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GREEN CARD
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Green Card Application Guide

Table of Contents
GREEN CARD APPLICATION GUIDE

1.0 INTRODUCTION ............................................................................................................................ 6


1.1 WHAT IS A GREEN CARD? ............................................................................................................... 6
1.2 CONDITIONAL RESIDENT GREEN CARD ........................................................................................... 6
1.3 PERMANENT RESIDENT GREEN CARD ............................................................................................. 6
1.4 TRAVELING WITH A GREEN CARD ................................................................................................... 6
1.5 FORM I-131 “APPLY FOR A REENTRY PERMIT” FROM WITHIN THE UNITED STATES ........................ 7
1.6 APPLY FOR REENTRY PERMIT VISA FROM ABROAD ........................................................................ 8
1.7 COMMUTER STATUS FOR INDIVIDUALS WORKING IN CANADA AND MEXICO.................................. 8
2.0 GREEN CARD THROUGH ADOPTION ..................................................................................... 9
2.1 BENEFITS FOR THE ADOPTED CHILD ............................................................................................. 10
2.2 LIMITATIONS FOR THE ADOPTED CHILD ........................................................................................ 10
2.3 HOW TO APPLY ............................................................................................................................. 10
3.0 GREEN CARD THROUGH EMPLOYMENT ........................................................................... 11
3.1 EMPLOYMENT FIRST PREFERENCE ................................................................................................ 11
3.2 EMPLOYMENT SECOND PREFERENCE ............................................................................................ 12
3.3 EMPLOYMENT THIRD PREFERENCE ............................................................................................... 12
3.4 EMPLOYMENT FOURTH PREFERENCE ............................................................................................ 13
3.5 EMPLOYMENT FIFTH PREFERENCE ................................................................................................ 13
3.6 BENEFITS....................................................................................................................................... 13
3.7 DRAWBACKS ................................................................................................................................. 13
3.8 ACCOMPANYING RELATIVES ......................................................................................................... 14
3.9 INADMISSIBILITY ........................................................................................................................... 14
3.10 JOB OFFER FROM U.S. EMPLOYER ................................................................................................. 14
3.11 CORRECT BACKGROUND ............................................................................................................... 14
3.12 NO QUALIFIED AMERICANS .......................................................................................................... 14
3.13 HOW TO APPLY ............................................................................................................................. 15
4.0 GREEN CARD THROUGH INVESTEMENT ........................................................................... 16
4.1 GREEN CARD THROUGH INVESTMENT PRIVILEGES........................................................................ 16
4.2 GREEN CARD THROUGH INVESTMENT LIMITATIONS ..................................................................... 17
4.3 ACCOMPANYING RELATIVES ......................................................................................................... 17
4.4 INADMISSIBILITY ........................................................................................................................... 17
4.5 GREEN CARD WITH CONDITIONS ................................................................................................... 17
4.6 HOW TO APPLY ............................................................................................................................. 17
5.0 GREEN CARD THROUGH MARRIAGE .................................................................................. 18
5.1 MARRIAGE INSIDE THE UNITED STATES ........................................................................................ 18
5.2 MARRIAGE OUTSIDE THE UNITED STATES ..................................................................................... 18
5.3 CONDITIONAL RESIDENCE GREEN CARD THROUGH MARRIAGE .................................................... 18
5.4 HOW TO APPLY ............................................................................................................................. 19
6.0 GREEN CARD AS A SPECIAL IMMIGRANT ......................................................................... 20
6.1 ACCOMPANYING RELATIVES ......................................................................................................... 20
6.2 INADMISSIBILITY ........................................................................................................................... 20
6.3 GREEN CARD AS A SPECIAL IMMIGRANT ....................................................................................... 20

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6.4 RELIGIOUS WORKERS.................................................................................................................... 20


6.5 FOREIGN MEDICAL GRADUATES ................................................................................................... 21
6.6 FORMER OVERSEAS UNITED STATES GOVERNMENT WORKERS .................................................... 21
6.7 RETIRED EMPLOYEES OF INTERNATIONAL ORGANIZATIONS ......................................................... 21
6.8 PERSON DECLARED DEPENDANT ON A JUVENILE COURT .............................................................. 22
6.9 HOW TO APPLY ............................................................................................................................. 22
7.0 GREEN CARD THROUGH A RELATIVE ................................................................................ 23
7.1 IMMEDIATE RELATIVE OF A UNITED STATES CITIZEN ................................................................... 23
7.2 PREFERENCE RELATIVE OF A GREEN CARD HOLDER OR U.S. CITIZEN ........................................... 23
7.3 ACCOMPANYING RELATIVE OF SOMEONE IN A PREFERENCE CATEGORY ...................................... 23
7.4 MARRIAGE TO A UNITED STATES CITIZEN .................................................................................... 23
7.5 DIVORCE ....................................................................................................................................... 24
7.6 CRUELTY ....................................................................................................................................... 25
7.7 DEPORTATION ............................................................................................................................... 25
7.8 WIDOWS/WIDOWERS .................................................................................................................... 25
7.9 PERSONAL PROBLEMS ................................................................................................................... 25
7.10 HOW TO APPLY ............................................................................................................................. 25
8.0 THE DV LOTTERY (GREEN CARD LOTTERY) .................................................................... 27
8.1 OVERVIEW OF THE DIVERSITY IMMIGRANT VISA PROGRAM ......................................................... 27
8.2 NUMBER OF APPLICANTS SELECTED PER COUNTRY ..................................................................... 27
8.3 DV-2007 (2005 GREEN CARD LOTTERY) ...................................................................................... 28
8.4 HOW TO APPLY ............................................................................................................................. 29
9.0 UNITED STATES CITIZENSHIP ............................................................................................... 30
9.1 OVERVIEW .................................................................................................................................... 30
9.2 UNITED STATES CITIZENSHIP TEST ............................................................................................... 30
9.3 UNITED STATES DUAL CITIZENSHIP .............................................................................................. 30
9.4 UNITED STATES PASSPORT ............................................................................................................ 31
9.5 ADVANTAGES OF U.S. CITIZENSHIP .............................................................................................. 31
10.0 FREQUENTLY ASKED QUESTIONS........................................................................................ 33
11.0 ASSEMBLING OF APPLICATION ............................................................................................ 35
APPENDIX 1 .............................................................................................................................................. 37
U.S. EMBASSIES AND CONSULATES WORLDWIDE ..................................................................................... 37
APPENDIX 2 .............................................................................................................................................. 38
USCIS APPLICATION SUPPORT CENTERS (ASC)....................................................................................... 38
APPENDIX 3 .............................................................................................................................................. 48
USCIS FIELD OFFICES .............................................................................................................................. 48
APPENDIX 4 .............................................................................................................................................. 55
INFOPASS – SPEAK TO AN IMMIGRATION OFFICER ................................................................................. 55
APPENDIX 5 .............................................................................................................................................. 56
CASE STATUS ............................................................................................................................................ 56
APPENDIX 6 .............................................................................................................................................. 58
DO I NEED AN IMMIGRATION ATTORNEY?................................................................................................. 58
APPENDIX 7 .............................................................................................................................................. 59
GLOSSARY OF TERMS ................................................................................................................................ 59

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APPENDIX 8 .............................................................................................................................................. 69
ADOBE ACROBAT HELP ............................................................................................................................ 69

IMMIGRATION FORMS INCLUDED:

• Form DS-230 Application for Immigrant Visa and Alien Registration


• Form DSP-122 Supplemental Registration for the DV Immigrant Program
• Form ETA 9089 Application for Permanent Employment Certification
• Form G-325 Biographic Information
• Form G-325A Biographic Information
• Form I-130 Petition for Alien Relative
• Form I-131 Application for Travel Document
• Form I-134 Affidavit of Support
• Form I-140 Immigrant Petition for Alien Worker
• Form I-290B Notice of Appeal or Motion
• Form I-360 Petition for Amerasian, Widow(er), or Special Immigrant
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485A Supplement A
• Form I-526 Immigrant Petition by Alien Entrepreneur
• Form I-539 Application to Extend/Change Nonimmigrant
• Form I-600 Petition To Classify Orphan As an Immediate Relative
• Form I-600A Application for Advance Processing of Orphan Petition
• Form I-601 Application for Waiver of Grounds of Excludability
• Form I-693 Medical Examination of Alien Seeking Adjustment of Status
• Form I-751 Petition to Remove Conditions of Residence
• Form I-765 Application for Employment Authorization
• Form I-824 Application for Action on an Approved Application or Petition
• Form I-829 Petition by Entrepreneur to Remove Conditions
• Form I-864 Affidavit of Support Under Section 213A of the Act
• Form I-864P Poverty Guidelines
• Form I-907 Request for Premium Processing Service
• Form M-603 Photo Requirements
• Form N-470 Application to Preserve Residence for Naturalization Purposes
• Form N-600 Application for Certificate of Citizenship
• Form N-600K Application for Citizenship and Issuance of Certificate under Section 322

Important:

o You may not need to submit all of the forms listed above. Only submit the application
forms that apply to your case.
o You may not need to print this entire PDF file. You have the option of printing only the
pages that you need (such as application forms). Refer to Appendix 8 for PDF printing
instructions.
o Some application forms have an expiration date. Usually the USCIS issues a new version
of each form before the expiration date, but occasionally the USCIS does not issue a new
version before the form expires. On these rare cases, the immigration form continues to
be valid until the new version is issued. However, not all expired application forms are
valid and can be submitted. Expired forms can only be submitted when a new version
has not yet been published.

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1.0 INTRODUCTION
1.1 What is a Green Card?
A Green Card or Permanent Resident Card is a person’s proof of lawful permanent residency in
the United States. An individual with a Green Card has the right to live and work permanently in
the United States. A person’s valid Green Card also means that he or she is registered in the
U.S. according to United States immigration laws. The Green Card or Permanent Resident card
is also called Form I-551.

A Green Card should contain an expiration date on the front of the card, and it is normally valid
for a period of 10 years. If the Green Card does not have an expiration date on the front, then it is
very old and should be renewed. It is important to keep the card up-to-date as an expired card
violates federal laws. It may be difficult to prove that an individual is a U.S. resident with an
expired Green Card, and there might be problems entering the U.S. on an expired Green Card.

It is important to distinguish between a Green Card with no conditions and a Green Card that has
conditions. An individual with a Green Card with conditions is called a Conditional Permanent
Resident, which is the situation during the first two years of obtaining a person’s first Green Card.
The procedure of removing the 2-year conditions is different from simply renewing a Green Card.

1.2 Conditional Resident Green Card


A Conditional Residence Green Card is given to foreign individuals who became a Conditional
U.S. Resident through marriage to a U.S. resident or through financial investments in a U.S.
business. A Conditional Residence Green Card is only valid for two years. Conditional residents
should apply to have the conditions removed from the Green Card by applying 90 days or less
before expire date. After that time, the card is void and the person holding it is considered “Out of
Status”. The conditional resident status will automatically be terminated and the USCIS will order
removal proceedings against the individual.

For more information about how to remove conditions on a Green Card, visit:
http://www.usimmigrationsupport.org/remove_conditions.html

1.3 Permanent Resident Green Card


The Permanent Resident Green Card looks the same as the Conditional Residence Green Card,
but without the conditions. The Permanent Resident Green Card is an identification card that only
non-U.S. residents can have, which entitles them to live and work in the United States. The
Permanent Resident Green Card has an expiry date and must be renewed every 10th year. Green
card holders must carry a valid green card at all times by law and must show the card upon
request to a USCIS officer.

For more information about how to renew a Green Card, visit:


www.usimmigrationsupport.org/greencard_renewal.html

1.4 Traveling with a Green Card


The purpose of a reentry permit is to validate that green card holders (permanent and conditional
residents) intent to keep their status as U.S. residents when traveling abroad. The amount of time
spent abroad determines your intention to keep your permanent resident status:

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• Trips shorter than one year do not normally require a travel permit, but other documents
are recommend to bring upon reentry
• Trips longer than one year but less than two years require a travel permit in addition to
other recommended documents
• Trips over two years may lead to individuals having to obtain a returning resident visa
from a U.S. embassy or consulate

A reentry permit is necessary to obtain for several reasons:


• Keep your Permanent Resident Card valid to reenter the United States
• Keep your U.S. permanent residence valid if you travel outside the U.S. for more than
one year

U.S. law does not require you to have the reentry permit in your possession when you leave the
United States. However, travelers must apply before they leave the United States. The problem
with applying in advance and leaving the country before the permit is approved is that your
application may be denied. This will lead to additional problems when you try to return to the
United States.

Before an individual can apply for U.S. citizenship through the naturalization process, he or she
needs to fulfill a residency requirement. The time spent abroad does not count towards this
requirement. Travelers staying abroad for more than one year but less than two years will disrupt
their residency unless a Form N-470 is filed and approved. It is not recommended to depart the
United States with a Green Card that will expire abroad.

For more information how to apply for a Reentry Permit visit:


http://www.usimmigrationsupport.org/reentry_permit.html

1.5 Form I-131 “Apply for a Reentry Permit” from within the United
States
• Only conditional or permanent residents may apply for a reentry permit
• The permission to return to the U.S. is granted through a “Travel Document”
• You can only have one valid travel document at the time
• A travel document may not be allowed to be issued to certain countries noted in the
Federal Register
• INA § 212 states that any immigrant who is not in possession of valid travel documents
will not be admitted to the United States
• Permanent residents shall have the reentry permit valid for two years
• Conditional residents shall have the reentry permit valid for two years unless the
conditions are due to be removed earlier, where the removal date and the reentry expire
date becomes the same date
• The application must be signed by all applicants over the age of 14
• Applicants under the age of 14 may have a parent or legal guardian sign the application
• The correct fee must be included with the application or it will rejected and returned
• All questions must be answered
• Type “N/A” if an item is not applicable
• Write “None” if the answer is none
• If there is not enough space to answer a question properly, attach a piece of paper with
your A-number and the question in the header
• You may include a copy of required documentation as long as the original is not required
• Original documents submitted will be returned when they are no longer required
• You may be called for an interview or required to provide additional evidence by mail
before an application can be approved

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• Providing false information and documentation may lead to denial of benefits, fines,
criminal prosecution and deportation from the United States
• For more information how to apply for a Reentry Permit visit:
http://www.usimmigrationsupport.org/reentry_permit.html

1.6 Apply for Reentry Permit Visa from Abroad


You may have to obtain a reentry permit (SB-1 Visa) as a returning resident at the local consulate
or embassy in the following scenarios:
• Your reentry permit has expired
• You have stayed abroad for more than one year without a travel permit

You will normally have to provide evidence for why your stay was extended for more than one
year. Reasons for why your stay was extended for more than one year may be:
• Family emergency
• Accident abroad

You may be required to show evidence for the delay, which may be:
• A doctor’s notice explaining the circumstances
• A U.S. ambassador providing information around the circumstances of the country and
why you were not able to leave
• Other evidence showing that you tried to return but were unable to

Additional requirements:
• Proof that your stay was intended to temporary
• You never intended to abandon or give up your U.S. residency
o Did you file taxes as a U.S. resident?
o Did you pay your mortgage or lease on time all the time?
o Do you have a letter from a U.S. employer guaranteeing a job upon reentry?
o Can you provide other evidence?

The results of not being able to proof your temporary stay abroad may result in you loosing your
green card.

For more information how to apply for a Reentry Permit visit:


http://www.usimmigrationsupport.org/reentry_permit.html

1.7 Commuter Status for Individuals Working in Canada and Mexico


Green card holders that commute between the U.S. and Canada or Mexico on a daily or seasonal
basis may keep their green cards even though they live abroad for over one year. The USCIS will
grant such workers “Commuter Status”, but it is the individual’s responsibility to inform the USCIS
of the intent to remain a resident and proof that the stay on the other side of the border is for work
purpose. A lawful permanent resident may live in the Mexico or Canada but work in the United
States while keep their U.S. residency status. However, there are some issues that must be
considered:
• The time spent abroad does not count toward the time needed to apply U.S. citizenship
(naturalization)
• Commuters are not allowed to petition for immigration benefits on behalf of family

For more information about how to obtain commuter status, visit the nearest USCIS office or
request to talk to an immigration officer through InfoPass. See the Appendix section for more
information.

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2.0 GREEN CARD THROUGH


ADOPTION
Adoption is an alternative that provides many families or singles the opportunity to have children.
It also helps children without [caring] parents to find hope for a new and bright future. Adoption is
a way to help children in need, and many people who adopt are also stepparents and adopt their
spouses’ children.

There are also different kinds of adoptions, the most common being domestic, international,
stepparent and foster adoption. An adoption can be made in several different ways, through an
agent, privately or through adoption facilitators (where legal). All ways have different pros and
cons and should be considered before making the big decision. When following any of the above-
mentioned procedures, the state laws have to be followed if adopting within the U.S., and/or if
adopting from outside the U.S. the federal laws and the foreign country’s own laws need to be
applied.

The adoption process can be very long and deceiving, and it demands much from the couple or
person seeking to adopt a child. The process is also very costly and if adopting from abroad, the
time dedication can extend two (2) years in many instances (depending on country). Many foreign
countries also demand residency or property ownership in the chosen adoption country. This
excludes many potential parents, and makes the selection more specified.

For a domestic adoption, within the 50 U.S. states, there is a certain process to go through for a
legal and successful adoption. When the parents have decided on what type and where from the
adoption will take place, a screening takes place to determine if the requirements are met, and no
unlawful and/or unjust aspects are involved. All of the U.S. states and most international
adoptions made from the U.S. require a home study to be made to the potential adoptive parents.
A home study is a thorough investigation of the family/person and household that wants to adopt
a child, where interviews are performed and background checks are made. The “normal” process
time for a home study is three (3) to six (6) months, but can be altered depending on the situation.

Checking the current state laws in the adoption state is very important, and they all have some
specific regulations that differ from each other. An example of this would be adoption by an
unmarried person (individual adoption) which is currently legal in all the U.S. states except
Florida, Mississippi, Wisconsin, Oklahoma, Colorado and Utah. They do not permit gay, lesbian
and bisexual persons to petition to individually adopt a child either. About half the U.S. states
require the adoptive parents to be married, and half do not permit an unmarried partner to adopt
the child in the current relationship. This is can also be called Second Parent Adoption.

Deciding to pursue an international adoption is much more costly and complicated in terms of
legal time consuming matters. Since international actions have to consider both the laws of the
home country of the parents and the home country of the child being adopted, the laws and
regulations are many more and difficult to apply. The requirements on adoptive parents also vary
with the country of choice. Most countries have different limits and regulations for age, income,
number of already present children in the household, and if the adoptive parent is single gender is
also considered.

Some examples of these specific regulations and requirements are: some agencies in Korea
require that the weight of the adoptive parent(s) is not more then 30% above normal weight for
the height. Another example is Slovakia, where the adoptive parents have to maintain a long-term
residency in Slovakia and stay during the entire adoption process (which in many instances could
take up to two (2) years).

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Once a home-study is completed and all the necessary requirements are met, a family is most
likely going to receive an approval for child adoption. The period from the approved home-study
to the actual arrival of the new family member (from an international destination) is anywhere
between 12-18 months, but can also vary depending on the country or origin for the child.

One of the benefits from international adoption is that there are laws that specify that this type of
adoption have to deal with orphans only, which excludes the possibility of the birthmother
changing her mind. International adoptions include much more paper work than domestic ones,
and utilizing the help of an agency is most likely a good choice if a foreign adoption is considered.

2.1 Benefits for the Adopted Child


• The adopted child may live anywhere in the united states
• The adopted child will have the right to work in the U.S. or the choice not to work at
all
• The adopted child will have the right to travel in and outside of the United States
• The adopted child can become an American citizen immediately after getting the
green card

2.2 Limitations for the Adopted Child


• The adopted child must reside in the United States permanently; the green card
cannot be used only for work and travel purposes
• The adopted child’s biological parents can never benefit from the child’s adoption,
i.e., they can never get immigration benefits such as a green card
• The adopted child should not remain outside of the United States for more than year
at a time without a special permission; otherwise, the child might lose the green card.
• The child might lose the green card if he/she commits a crime or participates in
politically subversive or other proscribed activities

2.3 How to Apply


Generally, the following forms are related to the Green Card application for an adopted child:

• FORM DS-230 Application for Immigrant Visa and Alien Registration


• FORM I-600 Petition To Classify Orphan As an Immediate Relative
• FORM I-600A Application for Advance Processing of Orphan Petition
• FORM I-864 Affidavit of Support Under Section 213A of the Act
• FORM N-600 Application for Certificate of Citizenship
• FORM N-600K Application for Citizenship and Issuance of Certificate under
Section 322
• FORM M-603 Photo Requirements

For detailed filing instructions visit www.usimmigrationsupport.org/greencard_adoption.html

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3.0 GREEN CARD THROUGH


EMPLOYMENT
There are five different employment categories that determine how difficult it will be for you to get
your green card. The first preference category does not require a Labor Certification but the other
categories do:

1. Employment First Preference - Priority workers.

2. Employment Second Preference - Workers with advanced degrees or exceptional ability.

3. Employment Third Preference - Skilled or unskilled workers without advanced degrees.

4. Employment Fourth Preference - Religious workers and various miscellaneous categories


of workers and other individuals.

5. Employment Fifth Preference - Individual investors willing to invest $1,000,000 in a U.S.


business (or $500,000 in economically depressed areas).

3.1 Employment First Preference


Persons of Extraordinary Ability

Although you do not need a specific job offer from a U.S. employer, you must prove that you
intend to continue working in your field when you arrive in the U.S. and that you are still at the top
of your field and not retiring or in decline. Your ability can either be in sciences, arts, education,
business, athletics and your achievements must be publicly recognized.

Professors and Researchers

If you have international recognition as a professor or researcher with three years minimum
experience, you will fall under this category and be eligible to apply for a green card. However,
you do need to have an offer of employment. The company employing you must have reached
significant achievements and must also employ at least three other full time workers.

Multi-National Executives and Managers

If you have worked as an executive manager by a company outside the U.S. for at least one out
of the past three years, and now wish to transfer to the same company in the U.S. or to a
company who is a subsidiary, you will qualify for a green card. The U.S. based company must
have been operational for at least one year.

To qualify as a petitioning company for the applicant, the company must meet at least one of the
following requirements:
• They must be different branches of the same company.
• They are a joint venture where the parent company owns half or has equal control
and veto power.
• One company must be a majority-controlled subsidiary of the other.
• The foreign and U.S. companies are under the control of the same person, persons,
company or group of companies.

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For the applicant to meet managerial or supervisory classifications, he/she must meet all of the
following requirements:

Manager

• He or she manages the organization or a department or function of the organization.


• He/she supervises and controls the work of other supervisory, professional or
managerial employees, or manages an essential function of the organization.
• He/she has the authority to hire and fire those persons supervised, or if none are
supervised, works at a senior level within the organization.
• He/she has the authority to make decisions concerning the day-to-day operations of
the activities or function of the organization over which he/she has authority.

Supervisor

• He/she directs the management of the organization or a major part or function of the
organization.
• He/she sets the goals and policies of the organization or a part or function of the
organization.
• He/she has extensive decision-making authority.
• He/she receives only general supervision or direction from higher-level executives,
board of directors or the stockholders of the organization.

3.2 Employment Second Preference


To qualify for this category you must be a professional who has obtained a university degree or
have exceptional ability in science, arts, or business. Under this category, you must be coming to
the U.S. having already received an offer of employment. (There are limited exceptions to this).

Advance Degree Professionals

To qualify as an advance degree professional, you must have achieved a graduate level degree
or a professional degree requiring postgraduate education. The exception to this is if you have a
standard bachelor’s degree plus five years of professional experience in your field.

Persons of Exceptional Ability

To qualify as a person of exceptional ability, you do not necessarily need to have international
acclaim. However, you do need national acclaim in your specific field of sciences, arts, or
business and be considered as a person who has significantly accomplished more than the
average person in that profession.

Under the second preference category, generally, you do need a Labor Certification. There are
exceptions to this rule though. If your arrival and residence in the U.S. will benefit the country by
having a substantial positive effect on the economy, employment rate, education, housing or
cultural aspects, you may not require a Labor Certification.

3.3 Employment Third Preference


Applicants falling under this category must be aware that only 10,000 of the current 40,000 quota
allocation will go to persons under this category. The waiting period for a green card applied for
under this category is currently at least five years.

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Professional Workers

Professions falling under this category include: Architects, Lawyers, Physicians, Engineers,
Teachers, Accountants, Computer Systems Analysts, Physical therapists, Chemists,
Pharmacists, Medical Technologists, Hotel Managers, Fashion Designers, Commercial Airline
Pilots.

If you have the necessary bachelor degree, it is simple to prove your eligibility under this
category.

Skilled Workers

To be classified as a skilled worker you do not need a college degree, but you do need at least
two years of training and/or experience. To find out how much training or experience you need for
a particular job contact your local State Labor Department office or look it up in the Department of
Labor ‘Dictionary of Occupational Titles’

Unskilled Workers

The unskilled worker category usually includes all other jobs that do not fall into previously
mentioned categories. For this category, you need specific qualifications required by the
particular job.

3.4 Employment Fourth Preference


This is the fourth category of employment-based workers. It encompasses religious workers,
which includes ministers and religious professionals. The fourth preference also includes various
miscellaneous categories of workers.

3.5 Employment Fifth Preference


This employment category is for investors willing to invest a minimum of $ 500,000 to $ 1,000,000
in a new U.S. business that will create jobs. The minimum amount depends on the location of the
enterprise.

3.6 Benefits
• You may live anywhere in the U.S. and stay as long as you want.
• As long as you start out working for the company through which you obtained the
green card, you may later work at any job, for any company, anywhere in the U.S., or
you may choose not to work at all.
• You may travel in and out of the U.S. whenever you wish.
• You may apply to become an American citizen after you have held your green card
for a certain length of time.
• In some cases, your spouse and unmarried children under the age of 21 may also be
eligible for green cards as accompanying relatives.

3.7 Drawbacks
• Your place of actual residence must be in the U.S. You cannot use a green card just
for work and travel purposes.
• You must pay taxes on your worldwide income because you are regarded as a U.S.
resident.
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• You cannot remain outside the U.S. for more than one year at a time without special
permission, or you risk losing your green card.
• If you commit certain crimes, participate in politically subversive activities or engage
in other prohibited activities, your green card can be taken away and you can be
deported.
• Under most categories, you must work full time and not be self-employed.

3.8 Accompanying Relatives


If you are married or have children below the age of 21 and you acquire a green card through
employment, your spouse and children can get green cards as accompanying relatives by
proving their relationship to you and submitting other required paperwork and documents. Their
green cards will also be issued conditionally and will become permanent when your resident
status becomes permanent.

3.9 Inadmissibility
If you have ever been arrested for a crime, lied on an immigrant application, lied to an
immigration officer, suffered certain physical or mental illness, or are otherwise inadmissible, you
may be unable to receive a green card unless you can qualify for what is known as a 'waiver of
inadmissibility'. The same applies to family members.

3.10 Job Offer from U.S. Employer


You cannot begin the application procedure until you have found an employer willing to be an
active part in your application. Your employer must be willing to wait until your green card is
approved before you can work. Employers can be a company, institution, a single person or an
agent who can prove that he/she can pay your salary.

There are two exceptions to this rule. You may not need a job offer before applying for a green
card if you qualify as a person with extraordinary abilities, or a ‘priority worker’, or if you fall under
the employment based second preference.

3.11 Correct Background


You must prove that you have the correct background for the job in terms of experience, training
and education. It is not acceptable to simply prove that you are intelligent, honest, hard working
and reliable. You must show you have the necessary experience and education as requested.

3.12 No Qualified Americans


One of the objectives of a green card through employment is that you, the applicant, will be
assisting a U.S. company. Therefore, you and your employer must be able to prove that there are
no other qualified Americans either willing or able to take the position. To prove this, a Labor
Certification is required. This is much easier to obtain if the applicant has exceptional ability, is
college educated, intends to work in a job with undesirable working hours or has special skills
and/or training.

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3.13 How to Apply


Generally, the following forms are related to the Green Card application through employment:

• Form ETA 9089 Application for Permanent Employment Certification


• Form G-325 Biographic Information
• Form I-131 Application for Travel Document
• Form I-134 Affidavit of Support
• Form I-140 Immigrant Petition for Alien Worker
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485A Supplement A
• Form I-693 Medical Examination of Alien Seeking Adjustment of Status
• Form I-765 Application for Employment Authorization
• Form I-864 Affidavit of Support Under Section 213A of the Act
• Form M-603 New Photo Requirements

For more information about how to obtain a Green Card through employment visit
http://www.usimmigrationsupport.org/greencard_employment.html

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4.0 GREEN CARD THROUGH


INVESTEMENT
Green Cards through investment are available to all qualified applicants. Petition approval
normally takes from two to six months, and the application process takes one to six months.
Permanent residency (green card) in the United States is available to anyone who invests a
minimum of $1 million in creating a new U.S business or expanding an existing one. This amount
can be reduced to $500,000 if the business is located in an urban or rural area with a high
unemployment rate. State governments will identify parts of different states that class as high
unemployment areas and will notify the USCIS. The investor must employ at least ten full time
employees. This cannot include family members, although the investor should be an active
member of the management team.

