DHS Privacy Notice
AUTHORITIES: Sections 1103, 1158, 1182, 1203, and 1204 of Title 8 of the U.S. Code authorize USCIS to collect the information requested on this form and the associated evidence.
PURPOSE: The primary purpose for providing the requested information is to authorize an electronic credit card or Automated Clearing House (ACH) payment in Pay.gov, which is owned and operated by the Department of Treasury, for the filing fees associated with the separate submission of I-131A.
DISCLOSURE: The information you provide is voluntary. However, failure to make a payment towards the associated benefit request fee may delay or prevent USCIS from accepting your benefit request form.
ROUTINE USES: This information may be used by and disclosed to USCIS personnel and contractors or other agents who need the information to assist in activities related to processing your filing fees. Additionally, USCIS may disclose the information to other federal, state, and local authorized organizations in accordance with approved routine uses, as described in the associated published system of records notice [TREASURY/FMS.017 - Collections Records - Treasury/Financial Management Service, which can be found at http://www.treasury.gov/privacy, and DHS-USCIS-007 - Benefits Information System, available at www.dhs.gov/privacy]. The information may also be made available as appropriate for law enforcement purposes or in the interest of national security.
Paperwork Reduction Act Burden Disclosure Notice
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 curently valid OMB control number. The public reporting burden for this collection of information is estimated at .167 hour or 5 minutes per response, including the time for reviewing instructions and completing and submitting the authorization. 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
Office of Policy and Strategy, Regulatory Coordination Division
5900 Capital Gateway Drive, Mail Stop #2140
Camp Springs, MD 20588-0009
Do not mail your Application for Travel Document Fee payment to this address.
OMB No. 1615-0135
Expires: 08/31/2018
