Form I-944 Edition 10/15/19 Page 14 of 18
Declarant’s Contact Information
Declarant's Daytime Telephone Number Declarant's Mobile Telephone Number (if any)3. 4.
Declarant's Email Address (if any)5.
Federal Agency Disclosure and Authorizations
I authorize, as applicable, the Social Security Administration (SSA) to verify my Social Security number (to match my name, Social
Security number, and date of birth with information in SSA records and provide the results of the match) to USCIS. I authorize SSA to
provide explanatory information to USCIS as necessary.
I authorize, as applicable, the SSA, U.S. Department of Agriculture (USDA), U.S. Department of Health and Human Services (HHS),
U.S. Department of Housing and Urban Development (HUD), and any other government agency that has received and/or adjudicated
a request for a public benefit, as defined in 8 C.F.R. 212.21(b), submitted by me or on my behalf, and/or granted one or more public
benefits to me, to disclose to USCIS that I have applied for, received, or have been certified to receive, a public benefit from such
agency, including the type and amount of benefit(s), date(s) of receipt and any other relevant information provided to the agency for
the purpose of obtaining such public benefit, to the extent permitted by law. I also authorize SSA, USDA, HHS, HUD, and any other
U.S. Government agency to provide any additional data and information to USCIS, to the extent permitted by law.
I authorize, as applicable, custodians of records and other sources of information pertaining to my request for or receipt of public benefits
to release information regarding my request for and/or receipt of public benefits, upon the request of the investigator, special agent, or
other duly accredited representative of any federal agency authorized above, regardless of any previous agreement to the contrary.
I understand that the information released by records custodians and sources of information is for official use by the federal government,
that the U.S. Government will use it only to review if I have received public benefits in regards to my eligibility for immigration
benefits and to enforce immigration laws, and that the U.S. Government may disclose the information only as authorized by law.
Credit Reports and Scores Disclosure and Authorization
USCIS may require information from one or more consumer reporting agencies in order to obtain information, including credit reports
and scores, in connection with a background investigation regarding your eligibility for immigration benefits.
Part 5. Declarant’s Statement, Contact Information, Certification, and Signature (continued)
I authorize USCIS to request, and any consumer reporting agency to provide, such reports.
NOTE: If you have a security freeze on your consumer or credit report file, we may not be able to access the information necessary to
complete your investigation. To avoid any delays, you should expeditiously respond to any requests made to release the credit freeze.
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this declaration, in supporting documents, and in my USCIS records, to
other entities and individual where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information contained in, and submitted with, my declaration; and
2) All of this information was complete, true, and correct at the time of filing.