The investment can include cash equivalents such as certificates of deposits, loans and notes.
Borrowed funds may also be used as long as the investor is personally liable in the event of a
default, and the loan is adequately secured and not by the assets of the business being
purchased. A number of investors may join together in creating or expanding a U.S business and
each may qualify for a green card through the single company. However, the investment of each
person still has to be for the minimum qualifying amount, and each investor must be separately
responsible for the creation of ten new jobs. Although it is expected that the investment will be
well underway when the green card application is made, the law does require the investment to
be in a completely new commercial enterprise. The exception to this rule is that the investor can
purchase an existing business if he or she increases either its net worth or the number of
employees by at least 40 %.

If the existing business purchased is in financial trouble, an investment designed to save that
business will qualify the investor for a green card in this category. Purchasing a troubled business
releases the investor from having to increase the net worth or the number of employees.
However, it does not excuse the $1 million minimum investment requirement. To qualify as a
troubled business, the company must have been in operation for at least two years, and have had
an annual loss during those two years equal to at least 20% of the company's net worth. An
investor buying a troubled business is prohibited from laying off any employees.

A green card for an investor is first only issued conditionally. The conditional green card is
granted for two years. When the two years are over, the investor will have to file a request with
the USCIS to remove the condition. In deciding if the condition should be removed, the USCIS
will investigate whether or not the proposed investment has actually been made, if ten full-time
workers have been hired, whether or not the business is still operating, and if the business is still
owned by the investors who got the green card. If any of the required factors cannot be
established to the satisfaction of the USCIS or the petition for removal of the condition is not filed
within the final two-year period, the investor will lose his / her green card and be subject to
deportation from the United States.

4.1 Green Card through Investment Privileges


• Once the Green Card through Investment application is approved, you may live
anywhere in the United States.
When you first receive your Green Card through investment, you must work for your
own company (the company you bought or started in order to receive the Green
Card), but after a few years you will be eligible to work anywhere in the U.S. and for
any company.
• Your spouse and unmarried children may accompany you to the U.S.
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• You and you accompanying relatives may travel in and out of the U.S. as you wish

4.2 Green Card through Investment Limitations


• You must invest a large amount of money in the U.S.
• The company you buy or start in order to receive the Green Card must stay in
business for a certain period of time, and it must meet several requirements
• You may not remain outside the U.S. for more than 6 months at the time
• You will be taxed on your worldwide income, not only on the money earned in the
United States.

4.3 Accompanying Relatives


If you are married or have children below the age of 21 and you acquired a green card through
investment, your spouse and children can get green cards as accompanying relatives by proving
their relationship to you and submitting other required paperwork and documents. Their green
cards will also be issued conditionally and will become permanent when yours does.

4.4 Inadmissibility
If you have ever been arrested for a crime, lied on an immigrant application, lied to an
immigration officer, suffered certain physical or mental illness, or are otherwise inadmissible, you
may be unable to receive a green card unless you can qualify for what is known as a 'waiver of
inadmissibility'. The same applies to family members.

4.5 Green Card with Conditions


Individuals who have invested in a U.S. business will be issued a conditional Green Card. should
use. The application form to remove the conditions must be filed during the 90-day period before
the Conditional Residence Card expires by using form I-829. The spouse and children may also
be included on the petition. For more information about how to obtain to remove conditions on a
Green Card visit http://www.usimmigrationsupport.org/remove_conditions.html

4.6 How to Apply


Generally, the following forms are related to the Green Card application through investment:

• Form G-325A Biographic Information


• Form I-131 Application for Travel Document
• Form I-134 Affidavit of Support
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485A Supplement A
• Form I-526 Immigrant Petition by Alien Entrepreneur
• Form I-539 Application to Extend/Change Nonimmigrant
• Form I-693 Medical Examination of Alien Seeking Adjustment of Status
• Form I-765 Application for Employment Authorization
• Form I-829 Petition by Entrepreneur to Remove Conditions
• Form M-603 New Photo Requirements

For more information about how to obtain a Green Card through investment visit
http://www.usimmigrationsupport.org/greencard_investment.html

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5.0 GREEN CARD THROUGH


MARRIAGE
5.1 Marriage inside the United States
The U.S. citizen must submit a visa petition to the appropriate USCIS Office to prove that the
marriage is bona fide, that is, entered into for love rather than simply for the foreign-born spouse
to obtain a green card.

5.2 Marriage outside the United States


The process is roughly the same except that the foreign-born spouse usually must remain in his
or her country until he or she obtains a green card.

The process begins when the citizen spouse submits a visa petition to either the USCIS office,
which has jurisdiction over his residence or directly to the U.S. Embassy or Consulate in the
country where the foreign-born spouse resides.

The citizen spouse must attach the same items with the visa petition which are listed in Section 1.

Once the visa petition is approved, the foreign-born spouse will receive a packet from the
National Visa Center (NVC) which includes the requirements that the foreign-born spouse must
meet and what documents must be presented at the immigrant visa interview abroad (e.g.,
passport, police clearances, results of medical examinations, etc.). Usually, the foreign-born
spouse is interviewed and granted an immigrant visa within three to six months. The State
Department charges a fee for an immigrant visa.

Sometimes, in order to avoid a lengthy separation, the spouses return to the United States after
the marriage and proceed to file the necessary applications once they are both in the U.S.
However, it is not uncommon for the USCIS to stop the foreign-born spouse at the border and
exclude him or her from the U.S. as an intending immigrant. It is important to notice that e.g. a
spouse entering the United States under the Visa Waiver Program cannot change status in the
United States. However, if the foreign-born spouse is able to enter the United States on a visa
that allows him or her to change status, the USCIS will not deny his or her application for a green
card.

5.3 Conditional Residence Green Card through Marriage


A Conditional Residence Green Card is given to foreign individuals who became a Conditional
U.S. Resident through marriage to a U.S. resident or through financial investments in a U.S.
business. Individuals under these circumstances have conditions on their Green Card that need
to be removed. A Conditional Residence Green Card is only valid for two years. After that time,
the card is void and the person holding it is considered “Out of Status”. The conditional resident
status will automatically be terminated and the USCIS will order removal proceedings against the
individual.

The process of removing the conditions on the Conditional Residence Green Card is different
from renewing the Green Card. Once the conditions are removed, the individual is subject to the
10-year renewal and must use Form I-90 unless the foreign fiancé applies for U.S. citizenship.

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For more information about how to obtain to remove conditions on a Green Card visit
http://www.usimmigrationsupport.org/remove_conditions.html

5.4 How to Apply


Generally, the following forms are related to the Green Card application through marriage:

• Form G-325A Biographic Information


• Form I-130 Petition for Alien Relative
• Form I-131 Application for Travel Document
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485A Supplement A
• Form I-693 Medical Examination of Alien Seeking Adjustment of Status
• Form I-751 Petition to Remove Conditions of Residence
• Form I-765 Application for Employment Authorization
• Form I-864 Affidavit of Support Under Section 213A
• Form M-603 New Photo Requirements

For more information about how to obtain a Green Card through marriage visit
http://www.usimmigrationsupport.org/greencard_marriage.html

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6.0 GREEN CARD AS A SPECIAL


IMMIGRANT
Currently, the U.S issues Green Cards to immigrants with special circumstances providing the
applicants and his/her situation fits certain requirements and criteria. The procedure of applying
for a green card involves two steps: Step One, The Petition and Step Two, The Application. The
whole process can take over one year and can be carried out in the U.S or at a consulate abroad.

Special Immigrant visas are available to you if you fall under one of the following categories:
• Workers for recognized religious organizations.
• Foreign medical graduates who have been in the U.S a long time.
• Foreign workers who were formerly longtime employees of the U.S government.
• Retired officers or employees of certain international organizations who have lived in
the U.S for a certain time.
• Foreign nationals who have been declared dependant on juvenile courts in the U.S.

6.1 Accompanying Relatives


If you are married or have children below the age of 21 and you acquire a green card, your
spouse and children can get green cards as accompanying relatives by proving their relationship
to you and submitting other required paperwork and documents.

6.2 Inadmissibility
If you have ever been arrested for a crime, lied on an immigrant application, lied to an
immigration officer, suffered certain physical or mental illness, or are otherwise inadmissible, you
may be unable to receive a green card unless you can qualify for what is known as a 'waiver of
inadmissibility'. The same applies to family members.

6.3 Green Card as a Special Immigrant


There are several categories of “Special Immigrants”. Read carefully the descriptions below to
find out of if you qualify.

6.4 Religious Workers


Clergy and other religious workers are eligible to apply for a green card. The definition of clergy is
a person authorized by a recognized religious denomination to conduct religious activities. This
includes: Ministers, priests, rabbis, salaried Buddhist monks, commissioned officers of the
salvation army, practitioners and nurses of the Christian science church and ordained deacons.

Any other religious workers not considered part of the clergy may also be eligible providing
he/she is authorized to perform normal religious duties.

To qualify as a special Immigrant using religion as a cause, you must have been a member of a
recognized religion in the U.S for a minimum of two years and have remained employed by the
same religious group for the duration. You must also intend to come to the U.S or remain there
legally, for the purpose of working as a minister of that religion.

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Your children below the age of 21 are eligible to apply for a green card after yours has been
approved. They must provide proof of their family relationship to you and how long they have
lived with you.

6.5 Foreign Medical Graduates


You qualify as a special immigrant under this circumstance if you came to the U.S before January
10, 1978, on either an H or a J visa and you meet the following requirements:
• You were physically in the U.S and practicing medicine on January 9, 1978.
• You have lived continuously in the U.S and practiced medicine since January 9,
1978.
• You were permanently licensed to practice medicine in a U.S state on or before
January 9, 1978.

If you came to the U.S on a J-1 visa and were subject to the two year home residency
requirement, you got a waiver of the home residency requirement, or you have a ‘no objection’
letter from your home government.

6.6 Former Overseas United States Government Workers


You and your spouse/children may apply if you have been employed abroad by the U.S
government for at least fifteen years. You must have the recommendation of the principle officer-
in-charge of the U.S government foreign office which you were employed. Also, the U.S
secretary of state must approve the recommendation

6.7 Retired Employees of International Organizations


You may be eligible as a special immigrant if you are a retired employee of an international
organization, if you are the unmarried child of an officer, employee, former officer or former
employee of an international organization or if you are the spouse of an officer or employee.

If you were married to a qualifying officer or employee who has now died, you are still eligible
providing you lived in the U.S for fifteen years on a G-4 or an N visa before the death of your
spouse and you have lived in the U.S for at least three and a half years before you apply. If this is
the case, you must also apply within six months after your spouse’s death.

The following details the requirements for both a retired employee and unmarried child:

Retired Employee

• You have resided in the U.S for at least fifteen years prior to your retirement on a G-4
or N visa.
• You lived and were physically present in the U.S for at least half of the seven years
immediately before applying for a green card.
• You apply to receive a green card within six months after your retirement.

Unmarried Child

• You have a G-4 or N visa.


• You lived and were physically present in the U.S for at least half of the seven-year
period before applying for a green card.
• You lived in the U.S for at least a total of seven years while you were between the
ages of five and twenty-one.

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• You apply for a Green Card before your 25th birthday.

6.8 Person Declared Dependant on a Juvenile Court


You may apply for a green card under this circumstance if you meet the following conditions:
• You are under the age of twenty-one and unmarried.
• You have been declared dependant on a juvenile court located in the U.S.
• The court has stated you are eligible for long term foster care or you have been
committed to the care of a state agency.

The court has determined that it is on your best interest to remain in the United States.

6.9 How to Apply


Generally, the following forms are related to the Green Card application as a special immigrant:

• Form G-325 Biographic Information


• Form I-134 Affidavit of Support
• Form I-360 Petition for Amerasian, Widow(er), or Special Immigrant
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485A Supplement A
• Form I-765 Application for Employment Authorization
• Form M-603 New Photo Instructions

For more information about how to obtain a Green Card as a special immigrant visit
http://www.usimmigrationsupport.org/greencard_specialimmigrant.html

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7.0 GREEN CARD THROUGH A


RELATIVE
An individual qualifies for a Green Card through Relatives if he/she has close family member who
are United States citizen or who are legal permanent residents of the United States (green card
holders). A “close family member” is defined in the follow sub chapters.

7.1 Immediate Relative of a United States Citizen


• Widows (if married for at least two years and applying for a green card within two years
of the U.S. citizen’s death)
• Widowers (if married for at least two years and applying for a green card within two
years of the U.S. citizen’s death)
• Stepparents if marriage took place before the child’s 18th birthday
• Stepchildren if marriage of the parents took place before the child’s 18th birthday
• Parents and children related through adoption if adoption to place before the child
reached the age of 16 and the child was legally in custody for 2 years prior to filing the
green card petition

7.2 Preference relative of a Green Card holder or U.S. Citizen


• Family first preference:
o These are unmarried people at any age who have at least one U.S. citizen parent
• Family second preference:
o Spouses and children under the age of 21 of green card holders
o Unmarried sons and daughters of green card holders who are at least 21 years
old
• Family third preference:
o Married people at any age who have at least one U.S. citizen parent
• Family fourth preference:
o Sisters and brothers of U.S. citizens where the U.S. citizen is at least 21 years of
age

7.3 Accompanying Relative of Someone in a Preference Category


• If you get a green card as a preference relative, and you are married or have unmarried
children under the age of 21, then your spouse and children are entitled to green cards
as accompanying relatives.
• If you qualify as an immediate relative, your spouse and children cannot. The way
around that problem is simply solved by having the U.S. citizen petition for his/her
spouse and children separate. The idea is to not have the children ride on the non-U.S.
parent’s green card application.

7.4 Marriage to a United States Citizen


• If you have been married for at least two years to a U.S. citizen, and the USCIS trust
your marriage to be valid, you will obtain your green card by going through the
application process.

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• If you have been married to a U.S. citizen for less than two (2) years, and the USCIS
trust your marriage to be valid, you will get a conditional green card with a validity of
two years. After the two years have past, you can have the condition removed and your
green card is changed to a permanent green card valid for ten (10) years at the time.

• If during the two years you have a conditional green card, the situation between you
and your spouse has changed, then you must file for a removal of the condition
yourself. You might be able to keep your green card, but you have to proof one of the
following:

o Yours spouse might have died but the marriage was entered in good faith
o You divorced each other, but the marriage was established in good faith
o A potential deportation can cause extreme hardship
o You were abused by the U.S. citizen or U.S. green card holder spouse

It is recommended to schedule the second interview to get the condition on the green card
removed after you have been married for two years. Once the green card is approved after two
years of marriage, it becomes permanent.

It is important to be aware of that there are restrictions for re-marriage between year 1 and 5 after
you get your permanent green card. Should you get divorced between year 1 and 5, you cannot
remarry a non-U.S. citizen and try to get that person a green card without getting in trouble with
the USCIS. USCIS believes that any remarriage of a non-U.S. citizen to a newly gifted green card
holder is based on convenience.

There are particular quota restrictions for all four before mentioned categories. However, they
change from year to year, but to provide you with an idea, see the following quotas for 2004:

• Family first preference:


o Three years for natives of all countries. The exceptions are natives from the
Philippines who have an estimated waiting period of fourteen years, and natives
of Mexico who have an estimated waiting period of nine years.
• Family second preference:
o Four years for natives of all countries. The exceptions are natives of Mexico who
have a waiting period of 7-9 years.
• Family third preference:
o Six years for natives of all countries. The exceptions are natives of Mexico who
have a waiting period of 9 years, and natives of the Philippines who have an
estimated waiting period of fourteen years.
• Family fourth preference:
o Eleven years for natives of all countries. Natives of the Philippines have an
estimated waiting period of twenty-two years.

Detailed Information on Green Card through Marriage:


This immigration manuals focus mostly on obtaining a green card through other family members.
For detailed information on how to apply for a green card through Marriage to U.S. citizen visit
http://www.usimmigrationsupport.org/greencard_marriage.html

7.5 Divorce
Relationships do not always work out, but what concerns the USCIS is the intent at the time of
marriage. If you do get divorced while you have a conditional green card, you can still apply to get
the condition removed as long as the marriage was legit from the beginning. However, be aware
of that your divorced American spouse must be willing to file a petition on your behalf too. It is

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strongly recommended to contact an immigration and divorce attorney before submitting an


application to remove the conditional residence if the marriage has ended in divorce.

7.6 Cruelty
Unfortunately in some cases, the U.S. citizen batters and abuses the spouse or children of the
non-U.S. citizen, and refuses to file a petition for a green card on your behalf. In such a situation,
you are able file a petition for yourself, but you must be physically present in the U.S. to take
advantage of this opportunity. In addition, you must be able to proof that:
• The abuse or cruelty took place
• That you have good moral character
• That you lived with the spouse or parent once you entered the U.S.
• In cases where you are the spouse, you must prove that the marriage was entered in
good faith

7.7 Deportation
In some cases you might end up marrying a U.S. green card holder who is in the process of being
deported. You are still entitled to apply for a green card, but the USCIS will hold you to very strict
standards of why you are marrying someone who is being deported from the United States.
Strong evidence must be provided and expect a very detailed marriage interview. It is strongly
recommended to hire an immigration attorney in such a situation.

7.8 Widows/Widowers
There are particular rules that apply to widows and widowers of U.S. citizens. The only way you
as a non-U.S. citizen is able to take advantage of the rules for widows/widowers, is if you were
married for at least two (2) years before the U.S. spouse’s death. You as the surviving national
can file your own green card petition on Form I-360, which is included in this application guide.

There is an upper limit of 2 years to file Form I-360 after the U.S. spouse died. If the surviving
national decides to re-marry after the death of the U.S. citizen, he/she looses the rights to apply
for a green card as a widow/widower. However, you are able remarry after you get the green card
without any problems. It is important to understand that this rule only applies to spouses of U.S.
citizens, and not U.S. green holders. The U.S. green card holder must, in this situation, be alive
until the permanent residency application is approved. It is strongly recommended to get a lawyer
involved if this is your case.

7.9 Personal Problems


You may be inadmissible for a green card if you ever have been arrested for a crime, stayed in
the U.S. for more than six (6) months unlawfully, lied on the immigration application/to the
immigration officer or suffer from physical or mental illness.

7.10 How to Apply


Generally, the following forms are related to the Green Card application through a relative:

• Form G-325A Biographic Information


• Form I-130 Petition for Alien Relative
• Form I-131 Application for Travel Document
• Form I-360 Petition for Amerasian, Widow(er) or Special Immigrant
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• Form I-485 Application to Register Permanent Residence or to Adjust Status


• Form I-485A Supplement A
• Form I-693 Medical Examination of Alien Seeking Adjustment of Status
• Form I-751 Petition to Remove Conditions of Residence
• Form I-765 Application for Employment Authorization
• Form I-864 Affidavit of Support Under Section 213A of the Act
• Form I-907 Request for Premium Processing Service
• Form M-603 New Photo Requirements

For more information about how to obtain a Green Card through a relative visit
http://www.usimmigrationsupport.org/greencard_relatives.html

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8.0 THE DV LOTTERY (GREEN CARD


LOTTERY)
The Diversity Immigrant Visa Program is now being processed electronically (over the internet).
Paper applications submitted by mail are no longer accepted. Until the 2002, Green Card Lottery
(DV-2004) applications had to be submitted by mail, and the application form had to be signed by
the applicant. These requirements no longer apply. The applicant does not have to sign the initial
application form, which is now submitted online.

Being selected in the Green Card Lottery does not automatically guarantee that the individual will
receive a Green Card. Additional forms and documents must be submitted to the U.S.
government before the application is approved, and the foreign national receives permanent
residence in the United States. It is a misconception to believe that “winning” the Green Card
Lottery automatically grants the selected applicant U.S. residence, a Green Card or United States
Citizenship.

8.1 Overview of the Diversity Immigrant Visa Program


The United States Government issues 50,000 permanent resident cards (Green Cards) every
year to applicants selected in the Diversity Immigrant Visa Program, commonly knows as the
Green Card Lottery. Applicants are selected randomly by a computer generated drawing.
Selected applicants, their spouses and unmarried children under 21 years of age will be
authorized to live and work permanently in the United States.

Every year over 8 million applications are submitted electronically (over the internet) to the U.S.
government. However, only 100,000 receive a notification letter that they were selected. Just
receiving the notification letter does not guarantee that the individual will receive a Green Card.
The following also apply:

1. The applicant still has to prove he/she meets the requirements


2. Have a low DV Lottery Rank Number (1 is the best, and 100,000 is the worst)
3. The application must be submitted and approved by the deadline

In order to actually be granted permanent residence in the United States, the applicant must act
quickly upon receiving the notification letter (Notice of Approval). Therefore, it is important to be
prepared in advance and act quickly upon receiving the Notice of Approval.

8.2 Number of Applicants Selected Per Country


The following is a statistical breakdown of the numbers persons who have actually received
immigrant visas after completing the application process in the last two DV Lottery Programs.
This information is provided only for information purposes. The number of immigration visas (and
Green Cards) issued on the next DV Lottery program will most certainly be different, but the
numbers below should provide the applicant with a general idea of how many Green Card were
issued to his/her country in the last three years.

This list has been compiled from official sources, and it displays data from the DV-2005 (the 2003
Green Card Lottery), the DV-2006 (the 2004 Green Card Lottery) and the DV-2007 (the 2005
Green Card Lottery).

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8.3 DV-2007 (2005 Green Card Lottery)

AFRICA
ALGERIA 912 ERITREA 582 NAMIBIA 8
ANGOLA 13 ETHIOPIA 6,871 NIGER 62
BENIN 218 GABON 42 NIGERIA 9,849
BOTSWANA 1 GAMBIA, THE 50 RWANDA 41
BURKINA FASO 95 GHANA 3088 SAO TOME AND PRINCIPE 2
BURUNDI 16 GUINEA 146 SENEGAL 228
CAMEROON 1461 GUINEA-BISSAU 5 SEYCHELLES 4
CAPE VERDE 3 KENYA 2337 SIERRA LEONE 540
CENTRAL AFRICAN REP 13 LESOTHO 0 SOMALIA 160
CHAD 28 LIBERIA SOUTH AFRICA 287
COMOROS 7 LIBYA 37 SUDAN
CONGO 687 MADAGASCAR 21 SWAZILAND 5
CONGO, DEMOCRATIC REPUBLIC MALAWI 18 TANZANIA 148
OF THE 42 MALI 76 TOGO 1,592
COTE D’IVOIRE 308 MAURITANIA 17 TUNISIA
DJIBOUTI 11 MAURITIUS 8 UGANDA 213
EGYPT 7,229 MOROCCO 4,922 ZAMBIA 92
EQUATORIAL GUINEA 1 MOZAMBIQUE 4 ZIMBABWE 73

OCEANIA
AUSTRALIA 532 MICRONESIA, FEDERATED PAPUA NEW GUINEA 6
CHRISTMAS ISLANDS 0 STATES OF 4 SAMOA 10
COOK ISLANDS 3 NAURU 1 SOLOMON ISLAND 0
FIJI 514 NEW ZEALAND 205 TONGA 171
KIRIBATI 0 NIUE 0 TUVALU 7
MARSHALL ISLANDS 1 PALAU 3 VANUATU 0

NORTH AMERICA
THE BAHAMAS 12

ASIA
AFGHANISTAN 80 IRAQ 80 NORTH KOREA 0
BAHRAIN 1 ISRAEL 126 OMAN 1
BANGLADESH 5,901 JAPAN 333 QATAR 1
BHUTAN 2 JORDAN 63 SAUDI ARABIA 27
BRUNEI 0 KUWAIT 42 SINGAPORE 46
BURMA 651 LAOS 9 SRI LANKA 383
CAMBODIA 177 LEBANON 86 SYRIA 40
HONG KONG SPECIAL ADMIN. MALAYSIA 76 TAIWAN 398
REGION 81 MALDIVES 0 THAILAND 81
INDONESIA 245 MONGOLIA 113 UNITED ARAB EMIRATES 19
YEMEN 43

EUROPE
ALBANIA 1,988 GREECE 41 NEW CALEDONIA 3
ANDORRA 0 GUADELOUPE 3 NORTHERN IRELAND 42
ARMENIA 691 HUNGARY 138 NORWAY 21
AUSTRIA 74 ICELAND 13 PORTUGAL 29
AZERBAIJAN 125 IRELAND 160 REUNION 8
BELARUS 705 ITALY 214 ROMANIA 1,255

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BELGIUM 57 KAZAKHSTAN 177 SAN MARINO 0


BOSNIA & HERZEGOVINA 90 KYRGYZSTAN 123 SERBIA & MONTENEGRO
BULGARIA 1,674 LATVIA 75 505
CROATIA 40 LIECHTENSTEIN 0 SLOVAKIA 171
CYPRUS 7 LITHUANIA 298 SLOVENIA 7
CZECH REPUBLIC 85 LUXEMBOURG 6 SPAIN 97
DENMARK 50 MACAU 8 SWEDEN 121
ESTONIA 40 MACEDONIA, FORMER SWITZERLAND 104
FINLAND 33 YUGOSLAV REP. OF 213 TAJIKISTAN 84
FRANCE 380 MALTA 4 TURKEY 1,418
FRENCH POLYNESIA 10 MARTINIQUE 2 TURKMENISTAN 59
FRENCH SOUTHERN AND MOLDOVA 273 UKRAINE 7,205
ANTARCTIC LANDS 1 MONACO 1 UZBEKISTAN 1,536
GEORGIA 323 NETHERLANDS 88 VATICAN CITY 0
GERMANY 1047 NETHERLANDS ANTILLES 8 WESTERN SAHARA 1

SOUTH AMERICA, CENTRAL AMERICA, AND THE CARIBBEAN


ARGENTINA 86 DOMINICA 12 PERU 1,274
BARBADOS 9 ECUADOR 170 SAINT KITTS AND NEVIS 4
ANTIGUA AND BARBUDA 2 GRENADA 6 SAINT LUCIA 4
BELIZE 5 GUATEMALA 43 SAINT VINCENT AND THE
BOLIVIA 88 GUYANA 17 GRENADINES 3
BRAZIL 488 HONDURAS 28 SURINAME 3
CHILE 42 NICARAGUA 19 TRINIDAD AND TOBAGO 85
COSTA RICA 18 PANAMA 14 URUGUAY 4
CUBA 427 PARAGUAY 20 VENEZUELA 226

Natives of the following countries were not eligible to participate in DV-2007:


Canada, China (mainland-born, excluding Hong Kong S.A.R., and Taiwan), Colombia, Dominican
Republic, El Salvador, Haiti, India, Jamaica, Mexico, Pakistan, the Philippines, Poland, Russia,
South Korea, United Kingdom (except Northern Ireland) and its dependent territories and
Vietnam.

8.4 How to Apply


Generally, the following forms are related to the Green Card application for those that “win” the
DV lottery:

• Form DS-230 Application for Immigrant Visa and Alien Registration


• Form DSP-122 Supplemental Registration for the DV Immigrant Program
• Form G-325A Biographic Information
• Form I-131 Application for Travel Document
• Form I-485 Application to Register Permanent Residence or to Adjust Status
• Form I-485a Supplement A (and Penalty Fee)
• Form I-601 Application for Waiver of Grounds of Excludability
• Form I-765 Application for Employment Authorization
• Form I-824 Application for Action on an Approved Application or Petition
• Form I-864P Poverty Guidelines

For more information about how to apply for the Green Card Lottery visit
http://www.usimmigrationsupport.org/greencardlottery.html

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9.0 UNITED STATES CITIZENSHIP


9.1 Overview
If you want to be naturalized (the term describing how to obtain U.S. citizenship) you must have
been admitted to the United States legally to become a permanent resident and be at least 18
years old. You must have been lawfully admitted to the United States, which means that you have
legally obtained the privilege of living permanently in the United States as an immigrant. If you
have been lawfully admitted, you will be provided with Form I-551, Permanent Resident Card, as
proof of your status.

If you want to file for United States citizenship as an immigrant, you need to meet the following
requirements:
• You have been lawfully admitted to stay permanently in the United States
• You have lived in the United States as a lawful resident for at least five years before
applying for a citizenship. You have not left the country for more than one year in total
during that time
• You have been present in the United States for at least 30 months of the past five years
• If you have been absent for more than six months, you will not be considered living in the
United States continuously unless you can prove that you did not abandon your
residence during your time of absence
• You have resided within a state or district for 3 months or more

For more information about U.S. citizenship, visit:


www.usimmigrationsupport.org/citizenship_application.html

9.2 United States Citizenship Test


In order to become a legal citizen of the United States, there is a list of things you need to
complete. One of them is to pass the United States Citizenship Exam. The “U.S Citizenship Test
Study Guide” will help you prepare for the United States Citizenship Exam. You can use the
information manual to study on your own or with friends. It can also be used as a textbook in a
formal classroom that prepares students to become an American citizen. It is written in simple
English so that the content of can be understood by people whose English is not yet very fluent.

