Privacy Statement
Authority and Purpose: The Immigration and Nationality Act, as amended, (8 U.S.C. 1103, 1183,
1226, 1229c, and 1363) authorizes the collection of this information to permit an individual or company
to sign a notarized affidavit when the original Receipt of Immigration Officer-United States Bonds,
Notes or Cash (ICE Form I-305) is lost or missing.
Disclosure: Submission of this form and the information contained on this form is voluntary; however,
the obligor will be unable to reclaim the principal amount of the immigration bond unless this form or
the original ICE Form I-305 is provided to ICE.
Routine Uses: This information will be used by and disclosed to DHS personnel and contractors or
other agents who need the information to support the enforcement of immigration laws and the
provision of immigration benefits. DHS may share this information with the U.S. Justice Department
and other Federal and State agencies for collection, enforcement, investigatory, or litigation purposes,
or as otherwise authorized pursuant to its published Privacy Act system of records notice.
ICE Form I-395 (02/09)
Public Reporting Burden
U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency
mission under the Department of Homeland Security. The estimated average time to review the
instructions, search existing data sources, gather and maintain the data needed and completing and
reviewing this collection of information is 30 minutes (.50 hours) per response. An agency may not
conduct or sponsor, and a person is not required to respond to, an information collection unless it
displays a currently valid OMB Control Number. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to the
Department of Homeland Security, U.S. Immigration and Customs Enforcement, 500 12th Street, S.
W., Room 3138, Washington, D.C. 20536 (Do not mail your completed application to this
address.)