To order USCIS forms, call our toll-free number at 1-800-870-3676. You can also get USCIS forms and information on immigration laws, regulations and procedures by telephoning our National Customer Service Center at 1-800-375-5283 or visiting our internet website at www.uscis.gov.

Use InfoPass for Appointments.

As an alternative to waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our internet-based system, InfoPass. To access the system, visit our website at www.uscis.gov. Use the InfoPass appointment scheduler and follow the screen prompts to set up your appointment. InfoPass generates an electronic appointment notice that appears on the screen. Print the notice and take it with you to your appointment. The notice gives the time and date of your appointment, along with the address of the USCIS office.

Public Reporting Burden.

Under the Paperwork Reduction Act (5 U.S.C. 1320), a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.

We try to create forms and instructions that are accurate, can be easily understood and that impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex.

The estimated average time to complete and file this application is 15 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

If you have comments regarding the accuracy of this estimate or suggestions for making this form simpler, write to the U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue, N.W., Washington, DC 20596; OMB No. 1653-0030. Do not send your request to this office address.

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