For more information about the U.S. citizenship test, visit:


www.usimmigrationsupport.org/citizenship_test.html

9.3 United States Dual Citizenship


Dual citizenship is a concept which means that an individual is a citizen of two countries at the
same time. Every independent nation in world has its own laws regarding dual citizenship. Some
countries allow it - others do not. Some countries may take a citizenship away when an individual
of the country takes upon a new citizenship. An individual will not be recognized as a dual citizen
if one of the countries does not recognize dual citizenship.

Individuals can obtain a second citizenship in a different ways such as through naturalization,
birth, period of stay in the U.S. and nationality of parents/grandparents. The focus of dual
citizenship becomes a complex matter because different countries have different rules and
regulations. The process of determining your present citizenship status can be a difficult and
lengthy process. It is recommended to find out the circumstances around your existing citizenship
to avoid problems in the future. The 14th Amendment to the Constitution states that; “All persons

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born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the
United States and of the State wherein they reside.” This sentence is frequently referred to as the
“citizenship clause”.

The U.S. Government recognizes that dual nationality exists. However, it does not encourage it
as a matter of policy because of the problems it may cause. There may be law conflicting issues
between the U.S. and the other country. Dual nationality may limit U.S. Government efforts to
assist citizens abroad. Depending on where the dual national lives, the local government tends to
have a stronger claim to the person’s allegiance.

For information about U.S. dual citizenship, visit


www.usimmigrationsupport.org/dual_citizenship.html

9.4 United States Passport


A passport is necessary to have when traveling abroad. Conditional or permanent residents must
bring their valid national passports (and valid Green Card), while U.S. citizens must bring their
U.S. passports. No individual will be allowed to board an airplane without having a valid passport
when traveling abroad. Conditional or permanent residents must first obtain U.S. citizenship
before applying for a passport. Having a United States passport is a privilege that only United
States citizens have. A United State citizen is not a green card holder or a person holding a work
visa (H1-B, E1, etc).

Visit the U.S. Immigration Support (an independent organization) website for more information on
how to apply for a U.S. passport: www.usimmigrationsupport.org/passport.html

9.5 Advantages of U.S. Citizenship


United States citizenship is one step beyond permanent residency (Green Card). Citizenship
gives the holder the maximum rights available in the United States. In order to apply for
citizenship, green card holders must have been a permanent resident for a certain number of
years. Naturalized citizens can obtain a Certificate of Naturalization.

United States citizens may also find it advantageous to use a U.S. passport when traveling
abroad, while green card holders must travel on their native passport. There are certain
restrictions that green card holders must be aware of when traveling abroad for longer periods of
time. Several countries allow dual citizenship including the United States. Citizens have much
greater ability to sponsor relatives for U.S. immigration benefits (visas, Green Card, etc). Many
government contracts and jobs require the applicant to be a United States citizen.

• Only United States citizens can obtain a U.S. passport.

• U.S. citizens can reside abroad for longer periods of time, while Green Card holders may
have their permanent resident status revoked.

• Green cards must be renewed every 10 years for a fee (currently $ 370), while citizenship
once obtained does not expire or need to be renewed.

• Many countries have waived visa requirements for U.S. passport holders, while Green
Card holders with native passports may have to apply for visas in advance.

• U.S. citizens are eligible to receive additional services and assistance from U.S.
Embassies and Consulates abroad.

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• U.S. citizens do not have to carry proof of citizenship, while green card holders must
always be able to proof their legal status in the United States by carrying a valid Green
Card. ICE (Immigration and Customs Enforcement) has detained permanent residents
who did not have their green cards with them.

• U.S. citizens have the right to vote in the United States.

• The right to sponsor relatives and family members so they can immigrate to the United
States.

• United States citizens cannot be deported, while green card holders may be deported in
certain cases, such as being convicted of a crime.

• The right to run for public office.

Finally, there are intangible benefits. Most Green Card holders have decided that the United
States will be the permanent home for their families. They find it of psychological benefit to be on
equal footing with their American peers.

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10.0 FREQUENTLY ASKED QUESTIONS


Question: I am going to Puerto Rico. What documentation must I bring?
Answer: Puerto Rico is a territory of the United States and by law you are required to
carry your Green Card. It is also recommended to bring your passport. Other
U.S. territories include Guam, Puerto Rico, the U.S. Virgin Islands, American
Samoa, Swains Island and the Commonwealth of the Northern Mariana Islands

Question: I am Green Card holder and I want to go back to the Philippines for 1 month. Do I
need an US Visa to enter the US?
Answer: You do not need a reentry permit to be away for one month as long as you have
a valid Green Card (upon departure and reentry) and a valid passport. You may
want to bring additional documentation proofing your intent to remain a U.S.
resident such as a letter from your employer, copy of your tax returns or a copy
of your mortgage or lease.

Question: My friend has had a Green Card for 3 months. Now he is going back to Brazil
later this month. How long can he stay out of the country?
Answer: Individuals with a Conditional Green Card is recommended to obtain a travel
permit to avoid any problems with U.S. immigration upon reentry. An approved
travel permit is valid for one year.

Question: I have been a legal resident of the U.S. for over 22 years, but I am still an Indian
citizen. Now I am considering to live in India for a few years to be near my family.
Is that possible without loosing my resident status and/or my Green Card?
Answer: There are several things to be aware of in this scenario including the time spent
abroad between each U.S. visit, an approval of a travel document, when the
Green Card is due to expire and ties to the United States. It is recommended to
obtain a reentry permit for stays abroad between 1 and 2 years.

Question: My Parents have got Green Cards though me (I am a citizen of the U.S.) and
they are from Israel. Do they have to come once a year to keep their Green card
valid? What happens if they miss or have to miss a year and can not come to the
U.S.?
Answer: This scenario includes the questions of whether the parents wants to remain U.S.
residents or not. What is the intent of living abroad? Are they filing U.S. taxes as
residents or non-residents? It is strongly recommended to contact the local U.S.
embassy to clarify the situation to avoid any problems upon entry to the United
States.

Question: I am applying for U.S. citizenship, but my Green Card has expired. Can I still
apply?

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Answer: No. You need to be in legal status before you can apply for U.S. citizenship. For
more information about how to renew your Green Card, visit
www.usimmigrationsupport.org/greencard_renewal.html

Question: My Green Card is about to expire. Can I apply for U.S. citizenship beforehand
to avoid obtaining a new Green Card?
Answer: By law you must be in legal status. If you do not have proof of U.S. citizenship
before your Green Card expires, it is strongly recommended to renew it. For
information visit: www.usimmigrationsupport.org/greencard_renewal.html

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11.0 ASSEMBLING OF APPLICATION


The USCIS instructs all applicants to follow these guidelines when submitting immigration forms
and supplementary evidence.

• Mark both the envelope and the cover letter as to the nature of the submission. Example:
ORIGINAL SUBMISSION – CHANGE OF ADDRESS – FORM AR-11

• Use the appropriate mailing address (Ref. Appendix 2) and mark both the envelope and
the cover letter with the form type: AR-11

• If the A-Number and receipt number are available, include both. Other names to include
are original filing name, maiden name, and any aliases.

• The order of the papers should begin with the AR-11 followed by supplementary
documents, if applicable.

• If the initial application has been denied and the applicant provides supplementary
information, include a cover letter on top of the packet following by all the necessary
documents.

• Do not use binders or folders that cannot be easily disassembled.

• Use ACCO fasteners or similar to hold together thick or bulky applications or petitions.

• If you use tabs, do so at the bottom of the file – not on the side.

• Do not use heavy-duty staples, but rather utilize ACCO fasteners or heavy clips.

• Do not submit originals unless this is specifically required.

• Avoid submitting oversized documentation when possible.

• If more than one case is included in the package send to the USCIS, make sure that they
are clearly separated.

• Include copies of any prior approval notices with any new requests for extensions of stay,
change of status, or amended petitions.

• Create an extra copy package for yourself of all submissions you have made.

• Try to submit the package as complete as possible so the case can be adjudicated from
what you submit.

• Do not refer to documents from previous filings even though the documents are the
same. Always include the documents that are necessary.

• Be sure to complete all items on the petition or application. Do not enter "N/A" when
"None" is appropriate.

• All foreign language documents must be certified by the translator including the
translator’s statement that he or she is competent to translate.

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• The certification format should include the certifier's name, signature, address, and date
of certification. See example below:

• Certification by Translator

I [typed name], certify that I am fluent (conversant) in the English and [language]
languages, and that the above/attached document is an accurate translation of
the document attached entitled______________.

Signature

Date Typed Name


Address

Ordinarily regular copies are acceptable for the initial filing. Original documents or “Certified
Copies” are no longer required unless specifically requested. However, the originals should be
readily available in case of a request for originals.

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APPENDIX 1
U.S. Embassies and Consulates Worldwide
The United States has embassies and consulates in almost every country around the world with a
few exceptions. For a full list of all U.S. embassies and consulates worldwide, visit the link below.

http://usembassy.state.gov

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APPENDIX 2
USCIS Application Support Centers (ASC)
National Toll Free Telephone Number: 1-800-375-5283

Alabama

USCIS Application Support Center


Metairie Centre, Suite 300 (Third Floor)
2424 Edenborn Avenue
Metairie, LA 70001

Alaska

USCIS Application Support Center


th
620 E. 10 Avenue – Suite 7
Anchorage, AK 99501

Arizona

USCIS Application Support Center USCIS Application Support Center


1605 Isleta Boulevard, SW Suite C 6175 South Pecos Road
Albuquerque, NM 87105-4793 Las Vegas, NV 89120-6283

USCIS Application Support Center USCIS Application Support Center


2545 East Thomas Road 1835 South Alvernon Way Suites 217
Phoenix, AZ 85016-7941 Tucson, AZ 85711-5693

USCIS Application Support Center


3250 South 4th Avenue Suite E
Yuma, Arizona 85365-4051

Arkansas

USCIS Application Support Center USCIS Application Support Center


3701 West Northwest Highway Suite 211 4977 Old Greenwood Road
Village at Bachman Lake Fort Smith, AR 72903-6906
Dallas, TX 75220-4961

USCIS Application Support Center


842 Virginia Run Cove
Memphis, TN 38122-4419

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California

USCIS Application Support Center USCIS Application Support Center


4701 Planz Road Suite A12 16 Heffernan Avenue
Bakersfield, CA 93309-6349 Calexico, CA 92231

USCIS Application Support Center USCIS Application Support Center


Bellflower Plaza Golden Vista Plaza
17610 Bellflower Blvd. – Suite A -110 9251 Garvey Avenue – Suite Q
Bellflower, CA 90706 South El Monte, CA 91733

USCIS Application Support Center USCIS Application Support Center


8381 La Palma Avenue – Suite A 4893 E. Kings Canyon
Buena Park, CA 90620 Fresno, CA 93727

USCIS Application Support Center USCIS Application Support Center


6831-B Hollister Avenue 825 Riverside Parkway Suite 100
Goleta, CA 93117 West Sacramento, CA 95605-1502

USCIS Application Support Center USCIS Application Support Center


15715 Crenshaw Blvd. – Room B-112 Santa Rita Plaza
Gardena, CA 90249 1954 N. Main Street
Salinas, CA 93906
USCIS Application Support Center
888 Wilshire Blvd. USCIS Application Support Center
Los Angeles, CA 90017 2509 El Cajon Blvd
San Diego, CA 92104
USCIS Application Support Center
5949 W. Pico Blvd USCIS Application Support Center
Los Angeles, CA 90035 250 Broadway
San Francisco, CA 94111
USCIS Application Support Center
901 N. Carpenter Road. – Suite 14 USCIS Application Support Center
Modesto, CA 95351 122 Charcot Avenue
San Jose, CA 95131-1101
USCIS Application Support Center
2040 Telegraph Avenue USCIS Application Support Center
Oakland, CA 94612 727 W. San Marcos Blvd # 101 – 102
San Marcos, CA 92069
USCIS Application Support Center
825 Riverside Parkway Suite 100 USCIS Application Support Center
West Sacramento, CA 95605-1502 1666 N. Main Street # 100 – A
Santa Ana, CA 92701
USCIS Application Support Center
435 W. Mission Blvd. Suite 110 USCIS Application Support Center
Pomona, CA 91766 1401 Guerneville Road # 100
Santa Rosa, CA 95403
USCIS Application Support Center
10082 Magnolia Avenue USCIS Application Support Center
Riverside, CA 92503 14515 Hamlin Street – Suite 200
Van Nuys, CA 91411
USCIS Application Support Center
2000 Outlet Center Drive Suite 200
Oxnard, CA 93036-0609

Colorado

USCIS Application Support Center USCIS Application Support Center


15037 E. Colfax Avenue – Unit G 2454 Highway 6 and 50 – Valley Plaza – Suite 115
Aurora, CO 80011 Grand Junction, CO 81505

USCIS Application Support Center USCIS Application Support Center


1605 Isleta Boulevard, SW Suite C 271 West 3rd Street Suite 1050
Albuquerque, NM 87105-4793 Wichita, KS 67202-1203

Connecticut

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USCIS Application Support Center USCIS Application Support Center


249 Pearl Street 246 North Avenue
Hartford, CT 06103-2112 New Rochelle, NY 10801-6405

Delaware

USCIS Application Support Center USCIS Application Support Center


655 South Bay Road, Suite 4E 2040 Shipley Drive Suite 2C
Dover, DE 19901-4656 Salisbury, MD 21801-7874

District of Columbia

USCIS Application Support Center


8850 Richmond Highway, Suite 100
Alexandria, VA 22309-1586

Florida

USCIS Application Support Center USCIS Application Support Center


st
11690 State Road 84 521 NE. 81 Street, Bay 11
Davie, FL 33325 Miami, FL 33138

USCIS Application Support Center USCIS Application Support Center


Westland Promenade Terracotta Business Center
th
3700 West 18 Avenue #110 5449 S Semoran Blvd #18C
Hialeah, FL 33012 Orlando, FL 32822

USCIS Application Support Center USCIS Application Support Center


4121 Southpoint Boulevard 9280 Bay Plaza Boulevard – Suite 726
Jacksonville, FL 32216 Tampa, FL 33619

USCIS Application Support Center USCIS Application Support Center


th
11865 SW 26 Street (Coral Way) – Suite J-6 2711 Exchange Court
Miami, FL 33175 West Palm Beach, FL 33401

Georgia

USCIS Application Support Center USCIS Application Support Center


1255 Collier Road, Suite 100 1 Poston Road, Suite 130 Parkshore Center
Atlanta, GA 30318 Charleston, SC 29407

Guam

USCIS Application Support Center


108 Hernan Cortez Ave. – Sirena Plaza #100
Hagatna, GU 96910

Hawaii

USCIS Application Support Center


677 Ala Moana Blvd. – Suite # 102/103
Honolulu, HI 96813

Idaho

USCIS Application Support Center USCIS Application Support Center


1185 South Vinnell Way 1820 E. 17TH Street – Suite 190
Boise, ID 83709 Idaho Falls, ID 83404

USCIS Application Support Center


Thomas Foley U.S. Federal Courthouse
920 West Riverside Room 691
Spokane, WA 99201-1012

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Illinois

USCIS Application Support Center USCIS Application Support Center


4853 North Broadway 888 South Route 59 Suite 124
Chicago, IL 60640-3603 Naperville, IL 60540-0962

USCIS Application Support Center USCIS Application Support Center


5160 South Pulaski Road Super Mall Suite 101 4701 North Cumberland Suites 1-3 B, C, D
Chicago, IL 60632-4253 Norridge, IL 60706-4277

USCIS Application Support Center USCIS Application Support Center


7852 Interstate Plaza Drive 1222 Spruce Street Room 1.212
Hammond, IN 46324-3362 Saint Louis, MO 63103-2822

USCIS Application Support Center USCIS Application Support Center


950 North Meridian Street, Room 400 25 South Greenbay Road
Indianapolis, IN 46204-3915 Waukegan, IL 60085-4815

USCIS Application Support Center


Gene Snyder U.S. Courthouse and Custom House 601
West Broadway Suite 22
Louisville, KY 40202-2250

Indiana

USCIS Application Support Center USCIS Application Support Center


550 Main Street Room 1524 950 North Meridian Street, Room 400
Cincinnati, OH 45202-5298 Indianapolis, IN 46204-3915

USCIS Application Support Center USCIS Application Support Center


7852 Interstate Plaza Drive Gene Snyder U.S. Courthouse and Custom House 601
Hammond, IN 46324-3362 West Broadway Suite 22
Louisville, KY 40202-2250

Iowa

USCIS Application Support Center USCIS Application Support Center


210 Walnut Street Room 949 1360 University Avenue West Room 103
Des Moines, IA 50309-2110 Saint Paul, MN 55104-4092

USCIS Application Support Center USCIS Application Support Center


1717 Avenue H E 300 East 8th Street Riverside Station
Omaha, NE 68110-2752 Sioux Falls, SD 57103-7023

Kansas

USCIS Application Support Center USCIS Application Support Center


9747 Northwest Conant Avenue 271 West 3rd Street Suite 1050
Kansas City, MO 64153-1833 Wichita, KS 67202-1203

USCIS Application Support Center


1717 Avenue H E
Omaha, NE 68110-2752

Kentucky

USCIS Application Support Center USCIS Application Support Center


210 Kanawha Boulevard 550 Main Street Room 1524
West Charleston, WV 25302-2201 Cincinnati, OH 45202-5298

USCIS Application Support Center USCIS Application Support Center


Gene Snyder U.S. Courthouse and Custom House 601 247 Venture Circle
West Broadway Suite 22 Nashville, TN 37228-1603
Louisville, KY 40202-2250

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Louisiana

USCIS Application Support Center USCIS Application Support Center


Metairie Centre, Suite 300 7334 South Westmoreland
2424 Edenborn Avenue Road Dallas, TX 75237-2908
Metairie, LA 70001

USCIS Application Support Center


Corum Plaza 8505 Gulf Freeway Suite D
Houston, TX 77017-5043

Maine

USCIS Application Support Center


176 Gannett Drive South
Portland, ME 04106-6909

Maryland

USCIS Application Support Center USCIS Application Support Center


8850 Richmond Highway, Suite 100 800 Penn Avenue Suite 101
Alexandria, VA 22309-1586 Pittsburgh, PA 15222-3623

USCIS Application Support Center USCIS Application Support Center


00 South Charles Street, Suite 201 2040 Shipley Drive Suite 2C
Baltimore, MD 21201 Salisbury, MD 21801-7874

USCIS Application Support Center USCIS Application Support Center


655 South Bay Road, Suite 4E Glenmont Plaza 12331 Georgia Avenue, Suite C
Dover, DE 19901-4656 Wheaton, MD 20906-3646

Massachusetts

USCIS Application Support Center USCIS Application Support Center


170 Portland Street 1086 Troy-Schenectady Road
Boston, MA 02114-1706 Latham, NY 12110-1024

USCIS Application Support Center USCIS Application Support Center


249 Pearl Street Crossroads Office Park, 105
Hartford, CT 06103-2112 Sockanosset Cross Road, Suite 210
Cranston, RI 02920-5560

Michigan

USCIS Application Support Center USCIS Application Support Center


2652 East Jefferson Avenue Chene Square Mall Bretwood Center 4484 Breton Road
Detroit, MI 48207-4129 Kentwood, MI 49508-5270

USCIS Application Support Center


7852 Interstate Plaza Drive
Hammond, IN 46324-3362

Minnesota

USCIS Application Support Center USCIS Application Support Center


Federal Building 515 West First Street Room 208 1360 University Avenue West Room 103
Duluth, MN 55802-1350 Saint Paul, MN 55104-4092

USCIS Application Support Center USCIS Application Support Center


657 2nd Avenue North Suite 248 300 East 8th Street Riverside Station
Fargo, ND 58102-4727 Sioux Falls, SD 57103-7023

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Mississippi

USCIS Application Support Center USCIS Application Support Center


100 West Capitol Street Metairie Centre, Suite 300
McCoy Federal Building Suite 727 2424 Edenborn Avenue
Jackson, MS 39269-1602 Metairie, LA 70001

USCIS Application Support Center


842 Virginia Run Cove
Memphis, TN 38122-4419

Missouri

USCIS Application Support Center USCIS Application Support Center


4977 Old Greenwood Road 842 Virginia Run Cove
Fort Smith, AR 72903-6906 Memphis, TN 38122-4419

USCIS Application Support Center USCIS Application Support Center


9747 Northwest Conant Avenue 1222 Spruce Street Room 1.208
Kansas City, MO 64153-1833 Saint Louis, MO 63103-2822

Montana

USCIS Application Support Center USCIS Application Support Center


2800 Skyway Drive Thomas Foley U.S. Federal Courthouse
Helena, MT 59602-1230 920 West Riverside Room 691
Spokane, WA 99201-1012
USCIS Application Support Center
1675 Samco Road
Rapid City, SD 57702

Nebraska

CIS Application Support Center USCIS Application Support Center


15037 East Colfax Avenue Unit G 1717 Avenue H E
Aurora, CO 80011-5777 Omaha, NE 68110-2752

USCIS Application Support Center USCIS Application Support Center


150 East B Street Room 1014 300 East 8th Street Riverside Station
Casper, WY 82601-7005 Sioux Falls, SD 57103-7023

Nevada

USCIS Application Support Center USCIS Application Support Center


6175 South Pecos Road 1351 Corporate Blvd.
Las Vegas, NV 89120 Reno, NV 89502

New Hampshire

USCIS Application Support Center


803 Canal Street
Manchester, NH 03101

New Jersey

USCIS Application Support Center USCIS Application Support Center


116 Kansas St. – Main Floor 24 Commerce Street
Hackensack, NJ 07601 Newark, NJ 07102

USCIS Application Support Center


120 North 8th Street
Philadelphia, PA 19107-2422

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New Mexico

USCIS Application Support Center USCIS Application Support Center


1605 Isleta Boulevard, SW Suite C 3502 Slide Road Suite A-24
Albuquerque, NM 87105-4793 Lubbock, TX 79414-2547

USCIS Application Support Center


10500 Montwood Drive
El Paso, TX 79935-2703

New York

USCIS Application Support Center USCIS Application Support Center


2378 Grand Concourse 201 Varick Street Room #1023
Bronx, NY 10458-6907 New York, NY 10014-7055

USCIS Application Support Center USCIS Application Support Center


227 Livingston Street 24 Commerce Street Suite 200
Brooklyn, NY 11201-5838 Newark, NJ 07102-4005

USCIS Application Support Center USCIS Application Support Center


130 Delaware Avenue 246 North Avenue New
Buffalo, NY 14202-2498 Rochelle, NY 10801-6405

USCIS Application Support Center USCIS Application Support Center


100 Main Street, Suite B 64 Grice Brook Road
Hempstead, NY 11550-2418 Saint Albans, VT 05478-9500

USCIS Application Support Center USCIS Application Support Center


153-01 Jamaica Avenue, 1st Floor 412 South Warren
Jamaica, NY 11432 Street Syracuse, NY 13202-2604

USCIS Application Support Center USCIS Application Support Center


1086 Troy-Schenectady Road 63-05 Roosevelt Avenue
Latham, NY 12110-1024 Woodside, NY 11377-3641

North Carolina

USCIS Application Support Center USCIS Application Support Center


4801 Chastain Avenue Building #10, Suite #175 2500 Almeda Avenue Suite 114
Charlotte, NC 28217-2231 Norfolk, VA 23513

North Dakota

USCIS Application Support Center USCIS Application Support Center


Located in the Federal Building/US Post Office) 2800 Skyway Drive
657 2nd Avenue North Suite 248 Helena, MT 59602-1230
Fargo, ND 58102-4727

Ohio

USCIS Application Support Center USCIS Application Support Center


550 Main Street – Room 1524 Leveque Towers – 50 W Broad Street – Suite 321
Cincinnati, OH 4520 Columbus, OH 43215

USCIS Application Support Center USCIS Application Support Center


th
AJC Federal Building – 1240 E. 9 Street – Room 1259 2652 East Jefferson Avenue Chene Square Mall
Cleveland, OH 44199 Detroit, MI 48207-4129

Oklahoma

USCIS Application Support Center USCIS Application Support Center


4977 Old Greenwood Road 4400 Southwest 44th Street Suite A
Fort Smith, AR 72903-6906 Oklahoma City, OK 73119-2800

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Oregon

USCIS Application Support Center USCIS Application Support Center


1185 South Vinnell Way 415 North 3rd Street
Boise, ID 83709-1656 Yakima, WA 98901-2331

USCIS Application Support Center


721 Southwest 14th Avenue
Portland, OR 97205-1904

Pennsylvania

USCIS Application Support Center USCIS Application Support Center


130 Delaware Avenue 800 Penn Avenue Suite 101
Buffalo, NY 14202-2498 Pittsburgh, PA 15222-3623

USCIS Application Support Center USCIS Application Support Center


24 Commerce Street Suite 200 412 South Warren Street
Newark, NJ 07102-4005 Syracuse, NY 13202-2604

USCIS Application Support Center USCIS Application Support Center


120 North 8th Street 3400 Concord Road
Philadelphia, PA 19107-2422 York, PA 17402-9007

Puerto Rico

USCIS Application Support Center


458 Ing. Jose Canals Street
San Juan, PR 00918

Rhode Island

USCIS Application Support Center


105 Sockanosset Cross Rd. – Suite 210
Cranston, RI 02920

South Carolina

USCIS Application Support Center USCIS Application Support Center


1 Poston Road, Suite 130 Parkshore Center 4801 Chastain Avenue Building #10, Suite #175
Charleston, SC 29407 Charlotte, NC 28217-2231

South Dakota

USCIS Application Support Center USCIS Application Support Center


th
1675 Samco Road Riverside Station – 300 East 8 Street
Rapid City, SD 57702 Sioux Falls, SD 57104

USCIS Application Support Center


657 2nd Avenue North Suite 248
Fargo, ND 58102-4727

Tennessee

USCIS Application Support Center USCIS Application Support Center


1341 Sycamore View – Suite 100 247 Venture Circle
Memphis, TN 38134 Nashville, TN 37228

Texas

USCIS Application Support Center USCIS Application Support Center

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943 North Expressway 77 Corum Plaza 8505 Gulf Freeway Suite D


Southwind Shopping Center, Suite 23 Houston, TX 77017-5043
Brownsville, TX 78520-8670

USCIS Application Support Center USCIS Application Support Center


3701 West Northwest Highway Suite 211 707 East Calton Road Suite 301
Village at Bachman Laredo, TX 78041-3638.
Lake Dallas, TX 75220-4961

USCIS Application Support Center USCIS Application Support Center


7334 South Westmoreland Road 3502 Slide Road Suite A-24
Dallas, TX 75237-2908 Lubbock, TX 79414-2547

USCIS Application Support Center USCIS Application Support Center


10500 Montwood Drive 220 South Bicentennial Suite C
El Paso, TX 79935-2703 McAllen, TX 78501-7019

USCIS Application Support Center USCIS Application Support Center


4200 South Freeway 4400 Southwest 44th Street Suite A
Fort Worth Town Center Mall Suite # 1309 Oklahoma City, OK 73119-2800
Fort Worth, TX 76115-1400

USCIS Application Support Center USCIS Application Support Center


10555 Northwest Freeway Suite 150 5121 Crestway Drive Suite 112
Houston, TX 77092-8209 San Antonio, TX 78239-1975

USCIS Application Support Center


7086 Bissonnet Street
Houston, TX 77074-6010

Utah

USCIS Application Support Center USCIS Application Support Center


1605 Isleta Boulevard, SW Suite C 5536 South 1900 West Street Building C
Albuquerque, NM 87105-4793 Taylorsville, UT 84118-9007

USCIS Application Support Center


6175 South Pecos Road
Las Vegas, NV 89120-6283

Vermont

USCIS Application Support Center USCIS Application Support Center


1086 Troy-Schenectady Road 64 Grice Brook Road Saint
Latham, NY 12110-1024 Albans, VT 05478-9500

Virgin Islands

USCIS Application Support Center USCIS Application Support Center


Sunny Isles Shopping Center South Nisky Center – Suite 1A
Christiansted, St. Croix, VI 00823 St. Thomas, VI 00802

Virginia

USCIS Application Support Center USCIS Application Support Center


8850 Richmond Highway, Suite 100 2500 Almeda Avenue Suite 114
Alexandria, VA 22309-1586 Norfolk, VA 23513

USCIS Application Support Center USCIS Application Support Center


210 Kanawha Boulevard 2040 Shipley Drive Suite 2C
West Charleston, WV 25302-2201 Salisbury, MD 21801-7874

Washington

USCIS Application Support Center USCIS Application Support Center

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721 Southwest 14th Avenue Thomas Foley U.S. Federal Courthouse


Portland, OR 97205-1904 920 West Riverside Room 691
Spokane, WA 99201-1012

USCIS Application Support Center USCIS Application Support Center


12500 Tukwila International Boulevard 415 North 3rd Street
Seattle, WA 98168 Yakima, WA 98901-2331

West Virginia

USCIS Application Support Center USCIS Application Support Center


210 Kanawha Boulevard Glenmont Plaza 12331 Georgia Avenue, Suite C
West Charleston, WV 25302-2201 Wheaton, MD 20906-3646

USCIS Application Support Center


800 Penn Avenue Suite 101
Pittsburgh, PA 15222-3623

Wisconsin

USCIS Application Support Center USCIS Application Support Center


Federal Building 515 West First Street Room 208 1360 University Avenue West Room 103
Duluth, MN 55802-1350. Saint Paul, MN 55104-4092

