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Fee Waiver Additional Information

The collection of information on fee waiver requests is covered by the Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.), as amended; OMB No. 1615-0116; Expires 05/31/2015. 

Any personally identifiable information (PII) that is collected, used, maintained, and/or disseminated through fee waiver requests is covered by the Privacy Act of 1974 (5 U.S.C. 552a), as amended.

USCIS Privacy Act Statement

  • AUTHORITIES:  Section 286 of the Immigration and Nationality Act, as amended and 8 C.F.R. 103.7(c) authorize USCIS to collect the information and associated evidence on this form.
  • PURPOSE:  The primary purpose for providing the requested information on this form is to determine if you have established eligibility for a fee waiver for the associated immigration benefit for which you are filing.
  • DISCLOSURE:  The information you provide is voluntary.  However, failure to provide the requested information may delay a final decision or result in the denial of the fee waiver request and rejection of your application or petition based on non-payment of the fee.
  • ROUTINE USES:  The information you provide on this form may be shared with other Federal, State, local and foreign government agencies in accordance with approved routine uses, as described in the associated published system of records notice [DHS/USCIS/ICE/CBP-001 - Alien File, Index, and National File Tracking and DHS-USCIS-007 - Benefits Information System of Records], which can be found 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

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 1 hour and 10 minutes per response, including the time for reviewing instructions and completing 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. 1615-0116. Do not mail your completed Form I-912 to this address.

This page can be found at: http://www.uscis.gov/feewaivernotice

Last Reviewed/Updated: 05/28/2013