USCIS Application Support Center


310 East Knapp Street First Floor, Room 154
Milwaukee, WI 53202-4504

Wyoming

USCIS Application Support Center USCIS Application Support Center


15037 East Colfax Avenue Unit G 1675 Samco Road
Aurora, CO 80011-5777 Rapid City, SD 57702.

USCIS Application Support Center USCIS Application Support Center


150 East B Street Room 1014 5536 South 1900 West Street Building C
Casper, WY 82601-7005 Taylorsville, UT 84118-9007

USCIS Application Support Center


1820 East 17th Street Suite 190
Idaho Falls, ID 83404-6471

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APPENDIX 3
USCIS Field Offices
National Toll Free Telephone Number: 1-800-375-5283

Alabama

USCIS Field Office


Martin Luther King, Junior Federal Building
77 Forsyth Street, South West
Atlanta, GA 30303

Alaska

USCIS Field Office


Anchorage District Office
620 East 10th Avenue, Suite 102
Anchorage, AK 99501

Arizona

USCIS Field Office USCIS Field Office


2035 North Central Avenue 6431 South Country Club Road
Phoenix, AZ 85004 Tucson, AZ 85706-5907

Arkansas

USCIS Field Office USCIS Field Office


842 Virginia Run Cove 4977 Old Greenwood Road
Memphis, TN 38122 Fort Smith, AR 72903

California

USCIS Field Office USCIS Field Office


16 Heffernan Avenue 655 West Rialto Avenue San
Calexico, CA. 92231 Bernardino, CA 92410.

USCIS Field Office USCIS Field Office


1261 3rd Avenue, Suite A 880 Front Street
Chula Vista, CA 91911 San Diego, CA 92101-8834

USCIS Field Office USCIS Field Office


1177 Fulton Mall 444 Washington Street San
Fresno, CA 93721-1913 Francisco, CA 94111

USCIS Field Office USCIS Field Office


300 North Los Angeles Street 1887 Monterey Road
Los Angeles, CA 90012 San Jose, CA 95112

USCIS Field Office USCIS Field Office


650 Capitol Mall 34 Civic Center Plaza
Sacramento, CA 95814 Santa Ana, CA 92701

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Colorado

USCIS Field Office


4730 Paris Street
Denver, CO 80239

Connecticut

USCIS Field Office


450 Main Street, 4th Floor
Hartford, CT 06103-3060

Delaware

USCIS Field Office


1305 McD Drive
Dover, DE 19901

Distric of Columbia

USCIS Field Office


4420 N. Fairfax Drive
Arlington, VA 22203

Florida

USCIS Field Office USCIS Field Office


7880 Biscayne Boulevard 4121 Southpoint Boulevard
Miami, FL 33138 Jacksonville, FL 32216

USCIS Field Office USCIS Field Office


9403 Tradeport Drive 326 Fern St
Orlando, FL 32827 West Palm Beach, FL 33401

USCIS Field Office


5524 West Cypress Street
Tampa, FL 33607-1708

Georgia

USCIS Field Office


Martin Luther King Jr. Federal Building
77 Forsyth Street SW
Atlanta, GA 30303

Guam

USCIS Field Office


Sirena Plaza, Suite 100
108 Hernan Cortez Avenue
Hagatna, GU 96910

Hawaii

USCIS Field Office


595 Ala Moana Boulevard
Honolulu, HI 96813

Idaho

USCIS Field Office USCIS Field Office

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1185 South Vinnell Way U.S. Courthouse 920


Boise, ID 83709 West Riverside, Room 691
Spokane, WA 99201

Illinois

USCIS Field Office USCIS Field Office


10 West Jackson Boulevard Robert A. Young Federal Building
Chicago, Illinois 60604 1222 Spruce Street
Saint Louis, MO 63103

Indiana

USCIS Field Office USCIS Field Office


101 West Congress Parkway 950 N. Meridian St., Room 400
Chicago, IL 60605. Indianapolis, IN 46204-3915

Iowa

USCIS Field Office USCIS Field Office


210 Walnut Street, Room 369 Federal Building 1717 Avenue H E
Des Moines, IA 50309 Omaha, NE 68110-2752

Kansas

USCIS Field Office USCIS Field Office


9747 NW Conant Avenue 271 West 3rd Street North, Suite 1050
Kansas City, MO 64153. Wichita, KS 67202-1212

Kentucky

USCIS Field Office


Gene Snyder U.S. Courthouse and Customhouse - Room 390
601 West Broadway
Louisville, KY 40202

Louisiana

USCIS Field Office


Metairie Centre, Suite 300 (Third Floor)
2424 Edenborn Avenue
Metairie, LA 70001

Maine

USCIS Field Office


176 Gannett Drive
South Portland, ME 04106

Maryland

USCIS Field Office


Fallon Federal Building - 31 Hopkins Plaza
Baltimore, MD 21201

Massachusetts

USCIS Field Office


John F. Kennedy Federal Building - Government Center
Boston, MA 02203

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Michigan

USCIS Field Office


333 Mt. Elliot
Detroit, MI 48207

Minnesota

USCIS Field Office


2901 Metro Drive, Suite 100
Bloomington, MN 55425

Mississippi

USCIS Field Office USCIS Field Office


842 Virginia Run Cove Metairie Centre, Suite 300
Memphis, TN 38122 2424 Edenborn Avenue
Metairie, LA 70001

Missouri

USCIS Field Office USCIS Field Office


9747 Northwest Conant Avenue Robert A. Young Federal Building
Kansas City, MO 64153 1222 Spruce Street, Room 1.100
St. Louis, MO 63103-2815

Montana

USCIS Field Office


2800 Skyway Drive
Helena, MT 59602

Nebraska

USCIS Field Office


3736 South 132nd Street
Omaha, NE 68144

Nevada

USCIS Field Office USCIS Field Office


1351 Corporate Boulevard 3373 Pepper Lane
Reno, NV 89502 Las Vegas, NV 89120-2739

New Hampshire

USCIS Field Office


803 Canal Street
Manchester, NH 03101

New Jersey

USCIS Field Office USCIS Field Office


530 Fellowship Road Peter Rodino Federal Building
Mount Laurel, NJ 08054 970 Broad Street
Newark, NJ 07102

New Mexico

USCIS Field Office USCIS Field Office


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1545 Hawkins Boulevard 1720 Randolph Road SE


El Paso, TX 79925. Albuquerque, NM 87106

New York

USCIS Field Office USCIS Field Office


100 State Street, Room 418 1086 Troy-Schenectady Road
Rochester, NY 14614 Latham, NY 12110

USCIS Field Office USCIS Field Office


26 Federal Plaza Federal Center, 130 Delaware Avenue
New York City, NY 10278 Buffalo, NY 14202

USCIS Field Office


412 South Warren Street
Syracuse, NY 13202

North Carolina

USCIS Field Office


6130 Tyvola Centre Drive
Charlotte, NC 28217

North Dakota

USCIS Field Office


2901 Metro Drive, Suite 100
Bloomington, MN 55425

Ohio

USCIS Field Office USCIS Field Office


A.J.C. Federal Building J.W. Peck Federal Building
1240 East Ninth Street, Room 501 550 Main Street, Room 4001
Cleveland, OH 44199 Cincinnati, OH 45202

USCIS Field Office


Leveque Tower 50
West Broad Street, Suite 306
Columbus, OH 43215

Oklahoma

USCIS Field Office


4400 SW 44th Street - Suite "A"
Oklahoma City, OK 73119-2800

Oregon

USCIS Field Office


511 NW Broadway
Portland, OR 97209

Pennsylvania

USCIS Field Office USCIS Field Office


1600 Callowhill Street 3000 Sidney Street, Suite 200
Philadelphia, PA 19130 Pittsburgh, PA 15203

Puerto Rico

USCIS Field Office

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San Patricio Office Center


7 Tabonuco Street, Suite 100
Guaynabo, PR 00968

Rhode Island

USCIS Field Office


200 Dyer Street
Providence, RI 02903

South Carolina

USCIS Field Office USCIS Field Office


142-D West Phillips Road 170 Meeting Street, Fifth Floor
Greer, SC 29650 Charleston, SC 29401

South Dakota

USCIS Field Office


2901 Metro Drive, Suite 100
Bloomington, MN 55425

Tennessee

USCIS Field Office


842 Virginia Run Cove
Memphis, TN 38122

Texas

USCIS Field Office USCIS Field Office


8101 North Stemmons Freeway 126 Northpoint
Dallas, TX 75247 Houston, TX 77060

USCIS Field Office USCIS Field Office


1545 Hawkins Boulevard, Suite 167 8940 Fourwinds Drive
El Paso, TX 79925 San Antonio, TX 78239

USCIS Field Office


1717 Zoy Street
Harlingen, TX 78552

Utah

USCIS Field Office


5272 South College Drive, Suite 100
Salt Lake City, UT 84123

Vermont

USCIS Field Office


64 Gricebrook Road
St. Albans, VT 05478

Virgin Islands

USCIS Field Office USCIS Field Office


Nisky Center, Suite 1A First Floor South Sunny Isle Shopping Center
Charlotte Amalie, St. Thomas Christiansted, St. Croix
United States Virgin Islands 00823 United States Virgin Islands 00802

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Virginia

USCIS Field Office USCIS Field Office


2675 Prosperity Avenue 5280 Henneman Drive
Fairfax, VA 22031-4906 Norfolk, VA 23513

Washington

USCIS Field Office USCIS Field Office


815 Airport Way South 920 W. Riverside Room 691
Seattle, WA 98134 Spokane, WA 99201

USCIS Field Office


415 North 3rd Street
Yakima, WA 98901

West Virginia

USCIS Field Office USCIS Field Office


3000 Sidney Street, Suite 200 210 Kanawha Boulevard West
Pittsburgh, PA 15203 Charleston, WV 25302

Wisconsin

USCIS Field Office USCIS Field Office


2901 Metro Drive, Suite 100 310 E. Knapp Street
Bloomington, MN 55425. Milwaukee, WI 53202

Wyoming

USCIS Field Office USCIS Field Office


150 East B Street, Room 1014 4730 Paris Street
Casper, WY 82601 Denver, CO 80239

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APPENDIX 4
INFOPASS – Speak to an Immigration Officer
General Overview

InfoPass is an internet based system allowing individuals in the United States to make an
appointment to speak with an Immigration Officer. The service is free and the time and date is
easy to arrange. In cases of complex immigration issues, it may be better to ask an experienced
immigration officer. By scheduling your appointment online you can save time in comparison to
showing up in person and waiting in line. However, there may be times when you have more
generic questions, but for which you do not require an appointment with an Immigration Officer.
For routine questions, call NCSC at 1-800-375-5283.

How does InfoPass work?

Log on to: https://infopass.uscis.gov/info_en.php


• Step 1: Select the language you want to use (12 different languages)
• Step 2: Select “Make an Appointment.”
• Step 3: Type in the zip code where you live. If you are not sure of your local zip code,
visit this link: http://zip4.usps.com/zip4/welcome.jsp
• Step 4: Pick the type of appointment that matches best with the kind of inquiry or problem
you have.
• Step 5: Fill in your name, date of birth, zip code, and phone number. E-mail address is
optional.
• Step 6: Pick a date and time for your appointment. It may be that the time and date for
when you wish to visit is already booked. It is recommended to check back several times
as InfoPass is updated daily.
• Step 7: Once you have found a time, date, and location of your appointment, the
information will show up on the PC screen. It is important that you print out this
information and bring it with you to the appointment.

What to bring to your appointment?

• A printout of the appointment notice confirmation, refer to Step 7 above


• Personal identification (passport, driver’s license, green card, government issued ID,
Alien Registration Card, I-94, or Work Authorization Card)
• Any forms received such as receipt notices, letters showing approval or denial, original
documents and translations that relate to you situation

Reschedule of an appointment?

• Through InfoPass you can cancel or reschedule your appointment


• The identification numbers at the bottom of the appointment confirmation notice serve as
the numbers for logging in, changing or canceling your appointment
• Try to avoid a no-show by canceling your appointment if you cannot go
• There is no fee or penalty for rescheduling
• If the appointment notice is lost, a new one can be printed by accessing InfoPass and
entering the information requested

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APPENDIX 5
Case Status
This appendix applies only to individuals that have already submitted an application or petition
and received an “A – Number”. There are different ways of checking the status, but the process
differs depending on the type of application, where and how it is submitted, and in some cases
the applicant’s citizenship.

Electronically filed applications or cases at a Service Center


• Online:
o The following information needs to be available:
ƒ Receipt number (three letters + ten numbers)
o https://egov.immigration.gov/cris/jsps/index.jsp
• Telephone:
o 1-800-375-5283
o The following information needs to be available:
ƒ Receipt number (three letters + ten numbers)

In writing for applications or cases submitted to a Field Office


• See Appendix 3 for mailing addresses
• Include the following information:
o Your current name and address (if different from the application, write your name
and address as it appears)
o Any A-number (8 or 9 digit number following the letter "A")
o Your date of birth
o The date and place where the application was filed
o Any other receipt number from any receipt notice
o A copy of the most recent notice sent to you
o Date and office where the fingerprinting took place
o Date and office where the interview took place
o The applicant must sign and date the request letter
o Mark the envelope: ATTN: Status Inquiry

Applications filed at a local USCIS Office


• Telephone:
o Only contact the USCIS if your application has been pending for longer than the
time indicated on the receipt
o Call 1-800-375-5283 (National Customer Service Center)
o Have the following information available:
ƒ The A-Number
ƒ Any receipt number(s)
ƒ Last notice received about your case
• Personal visits to the local USCIS office:
o Bring the following information:
ƒ Any A-number assigned to your case
ƒ Date application was filed
ƒ Time application was filed
ƒ Any receipt number received
ƒ Any notice received
ƒ Date and office where the fingerprinting took place
ƒ Date and office where the interview took place

• In writing to the local USCIS office:


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o Include your current name and address (if different from the application, write
your name and address as it appears)
o Any A-number (8 or 9 digit number following the letter "A")
o Your date of birth
o The date and place where the application was filed
o Any other receipt number from any receipt notice
o A copy of the most recent notice sent to you
o Date and office where the fingerprinting took place
o Date and office where the interview took place
o The applicant must sign and date the request letter
o Mark the envelope: ATTN: Status Inquiry

Change of Address:
• Applicants that have changed address while their application is being processed must
update their address with the USCIS
• The process differs depending on where the application was filed and the citizenship of
the applicant:
o Applications or petitions filed at a Service Center:
ƒ U.S. citizens that filed an application or petition with a Service Center
should call the National Customer Service Center at 1-800-375-5283 and
update their address over the phone
ƒ Non-U.S. citizens that filed an application or petition with a Service
Center must call the National Customer Service Center at 1-800-375-
5283 and update their address over the phone and submit form AR-11
(Change of Address)
• Applications filed at a Field Office require:
o Submission of Form AR-11 (Change of Address)
o In writing:
ƒ Include the name as spelled in the application
ƒ The A-number
ƒ Your previous and new address
ƒ The letter must be marked: “ATTN: CHANGE OF ADDRESS”
ƒ Write the address like this:
USCIS ________ District Office
(for example, Boston District Office)
123 Main Street, City, State, Zip
ATTN: Change of Address

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APPENDIX 6
Do I need an Immigration Attorney?
You may wonder if an immigration attorney is necessary in order to successfully file your
application. This appendix will cover some facts about immigration lawyers and why you should
or should not file your application with the assistance of an attorney.

There are a number of do-it-yourself immigration packages where you do all the work including
this immigration package. Nevertheless, due to the number of choices available there is also
more room for mistakes. The catch is that you must stay well informed in order to be sure you are
not breaking any rules or submitting an incomplete application.

With the help of the Internet, long distance client/attorney relationships are available. One good
reason for going with a lawyer is to ensure that your case is in good hands and being processed
correctly. However, a lawyer who is not an expert in your case can make matters worse and you
may have been better off on your own.

A good immigration attorney knows what questions to ask in order to file your application
correctly. However, it is advisable to learn the basics yourself. Staying informed will help you
follow the application process carefully and possibly spot mistakes that can jeopardize your
application. You cannot have full control over your own situation, but at least you know what is
going on and what to expect in the future.

We recommend you study this application guide carefully. You are able to do everything yourself,
but if you have questions or concerns we recommend you consult with the United States
Consulate or Embassy in your country. If you are already in the United States, call the USCIS toll
free number or visit your local USCIS office. Contact information can be found in a different
appendix in this information guide.

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APPENDIX 7
Glossary of Terms
A" Number The term used on the Alien Registration number. An “A” number is issued to all
aliens applying for permanent residence.
Academic Training This type of training is for students on a J-1 visa. The training is similar to
students on an F-1 visa doing the Optional Professional Training (OPT).
However, academic training is only for J-1 visa holders.
Acquired Citizenship Citizenship bestowed at birth on children who are born overseas to U.S. citizen
parent(s).
Act Act means the “Immigration and Nationality Act” (or INA), as amended.
ACWIA American Competitiveness and Workforce Improvement Act of 1998.
Adjudication The term describing the USCIS process of reviewing and processing
applications and petitions.
Admission Admission in immigration terms is related to the lawful entry into the United
States after inspection and authorization by an immigration officer. Note that
admission does exclude a person who is paroled or permitted to land
temporarily.
Adjustment of A process that permits a number of foreigners who are already in the United
Immigrant Status States to apply for immigrant status. Foreigners who enter the United States as
nonimmigrants, refugees, or parolees might have their status altered to that of
legal permanent resident if they are qualified to obtain an immigrant visa and
one is available right away. If the status is changed successfully, the alien is
considered an immigrant as of the date of the adjustment regardless if the alien
may have been in the United States for a long period of time.
Admission Number The particular number is found on your I-94 card, which will change every time
you enter the Unites States. Remember to give this card back once your leave
the U.S. so there is a record of your U.S. entry and departure.
Advance parole The term used for legal permission to leave the United States and reenter during
the adjustment of the individuals status procedures.
Affidavit of Support The affidavit of support is a sworn document provided by an individual who will
provide financial support to an alien that seeks to adjust existing status or enter
the United States. In some cases, the Affidavit of Support is required and needs
to be included as a part of the petition process. There are two Affidavits of
Support: Form I-864 and Form I-134. The law and regulations must be consulted
to learn the appropriate use and requirements for each.
Aggravated Felon The description of an individual who has been convicted of any of numerous
crimes set forth in INA Section 101(a)(43), 8 USC Section 1101. Aggravated
felon status creates numerous substantive and procedural disabilities with
respect to asylum, admissibility, removal, judicial review, etc., as set forth in INA
Sections 298, 212, 237 - 242, 8 USC Sections 1158, 1182.
Agricultural Worker An agricultural worker is a foreign worker who is coming to the United States to
carry out agricultural work or services, as defined by the Secretary of Labor, for
a temporary period of time as a nonimmigrant.
AILA Abbreviation for American Immigration Lawyers Association.
Alien Any person who is not a citizen or national of the United States of America;
foreigner.
Aliens Previously A term used to describe the inadmissibility for individuals previously removed
Removed from anywhere between 5 to 20 years, depending upon the circumstances of
each case. INA Section 212(a)(9)(A), 8 USC Section 1182.
Amerasian Act Public Law 97-359 (Act of 10/22/82) that permits certain Amerasian children to
immigrate to the United States. An alien must have been born in Cambodia,
Korea, Laos, Thailand, or Vietnam after December 31, 1950, and before
October 22, 1982, and have been fathered by a U.S. citizen for him/her to meet

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the requirements for benefits under this law.


Amerasian (Vietnam) Immigrant visas are granted to Amerasians under Public Law 100-202 (Act of
12/22/87). This law grants aliens who are born in Vietnam after January 1, 1962,
and before January 1, 1976 admission to the United States provided he/she was
fathered by a U.S. citizen. The alien may be accompanied by spouses, children,
and parents or guardians.
Applicant The individual applying for visa, change of status or citizenship.
Application for Immigrant Visa and Alien Registration
The procedures for applying for immigrant status through a U.S. consulate.
Application Support USCIS applications for Naturalization or to Register Permanent Residence or
Centers Adjust Status necessitate the USCIS to carry out a FBI fingerprint background
check on the applicant. Most applicants that require a background check have to
be present for one at a specific Application Support Center (ASC) or Designated
Law Enforcement Agency (DLEA) for fingerprinting purposes.
Apprehension Apprehension refers to arresting a removable foreigner by U.S. Immigration and
Customs Enforcement (ICE).
ASC Abbreviation for INS/USCIS Application Support Center
Asylee A foreigner in the United States or at a port-of-entry who is established to be
incapable or reluctant to go back to his or her country of nationality, or to ask for
the protection from that country because of persecution or a well-substantiated
fear of persecution. The reasons for fear of persecution have to be the
foreigner’s race, religion, nationality, membership in a unique social group, or
political views. The country of nationality is considered to be the country in which
the foreigner most recently lived for those without any nationality. Asylees are
entitled to adjust to the legal permanent resident category after one year of
continuous presence in the United States. This category is limited to 10,000
adjustments per fiscal year.
BCIS BCIS stands for the Bureau of Citizenship and Immigration Services.
Beneficiaries Foreigners who obtain lawful immigration statuses as a result of their
relationship to U.S. citizens, lawful permanent residents, or U.S. employers.
BIA Abbreviation for Board of Immigrant Appeals.
Bona Fide Genuine or authentic.
Border Crosser Border crosser is a foreign resident who reenters the United States after being
not present for less than six months in Canada or Mexico. It also refers to a
nonresident alien who reenters the United States via the Canadian border for
stays that are less than six months or across the Mexican border for stays that
are less than 72 hours.
Business A foreigner who enters the United States on a temporary basis to take part in
Nonimmigrant commercial deals that do not involve lucrative work in the United States such as
someone who is involved in international commerce on behalf of a foreign
company.
Cancellation of It is a legal procedure undertaken in front of an immigration judge in order to
Removal adjust the status of a foreigner from deportable to a legal permanent resident.
Certificate of It is a legal document that is issued to derivative citizens and foreigners who
Citizenship obtained U.S. citizenship in order to prove identity and U.S. citizenship.
Certificate of An official document which is issued by the Department of Homeland Security.
Naturalization The certificate is the proof that an individual has become a U.S. citizen
(naturalized) after immigration to the United States.
Change of Status The application process of changing status from one immigration status to
another immigration status.
CIS The abbreviation for "Citizenship and Immigration Services". See BCIS or
USCIS.
Citizenship Normally citizenship describes the country that a person is born in. However, a
person can change citizenship in a process called naturalization.
Civil Surgeons Doctors trained and certified by the U.S. Citizenship and Immigration Service.
These are the doctors you should go to if USCIS asks you for immigration
examinations.
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Conditional Resident Conditional residents are those foreigners who have conditional permanent
resident status such as the spouse of an American citizen. They are usually
required to formally request the elimination of the set conditions before the
second anniversary of the approval of his or her conditional status.
Consul A diplomat appointed by the United States government to protect its commercial
interests and help its citizens in a foreign country. The consul is also responsible
for issuing visas to non-U.S. citizens who wish to travel to the United States.
Consular Processing This is the application process an alien goes through to apply for permanent
residency at a U.S. Consulate in his or her home country. The applicant must
have an approved I-140 in addition to an immigrant number.
Consulate Official United States government office located in foreign country. Consulates
deal with foreign trade and visa issues. Consulates are normally located in major
cities.
Continuity of When an alien is seeking U.S. residency, an absence of more than one year will
Residence automatically lead to a break of the continuity of the alien’s residence. The
consequence of breaking the continuity is that the alien must begin the process
all over again. While an applicant can get permission to leave the U.S. during
the residency period, it is generally not recommended to do so.
Conviction The process of a formal judgment of guilt entered by a court of competent
jurisdiction.
CPT CPT stands for Curricular Practical Training. CPT is a description for off-campus
work permission granted to foreigners going to school or university in the U.S.
where the work is a part of an internship.
Crewman An alien who serves in a capacity obligatory for typical operations and service
on board of a vessel or airplane.
CSC Abbreviation for California Service Center
Department of State The Department of State is an Executive Branch Department with jurisdiction
over non-domestic issues. It is the government agency responsible for
managing the United States foreign affairs.
Departure under The physical observation of an unlawful foreigner departing the United States by
Safeguards a U.S. Immigration and Customs Enforcement officer.
Dependent An official term used on the spouse and children of the principal applicant.
Deportable Alien A deportable alien is anybody who entered the United States illegally or legally,
but breached the terms of his/ her classification or status later on.
Deportation Deportation is the legal act of removing an alien from the United States after
he/she has been found removable for infringing the immigration laws.
Deportation is ordered by an immigration judge without any kind of punishment.
Derivative Citizenship U.S. citizenship passed on to children through the naturalization of parents or to
foreign-born children adopted by U.S. citizen parents.
DHS Abbreviation for Department of Homeland Security
District Geographic regions into which the United States and its territories are divided
for Immigration and Naturalization Services’ purposes.
Diversity A category of immigrants from underrepresented countries and countries
unfavorably affected by the Immigration and Nationality Act Amendments of
1965. The main goal of diversity visas is to increase immigrants from such
countries.
Diversity Country The description of a country that has low rates of immigration to the United
States. The citizens of a diversity country can enter in the diversity visa program.
Diversity Immigrant The United States Government issues 50,000 Green Cards every year through
Visa Program the Diversity Immigrant Visa Program, commonly known as the Green Card
Lottery. Applicants are selected randomly by a computer-generated drawing.
Docket Control The USCIS means for following the case status of possible removable
foreigners.
DOL DOL is an acronym for the Department of Labor of the United States.
DOS Abbreviation for Department of State
Dual Intent Dual intent is the process of nonimmigrants in E, H, and L status that may
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simultaneously have intent to stay in the U.S. temporarily or permanently.


EAD An Employment Authorization Document (EAD) is a work authorization card that
is issued by the USCIS. The EAD is the size and shape of driver’s license.
Embassy Official United States government office located in foreign country. Embassies
are usually located in the capital of the country. Embassies deal with political,
economic, and visa issues. The local ambassador is in charge of the Embassy.
Employer Sanctions U.S. employers who hire illegal immigrants are subject to civil fines or criminal
penalties if a pattern of violations is found.
Employment An employment letter is needed for employees who wish to be sponsored for
Authorization Letter nonimmigrant work status or permanent resident status. The letter is completed
by the sponsoring employer.
Entry Visa The visa that the U.S. State Department adds to a page in an individual’s
passport. The granting of an entry visa means that the U.S. State Department is
eligible to enter the U.S. for a particular purpose. Note that an expired visa does
not affect an individual’s legal stay in the U.S. As long as the I-94 card is valid,
the visa can be expired. However, if the individual leaves the U.S., a valid visa is
necessary to enter again. One cannot enter the U.S. with an expired visa.
Exchange Visitor An exchange visitor is a foreigner who enters the United States as a partaker in
an official program by the Secretary of State for the purpose temporarily. Some
of the activities could be teaching, instructing or lecturing, studying, observing,
conducting research, consulting, demonstrating special skills, or receiving
training.
Exclusion Exclusion is the official term for denying an alien entry into the United States
either through an expedited removal procedure or through removal proceedings
in the presence of an immigration judge.
Extension of Stay The term used to describe the application process of extending the stay period
listed on Form I-94.
F-1 Status F-1 is the visa type used by international students to enter the United States.
The I-94 Form in the passport will be marked with the letters “F-1” and “D/S”.
D/S stands for “Duration of Status”.
Fiance of U.S. Citizen A nonimmigrant foreigner who enters the United States to finalize a valid
marriage within ninety days of her/his entry with a U.S. citizen
Files Control Office An USCIS field office is either a district or a sub-office of that district where
foreigners’ case files are maintained and controlled.
Fiscal Year The fiscal year starts October 1 and ends in September 30.
Foreign Affairs The abbreviation for Foreign Affairs Manual Chapter 41, which relates to
Manual (FAM) nonimmigrant visas. Chapter 42 covers immigrant visas.
Foreign Alien/National Any person born outside the U.S. who is not a U.S. citizen or permanent
resident.
Foreign Government Foreigners who are accredited by a foreign government to work as diplomats,
Official public ministers, career diplomatic or consular officials, other accredited officers,
or assistants, servants or personal employees of accredited officials, and their
spouses and dependent children. These officials enter the United States for a
temporary period as nonimmigrants.
Foreign Information A foreigner who enters the United States temporarily as a bona fide envoy of
Media Representative foreign press, radio, film, or other foreign information media and the foreigner’s
spouse and dependent children.
Foreign State of The independent country that an immigrant under the preference scheme is
Chargeability credited to.
Form DS- 2019 This is a document that the university or school a person is attending provides to
the new student which allows he or she to enter the U.S. legally through a J-1
visa.
General Naturalization The General provisions that every naturalization applicant must meet such as
Provisions being 18 years of age, a legal permanent resident with five years of continuous
residence in the United States who have been physically present in the country
for half that period and who have a good character for at least that period.
Geographic Area of This term refers to Africa, East Asia, Latin America and the Caribbean, Near
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Chargeability East and South Asia, and the former Soviet Union and Eastern Europe. The
world is divided into these areas for the preliminary admittance of refugees to
the United States.
Green Card A Green Card, officially known as a Permanent Resident Card (Form I-151 or
Form I-551) is evidence of lawful permanent resident status in the United States.
It allows a foreign national to live, work legally, travel abroad and return to the
United States. Green Card holders may also apply for U.S. citizenship after a
certain period of time.
H-1B Worker The classification of an individual who qualifies to perform a specialty occupation
in the U.S. The current period is three years with an option to renew the H-1B
visa for another 3 years after the first period is over.
Household Income The calculation of the income used to determine whether a sponsor meets the
minimum income requirements under Section 213A of the Immigration and
Nationality Act (INA).
Immediate Relatives Immediate relatives are spouses of U.S. citizens, unmarried citizens’ children
under the age 21, and parents of citizens 21 years of age or older. Immediate
relatives are excused from the numerical limitations imposed on immigration to
the United States
Immigrant See Permanent Resident Alien.
Immigration Act of Public Law 101-649 that increased the numerical limitations on legal immigration
1990 to the United States: amended the reasons for exclusion and deportation,
allowed provisional protected status to foreigners of some countries, amended
and established new nonimmigrant entrance classes, amended and extended
the Visa Waiver Pilot Program, and amended naturalization authority and
requirements.
Immigration Judge A lawyer selected by the Attorney General to perform as an administrative judge
within the Executive Office for Immigration Review. Immigration Judges are also
in charge of removal proceedings. INA Section 240, 8 USC Section 1229a.
Immigration and The Act regulates the immigration, temporary admission, naturalization, and
Nationality Act removal of aliens besides other U.S. immigration laws, treaties, and
conventions.
Immigration Marriage The law that discourages immigration-related marriage fraud by stipulating that
Fraud Amendments of foreigners who get their immigrant status based on a marriage of less than two
1986 years are conditional immigrants and should remove their conditional status by
applying at an U.S. Citizenship and Immigration Services office during the 90-
day period before the second-year anniversary of getting the conditional status.
The conditional immigrant status may be ended and the foreigners deported if
they cannot demonstrate that the marriage through which the status was
obtained was and is a valid one.
Immigration Reform The law which was passed to manage and discourage illegal immigration to the
and Control Act United States by making illegal foreigners who had been continuously unlawfully
(IRCA) of 1986 present since 1982 legal, legalizing certain agricultural workers, punishing
employers who intentionally employ undocumented workers, and increasing
enforcement at U.S. borders.
Immigration Status An individual’s immigration status is noted on the I-94 card by an Immigration
Inspector at the U.S. port-of-entry. During the duration of a person’s stay in the
U.S., this designation is very important. A visa can for example expire if this
designation is changed while you are in the United States.
INA See Immigration and Nationality Act.
Inadmissible This term refers to a foreigner who wants to enter the United States, but does
not meet the entrance criteria set in the INA. The foreigner may be then
removed or permitted to remove his or her application for admission in some
cases.
INS Abbreviation of "Immigration and Naturalization Service". The INS changed its
official name on March 1, 2003 to USCIS (United States Citizenship and
Immigration Services). INS was an extension of the U.S. Justice Department
with responsibility for the admission and control of aliens.
Intending Immigrant The terms used to describe any beneficiary of an immigrant visa petition filed

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under INA Section 204. An intending immigration is any individual who will
accompany or follow-to-join the principal beneficiary.
International A nonimmigrant foreigner who enters the United States temporarily as a
Representative principal or other accredited representative of a foreign government to an
international organization, an international organization officer or employee, and
the foreigner’s spouse and unmarried children.
Intracompany A foreigner who is engaged for at least one continuous year out of the last three
Transferee by an international company and who requests to come into the United States
temporarily to continue his/her work for the same employer as a manager,
executive, or specialized worker, and the foreigner’s spouse and unmarried
children.
J-1 Exchange Visitor J-1 visas are issued to individuals who take part in a wide range of exchange
Visa visitor programs sponsored by schools, businesses and a variety of
organizations and institutions. The individual's Form I-94 should be marked "J-1"
in addition to the letters "D/S" (Duration of Status). The duration of stay is the
period of time that is noted on Form IAP-66/DS-2019.
Joint Sponsor The description of a person who accepts legal responsibility for supporting an
immigrant with an I-864 Affidavit of Support along with the sponsor. There are
certain requirements for joint sponsors: he or she must be at least 18 years of
age, an American citizen or lawful permanent resident and have a domicile in
the United States.
Jurisdiction The term used to describe the level of authority to apply the law in a given
territory or region.
K-1 Fiancée/Fiancé The K-1 Visa, also known as the Fiancée/Fiancé Visa, may be used by United
Visa States citizens who wish to bring their prospective husbands or wives to the
United States with the intention of getting married.
Kentucky Consular KCC is a U.S. Department of State facility located in Williamsburg, Kentucky.
Center (KCC) The main task of the office is to provide domestic support to the worldwide
operations of the Bureau of Consular Affairs Visa Office. KCC also manages the
Diversity Visa (DV) Program.
Labor Certification Labor certification is a condition that U.S. employers should fulfill in order to hire
certain skilled workers. The certification is issued by the Secretary of Labor and
includes attestations by U.S. employers as to the statistics of U.S. workers
available to take on the employment sought after by foreigners, and the
consequence of the foreigner’s work on the wages and working conditions of
U.S. workers who hold similar jobs.
Last Residence This is a term that is frequently found on immigration and visa forms. The
country of your “Last Residence” is the country that an individual lived in before
entering the United States.
Lawful Permanent Any person who is not a citizen of the United States and who lives in the U.S.
Resident (LPR) under lawfully recognized and legally recorded permanent residence as an
immigrant. It’s also called Permanent Resident Alien, Resident Alien Permit
Holder, and Green Card Holder.
Legal Entry The process that most visitors and foreign workers go through when entering the
United States via official borders. A U.S. Immigration and Naturalization Service
Official inspects your documents and grants you permission to enter the United
States.
Legalization The spouses and children of foreigners who became legal immigrants under the
Dependents stipulation of the Immigration Reform and Control Act of 1986 between 1992 and
1994.
Legalized Aliens It refers to some illegal aliens who were entitled to submit an application for
temporary resident status under the legalization provision of the Immigration
Reform and Control Act of 1986.
Legitimated A child is legitimated if a natural father of a child born out of wedlock
acknowledges the child through a legal procedure. A legitimated child from any
country has two legal parents and cannot qualify as an orphan unless only one
of the parents is living or both of the parents have deserted the child.
Medical Waiver A medical waiver allows an immigration applicant to be allowed into, or stay in

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the United States even though he/ she have health conditions that makes them
inadmissible.
Migrant A migrant is an individual who departs his/her country to live in another country.
MSC Formerly the "Missouri Service Center" but now called the "National Benefits
Center" or NBC.
National An individual who has pledged allegiance to a certain country.
National Interest An immigrant visa for which can apply to outstanding aliens who are exceptional
Waiver (NIW) in their field.
National of the United A national of the United States is a citizen of the United States, or a person who,
States though not a citizen of the United States, owes permanent allegiance to the
United States. For more information, see INA Section 101(a)(22), 8 USC Section
1101(a)(22).
Nationality The description used on an individual’s citizenship or country where the person
is deemed a national.
NATO (North Atlantic A nonimmigrant foreigner who enters the United States temporarily as a
Treaty Organization) member of the armed forces or as a civilian employed by the armed forces on
Official assignment with a foreign government signatory to NATO, and the foreigner’s
spouse and unmarried children.
Naturalization The bestowment of citizenship upon a person when he/she is born.
Naturalization The form used by legal permanent residents to submit an application for U.S.
Application citizenship.
NBC National Benefits Center. The formerly the "Missouri Service Center".
Nonimmigrant A foreigner who enters the United States temporarily for a specific purpose and
who must fulfill two requirements: a permanent residence overseas and actual
qualification for the nonimmigrant classification. Some of the nonimmigrant
classifications are students, international representatives, temporary workers
and trainees, exchange visitors, intracompany transferees, NATO officials,
religious workers among others. Most nonimmigrants can be accompanied or
joined by spouses and unmarried minor children.
Nondiversity Country A country that has high rates of immigration to the United States. Note that
passport holders of non-diversity countries cannot participate in the Diversity
Visa Program. Another word for non-diversity countries are occasionally called
non-qualifying or excluded countries.
Nonimmigrant status The term used to describe an individual’s status for a set period of time. It is a
limited status while in the United States. The individual is not a permanent
resident of the United States while on a Nonimmigrant Status.
Nonpreference This category was removed by the Immigration Act of 1990 and used to grant
Category Nonpreference visas to qualified applicants who were not entitled to a visa under
the preferences categories.
North American Free- The agreement that governs the mutual trading relationship between the United
Trade Agreement States and Canada and establishes a similar relationship with Mexico.
(NAFTA)
Not Subject to This means that an alien is entitled to immigrant status as an immediate relative
Numerical Limitation within the meaning of INA 201(b)(2)(i), or as a special immigrant within the
meaning of INA 101(a)(27) (A) and (B), unless specifically subject to a limitation
other than under INA 201(a), (b), or (c).
Notice of Action A form issued by the USCIS as a proof that a petition or application is received
and in process. The Notice of Action is also issued by the USCIS as a receipt for
paid fees. The Notice of Action number is I-797. This is not a downloadable
form, it is sent to the applicant by the USCIS.
NSC Nebraska Service Center
Numerical Limit, Those foreigners granted lawful permanent resident statuses and that are
Exempt from usually exempt from numerical limits set by the Immigration Act of 1990. Exempt
categories consist of immediate relatives of U.S. citizens, refugees, asylees,
Amerasians, aliens adjusted under the legalization provisions of the Immigration
Reform and Control Act of 1986, and certain parolees from the former Soviet
Union and Indochina.
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Nursing Relief Act of The act allows H-1 nonimmigrant registered nurses to become legal permanent
1989 residents if they had been employed as nurses for at least 3 years and who
meet certain labor certification requirements.
OPT OPT stands for Optional Practical Training. OPT is an opportunity for foreign
students to work a year off-campus. A new OPT can be received at different
study levels.
Parolee A parolee is a foreigner who appears to be inadmissible to the inspecting officer;
however, he/she is permitted to enter the United States for urgent humanitarian
reasons or when that foreigner’s admittance is deemed to be of an important
public benefit. Parole is not an official right of entry to the United States and
grants temporary status only, which require parolees to leave when the
conditions supporting their parole stop to exist.
Passport A document that is issued by the government of the country of your citizenship.
Passports have expiry dates, and while you travel in the U.S. your passport
must remain valid throughout the entire duration of your stay.
Per-Country Limit The number limits family-sponsored and employment-based preference visas
that can be issued to citizens of any country in a fiscal year.
Permanent Resident Any person who is not a citizen of the United States and who lives in the U.S.
under lawfully recognized and legally recorded permanent residence as an
immigrant. It is also called Permanent Resident Alien, Resident Alien Permit
Holder, and Green Card Holder.
Petition A generic word used to describe the forms used by the USCIS to determine
eligibility for different visa categories.
Port-of-entry Any location in the United States or its territories where foreigners and U.S.
citizens alike can enter the United States such as airports and border crossings.
Practical Training A work program designed to let foreign students work in the United States while
attaining their university degree or after attaining their degree.
Pre-Inspection The process of inspecting airport passengers before departing from foreign
countries to the United States. However, the United States immigration does not
require inspection upon arrival.
Preference System The nine classes under which the family-sponsored and employment-based
(Immigration Act of immigrant preference visas are granted as of 1992.
1990)
Principal Alien It is the foreigner who submits an application for immigrant status and from
whom another foreigner may get lawful status under immigration law or
regulations such as spouses and children. The principal is the primary person
applying as opposed to dependent. Example; TN is a principal classification, and
TD is the dependent classification.
Priority Date This term refers to the date a petition is filed during a USCIS Immigrant visa
application process. If the foreigner relative has a priority date on or before the
date listed in the visa bulletin, then he or she is currently eligible for a visa.
Quota system The system used to limit the number of visas available to each country for
particular visa classifications.
Reentry Permit A declaration of an individual’s intention to maintain U.S. permanent residence
during prolonged absence from the United States. Its official name is "Form I-
131, Application for Travel Document." - Note that the alien must be physically
present in the United States to file an application for a reentry permit.
Refugee A refugee is anybody who is incapable or reluctant to go back to his/her country
of nationality while they are in another country because he/she will be
persecuted or afraid of being persecuted. The reasons for persecution or fear of
persecution have to be the foreigner’s race, religion, nationality, membership in
a unique social group, or political views. The country of nationality is considered
to be the country in which the foreigner most recently lived for those without
nationality. Refugees are entitled to adjust to the legal permanent resident
category after one year of continuous presence in the United States.
Refugee Approvals The number of refugees that are permitted to be admitted into the United States
during a fiscal year.

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Refugee Arrivals The number of refugees that actually entered the United States during a fiscal
year.
Refugee Authorized The ceiling number of refugees allowable to come into the United States during
Admissions a fiscal year which is decided by the President of the United States after
consulting with Congress.
Refugee-Parolee Refugee- parolees are those individuals who eligible for provisional admittance
to the United States between February 1970 and April 1980, but could not be
accepted because of insufficient numbers of seventh preference visas. As a
consequence, these individuals entered the United States as parolees.
Regional Offices There are three USCIS Regional Offices that supervise the work of USCIS
Districts and Border Patrol Sectors. They are located in Burlington, VT, for the
Eastern Region, Dallas, TX, for the Central Region, and Laguna Nigel, CA, for
the Western Region.
Registry Date Aliens who have continuously resided in the United States since January 1,
1972, are of good moral character, and are not inadmissible, are eligible to
adjust to legal permanent resident status under the registry provision. Before the
Immigration Reform and Control Act of 1986 amended the date, aliens had to
have been in the country continuously since June 30, 1948 to qualify.
Regulation A rule which is established under the provisions of INA 104(a). The rule is
further duly published in the Federal Register.
Removal The process of removing foreigners from the United States which justified
because they are found to be either inadmissible or deportable.
Request for Evidence A letter that the USCIS uses to request additional information on a pending
(RFE) case.
Resident Alien Any person who is not a citizen of the United States and who lives in the U.S.
under lawfully recognized and legally recorded permanent residence as an
immigrant. It is also called Permanent Resident Alien, Resident Alien Permit
Holder, and Green Card Holder.
Service Centers There are four service offices in the United States that are responsible for filing,
data entry, and arbitration of some applications for immigration services and
benefits. Service Centers are not staffed to receive walk-in applications or
questions so all applications have to be mailed.
SEVIS SEVIS stands for “The Student Exchange Visitor Information System”. This
particular system is used by the federal government to monitor student visas in
the United States.
Special Agricultural Foreigners who worked in perishable agricultural commodities for a specified
Workers (SAW) period of time and were allowed to enter the United States for short-term and
then became permanent residents under a provision of the Immigration Reform
and Control Act of 1986.
Special Immigrants Some classes of immigrants who were excepted from numerical restrictions
before fiscal year 1992 and subject to control under the employment-based
fourth preference beginning in 1992 such as persons who lost citizenship by
marriage, persons who lost citizenship by serving in foreign armed forces and so
forth.
Sponsored Immigrant An immigrant on whose behalf a sponsor has executed an affidavit of support.
The affidavit of support includes any spouse or child who will accompany or
follow-to-join the beneficiary of an immigrant visa petition filed by a sponsor.
Stowaway A foreigner who comes secretly to the United States by hiding in an airplane or
ship without being officially authorized to enter. Such a person will be denied
admission and will be returned to the point of embarkation by the transporter.
Subject to the The classes of legal immigrants subject to numerical limitations under the
Numerical Limit provisions of the flexible numerical limit of 675,000 set by the Immigration Act of
1990. The largest classes are the family-sponsored preferences, employment-
based preferences, and diversity immigrants.
Suspension of A remedy in deportation proceedings which must be initiated before removal
Deportation proceedings began under the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996 [IIRAIRA] on April 1, 1997. It involves certain
individuals who have been in the U.S. for 7 or 10 years and who met other
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criteria as set forth in former INA Section 244(a).


Temporary Protected The TPS sets up a legislative foundation for permitting a group of people
Status (TPS) provisional refuge in the United States. The Attorney General may select
nationals of a foreign country to be entitled for TPS with a finding that conditions
in that country present a risk to personal safety because of continuing armed
wars or a natural catastrophe. TPS is allowed for periods of 6 to 18 months in
the beginning and may be extended depending on the situation. Removal
procedures are generally suspended against foreigners while they are in
Temporary Protected Status.
Temporary Worker Nonimmigrant temporary worker classes of admission, who come to the United
States to work temporarily.
Treaty Trader or A nonimmigrant foreigner coming to the United States, under the provisions of a
Investor treaty of commerce and navigation between the United States and the foreign
state of such alien, to perform extensive trading or to manage the business in
which he/she has invested a considerable sum of money in addition to the
spouse and unmarried minor children.
United States-Canada The agreement that governs the mutual trading relationship between the United
Free-Trade Agreement States and Canada and establishes a similar relationship with Mexico.
USCIS USCIS is abbreviated for United States Citizenship and Immigration Services. It
is a bureau created under the Department of Homeland Security. The former
official name was INS, but INS was replaced by USCIS on 3/1/2003.
Visa A United States visa grants the holder the right to apply for entry to the United
States, but does not grant the visa holder the right to enter the United States.
Entry can be refused at the port-of-entry. The Department of State (DOS) is in
charge of visa administration at U.S. Embassies and Consulates outside of the
U.S. The Department of Homeland Security (DHS), Bureau of Customs and
Border Protection (BCBP) immigration inspectors decide admittance, duration of
stay and conditions in the U.S. at a port-of-entry. DHS immigration inspectors
will record the terms of your admission on your I-94 or I-94W and in your
passport upon approval of entry.
Visa Waiver Program The program permits citizens of certain countries to enter the U.S. for business
or pleasure up to 90 days. The following countries are currently in the visa
waiver program: Andorra, Austria, Australia, Belgium, Brunei, Denmark, Finland,
France, Germany, Iceland, Ireland, Italy, Japan, Liechtenstein, Luxembourg,
Monaco, the Netherlands, New Zealand, Norway, Portugal, San Marino,
Singapore, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom.
VSC Vermont Service Center.
Western Hemisphere Used on North America, Central America, South America, and the adjacent
islands according to INA 101(b)(5).
Work Permit A work permit is normally used to describe an Employment Authorization
Document.

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Green Card Application Guide

APPENDIX 8
Adobe Acrobat Help
Adobe Acrobat is software that supports Portable Document Format (PDF) files. Adobe Reader
(formerly called Adobe Acrobat Reader) is available as a free download from Adobe's website.
Adobe Reader allows the viewing and printing of PDF files. It is recommended to have the latest
version of Adobe Reader installed on your computer to properly view and print PDF files. You
should have at least version 7, preferably version 8 installed on your computer to properly view
and print PDF files.

Download Adobe Reader:

• Windows Users: www.adobe.com/products/acrobat/readstep2.html


• Mac Users: www.adobe.com/products/acrobat/readstep2_allversions.html

If you need assistance downloading or installing Adobe Reader visit www.adobe.com/support

How to Check for Updates:

1. Open Adobe Acrobat Reader


2. Click on “Help” on the top menu
3. Select “Check for Updates…”
4. Follow the instructions and download any available updates

Fillable PDF Forms:

“Fillable” means that you can fill in blank fields in the PDF file, then print it. This is feature only
available on the latest versions of Adobe Reader. This is a convenient way to complete
application forms. Not all application forms are fillable. However, if the application forms in the
PDF file are fillable, the “Highlight Fields” option will be displayed on Adobe Reader. If you select
this option, all fillable fields will be highlighted in blue.

Example of PDF files with fillable fields:

Adobe Reader Version 7 Adobe Reader Version 8

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Green Card Application Guide

Printing Instructions:

Most users know how to print a Word document, web page or even a PDF file. You simply click
on “File” then on “Print”, or you may use the “Ctrl+P” keyboard shortcut. However, you may only
need to print certain pages, such as application forms at the end of a long PDF file. You don’t
need to print the entire file if you only require the application forms for example. You may print
only selected pages.

Follow the instructions bellow to print selected pages of a PDF file.

1. Click on “File” then “Print” (or use the “Ctrl+P” keyboard shortcut)
2. In the “Print Range” section select “Pages” then enter the pages you would like to print.
Example: If you wish to print all pages between 87 and 89, enter 87-89.

Note: This is a screenshot from the free Adobe Reader 8. The latest version of Adobe Reader
can be found at www.adobe.com/products/acrobat/readstep2.html

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United States Immigration
Do-It-Yourself Immigration Guides
Save up to 90% in legal fees

United States Immigration Guides Include:


• Application requirements
• Detailed list of benefits and drawbacks
• Step-by-Step instructions
• Consular and USCIS application procedures
• Document checklist
• Frequently asked questions
• Official United States application forms
• List of USCIS offices
• List of U.S. Embassies and Consulates

U.S. Immigration guides are also available in Spanish.


Visit: www.MigracionUSA.org

U.S. Immigration Guides: Additional Information Guides:

• United States Passport Application and Renewal • Social Security Card


• United States Citizenship • U.S. Drivers License and State ID Card
• United States Citizenship Test Study Guide • FOIA (Freedom of Information Act) Request
• Dual Citizenship • Request a Copy of your Birth Certificate
• Certificate of United States Citizenship/Naturalization • How to Start a Business in the United States
• Green Card through Employment • How to Get a Job in the United States
• Green Card through Investment • How to Get a High School Diploma in the United States
• Green Card through Marriage • How to Establish a Credit History and Get a Credit Card
• Green Card through Relatives • The Newcomer’s Guide to the United States
• Green Card as a Special Immigrant • Internships in the United States
• Green Card Renewal • TOEFL (Test of English as a Second Language)
• How to Replace a Lost or Stolen Green Card • Pet and Animal Importation to the United States
• Green Card Lottery Application Guide
• B-1 Business Visitor Visa How to Order:
• B-2 Tourist Visitor Visa
• B-1/B-2 Visa Extension of Stay 1. Logon to www.usimmigrationsupport.org
• C-1 Transit Visa 2. Submit your order online
• E-1 Treaty Trader Visa 3. Download eBooks instantly
• E-2 Treaty Investor Visa
• E-3 Work Visa for Australians

SAVE 10%
• F-1 Student Visa
• H-1B Work Visa
• H-2B Work Visa
• H-3 Trainee Work Visa
• J-1 Exchange Visitor Visa PROMOTIONAL CODE: ENG9210
• K-1 Fiancée/Fiancé Visa
• L-1 Intracompany Transfer Visa Enter code at checkout to receive a discount.
• R-1 Religious Worker Visa Logon to www.usimmigrationsupport.org
• TN Nafta Work Visa for Canadians and Mexicans
• Visa Waiver United States Immigration Support
• Change of Address for Green Card and Visa Holders
511 Avenue of the Americas # 45
New York, NY 10011
• Asylum and Refugee Application Web: www.usimmigrationsupport.org
Email: info@usimmigrationsupport.org

www.usimmigrationsupport.org
U.S. Department of State OMB APPROVAL NO. 1405-0015
EXPIRES: 05/31/2011
APPLICATION FOR ESTIMATED BURDEN: 1 HOUR*
(See Page 2)
IMMIGRANT VISA AND
ALIEN REGISTRATION

PART I - BIOGRAPHIC DATA


Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please
print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a
separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.
Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for
Immigrant Visa and Alien Registration.
1. Family Name First Name Middle Name

2. Other Names Used or Aliases (If married woman, give maiden name)

3. Full Name in Native Alphabet (If Roman letters not used)

4. Date of Birth (mm-dd-yyyy) 5. Age 6. Place of Birth (City or town) (Province) (Country)

7. Nationality (If dual national, 8. Gender 9. Marital Status


give both)
Female Single (Never married) Married Widowed Divorced Separated
Male Including my present marriage, I have been married times.
10. Permanent address in the United States where you intend to live, if 11. Address in the United States where you want your Permanent
known (street address including ZIP code). Include the name of a person Resident Card (Green Card) mailed, if different from address in item #10
who currently lives there. (include the name of a person who currently lives there).

Telephone number Telephone number


12. Your Present Occupation 13. Present Address (Street Address) (City or Town) (Province) (Country)

Telephone Number (Home) Office

14. Name of Spouse (Maiden or family name) First Name Middle Name

Date (mm-dd-yyyy) and Place of Birth of Spouse

Address of Spouse (If different from your own) Spouse's Occupation

Date of Marriage (mm-dd-yyyy)

15. Father's Family Name First Name Middle Name

16. Father's Date of Birth Place of Birth Current Address If Deceased, Give Year
(mm-dd-yyyy) of Death

17. Mother's Family Name at Birth First Name Middle Name

18. Mother's Date of Birth Place of Birth Current Address If Deceased, Give Year
(mm-dd-yyyy) of Death

DS-230 Part I This Form May be Obtained Free at Consular Offices of the United States of America
05-2008 Previous Editions Obsolete Page 1 of 4
19. List Names, Dates and Places of Birth, and Addresses of ALL Children.
NAME DATE (mm-dd-yyyy) PLACE OF BIRTH ADDRESS (If different from your own)

20. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality. Begin
with your present residence.
CITY OR TOWN PROVINCE COUNTRY FROM/TO (mm-yyyy)

21a. Person(s) named in 14 and 19 who will accompany you to the United States now.

21b. Person(s) named in 14 and 19 who will follow you to the United States at a later date.

22. List below all employment for the last ten years.
EMPLOYER LOCATION JOB TITLE FROM/TO (mm-yyyy)

In what occupation do you intend to work in the United States?


23. List below all educational institutions attended.
SCHOOL AND LOCATION FROM/TO (mm-yyyy) COURSE OF STUDY DEGREE OR DIPLOMA

Languages spoken or read:

Professional associations to which you belong:


24. Previous Military Service
Yes No
Branch: Dates (mm-dd-yyyy) of Service:
Rank/Position: Military Speciality/Occupation:
25. List dates of all previous visits to or residence in the United States. (If never, write "never") Give type of visa status, if known. Give DHS "A"
number if any.
FROM/TO (mm-yyyy) LOCATION TYPE OF VISA "A" NO. (If known)

SIGNATURE OF APPLICANT DATE (mm-dd-yyyy)

Privacy Act and Paperwork Reduction Act Statements


The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you
provide on this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide
all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an
immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social
Security Administration will use the information to issue you a social security number and card.
*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources,
gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to
respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the
burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.
DS-230 Part I Page 2 of 4
U.S. Department of State OMB APPROVAL NO. 1405-0015

APPLICATION FOR IMMIGRANT VISA AND EXPIRES: 05/31/2011


ESTIMATED BURDEN: 1 HOUR*
ALIEN REGISTRATION
PART II - SWORN STATEMENT
INSTRUCTIONS: Complete one copy of this form for yourself and each member of your family, regardless of age, who will
immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If
there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any
additional sheets to this form. The fee should be paid in United States dollars or local currency equivalent, or by bank draft.

WARNING: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
Even if you are issued an immigrant visa and are subsequently admitted to the United States, providing false information on this
form could be grounds for your prosecution and/or deportation.

This form (DS-230 PART II), together with Form DS-230 PART I, constitutes the complete Application for Immigrant Visa and
Alien Registration.

26. Family Name First Name Middle Name

27. Other Names Used or Aliases (If married woman, give maiden name)

28. Full Name in Native Alphabet (If Roman letters not used)

29. Name and Address of Petitioner

Telephone number:
30. United States laws governing the issuance of visas require each applicant to state whether or not he or she is a member of any class of
individuals excluded from admission into the United States. The excludable classes are described below in general terms. You should read
carefully the following list and answer YES or NO to each category. The answers you give will assist the consular officer to reach a decision
on your eligibility to receive a visa.
EXCEPT AS OTHERWISE PROVIDED BY LAW, ALIENS WITHIN THE FOLLOWING CLASSIFICATIONS ARE INELIGIBLE TO RECEIVE A VISA.
DO ANY OF THE FOLLOWING CLASSES APPLY TO YOU?
a. An alien who has a communicable disease of public health significance; who has failed to present documentation of having Yes No
received vaccinations in accordance with U.S. law; who has or has had a physical or mental disorder that poses or is likely
to pose a threat to the safety or welfare of the alien or others; or who is a drug abuser or addict.
b. An alien convicted of, or who admits having committed, a crime involving moral turpitude or violation of any law relating Yes No
to a controlled substance or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the
trafficking activities in the past five years; who has been convicted of 2 or more offenses for which the aggregate
sentences were 5 years or more; who is coming to the United States to engage in prostitution or commercialized vice or
who has engaged in prostitution or procuring within the past 10 years; who is or has been an illicit trafficker in any
controlled substance; who has committed a serious criminal offense in the United States and who has asserted immunity
from prosecution; who, while serving as a foreign government official, was responsible for or directly carried out particularly
severe violations of religious freedom; or whom the President has identified as a person who plays a significant role in a
severe form of trafficking in persons, who otherwise has knowingly aided, abetted, assisted or colluded with such a
trafficker in severe forms of trafficking in persons, or who is the spouse, son or daughter of such a trafficker who knowingly
has benefited from the trafficking activities within the past five years.
c. An alien who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist Yes No
activities, the overthrow of the Government of the United States or other unlawful activity; who is a member of or
affiliated with the Communist or other totalitarian party; who participated, engaged or ordered genocide, torture, or
extrajudicial killings; or who is a member or representative of a terrorist organization as currently designated by the U.S.
Secretary of State.
d. An alien who is likely to become a public charge. Yes No

e. An alien who seeks to enter for the purpose of performing skilled or unskilled labor who has not been certified by the Yes No
Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed
the NBME exam or its equivalent; or who is a health care worker seeking to perform such work without a certificate from
the CGFNS or from an equivalent approved independent credentialing organization.
f. An alien who failed to attend a hearing on deportation or inadmissibility within the last 5 years; who seeks or has sought a Yes No
visa, entry into the United States, or any immigration benefit by fraud or misrepresentation; who knowingly assisted any
other alien to enter or try to enter the United States in violation of law; who, after November 30, 1996, attended in
student (F) visa status a U.S. public elementary school or who attended a U.S. public secondary school without
reimbursing the school; or who is subject to a civil penalty under INA 274C.

Privacy Act and Paperwork Reduction Act Statements


The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you
provide on this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide
all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an
immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social
Security Administration will use the information to issue you a social security number and card.
*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources,
gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to
respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the
burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.

DS-230 Part II PREVIOUS EDITIONS OBSOLETE Page 3 of 4


g. An alien who is permanently ineligible for U.S. citizenship; or who departed the United States to evade military service in Yes No
time of war.
h. An alien who was previously ordered removed within the last 5 years or ordered removed a second time within the last Yes No
20 years; who was previously unlawfully present and ordered removed within the last 10 years or ordered removed a
second time within the last 20 years; who was convicted of an aggravated felony and ordered removed; who was
previously unlawfully present in the United States for more than 180 days but less than one year who voluntarily
departed within the last 3 years; or who was unlawfully present for more than one year or an aggregate of one year
within the last 10 years.
i. An alien who is coming to the United States to practice polygamy; who withholds custody of a U.S. citizen child outside Yes No
the United States from a person granted legal custody by a U.S. court or intentionally assists another person to do so;
who has voted in the United States in violation of any law or regulation; or who renounced U.S. citizenship to avoid
taxation.
j. An alien who is a former exchange visitor who has not fulfilled the 2-year foreign residence requirement. Yes No
k. An alien determined by the Attorney General to have knowingly made a frivolous application for asylum. Yes No
l. An alien who has ordered, carried out or materially assisted in extrajudicial and political killings and other acts of violence Yes No
against the Haitian people; who has directly or indirectly assisted or supported any of the groups in Colombia known as
FARC, ELN, or AUC; who through abuse of a governmental or political position has converted for personal gain,
confiscated or expropriated property in Cuba, a claim to which is owned by a national of the United States, has trafficked
in such property or has been complicit in such conversion, has committed similar acts in another country, or is the spouse,
minor child or agent of an alien who has committed such acts; who has been directly involved in the establishment or
enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman
to undergo sterilization against his or her free choice; or who has disclosed or trafficked in confidential U.S. business
information obtained in connection with U.S. participation in the Chemical Weapons Convention or is the spouse, minor
child or agent of such a person.
31. Have you ever been charged, arrested or convicted of any offense or crime?
(If answer is Yes, please explain) Yes No

32. Have you ever been refused admission to the United States at a port-of-entry?
(If answer is Yes, please explain) Yes No

33a. Have you ever applied for a Social Security Number (SSN)? 33b. CONSENT TO DISCLOSURE: I authorize disclosure of
information from this form to the Department of Homeland Security
Yes Give the number No (DHS), the Social Security Administration (SSA), such other U.S.
Government agencies as may be required for the purpose of assigning
Do you want the Social Security Administration to assign you an SSN (and me an SSN and issuing me a Social Security card, and I authorize the
issue a card) or issue you a new card (if you have an SSN)? You must SSA to share my SSN with the INS.
answer "Yes" to this question and to the "Consent To Disclosure" in order Yes No
to receive an SSN and/or card. The applicant's response does not limit or restrict the Government's
Yes No ability to obtain his or her SSN, or other information on this form, for
enforcement or other purposes as authorized by law.
34. WERE YOU ASSISTED IN COMPLETING THIS APPLICATION? Yes No
(If answer is Yes, give name and address of person assisting you, indicating whether relative, friend, travel agent, attorney, or other)

DO NOT WRITE BELOW THE FOLLOWING LINE


The consular officer will assist you in answering item 35.
DO NOT SIGN this form until instructed to do so by the consular officer
35. I claim to be:
A Family-Sponsored Immigrant I derive foreign state chargeability
Preference:
under Sec. 202(b) through my
An Employment-Based Immigrant
Numerical limitation:
A Diversity Immigrant (foreign state)
A Special Category (Specify)
(Returning resident, Hong Kong, Tibetan, Private Legislation, etc.)
I understand that I am required to surrender my visa to the United States Immigration Officer at the place where I apply to enter the United States, and that the
possession of a visa does not entitle me to enter the United States if at that time I am found to be inadmissible under the immigration laws.
I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion
from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and/or deportation.
I, the undersigned applicant for a United States immigrant visa, do solemnly swear (or affirm) that all statements which appear in this application, consisting of
Form DS-230 Part I and Part II combined, have been made by me, including the answers to items 1 through 35 inclusive, and that they are true and complete to the
best of my knowledge and belief. I do further swear (or affirm) that, if admitted into the United States, I will not engage in activities which would be prejudical to the
public interest, or endanger the welfare, safety, or security of the United States; in activities which would be prohibited by the laws of the United States relating to
espionage, sabotage, public disorder, or in other activities subversive to the national security; in any activity a purpose of which is the opposition to or the control, or
overthrow of, the Government of the United States, by force, violence, or other unconstitutional means.
I understand that completion of this form by persons required by law to register with the Selective Service System (males 18 through 25 years of age) constitutes
such registration in accordance with the Military Selective Service Act.
I understand all the foregoing statements, having asked for and obtained an explanation on every point which was not clear to me.

Signature of Applicant

Subscribed and sworn to before me this day of at:

Consular Officer
THIS FORM MAY BE OBTAINED FREE AT CONSULAR OFFICES OF
DS-230 Part II THE UNITED STATES OF AMERICA Page 4 of 4
OMB APPROVAL NO. 1405-0098
U.S. Department of State
EXPIRATION DATE: 12/31/2006
SUPPLEMENTAL REGISTRATION FOR ESTIMATED BURDEN: 30 MINUTES
THE DIVERSITY IMMIGRANT VISA PROGRAM *See Page 2

INSTRUCTIONS

The following is a supplemental registration form for the Diversity Immigrant Visa Program under Section 203(c) of the Immigration and
Nationality Act.
Clearly print or type all answers in the English language. Answer all questions.

Using the enclosed self-adhesive return address label, immediately send this form along with Form DS-230 to: Diversity Immigrant Visa
Program, Kentucky Consular Center, 3505 N. Highway 25W, Williamsburg, KY 40769. Failure to follow instructions will disqualify your
application.
You will be notified by mail of your appointment date, therefore the answer to question No. 3 must be accurate.
1. NAME (Last, First, MI)

2. RANK ORDER NUMBER (Case number on envelope)

3. CURRENT MAILING ADDRESS (Address at which you receive your mail. Give any change of mailing address here.)

Telephone Number
4. NAME OF UNITED STATES CONSULAR OFFICE WHERE YOU WOULD LIKE TO PROCESS YOUR APPLICATION
This will usually be the consular office nearest the place you live. However, please note that some U. S. Embassies and Consulates do not
process immigrant visas. If you are not sure whether the U.S. Embassy or Consulate nearest you processes immigrant visas, or if you do
not know which is the U.S. Embassy or Consulate nearest you, please list the city and country where you live. If you live in the United States
and plan to adjust status with the Bureau of Citizenship and Immigration Services in the U.S., please list "BCIS"; if you live in the United
States but you intend to return abroad to be interviewed, please list the U.S. Embassy or Consulate that processes immigrant visas for the
area where you lived before you came to the United States.

5. THE COUNTRY YOU LISTED AS YOUR NATIVE COUNTRY ON YOUR DIVERSITY VISA PROGRAM APPLICATION
In most cases, this will be the country where you were born. You may also claim the country of birth of your husband or wife. In addition,
you may claim the country of birth of either of your parents, if neither of your parents lived in, or was born in, the country where you were
born.

6. EDUCATION
a. Check the highest level of education completed.

High School, No Degree High School Diploma Vocational School

College, No Degree University Degree Advanced Degree

Other

b. Names and addresses of all schools, colleges, and universities attended (include trade and vocational schools):
NAME OF EDUCATIONAL INSTITUTION FROM (mm-yyyy) -- TO (mm-yyyy) DEGREE(S) OR CERTIFICATE(S) RECEIVED

--
--

--

--

--

--

DSP-122
12-2003 Page 1 of 2
7. WORK EXPERIENCE
a. Within the last 5 years, I have worked at least 2 years in a job that requires at least 2 years of training or experience:

Yes No

b. Occupation - If you answered "yes" to question 7a, give the job title and describe the type of work you did. Be as specific as possible.

c. Names and addresses of your employers during the past 5 years in the work you described above, and the dates (beginning and ending
months and years) you worked for each.
NAME OF EMPLOYER ADDRESS FROM (mm-yyyy) -- TO (mm-yyyy)

SIGNED STATEMENT
I certify that only one application was or has been submitted by me or on my behalf for this immigrant visa
registration. I further certify that I have read and understand all the questions set forth above and that the
answers I have furnished on this form are true and correct to the best of my knowledge and belief. I understand
that any false or misleading statement may result in the refusal of a visa or denial of entry into the United States.

Signature of Applicant Date (mm-dd-yyyy)

PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS


The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of
State uses the facts you provide on this form primarily to determine your eligibility for a U.S. immigrant visa. Individuals who fail to submit
this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and
are subsequently admitted to the United States as an immigrant, the Bureau of Citizenship and Immigration Services will use the information
on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to
issue you a social security number and card.
*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for
searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In
accordance with
5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB
control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to the U.S. Department
of State, A/RPS/DIR, 1800 G Street (Suite 2400), NW, Washington, DC 20522.
DO NOT WRITE IN THIS SPACE - FOR OFFICIAL USE ONLY

Occupation Code:

DSP-122 Page 2 of 2
Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor

IMPORTANT: Please read these instructions carefully before completing ETA Form 9089 – Application
for Permanent Employment Certification. These instructions contain full explanations of the questions
and attestations that make up Form ETA 9089.

Any employer or alien, or their agent or attorney, who knowingly and willingly furnishes any false
information in the preparation of ETA Form 9089 and any supporting documentation, or aids, abets, or
counsels another to do so is committing a federal offense, punishable by fine or imprisonment up to five
years or both (18 U.S.C. §§ 2, 1001). Other penalties apply as well to fraud or misuse of this immigration
document and to perjury with respect to this form (18 U.S.C. §§ 1546, 1621).

Employing or continuing to employ an alien unauthorized to work in the United States is illegal and may
subject the employer to criminal prosecution, civil money penalties, or both.

Privacy Statement Information


In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that the
information provided herein is protected under the Privacy Act. The Department of Labor (Department)
maintains a System of Records titled Employer Application and Attestation File for Permanent and Temporary
Alien Workers (DOL/ETA-7) that includes this record.

Under routine uses for this system of records, case files developed in processing labor certification
applications, labor condition applications, or labor attestations may be released as follows: in connection with
appeals of denials before the DOL Office of Administrative Law Judges and Federal courts, records may be
released to the employers that filed such applications, their representatives, to named alien beneficiaries or
their representatives, and to the DOL Office of Administrative Law Judges and Federal courts; and in
connection with administering and enforcing immigration laws and regulations, records may be released to
such agencies as the DOL Office of Inspector General, Employment Standards Administration, the
Department of Homeland Security, and the Department of State.

Further relevant disclosures may be made in accordance with the Privacy Act and under the following
circumstances: in connection with federal litigation; for law enforcement purposes; to authorized parent
locator persons under Pub. L. 93-647; to an information source or public authority in connection with
personnel, security clearance, procurement, or benefit-related matters; to a contractor or their employees,
grantees or their employees, consultants, or volunteers who have been engaged to assist the agency in the
performance of Federal activities; for Federal debt collection purposes; to the Office of Management and
Budget in connection with its legislative review, coordination, and clearance activities; to a Member of
Congress or their staff in response to an inquiry of the Congressional office made at the written request of the
subject of the record; in connection with records management; and to the news media and the public when a
matter under investigation becomes public knowledge, the Solicitor of Labor determines the disclosure is
necessary to preserve confidence in the integrity of the Department, or the Solicitor of Labor determines that
a legitimate public interest exists in the disclosure of information, unless the Solicitor of Labor determines that
disclosure would constitute an unwarranted invasion of personal privacy.

OMB Notice Paperwork Reduction Act/Information Control Number 1205-0451


Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number.

Respondents are required to reply to these reporting requirements to obtain the benefits of permanent
employment certification. (Immigration and Nationality Act, Section 212(a)(5)). Public reporting burden for this
collection of information is estimated to average 1¼ hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate to the Division of
Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW *
Washington, DC * 20210. Do NOT send the completed application to this address.

Instructions for ETA Form 9089 Page 1 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Regulatory Information
The permanent labor certification program is governed by the Immigration and Nationality Act, 8 U.S.C. 1101
et seq. and 20 CFR part 656. This regulation can be found at
http://workforcesecurity.doleta.gov/foreign/perm.asp. Employers applying for labor certification must comply
with all regulatory and statutory requirements.

How to File
A. Who May File:
An employer who desires to apply for a labor certification, for occupations other than sports, on behalf
of an alien must file Form ETA 9089.

B. How/Where to File
1. For all occupations other than Schedule A and Sheepherders, ETA Form 9089 must be submitted
to the Department of Labor for processing in one of two ways:

• Online. Employers can complete and submit their permanent applications online at the
following web address: http://www.plc.doleta.gov.
• Mail. Applications can be mailed to the DOL Application Processing Center serving the state
where the job will be located. Addresses and a downloadable form and instructions can be
found at the following web address: http://workforcesecurity.doleta.gov/foreign/.

2. Applications for Sheepherders and Schedule A occupations are granted or denied by the United
States Citizenship and Immigration Service (USCIS). All applications for Sheepherders and
Schedule A labor certifications must be mailed to the USCIS service center serving the state
where the job will be located. Addresses can be found at: http://www.uscis.gov

3. All application information (a copy of certified Form ETA 9089, recruitment information, re-filing
information (if applicable), etc…) must be retained by the employer or their attorney/agent for five
years from the date of filing the Application for Permanent Employment Certification.

Section A
Refiling Instructions
Employers that filed applications under the previous regulations (Form ETA 750) may, if the employer has
not yet commenced the recruitment process by having a State Workforce Agency file a job order, refile
applications under the current regulations (ETA Form 9089) without loss of the previous filing date by the
following process:

The application must be for the identical job opportunity filed under the previous regulations, and the
employer must comply with all of the filing and recruiting requirements of the current regulation.

The employer must withdraw the case involving the identical job opportunity under the previous
regulations and refile under the current regulations. Withdrawal instructions can be found at
http://workforcesecurity.doleta.gov/foreign/

1. If this application was previously submitted under the former permanent application process (Form ETA-
750), select Yes to keep your original priority date. Otherwise, select No.

1-A. Enter the date you filed the application under the former permanent application process (Form ETA
750). Enter the date in mm/dd/yyyy format.

1-B. Enter the case number assigned by the SWA or local office to the application you submitted under the
former permanent application process (Form ETA 750).

Instructions for ETA Form 9089 Page 2 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section B
Schedule A or Sheepherder Information
1. Select Yes or No. If Yes, do not send the application to the Department of Labor. All applications in
support of Schedule A or Sheepherder Occupations must be sent directly to the appropriate
Department of Homeland Security (DHS) office. Consult the DHS website (http://uscis.gov) or the
blue pages in your local phone directory for the address of the DHS office that serves the area where
the alien will work.

Section C
Employer Information (Headquarters or Main Office)
1. Enter the full legal name of the business, firm, or organization, or, if an individual, enter the name
used on legal documents.

2. Enter the address of the employer’s principal place of business. This should be the address of the
headquarters or main office.

3. Enter the city, state or province, country and postal code of the principal place of business.

4. Enter the phone number, country or area code first, and extension (if applicable) of the employer.

5. Enter the total number of employees currently employed by the employer.

6. Enter the year the employer commenced business or incorporated. If the employer is a private
household employing a household domestic worker, this question may be skipped.

7. Enter the employer’s nine-digit Federal Employer Identification Number (EIN), which is assigned by
the Internal Revenue Service.

8. Enter the North American Industry Classification System (NAICS) code. This is a six-digit number. If
you do not know the NAICS code, you can search for the correct code at
http://www.naics.com/search.htm.

9. Select Yes or No. Closely Held Corporations are corporations that have relatively few shareholders
and whose shares are not generally traded in the securities market.

Section D
Employer Contact Information
This information must be different than the agent or attorney information entered in Section E. The person
listed in this section may be contacted for authentication of the application.
1. Enter the full legal name of the employer’s point of contact.

2. Enter the business address of the employer’s point of contact. P.O. Boxes are not acceptable.

3. Enter the city, state or province, country, and postal code of the employer’s point of contact.

4. Enter the phone number, country or area code first, and extension (if applicable) of the employer’s
point of contact.

5. Enter the full business e-mail address of the employer’s point of contact.

Instructions for ETA Form 9089 Page 3 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section E
Agent or Attorney Information
This information must be different than the employer contact information entered in Section D.
1. Enter the full legal name of the agent or attorney designated to act on behalf of the employer for this
application.

2. Enter the name of the company or law firm that employs the agent or attorney.

3. Enter the nine-digit Federal Employer Identification Number (EIN) assigned to the agent or attorney’s
company or law firm by the IRS.

4. Enter the phone number, country or area code first, and the extension (if applicable) of the agent or
attorney.

5. Enter the complete mailing address of the agent or attorney.

6. Enter the city, state or province, country and postal code of the agent or attorney.

7. Enter the full business e-mail address of the agent or attorney.

Section F
Prevailing Wage Information
Before you can complete this section of the form, you must secure a Prevailing Wage Determination (PWD)
from the State Workforce Agency (SWA) responsible for the state in which the work will be performed. A
listing of SWAs and their contact information can be found at: http://workforcesecurity.doleta.gov/map.asp

1. Enter the prevailing wage tracking number assigned by the SWA. This field is optional as not all
states assign a code.

2. Enter the Standard Occupational Classification (SOC) code (or O*NET/OES extension) specific to the
occupation listed in the prevailing wage determination request. Further information concerning SOC
codes can be found at: http://ows.doleta.gov/foreign/

3. Enter the occupational title associated with the SOC/O*NET(OES) code as determined by the SWA.

4. Enter the skill level of the job subject to this application as determined by the SWA.

5. Enter the prevailing wage rate for the job as assigned by the SWA in the PWD. Select whether the
offered wage is in terms of hour, week, bi-weekly, month, or year.

6. Identify the source of the prevailing wage from among the following: Occupational Employment
Statistics (OES), Collective Bargaining Agreement (CBA), Employer Conducted Survey, Davis-Bacon
Act (DBA), McNamara-O’Hara Service Contract Act (SCA), or Other.

6-A. If Other is identified for question 6, enter the name of the prevailing wage source as determined by
the SWA.

7. Enter the date the prevailing wage was issued by the appropriate SWA. Enter the date in mm/dd/yyyy
format.

8. Enter the expiration date of the validity period of the PWD received from the appropriate SWA. Enter
the date in mm/dd/yyyy format.

Instructions for ETA Form 9089 Page 4 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section G
Wage Offer Information
1. Enter the wage rate to be paid to the employee. If the wage offer is expressed as a range, enter the
bottom of the wage range to be paid in the From section and enter the top of the wage range to be
paid in the optional To section.

Identify whether the wage rate to be paid is in terms of per hour, week, bi-weekly, month, or year (you
may only select one).

Section H
Job Opportunity Information
1. Enter the full address of the primary site or location where the work will actually be performed.

2. Enter the city, state, and postal code of the primary site or location where the work will actually be
performed.
3. Enter the common name or payroll title of the job being offered.

4. Select the minimum level of education required to adequately perform the duties of the job being offered.

4-A. If Other was selected for question 4, identify the education required. Examples are MD and JD.

4-B. Enter the major field of study required in reference to Question 4. Skip this question if the answer to
question 4 is None or High School.

5. Select Yes or No to identify whether or not training is required for the job. Do not duplicate the time
requirements. For example, time required in training should not also be listed in education or experience.
Do not include restrictive requirements that are not actual business necessities for performance of the job
and that would limit consideration of other qualified U.S. workers.

5-A. If the answer to question 5 is Yes, enter the number of months of training that is required.

5-B. If the answer to question 5 is Yes, enter the field of training that is required for the job offered.

6. Select Yes or No to identify whether experience in the job offered is a requirement.

6-A. If the answer to question 6 is Yes, enter the number of months experience that are required for the job.

7. Select Yes or No to indicate if an alternate field of study is acceptable. This field of study is alternate to
the major field of study indicated in question 4-B.

7-A. If the answer to question 7 is Yes, enter the alternate field of study that is acceptable for the job offered.

8. Select Yes or No to indicate if there is an alternate combination of education and experience in the job
offered that will be accepted in lieu of the minimum education requirement identified in question 4 of this
section. For example, if the requirement is bachelors + 2 years experience but the employer will accept a
masters + 1 year experience, an alternate combination of education and experience exists.

8-A. If the answer to question 8 is Yes, select the alternate level of education that is acceptable in
combination with the number of months of experience specified in question 8-C.

8-B. If the answer to question 8-A is Other, enter the alternate level of education that is acceptable.

8-C. If the answer to question 8 is Yes, enter the number of months of experience in the job offered that is
acceptable in combination with the level of education specified in question 8-A.

Instructions for ETA Form 9089 Page 5 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section H Continued
9. Select Yes or No to indicate if a foreign educational equivalent is acceptable.

10. Select Yes or No to indicate if experience in an alternate occupation is acceptable.

10-A. If the answer to question 10 is Yes, enter the number of months of experience in the alternate
occupation that is required for the job offered.

10-B. If the answer to question 10 is Yes, enter the alternate occupation that is acceptable for the job offered.

11. Describe the job duties. Detail what would be performed by any worker filling the job. Specify equipment
used and pertinent working conditions.

12. Select Yes or No to indicate if the job opportunity’s requirements as specified in questions H-4 to H-11
are normal for the occupation being offered. If the answer to this question is No, the employer must be
prepared to provide documentation demonstrating that the job requirements are supported by business
necessity.

13. Select Yes or No to indicate if knowledge of a foreign language is required to perform the job duties. If the
answer to this question is Yes, the employer must be prepared to provide documentation demonstrating
that the language requirements are supported by business necessity.

14. Enter the job related requirements. Examples are shorthand and typing speeds, specific foreign
language proficiency, and test results. The employer must be prepared to document business necessity
for a foreign language requirement.

15. Select Yes or No to identify whether or not the job includes a combination of occupations. For example,
engineer-pilot.

16. Select Yes or No to indicate if the position identified in this application is being offered to the alien
identified in Section J.

17. Select Yes or No to indicate if the job requires the alien to live on the employer’s premises.

18. Select Yes or No to identify whether the application is for a live-in domestic service worker. Domestic
service workers refer to “private household workers.” The domestic service must be performed in or
about the private home of the employer whether that home is a fixed place of abode or a temporary
dwelling as in the case of an individual or family traveling on vacation. A separate and distinct dwelling
maintained by an individual or a family in an apartment house, condominium, or hotel may constitute a
private home.

18-A. If the answer to question 18 is Yes, select whether the employer and the alien have executed an
employment contract and the employer has provided a copy of the contract to the alien. Select NA
(not applicable) if the answer to question 18 is No.

Section I
Recruitment Information
1. Select Yes or No. Professional Occupations are defined as occupations for which the attainment of a
bachelor’s or higher degree is a usual education requirement for the occupation. For the purpose of
this question, Professional Occupations do not include college or university teachers. If the
answer to this question is Yes, you must complete questions 6 – 22 of this section.

2. Select Yes or No to identify whether or not the application is for a college or university teacher. If the
answer to this question is Yes, you must answer questions 2-A and 2-B.

Instructions for ETA Form 9089 Page 6 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section I Continued
2-A. Select Yes or No to indicate if you selected the candidate using a competitive recruitment and
selection process. If the answer to this question is Yes, you must complete questions 3 – 5 of this
section. In the event of an audit, the employer will be required to provide documentation as defined by
20 CFR 656.18.

2-B. Select Yes or No to indicate if you used the basic recruitment process for professional occupations. If
the answer to this question is Yes, you must complete questions 6 – 22 of this section.

Complete Questions 3 – 5 only if the answer to Section I/Question a.2-A is Yes

3. Enter the date the alien was selected using the competitive recruitment and selection process. Enter the
date in mm/dd/yyyy format.

4. Enter the name and date of the national professional journal in which the advertisement was placed.

5. Enter additional recruitment information. You may add an attachment if more space is necessary.

Complete Questions 6 – 12 unless your answer to Section B/Question 1 is Yes OR your answer to
Section I/Question a.2-A is Yes.

6. Enter the start date for the State Workforce Agency job order. Enter the date in mm/dd/yyyy format.

7. Enter the end date for the State Workforce Agency job order. Enter the date in mm/dd/yyyy format.

8. Select Yes or No to indicate if there is a Sunday edition of the newspaper in the area of intended
employment.

9. Enter the name of the newspaper (of general circulation) in which the first advertisement was placed.

10. Enter the date of the first advertisement identified in question 9. Enter the date in mm/dd/yyyy format.

11. Enter the name of the newspaper or professional journal in which the second advertisement (if applicable)
was placed. Also, select a checkbox to indicate whether the ad ran in a Newspaper or Journal.

12. Enter the date of the second newspaper advertisement or date of publication of journal identified in
question 11. Enter the date in mm/dd/yyyy format.

If the answer to Section I/Questions a.1 or a.2-B is Yes, at least 3 of the items in this section must be
completed. For questions 13-22, enter the dates in mm/dd/yyyy format.

13. Enter the dates advertised at a job fair (if applicable).

14. Enter the dates of on-campus recruiting (if applicable).

15. Enter the dates advertised on the employer’s website (if applicable).

16. Enter the dates advertised with a trade or professional organization (if applicable).

17. Enter the dates listed with a job search website (if applicable).

18. Enter the dates listed with a private employment firm (if applicable).

19. Enter the dates advertised with an employee referral program (if applicable).
20. Enter the dates advertised with a campus placement office (if applicable).

Instructions for ETA Form 9089 Page 7 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section I Continued
21. Enter the dates advertised with a local or ethnic newspaper (if applicable).

22. Enter the dates advertised with radio or TV stations (if applicable).

All must complete this section


23. Select Yes or No to indicate whether the employer has received payment of any kind for the submission
of this application, including intended payroll deductions from the alien’s wages.

23-A. If you answer Yes to question 23, please enter details of the payment for the submission of the
application, including the amount, date and purpose of the payment.

24. Select Yes, No, or NA to indicate whether the bargaining representative for workers in the occupation in
which the alien will be employed has been provided with notice of this filing at least 30 days but not more
than 180 days before the date the application is filed.

25. Select Yes, No, or NA to indicate if there is no bargaining representative, that a notice of this filing has
been posted for 10 business days in a conspicuous location at the place of employment, ending at least
30 days before but not more than 180 days before the date the application is filed.

26. Select Yes or No to indicate if the employer had a layoff in the area of intended employment in the
occupation involved in this application or in a related occupation within the six months immediately
preceding the filing of this application. A related occupation is defined as any occupation that requires
workers to perform a majority of the essential duties involved in the occupation for which certification is
sought.

26-A. Select Yes, No, or NA to indicate whether the laid off U.S. workers were notified and considered for
the job opportunity for which certification is sought.

Section J
Alien Information
This section must be different than the agent or attorney information in Section E.
1. Enter the alien’s last name, first name, and full middle name.

2. Enter the alien’s current address. This should be the address of the alien’s current residence.

3. Enter the city, state or province, country, and postal code of the alien’s current residence.

4. Enter the phone number for the alien’s current residence.

5. Enter the country of current citizenship for the alien.

6. Enter the alien’s country of birth.

7. Enter the alien’s date of birth in mm/dd/yyyy format.

8. Enter the alien’s class of admission if the alien has one. This is the current visa status of the alien (e.g.,
H-1B, H-2A, etc.).

9. Enter the alien registration number if the alien has one. This is a number assigned to the alien by USCIS.

10. Enter the alien admission number if the alien has one. This is a number assigned to the alien by USCIS.

Instructions for ETA Form 9089 Page 8 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section J Continued
11. Select the highest level of education received relevant to the requested occupation that has been
achieved by the alien. If the highest level of education achieved by the alien is not shown on the form,
select Other.

11-A. If Other was selected for question 11, identify the highest level of education relevant to the requested
occupation achieved by the alien. (e.g. MD, JD).

12. Enter the major field(s) of study for the alien in reference to the highest level of relevant education
achieved.

13. Enter the year the relevant education was completed by the alien. Enter the year in yyyy format.

14. Enter the name of the institution where the relevant education achieved by the alien, specified in question
11, was obtained.

15. Enter the address of the institution indicated in question 14.

16. Enter the city, state or province, country, and postal code of the institution indicated in question 14.

17. Select Yes, No, or NA to indicate whether the alien completed the training required for the requested job
opportunity, as indicated in question H.5.

18. Select Yes, No, or NA to indicate whether the alien has the experience as required for the requested job
opportunity indicated in question H.6.

19. Select Yes, No, or NA to indicate whether the alien possesses the alternate combination of education and
experience as indicated in question H.8.

20. Select Yes, No, or NA to indicate whether the alien has the experience in an alternate occupation
specified in question H.10.

21. Select Yes, No, or NA to indicate whether the alien gained any of the qualifying experience with the
employer in a position substantially comparable to the job opportunity requested.

22. Select Yes or No to indicate whether the employer paid for any of the alien’s education or training
necessary to satisfy any of the employer’s job requirements for this position.

23. Select Yes or No to indicate whether the alien is currently employed by the petitioning employer.

Section K
Alien Work Experience
List all jobs held by the alien in the past three years whether or not the job is related to the job opportunity for
which the employer is seeking certification. Also list all other experiences that qualify the alien for the job
opportunity. If you need more space to complete this section, you may use additional pages as attachments
for mailed applications, but you must list the primary jobs and experiences in these spaces. For electronic
applications, the system will allow employers to enter additional jobs.
Instructions for Section a – Job 1
1. Enter the full legal name of the business, firm, or organization that employed the alien.

2. Enter the address of the employer.

3. Enter the city, state or province, country and postal code for the business address.

Instructions for ETA Form 9089 Page 9 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section K Continued
4. Enter the type of business of the employer. For example, food service, landscaping, computer
hardware manufacturing, etc.

5. Enter the title of the job held by the alien.

6. Enter the date the alien started to work for the employer.

7. Enter the date the alien stopped working for the employer.

8. Enter the number of hours per week the alien worked while employed.

9. Enter the details of the job performed by the alien while employed. Include the phone number of the
employer and the name of the alien’s supervisor. Job descriptions should also include specific details
of the work performed, with emphasis on skills, qualifications, certifications, and licenses required,
managerial or supervisory functions performed, materials or products handled, and machines, tools,
and equipment used or operated.
Instructions for Section b – Job 2
Same as instructions for Section a – Job 1.

Instructions for Section c – Job 3


Same as instructions for Section a – Job 1.

Section L
Alien Declaration
1. Enter the last name, first name, and middle initial of the alien signing the application.

2. The signature of the alien identified by question 1 and the date of signature are required. The date of
signature must be in mm/dd/yyyy format.

Note – The signature and date signed do not have to be filled out when electronically submitting to the
Department of Labor for processing, but must be completed when submitting by mail. If the application is
submitted electronically, the certification MUST be signed immediately upon receipt from DOL before it
can be submitted to USCIS for final processing.

Section M
Declaration of Preparer
1. Select Yes or No to indicate whether the application was completed by the employer. If you select No,
questions 2 – 5 must be completed.

2. Enter the full legal name of the person who is responsible for preparation of the application.

3. Enter the job title held by the person who is responsible for preparation of the application.

4. Enter the e-mail address of the person who is responsible for preparation of the application.

5. The signature of the preparer identified by question 2 and the date of signature are required. The date of
signature must be in mm/dd/yyyy format.

Note – The signature and date signed do not have to be filled out when electronically submitting to the
Department of Labor for processing, but must be completed when submitting by mail. If the application is
submitted electronically, the certification MUST be signed immediately upon receipt from DOL before it
can be submitted to USCIS for final processing.

Instructions for ETA Form 9089 Page 10 of 11


Application for Permanent Employment Certification
OMB Approval: 1205-0451
Expiration Date: 06/30/2011 ETA Form 9089 - Instructions
U.S. Department of Labor
Section N
Employer Declaration
1. Enter the full legal name of the employer signing the application.

2. Enter the job title held by the employer.

3. The signature of the employer identified by question 1 and the date of signature are required. The date of
signature must be in mm/dd/yyyy format.

Note – The signature and date signed do not have to be filled out when electronically submitting to the
Department of Labor for processing, but must be completed when submitting by mail. If the application is
submitted electronically, the certification MUST be signed immediately upon receipt from DOL before it
can be submitted to USCIS for final processing.

Section O
U.S. Government Agency Use Only
Do not complete this section.

Instructions for ETA Form 9089 Page 11 of 11


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor

Please read and review the filing instructions before completing this form. A copy of the instructions
can be found at http://www.foreignlaborcert.doleta.gov/pdf/9089inst.pdf
Employing or continuing to employ an alien unauthorized to work in the United States is illegal and may
subject the employer to criminal prosecution, civil money penalties, or both.
A. Refiling Instructions
1. Are you seeking to utilize the filing date from a previously submitted
‰ Yes ‰ No
Application for Alien Employment Certification (ETA 750)?
1-A. If Yes, enter the previous filing date

1-B. Indicate the previous SWA or local office case number OR if not available, specify state where case was
originally filed:

B. Schedule A or Sheepherder Information


1. Is this application in support of a Schedule A or Sheepherder Occupation?
‰ Yes ‰ No
If Yes, do NOT send this application to the Department of Labor. All applications in support of Schedule A or
Sheepherder Occupations must be sent directly to the appropriate Department of Homeland Security office.

C. Employer Information (Headquarters or Main Office)


1. Employer’s name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Phone number Extension

5. Number of employees 6. Year commenced business

7. FEIN (Federal Employer Identification Number) 8. NAICS code

9. Is the employer a closely held corporation, partnership, or sole proprietorship in


which the alien has an ownership interest, or is there a familial relationship between ‰ Yes ‰ No
the owners, stockholders, partners, corporate officers, incorporators, and the alien?

D. Employer Contact Information (This section must be filled out. This information must be different from the
agent or attorney information listed in Section E).
1. Contact’s last name First name Middle initial

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Phone number Extension

5. E-mail address

ETA Form 9089 Page 1 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
E. Agent or Attorney Information (If applicable)

1. Agent or attorney’s last name First name Middle initial

2. Firm name

3. Firm EIN 4. Phone number Extension

5. Address 1

Address 2

6. City State/Province Country Postal code

7. E-mail address

F. Prevailing Wage Information (as provided by the State Workforce Agency)


1. Prevailing wage tracking number (if applicable) 2. SOC/O*NET(OES) code

3. Occupation Title 4. Skill Level

5. Prevailing wage Per: (Choose only one)


$ ‰
Hour ‰ Week ‰ Bi-Weekly ‰ Month ‰ Year
6. Prevailing wage source (Choose only one)
‰ OES ‰ CBA ‰ Employer Conducted Survey ‰ DBA ‰ SCA ‰ Other
6-A. If Other is indicated in question 6, specify:

7. Determination date 8. Expiration date

G. Wage Offer Information


1. Offered wage
From: To: (Optional) Per: (Choose only one)
$ $ ‰ Hour ‰ Week ‰ Bi-Weekly ‰ Month ‰ Year

H. Job Opportunity Information (Where work will be performed)


1. Primary worksite (where work is to be performed) address 1

Address 2

2. City State Postal code

3. Job title

4. Education: minimum level required:


‰ None ‰ High School ‰ Associate’s ‰ Bachelor’s ‰ Master’s ‰ Doctorate ‰ Other
4-A. If Other is indicated in question 4, specify the education required:

4-B. Major field of study

5. Is training required in the job opportunity? 5-A. If Yes, number of months of training required:
‰ Yes ‰ No

ETA Form 9089 Page 2 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
H. Job Opportunity Information Continued
5-B. Indicate the field of training:

6. Is experience in the job offered required for the job? 6-A. If Yes, number of months experience required:
‰ Yes ‰ No
7. Is there an alternate field of study that is acceptable?
‰ Yes ‰ No

7-A. If Yes, specify the major field of study:

8. Is there an alternate combination of education and experience that is acceptable? ‰ Yes ‰ No


8-A. If Yes, specify the alternate level of education required:
‰ None ‰ High School ‰ Associate’s ‰ Bachelor’s ‰ Master’s ‰ Doctorate ‰ Other
8-B. If Other is indicated in question 8-A, indicate the alternate level of education required:

8-C. If applicable, indicate the number of years experience acceptable in question 8:

9. Is a foreign educational equivalent acceptable? ‰ Yes ‰ No


10. Is experience in an alternate occupation acceptable? 10-A. If Yes, number of months experience in alternate
occupation required:
‰ Yes ‰ No
10-B. Identify the job title of the acceptable alternate occupation:

11. Job duties – If submitting by mail, add attachment if necessary. Job duties description must begin in this space.

12. Are the job opportunity’s requirements normal for the occupation?
‰ Yes ‰ No
If the answer to this question is No, the employer must be prepared to
provide documentation demonstrating that the job requirements are
supported by business necessity.
13. Is knowledge of a foreign language required to perform the job duties?
‰ Yes ‰ No
If the answer to this question is Yes, the employer must be prepared to
provide documentation demonstrating that the language requirements
are supported by business necessity.
14. Specific skills or other requirements – If submitting by mail, add attachment if necessary. Skills description must
begin in this space.

ETA Form 9089 Page 3 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
H. Job Opportunity Information Continued

15. Does this application involve a job opportunity that includes a combination of
‰ Yes ‰ No
occupations?

16. Is the position identified in this application being offered to the alien identified
‰ Yes ‰ No
in Section J?

17. Does the job require the alien to live on the employer’s premises?
‰ Yes ‰ No
18. Is the application for a live-in household domestic service worker? ‰ Yes ‰ No

18-A. If Yes, have the employer and the alien executed the required employment ‰ Yes ‰ No ‰ NA
contract and has the employer provided a copy of the contract to the alien?

I. Recruitment Information
a. Occupation Type – All must complete this section.
1. Is this application for a professional occupation, other than a college or
university teacher? Professional occupations are those for which a bachelor’s ‰ Yes ‰ No
degree (or equivalent) is normally required.

2. Is this application for a college or university teacher?


If Yes, complete questions 2-A and 2-B below. ‰ Yes ‰ No
2-A. Did you select the candidate using a competitive recruitment and
‰ Yes ‰ No
selection process?
2-B. Did you use the basic recruitment process for professional occupations?
‰ Yes ‰ No

b. Special Recruitment and Documentation Procedures for College and University Teachers –
Complete only if the answer to question I.a.2-A is Yes.
3. Date alien selected:

4. Name and date of national professional journal in which advertisement was placed:

5. Specify additional recruitment information in this space. Add an attachment if necessary.

c. Professional/Non-Professional Information – Complete this section unless your answer to question B.1 or
I.a.2-A is YES.
6. Start date for the SWA job order 7. End date for the SWA job order

8. Is there a Sunday edition of the newspaper in the area of intended employment? ‰ Yes ‰ No
9. Name of newspaper (of general circulation) in which the first advertisement was placed:

10. Date of first advertisement identified in question 9:

11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed:
‰ Newspaper ‰ Journal

ETA Form 9089 Page 4 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
I. Recruitment Information Continued

12. Date of second newspaper advertisement or date of publication of journal identified in question 11:

d. Professional Recruitment Information – Complete if the answer to question I.a.1 is YES or if the answer to
I.a.2-B is YES. Complete at least 3 of the items.
13. Dates advertised at job fair 14. Dates of on-campus recruiting
From: To: From: To:
15. Dates posted on employer web site 16. Dates advertised with trade or professional organization
From: To: From: To:
17. Dates listed with job search web site 18. Dates listed with private employment firm
From: To: From: To:
19. Dates advertised with employee referral program 20. Dates advertised with campus placement office
From: To: From: To:
21. Dates advertised with local or ethnic newspaper 22. Dates advertised with radio or TV ads
From: To: From: To:

e. General Information – All must complete this section.


23. Has the employer received payment of any kind for the submission of this
‰ Yes ‰ No
application?
23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment :

24. Has the bargaining representative for workers in the occupation in which the
‰ Yes ‰ No ‰ NA
alien will be employed been provided with notice of this filing at least 30 days
but not more than 180 days before the date the application is filed?
25. If there is no bargaining representative, has a notice of this filing been posted
‰ Yes ‰ No ‰ NA
for 10 business days in a conspicuous location at the place of employment,
ending at least 30 days before but not more than 180 days before the date the
application is filed?
26. Has the employer had a layoff in the area of intended employment in the
occupation involved in this application or in a related occupation within the six ‰ Yes ‰ No
months immediately preceding the filing of this application?
26-A. If Yes, were the laid off U.S. workers notified and considered for the job
opportunity for which certification is sought? ‰ Yes ‰ No ‰ NA

J. Alien Information (This section must be filled out. This information must be different from the agent
or attorney information listed in Section E).

1. Alien’s last name First name Full middle name

2. Current address 1

Address 2

3. City State/Province Country Postal code

4. Phone number of current residence

5. Country of citizenship 6. Country of birth

7. Alien’s date of birth 8. Class of admission

9. Alien registration number (A#) 10. Alien admission number (I-94)

11. Education: highest level achieved relevant to the requested occupation:


‰ None ‰ High School ‰ Associate’s ‰ Bachelor’s ‰ Master’s ‰ Doctorate ‰ Other

ETA Form 9089 Page 5 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
J. Alien Information Continued
11-A. If Other indicated in question 11, specify

12. Specify major field(s) of study

13. Year relevant education completed

14. Institution where relevant education specified in question 11 was received

15. Address 1 of conferring institution

Address 2

16. City State/Province Country Postal code

17. Did the alien complete the training required for the requested job opportunity,
‰ Yes ‰ No ‰ NA
as indicated in question H.5?

18. Does the alien have the experience as required for the requested job
opportunity indicated in question H.6? ‰ Yes ‰ No ‰ NA
19. Does the alien possess the alternate combination of education and experience
as indicated in question H.8? ‰ Yes ‰ No ‰ NA
20. Does the alien have the experience in an alternate occupation specified in
question H.10? ‰ Yes ‰ No ‰ NA

21. Did the alien gain any of the qualifying experience with the employer in a
position substantially comparable to the job opportunity requested? ‰ Yes ‰ No ‰ NA
22. Did the employer pay for any of the alien’s education or training
necessary to satisfy any of the employer’s job requirements for this position? ‰ Yes ‰ No
23. Is the alien currently employed by the petitioning employer?
‰ Yes ‰ No

K. Alien Work Experience

List all jobs the alien has held during the past 3 years. Also list any other experience that qualifies the alien for
the job opportunity for which the employer is seeking certification.
a. Job 1
1. Employer name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

ETA Form 9089 Page 6 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
K. Alien Work Experience Continued
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)

b. Job 2
1. Employer name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)

c. Job 3
1. Employer name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

ETA Form 9089 Page 7 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
K. Alien Work Experience Continued
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)

L. Alien Declaration
I declare under penalty of perjury that Sections J and K are true and correct. I understand that to knowingly furnish
false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is
a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other
penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents
under 18 U.S.C. §§ 1546 and 1621.
In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this
application if a labor certification is approved and I am granted a visa or an adjustment of status based on this
application.
1. Alien’s last name First name Full middle name

2. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for
processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification
MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

M. Declaration of Preparer

1. Was the application completed by the employer?


‰ Yes ‰ No
If No, you must complete this section.

I hereby certify that I have prepared this application at the direct request of the employer listed in Section C and
that to the best of my knowledge the information contained herein is true and correct. I understand that to
knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel
another to do so is a federal offense punishable by a fine, imprisonment up to five years or both under 18 U.S.C. §§ 2 and
1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such
documents under 18 U.S.C. §§ 1546 and 1621.
2. Preparer’s last name First name Middle initial

3. Title

4. E-mail address

5. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for
processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST
be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

ETA Form 9089 Page 8 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
N. Employer Declaration
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment:

1. The offered wage equals or exceeds the prevailing wage and I will pay at least the prevailing wage.
2. The wage is not based on commissions, bonuses or other incentives, unless I guarantees a wage paid on a
weekly, bi-weekly, or monthly basis that equals or exceeds the prevailing wage.
3. I have enough funds available to pay the wage or salary offered the alien.
4. I will be able to place the alien on the payroll on or before the date of the alien’s proposed entrance into the
United States.
5. The job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age, sex,
religion, handicap, or citizenship.
6. The job opportunity is not:
a. Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute
involving a work stoppage; or
b. At issue in a labor dispute involving a work stoppage.
7. The job opportunity’s terms, conditions, and occupational environment are not contrary to Federal, state or local
law.
8. The job opportunity has been and is clearly open to any U.S. worker.
9. The U.S. workers who applied for the job opportunity were rejected for lawful job-related reasons.
10. The job opportunity is for full-time, permanent employment for an employer other than the alien.

I hereby designate the agent or attorney identified in section E (if any) to represent me for the purpose of labor
certification and, by virtue of my signature in Block 3 below, I take full responsibility for the accuracy of any
representations made by my agent or attorney.

I declare under penalty of perjury that I have read and reviewed this application and that to the best of my knowledge
the information contained herein is true and accurate. I understand that to knowingly furnish false information in the
preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense
punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as
well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C.
§§ 1546 and 1621.

1. Last name First name Middle initial

2. Title

3. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of
Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any
resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final
processing.

O. U.S. Government Agency Use Only

Pursuant to the provisions of Section 212 (a)(5)(A) of the Immigration and Nationality Act, as amended, I hereby certify
that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the wages
and working conditions of workers in the U.S. similarly employed.

______________________________________________ ______________________________
Signature of Certifying Officer Date Signed

______________________________________________ ______________________________
Case Number Filing Date

ETA Form 9089 Page 9 of 10


OMB Approval: 1205-0451 Application for Permanent Employment Certification
Expiration Date: 06/30/2011
ETA Form 9089
U.S. Department of Labor
P. OMB Information Paperwork Reduction Act Information Control Number 1205-0451
Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number.

Respondent’s reply to these reporting requirements is required to obtain the benefits of permanent
employment certification (Immigration and Nationality Act, Section 212(a)(5)). Public reporting burden for this
collection of information is estimated to average 1¼ hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Send comments regarding this burden estimate to the Division of
Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW *
Washington, DC * 20210.
Do NOT send the completed application to this address.

Q. Privacy Statement Information

In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified
that the information provided herein is protected under the Privacy Act. The Department of Labor
(Department or DOL) maintains a System of Records titled Employer Application and Attestation
File for Permanent and Temporary Alien Workers (DOL/ETA-7) that includes this record.

Under routine uses for this system of records, case files developed in processing labor
certification applications, labor condition applications, or labor attestations may be released as
follows: in connection with appeals of denials before the DOL Office of Administrative Law
Judges and Federal courts, records may be released to the employers that filed such
applications, their representatives, to named alien beneficiaries or their representatives, and to
the DOL Office of Administrative Law Judges and Federal courts; and in connection with
administering and enforcing immigration laws and regulations, records may be released to such
agencies as the DOL Office of Inspector General, Employment Standards Administration, the
Department of Homeland Security, and the Department of State.

Further relevant disclosures may be made in accordance with the Privacy Act and under the
following circumstances: in connection with federal litigation; for law enforcement purposes; to
authorized parent locator persons under Pub. L. 93-647; to an information source or public
authority in connection with personnel, security clearance, procurement, or benefit-related
matters; to a contractor or their employees, grantees or their employees, consultants, or
volunteers who have been engaged to assist the agency in the performance of Federal activities;
for Federal debt collection purposes; to the Office of Management and Budget in connection with
its legislative review, coordination, and clearance activities; to a Member of Congress or their staff
in response to an inquiry of the Congressional office made at the written request of the subject of
the record; in connection with records management; and to the news media and the public when
a matter under investigation becomes public knowledge, the Solicitor of Labor determines the
disclosure is necessary to preserve confidence in the integrity of the Department, or the Solicitor
of Labor determines that a legitimate public interest exists in the disclosure of information, unless
the Solicitor of Labor determines that disclosure would constitute an unwarranted invasion of
personal privacy.

ETA Form 9089 Page 10 of 10


OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(1) Ident. See Instructions on Page 3 Form G-325 (Rev. 07/14/06)Y


OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.

Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(Other Agency Use) USCIS Use (Office of Origin)


Office Code:

Type of Case:
Date:

(2)Rec. Br. See Instructions on Page 3 Form G-325 (Rev. 07/14/06)Y Page 2
Instructions

What Is the Purpose of This Form?

Complete this biographical information form and include it with the application or petition you are submitting to U.S.
Citizenship and Immigration Services (USCIS).

USCIS will use the information you provide on this form to process your application or petition. Complete and submit all
copies of this form with your petition or application.

If you have any questions on how to complete the form, call our National Customer Service Center at 1-800-375-5283.

Privacy Act Notice.

We ask for the information on this form and associated evidence to determine if you have established eligibility for the
immigration benefit you are seeking. Our legal right to ask for this information is in 8 USC 1101 and 1255. We may
provide this information to other Government agencies. Failure to provide this information may delay a final decision or
result in denial of your application or petition.

Paperwork Reduction Act Notice.

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 gather the requested information, complete the form and include it with the appropriate
application or petition for filing purposes is 15 minutes. If you have any comments regarding the accuracy of this estimate
or suggestions for making this form simpler, write to U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W., Washington, D.C. 20529; OMB No. 1615-0008. Do not send
your form to this Washington, D.C. address.

Form G-325 (Rev. 07/14/06)Y Page 3


OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325A, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(1) Ident. See Instructions on Page 5 Form G-325A (Rev. 07/14/06)Y


OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325A, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(2) Rec. Br. See Instructions on Page 5 Form G-325A (Rev. 07/14/06)Y Page 2
OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325A, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(3) C. See Instructions on Page 5 Form G-325A (Rev. 07/14/06)Y Page 3


OMB No. 1615-0008; Exp. 05/31/09
Department of Homeland Security
U.S. Citizenship and Immigration Services G-325A, Biographic Information
(Family Name) (First Name) (Middle Name) Male Birth Date (mm/dd/yyyy) Citizenship/Nationality File Number
Female A
All Other Names Used (Including names by previous marriages) City and Country of Birth U.S. Social Security # (If any)

Family Name First Name Date, City and Country of Birth (If known) City and Country of Residence
Father
Mother
(Maiden Name)
Husband or Wife (If none, Family Name First Name Birth Date City and Country of Birth Date of Marriage Place of Marriage
so state.) (For wife, give maiden name) (mm/dd/yyyy)

Former Husbands or Wives (If none, so state) First Name Birth Date Date and Place of Marriage Date and Place of Termination of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)

Applicant's residence last five years. List present address first. From To
Street and Number City Province or State Country Month Year Month Year
Present Time

Applicant's last address outside the United States of more than one year. From To
Street and Number City Province or State Country Month Year Month Year

Applicant's employment last five years. (If none, so state.) List present employment first. From To
Full Name and Address of Employer Occupation (Specify) Month Year Month Year
Present Time

Show below last occupation abroad if not shown above. (Include all information requested above.)

This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization Other (Specify):
Status as Permanent Resident
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Submit all copies of this form.
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.

Applicant: Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
Complete This Box (Family Name) (Given Name) (Middle Name) (Alien Registration Number)

(4) Consulate See Instructions on Page 5 Form G-325A (Rev. 07/14/06)Y Page 4
Instructions

What Is the Purpose of This Form?

Complete this biographical information form and include it with the application or petition you are submitting to U.S.
Citizenship and Immigration Services (USCIS).

USCIS will use the information you provide on this form to process your application or petition. Complete and submit all
copies of this form with your petition or application.

If you have any questions on how to complete the form, call our National Customer Service Center at 1-800-375-5283.

Privacy Act Notice.

We ask for the information on this form and associated evidence to determine if you have established eligibility for the
immigration benefit you are seeking. Our legal right to ask for this information is in 8 USC 1101 and 1255. We may
provide this information to other Government agencies. Failure to provide this information may delay a final decision or
result in denial of your application or petition.

Paperwork Reduction Act Notice.

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 gather the requested information, complete the form and include it with the appropriate
application or petition for filing purposes is 15 minutes. If you have any comments regarding the accuracy of this estimate
or suggestions for making this form simpler, write to U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W., Washington, D.C. 20529; OMB No. 1615-0008. Do not send
your form to this Washington, D.C. address.

Form G-325A (Rev. 07/14/06)Y Page 5


OMB #1615-0012; Expires 01/31/11
Department of Homeland Security
U.S. Citizenship and Immigration Services Instructions for I-130, Petition for Alien Relative
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper and
indicate the part and number of the item to which the answer refers. If you do not follow the instructions, U.S. Citizenship
and Immigration Services (USCIS) may have to return your petition, which may delay final action. The filing addresses
provided on this form reflect the most current information as of the date this form was last printed. If you are filing Form I-130 more
than 30 days after the latest edition date shown in the lower right-hand corner, please visit our website online at www.uscis.gov before
you file, and check the Immigration Forms page to confirm the correct filing address and version currently in use. Check the edition
date located in the lower right-hand corner of the form. If the edition date on your Form I-130 matches the edition date listed for Form
I-130 on the online Immigration Forms page, your version is current and will be accepted by USCIS. If the edition date on the online
version is later, download a copy and use the online version. If you do not have Internet access, call the National Customer Service
Center at 1-800-375-5283 to verify the current filing address and edition date. Improperly filed forms will be rejected, and the fee
returned, with instructions to resubmit the entire filing using the current form instructions.

What Is the Purpose of This Form? Who May Not File This Form I-130?
A citizen or lawful permanent resident of the United States may You may not file for a person in the following categories:
file this form with U.S. Citizenship and Immigration Services 1. An adoptive parent or adopted child, if the adoption took place
(USCIS) to establish the existence of a relationship to certain after the child's 16th birthday, or if the child has not been in
alien relatives who wish to immigrate to the United States. the legal custody and living with the parent(s) for at least two
years.

Who May File Form I-130? 2. A natural parent, if the U.S. citizen son or daughter gained
permanent residence through adoption.
1. If you are a U.S.citizen you must file a separate Form I-130 for each 3. A stepparent or stepchild, if the marriage that created the
eligible relative. You may file a Form I-130 for: relationship took place after the child's 18th birthday.

A. Your husband or wife; 4. A husband or wife, if you and your spouse were not both
B. Your unmarried child under age 21; physically present at the marriage ceremony, and the marriage
C. Your unmarried son or daughter age 21 or older; was not consummated.
D. Your married son or daughter of any age; 5. A husband or wife, if you gained lawful permanent resident
E. Your brother(s) or sister(s) (you must be age 21 or older); status by virtue of a prior marriage to a U. S. citizen or lawful
F. Your mother or father (you must be age 21 or older). permanent resident, unless:

2. If you are a lawful permanent resident of United States, you A. A period of five years has elapsed since you became a
may file this form for: lawful permanent resident; or
A. Your husband or wife; B. You can establish by clear and convincing evidence that
B. Your unmarried child under age 21; the prior marriage through which you gained your
C. Your unmarried son or daughter age 21 or older. immigrant status was not entered into for the purpose of
evading any provision of the immigration laws; or
NOTE: C. Your prior marriage through which you gained your
1. There is no visa category for married children of permanent immigrant status was terminated by the death of your
residents. If an unmarried son or daughter of a permanent former spouse.
resident marries before the permanent resident becomes a 6. A husband or wife, if you married your husband or wife while
U.S. citizen, any petition filed for that son or daughter will be your husband or wife was the subject of an exclusion,
automatically revoked. deportation, removal, or rescission proceeding regarding his
or her right to be admitted into or to remain in the United
2. If your relative qualifies under paragraph 1(C), 1(D), or 1(E)
States, or while a decision in any of these proceedings was
above, separate petitions are not required for his or her
before any court on judicial review, unless:
husband or wife or unmarried children under 21 years of age.
You prove by clear and convincing evidence that the marriage
3. If your relative qualifies under paragraph 2(B) or 2(C) is legally valid where it took place, and that you and your
above, separate petitions are not required for his or her husband or wife married in good faith and not for the purpose
unmarried children under 21 years of age. of procuring the admission of your husband or wife as an
immigrant, and that no fee or any other consideration (other
4. The persons described in number 2 and 3 of the above NOTE
than appropriate attorney fees) was given for your filing of
will be able to apply for an immigrant visa along with your
this petition OR
relative.
Your husband or wife has lived outside the United States,
after the marriage, for a period of at least two years.
Form I-130 Instructions (Rev. 01/31/08)Y
7. A husband or wife, if it has been legally determined that What Documents Do You Need to Prove Family
such an alien has attempted or conspired to enter into a Relationship?
marriage for the purpose of evading the immigration laws.
You have to prove that there is a family relationship between
8. A grandparent, grandchild, nephew, niece, uncle, aunt, you and your relative. If you are filing for:
cousin, or in-law.
1. A husband or wife, submit the following documentation:
General Instructions A. A copy of your marriage certificate.
Step 1. Fill Out Form I-130 B. If either you or your spouse were previously married,
submit copies of documents showing that all prior
1. Type or print legibly in black ink. marriages were legally terminated.
2. If extra space is needed to complete any item, attach a C. A passport-style color photo of yourself and a
continuation sheet, indicate the item number, and date and passport-style color photo of your husband or wife,
sign each sheet. taken within 30 days of the date of this petition. The
photos must have a white background and be glossy
3. Answer all questions fully and accurately. State that an unretouched and not mounted. The dimensions of the
item is not applicable with "N/A." If the answer is none, full frontal facial image should be about 1 inch from
write "none." the chin to top of the hair. Using pencil or felt pen,
Translations. Any foreign language document must be lightly print the name (and Alien Registration Number,
accompanied by a full English translation that the translator has if known) on the back of each photograph.
certified as complete and correct, and by the translator's D. A completed and signed Form G-325A, Biographic
certification that he or she is competent to translate the foreign Information, for you and a Form G-325A for your
language into English. husband or wife. Except for your name and signature
Copies. If these instructions state that a copy of a document may you do not have to repeat on Form G-325A the
be filed with this petition, submit a copy. If you choose to send information given on your Form I-130 petition.
the original, USCIS may keep that original for our records. If
NOTE: In addition to the required documentation listed
USCIS requires the original, it will be requested.
above, you should submit one or more of the following
types of documentation that may evidence that bona fides
What Documents Do You Need to Show That You of your marriage:
Are a U.S. Citizen?
E. Documentation showing joint ownership or property;
1. If you were born in the United States, a copy of your birth or
certificate, issued by a civil registrar, vital statistics office, or F. A lease showing joint tenancy of a common residence;
other civil authority. or
2. A copy of your naturalization certificate or certificate of G. Documentation showing co-mingling of financial
citizenship issued by USCIS or the former INS. resources; or
3. A copy of Form FS-240, Report of Birth Abroad of a H. Birth certificate(s) of child(ren) born to you, the
Citizen of the United States, issued by a U.S. petitioner, and your spouse together; or
Embassy or consulate.
4. A copy of your unexpired U.S. passport; or I. Affidavits sworn to or affirmed by third parties having
personal knowledge of the bona fides of the marital
5. An original statement from a U.S. consular officer relationship. (Each affidavit must contain the full name
verifying that you are a U.S. citizen with a valid passport. and address, date and place of birth of the person
6. If you do not have any of the above documents and you making the affidavit, his or her relationship to the
were born in the United States, see instructions under petitioner of beneficiary, if any, and complete
Page 3, "What If a Document Is Not Available?" information and details explaining how the person
acquired his or her knowledge of your marriage); or
What Documents Do You Need to Show That You J. Any other relevant documentation to establish that
Are a Permanent Resident? there is an ongoing marital union.
If you are a permanent resident, you must file your petition NOTE: If you married your husband or wife while your
with a copy of the front and back of your permanent resident husband or wife was the subject of an exclusion, deportation,
card. If you have not yet received your card, submit copies of removal, or rescission proceeding (including judicial review
your passport biographic page and the page showing of the decision in one of these proceedings), this evidence
admission as a permanent resident, or other evidence of must be sufficient to establish the bona fides or your marriage
permanent resident status issued by USCIS or the former INS. by clear and convincing evidence.

Form I-130 Instructions (Rev. 01/31/08)Y Page 2


2. A child and you are the mother: Submit a copy of the child's What If Your Name Has Changed?
birth certificate showing your name and the name of your child.
If either you or the person you are filing for is using a name
3. A child and you are the father: Submit a copy of the child's other than shown on the relevant documents, you must file
birth certificate showing both parents' names and your marriage your petition with copies of the legal documents that effected
certificate. the change, such as a marriage certificate, adoption decree or
court order.
4. A child born out of wedlock and you are the father: If the child
was not legitimated before reaching 18 years old, you must file What If a Document Is Not Available?
your petition with copies of evidence that a bona fide parent-child
relationship existed between the father and the child before the In such situation, submit a statement from the appropriate
child reached 21 years. This may include evidence that the father civil authority certifying that the document or documents are
lived with the child, supported him or her, or otherwise showed not available. You must also submit secondary evidence,
continuing parental interest in the child's welfare. including:

5. A brother or sister: Submit a copy of your birth certificate and a A. Church record: A copy of a document bearing the seal
copy of your brother's or sister's birth certificate showing that you of the church, showing the baptism, dedication or
have at least one common parent. If you and your brother or sister comparable rite occurred within two months after birth,
have a common father but different mothers, submit copies of the and showing the date and place of the child's birth, date of
marriage certificates of the father to each mother and copies of the religious ceremony and the names of the child's
documents showing that any prior marriages of either your father parents.
or mothers were legally terminated. If you and your brother or
sister are related through adoption or through a stepparent, or if B. School record: A letter from the authority (preferably the
you have a common father and either of you were not legitimated first school attended) showing the date of admission to the
before your 18th birthday, see also 8 and 9 below. school, the child's date of birth or age at that time, place of
birth, and names of the parents.
6. A mother: Submit a copy of your birth certificate showing your
name and your mother's name. C. Census record: State or Federal census record showing
the names, place of birth, date of birth, or the age of the
7. A father: Submit a copy of your birth certificate showing the person listed.
names of both parents. Also give a copy of your parents' marriage D. Affidavits: Written statements sworn to or affirmed by
certificate establishing that your father was married to your mother two persons who were living at the time and who have
before you were born, and copies of documents showing that any personal knowledge of the event you are trying to prove.
prior marriages of either your father or mother were legally For example, the date and place of birth, marriage or
terminated. If you are filing for a stepparent or adoptive parent, or death. The person making the affidavit does not have to
if you are filing for your father and were not legitimated before be a U.S. citizen. Each affidavit should contain the
your 18th birthday, also see 4, 8, and 9. following information regarding the person making the
affidavit: his or her full name, address, date and place of
8. Stepparent/Stepchild: If your petition is based on a stepparent- birth, and his or her relationship to you, if any, full
stepchild relationship, you must file your petition with a copy of the information concerning the event, and complete details
marriage certificate of the stepparent to the child's natural parent explaining how the person acquired knowledge of the
showing that the marriage occurred before the child's 18th birthday, event.
copies of documents showing that any prior marriages were legally
terminated and a copy of the stepchild's birth certificate.
Where To File?
9. Adoptive parent or adopted child: If you and the person you are
filing for are related by adoption, you must submit a copy of the If you reside in the United States, file the I-130 form at the
adoption decree(s) showing that the adoption took place before the Lockbox according to following instructions:
child became 16 years old.
If you are the petitioner and you reside in Alaska, Arizona,
If you adopted the sibling of a child you already adopted, you must
California, Colorado, Guam, Hawaii, Idaho, Illinois, Indiana,
submit a copy of the adoption decree(s) showing that the adoption of
Iowa, Kansas, Michigan, Minnesota, Missouri, Montana,
the sibling occurred before that child's 18th birthday.
Nebraska, Nevada, North Dakota, Ohio, Oregon, South
In either case, you must also submit copies of evidence that each child Dakota, Utah, Washington, Wisconsin, or Wyoming and you
was in the legal custody of and resided with the parent(s) who adopted are filing only Form I-130, mail the petition to the USCIS
him or her for at least two years before or after adoption. Legal custody Lockbox Facility. The address is as follows:
may only be granted by a court or recognized government entity and is
usually granted at the time of the adoption is finalized. However, if
legal custody is granted by a court or recognized government agency USCIS
prior to the adoption, that time may count to fulfill the two-year legal P.O. Box 804625
custody requirement. Chicago, IL 60680-1029

Form I-130 Instructions (Rev. 01/31/08)Y Page 3


If you are the petitioner and you reside in Alabama, Arkansas, How to Check If the Fees Are Correct
Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, The form fee on this form is current as of the edition date
Maine, Maryland, Massachusetts, Mississippi, New Hampshire, appearing in the lower right corner of this page. However,
New Jersey, New Mexico, New York, North Carolina, Oklahoma, because USCIS fees change periodically, you can verify if the
Pennsylvania, Puerto Rico, Rhode Island, South Carolina, fees are correct by following one of the steps below:
Tennessee, Texas, Vermont, Virginia, U.S. Virgin Islands, West
Virginia, or District of Columbia and you are filing only Form 1. Visit our website at www.uscis.gov, select
I-130, mail the petition to the USCIS Lockbox Facility. The address "Immigration Forms," and check the appropriate fee;
is as follows: 2. Review the fee schedule included in your form package,
USCIS if you called us to request the form, or
P.O. Box 804616
3. Telephone our National Customer Service Center at
Chicago, IL 60680-1029
1-800-375-5283 and ask for the fee information.
NOTE: If the Form I-130 petition is being filed concurrently with
Form I-485, Application to Register Permanent Residence or Adjust
When Will a Visa Become Available?
Status, submit both forms concurrently to: When a petition is approved for the husband, wife, parent, or
unmarried minor child of a United States citizen, these persons
are classified as immmediate relatives. They do not have to wait
U.S. Citizenship and Immigration Services
for a visa number because immediate relatives are not subject to
P.O. Box 805887
the immigrant visa limit.
Chicago, IL 60680-4120
For private couriers (non USPS) deliveries: For alien relatives in preference categories, a limited number of
immigrant visas are issued each year. The visas are processed
U.S. Citizenship and Immigration Services in the order in which the petitions are properly filed and
Attn: FBASI accepted by USCIS. To be considered properly filed, a petition
427 S. LaSalle - 3rd Floor
must be fully completed and signed, and the fee must be paid.
Chicago, IL 60605-1098
Petitioners residing abroad: If you live in Canada, file your petition
at the Vermont Service Center. Exception: If you are a U.S. citizen For a monthly report on the dates when immigrant visas are
residing in Canada, and you are petitioning for your spouse, child, or available, call the U.S. Department of State at (202) 663-1541,
parent, you may file the petition at the nearest U.S. Embassy or or visit: www.travel.state.gov.
consulate, except for those in Quebec City. If you reside elsewhere
outside the United States file, your relative petition at the USCIS office
overseas or the U.S. Embassy or consulate having jurisdiction over the Address Changes
area where you live. For further information, contact the nearest U.S.
Embassy or consulate. If you change your address and you have an application or
petition pending with USCIS, you may change your address
What Is the Filing Fee? online at www.uscis.gov, click on "Change your address with
USCIS," and follow the prompts. Or you may complete and mail
The filing fee for a Form is $355. Form AR-11, Alien's Change of Address Card, to:
Use the following guidelines when you prepare your check or
U.S. Citizenship and Immigration Services
money order for Form I-130:
Change of Address
1. The check or money order must be drawn on a bank or P.O. Box 7134
other financial institution located in the United States and London, KY 40742-7134
must be payable in U.S. currency; and
For commercial overnight or fast freight services only, mail to:
2. Make the check or money order payable to U.S.
U.S. Citizenship and Immigration Services
Department of Homeland Security, unless:
Change of Address
A. If you live in Guam and are filing your petition 1084-I South Laurel Road
there, make it payable to Treasurer, Guam. London, KY 40744
B. If you live in the U.S. Virgin Islands and are filing Notice to Persons Filing for Spouses, If Married Less
your petition there, make it payable to
Than Two Years
Commissioner of Finance of the Virgin Islands.
Pursuant to section 216 of the Immigration and Nationality
C. If you live outside the United States, Guam, or the Act, your alien spouse may be granted conditional permanent
U.S. Virgin Islands, contact the nearest U.S. resident status in the United States as of the date he or she is
Embassy or consulate for instructions on the admitted or adjusted to conditional status by a USCIS officer.
method of payment. Both you and your conditional resident spouse are required to file
Form I-751, Joint Petition to Remove Conditional Basis of Alien's
NOTE: Please spell out U.S. Department of Homeland
Permanent Resident Status, during the 90-day period immediately
Security; do not use the initials "USDHS" or "DHS."
before the second anniversary of the date your alien spouse was
granted conditional permanent resident status.
Form I-130 Instructions (Rev. 01/31/08)Y Page 4
Otherwise, the rights, privileges, responsibilites, and duties
that apply to all other permanent residents apply equally to a Penalties
conditional permanent resident. A conditional permanent
resident is not limited to the right to apply for naturalization, If you knowingly and willfully falsify or conceal a material
file petitions on behalf of qualifying relatives, or reside fact or submit a false document with this request, we will
permanently in the United States as an immigrant in deny the benefit you are filing for, and may deny any other
accordance with our Nation's immigration laws. immigration benefit.

NOTE: Failure to file the Form I-751 joint petition to remove In addition, you will face severe penalties provided by law,
the conditional basis of the alien spouse's permanent resident and may be subject to criminal prosecution.
status will result in the termination of his or her permanent
resident status and initiation of removal proceedings.
Privacy Act Notice
Processing Information We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
Acceptance. Any I-130 petition that is not properly signed or
the immigration benefit for which you are filing. Our legal
accompanied by the correct fee will be rejected with a notice that
right to ask for this information is in 8 U.S.C. 1255. We may
the petition is deficient. You may correct the deficiency and
resubmit the petition. However, a rejected petition does not provide this information to other government agencies.
retain a filing date. A petition is not considered properly filed Failure to provide this information, and any requested
until accepted by USCIS. evidence, may delay a final decision or result in denial of
your request.
Initial Processing. Once the petition has been accepted, it will
be checked for completeness, including submission of the
required initial evidence. If you do not completely fill out the
Paperwork Reduction Act
form or file it without the required initial evidence, you will not
establish a basis for eligibility, and USCIS may deny your
An agency may not conduct or sponsor an information
petition. collection, and a person is not required to respond to a
collection of information unless it displays a currently valid
Requests for More Information. We may request more OMB control number. The public reporting burden for this
information or evidence, or we may request that you appear at collection of information is estimated at 90 minutes per
a USCIS office for an interview. We may also request that response, including the time for reviewing instructions and
you submit the originals of any copy. We will return these completing and submitting the form. Send comments
originals when they are no longer needed. regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
Decision. The decision on Form I-130 involves a
this burden, to: U.S. Citizenship and Immigration Services,
determination of whether you have established eligibility for
Regulatory Management Division, 111 Massachusetts
the requested benefit. You will be notified of the decision in
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC
writing.
20529. OMB No. 1615-0012. Do not mail your application
to this address.
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 Checklist
by telephoning our National Customer Service Center at
Did you answer each question on the Form I-130 petition?
1-800-375-5283 or visiting our internet website at www.uscis.
gov. Did you sign and date the petition?
Did you enclose the correct filing fee for each petition?
As an alternative to waiting in line for assistance at your local Did you submit proof of your U.S. citizenship or lawful
USCIS office, you can now schedule an appointment through permanent residence?
our internet-based system, InfoPass. To access the system, Did you submit other required supporting evidence?
visit our website. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment. If you are filing for your husband or wife, did you include:
InfoPass generates an electronic appointment notice that His or her photograph?
appears on the screen. Your completed Form G-325A?
His or her Form G-325A?

Form I-130 Instructions (Rev. 01/31/08)Y Page 5


Department of Homeland Security OMB #1615-0012; Expires 01/31/11
U.S. Citizenship and Immigration Services I-130, Petition for Alien Relative
DO NOT WRITE IN THIS BLOCK - FOR USCIS OFFICE ONLY
A#
Action Stamp Fee Stamp
Section of Law/Visa Category
201(b) Spouse - IR-1/CR-1
201(b) Child - IR-2/CR-2
201(b) Parent - IR-5
203(a)(1) Unm. S or D - F1-1
203(a)(2)(A)Spouse - F2-1 Petition was filed on: (priority date)
203(a)(2)(A) Child - F2-2 Personal Interview Previously Forwarded
203(a)(2)(B) Unm. S or D - F2-4 Pet. Ben. " A" File Reviewed I-485 Filed Simultaneously
203(a)(3) Married S or D - F3-1 Field Investigation 204(g) Resolved
203(a)(4) Brother/Sister - F4-1 203(a)(2)(A) Resolved 203(g) Resolved

Remarks:
A. Relationship You are the petitioner. Your relative is the beneficiary.
1. I am filing this petition for my: 2. Are you related by adoption? 3. Did you gain permanent residence through adoption?
Husband/Wife Parent Brother/Sister Child Yes No Yes No

B. Information about you C. Information about your relative


1. Name (Family name in CAPS) (First) (Middle) 1. Name (Family name in CAPS) (First) (Middle)

2. Address (Number and Street) (Apt. No.) 2.Address (Number and Street) (Apt. No.)

(Town or City) (State/Country) (Zip/Postal Code) (Town or City) (State/Country) (Zip/Postal Code)

3. Place of Birth (Town or City) (State/Country) 3. Place of Birth (Town or City) (State/Country)

4. Date of Birth 5. Gender 6. Marital Status 4. Date of Birth 5. Gender 6. Marital Status
Male Married Single Male Married Single
Female Widowed Divorced Female Widowed Divorced
7. Other Names Used (including maiden name) 7. Other Names Used (including maiden name)

8.Date and Place of Present Marriage (if married) 8. Date and Place of Present Marriage (if married)

9. U.S. Social Security Number (If any) 10. Alien Registration Number 9. U.S. Social Security Number (If any) 10. Alien Registration Number

11. Name(s) of Prior Husband(s)/Wive(s) 12. Date(s) Marriage(s) Ended 11. Name(s) of Prior Husband(s)/Wive(s) 12. Date(s) Marriage(s) Ended

13. If you are a U.S. citizen, complete the following: 13. Has your relative ever been in the U.S.? Yes No
My citizenship was acquired through (check one): 14. If your relative is currently in the U.S., complete the following:
Birth in the U.S. He or she arrived as a:
Naturalization. Give certificate number and date and place of issuance. (visitor, student, stowaway, without inspection, etc.)
Arrival/Departure Record (I-94) Date arrived

Parents. Have you obtained a certificate of citizenship in your own name?


Yes. Give certificate number, date and place of issuance. No Date authorized stay expired, or will expire, as
shown on Form I-94 or I-95

14. If you are a lawful permanent resident alien, complete the following: 15. Name and address of present employer (if any)

Date and place of admission for or adjustment to lawful permanent


residence and class of admission. Date this employment began

16. Has your relative ever been under immigration proceedings?


14b. Did you gain permanent resident status through marriage to a
U.S. citizen or lawful permanent resident? No Yes Where When
Yes No Removal Exclusion/Deportation Rescission Judicial Proceedings
INITIAL RECEIPT RESUBMITTED RELOCATED: Rec'd Sent COMPLETED: Appv'd Denied Ret'd

Form I-130 (Rev. 01/31/08)Y


C. Information about your alien relative (continued)
17. List husband/wife and all children of your relative.
(Name) (Relationship) (Date of Birth) (Country of Birth)

18. Address in the United States where your relative intends to live.
(Street Address) (Town or City) (State)

19. Your relative's address abroad. (Include street, city, province and country) Phone Number (if any)

20. If your relative's native alphabet is other than Roman letters, write his or her name and foreign address in the native alphabet.
(Name) Address (Include street, city, province and country):

21. If filing for your husband/wife, give last address at which you lived together. (Include street, city, province, if any, and country):
From: To:

22. Complete the information below if your relative is in the United States and will apply for adjustment of status.
Your relative is in the United States and will apply for adjustment of status to that of a lawful permanent resident at the USCIS office in:
If your relative is not eligible for adjustment of status, he or she will apply for a
visa abroad at the American consular post in:

(City) (State) (City) (Country


NOTE: Designation of an American embassy or consulate outside the country of your relative's last residence does not guarantee acceptance for
processing by that post. Acceptance is at the discretion of the designated embassy or consulate.
D. Other information
1. If separate petitions are also being submitted for other relatives, give names of each and relationship.

2. Have you ever before filed a petition for this or any other alien? Yes No
If "Yes," give name, place and date of filing and result.

WARNING: USCIS investigates claimed relationships and verifies the validity of documents. USCIS seeks criminal prosecutions when family
relationships are falsified to obtain visas.
PENALTIES: By law, you may be imprisoned for not more than five years or fined $250,000, or both, for entering into a marriage contract for the
purpose of evading any provision of the immigration laws. In addition, you may be fined up to $10,000 and imprisoned for up to five years, or both, for
knowlingly and willfully falsifying or concealing a material fact or using any false document in submitting this petition.

YOUR CERTIFICATION: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct.
Furthermore, I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs to determine eligiblity
for the benefit that I am seeking.
E. Signature of petitioner.
Date Phone Number ( )
F. Signature of person preparing this form, if other than the petitioner.
I declare that I prepared this document at the request of the person above and that it is based on all information of which I have any knowledge.
Print Name Signature Date
Address G-28 ID or VOLAG Number, if any.
Form I-130 (Rev. 01/31/08)Y Page 2
OMB No. 1615-0013; Expires 02/28/09

Department of Homeland Security


Instructions for Form I-131,
U.S. Citizenship and Immigration Services Application for Travel Document

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

The document may be accepted by a transportation


Updated Filing Address Information company in lieu of a visa as an authorization for the holder
The filing addresses provided on this form reflect the most to travel to the United States. An advance parole document
current information as of the date this form was last printed. is not issued to serve in place of any required passport.
If you are filing Form I-131 more than 30 days after the latest Advance parole is an extraordinary measure used sparingly
edition date shown in the lower right-hand corner, please to bring an otherwise inadmissible alien to the United
visit our website at www.uscis.gov before you file, and check States for a temporary period of time due to a compelling
the Forms and Fees page to confirm the correct filing address emergency. Advance parole cannot be used to circumvent
and version currently in use. Check the edition date located in the normal visa issuing procedures and is not a means to
the lower right-hand corner of the form. If the edition date on bypass delays in visa issuance.
your Form I-131 matches the edition date listed for Form
I-131 on the online Forms and Fees page, your version is NOTE: If you are in the United States and wish to travel
current and will be accepted by USCIS. If the edition date on abroad, you do not need to apply for advance parole if
the online version is later, download a copy and use the both conditions described below in A and B are met:
online version. If you do not have Internet access, call the
National Customer Service Center at 1-800-375-5283 to A. You are in one of the following nonimmigrant
verify the current filing address and edition date. Improperly categories:
filed forms will be rejected and the fee returned with
instructions to resubmit the entire filing using the current 1. An H-1, temporary worker, or H-4, spouse or child
form instructions. of an H-1; or
2. An L-1, intracompany transferee, or L-2, spouse or
child of an L-1; or
What Is the Purpose of This Form?
3. A K-3, spouse, or K-4, child of a U.S. citizen; or
This form may only be used to apply to U.S. Citizenship and 4. A V-2, spouse, or V-3, child of a lawful permanent
Immigration Services (USCIS) for the following travel resident; and
documents, and must not be used to request release from
immigration custody: B. A Form I-485, Application to Register Permanent
Residence or Adjust Status, was filed on your behalf
and is pending with USCIS.
1. Re-entry Permit - A reentry permit allows a permanent
resident or conditional resident to apply for admission to However, upon returning to the United States, you
the United States upon returning from abroad during the must present your valid H, L, K, or V nonimmigrant
permit's validity, without having to obtain a returning visa and continue to remain eligible for that status.
resident visa from a U.S. Embassy or consulate.

2. Refugee Travel Document - A refugee travel document Who May File Form I-131?
is issued to a person classified as a refugee or asylee, or to
a permanent resident who obtained such status as a result of
Each applicant must file a separate application for a travel
being a refugee or asylee in the United States. Persons who
document.
hold aslyee or refugee status, and are not permanent
residents must have a refugee travel document to return to 1. Re-entry Permit
the United States after temporary travel abroad.
A. If you are in the United States as a permanent resident
or conditional permanent resident, you may apply for a
3. Advance Parole Document - An advance parole
reentry permit. After filing your application for a re-
document is issued solely to authorize the temporary parole entry permit, USCIS will inform you in writing when
of a person into the United States. to go to your local Application Support Center (ASC)
for your biometrics appointment. (See Biometric
Services Requirement.)

Form I-131 Instructions (Rev. 02/26/08)Y


You must be physically present in the United States 3. A Re-entry Permit may not be extended.
when you file the Re-entry Permit application.
However, a Re-entry Permit may be sent to a U.S. C. A Re-entry Permit may not be issued to you if:
Embassy or consulate or Department of Homeland 1. You have already been issued such a document, and
Security (DHS) office abroad for you to pick up, if you it is still valid, unless the prior document has been
request it when you file your application. returned to USCIS, or you can demonstrate that it
Departure from the United States before a decision is was lost; or
made on an application for a Re-entry Permit usually 2. A notice was published in the Federal Register that
does not affect the application. However, where precludes the issuance of such a document for travel
biometric collection is required and the applicant to the area where you intend to go.
departs the United States before the biometrics are
collected, the application may be denied. NOTICE to permanent or conditional residents who
remain outside the United States for more than one
With the exception of having to obtain a returning year: If you do not obtain a Re-entry Permit and remain
resident visa abroad, a Re-entry Permit does not relieve outside the United States for one year or more, it may be
you of any of the requirements of U.S. immigration determined that you have abandoned your permanent or
laws. conditional resident status.
If you stay outside the United States for less than one 2. Refugee Travel Document
year, you are not required to apply for a Re-entry A. If you are in the United States in valid refugee or
Permit. You may re-enter the United States on your asylee status, or if you are a permanent resident as a
Permanent Resident Card (Form I-551). direct result of your refugee or asylee status in the
If you intend to apply in the future for naturalization, United States, you may apply for a Refugee Travel
absences from the United States for one year or more Document. Generally, you must have a Refugee Travel
will generally break the continuity of your required Document to return to the United States after
continuous residence in the United States. If you temporary travel abroad. After filing your application
intend to remain outside the United States for one year for a Refugee Travel Document, USCIS will inform
or more, you should file a Form N-470, Application to you in writing when to go to your local USCIS
Preserve Residence for Naturalization Purposes. For Application Support Center (ASC) for your biometrics
further information, contact your local USCIS office. appointment.
B. Validity of Re-entry Permit You should apply for a refugee travel document before
you leave the United States. However, a Refugee
1. Generally, a Re-entry Permit issued to a permanent
Travel Document may be sent to a U. S. Embassy or
resident shall be valid for two years from the date of
consulate or DHS office abroad for you to pick up, if
issuance. However, if since becoming a permanent
you request it when you file your application.
resident you have been outside the United States for
Departure from the United States before a decision is
more than four of the last five years, the permit will
made on the application for a Refugee Travel
be limited to one year, except that a permit with a
Document usually does not affect the application.
validity of two years may be issued to the following:
However, where biometric collection is required and
the applicant departs the United States before the
a. A permanent resident whose travel is on the biometrics are collected, the application may be
order of the U.S. Government, other than an denied.
exclusion, deportation, removal, or recision
order. Travel Warning Regarding Voluntary Re-availment

b. A permanent resident employed by a public WARNING to asylees who travel to the country of
international organization of which the United claimed persecution:
States is a member by treaty or statute.
If you applied for asylum on or after April 1, 1997, your
c. A permanent resident who is a professional
asylum status may be terminated if the Government
athlete and regularly competes in the United
determines that you have voluntarily availed yourself of the
States and worldwide.
protection of your country of claimed persecution. See Section
2. A Re-entry Permit issued to a conditional resident § 8 U.S.C.
208(c)(2)(D) of the Immigration and Nationality Act,
shall be valid for two years from the date of 1158(c)(2)(D).
issuance, or to the date the conditional resident must
apply for removal of the conditions on his or her
status, whichever date comes first.

Form I-131 Instructions (Rev. 02/26/08)Y Page 2


B. Validity of Refugee Travel Document F. Therefore, if you apply for adjustment of status after
1. A Refugee Travel Document shall be valid for one you return to the United States, resume an adjustment
year. application that was pending before you left, or return
to a status that requires you to establish that you are
2. A Refugee Travel Document may not be extended.
not inadmissible, you will need to apply for and
C. A Refugee Travel Document may not be issued to receive a waiver of inadmissibility before your
you if: adjustment application may be approved or your
status continued.
1. You have already been issued such a document and
it is still valid, unless the prior document has been G. Generally, only those persons who can establish
returned to USCIS, or you can demonstrate that it extreme hardship to their U.S. citizen or lawful
was lost; or permanent resident spouse or parent may apply for the
2. A notice was published in the Federal Register that waiver for humanitarian reasons to assure family unity
precludes the issuance of such a document for travel or when it is otherwise in the public interest. (See
to the area where you intend to go. sections 209(c), 212(a)(9) and 244(c) of the
Immigration and Nationality Act for more information
NOTICE to permanent residents who obtain on unlawful presence and the available waivers.)
permanent residence as a result of their refugee or
asylee status: If you do not obtain a Re-entry Permit A. If you are outside the United States and need to visit
and remain outside the United States for one year or the United States temporarily for emergent
more, it may be determined that you have abandoned humanitarian reasons:
your permanent resident status. 1. You may apply for an Advance Parole Document.
However, your application must be based on the
3. Advance Parole Document fact that you cannot obtain the necessary visa and
any required waiver of inadmissibility. Parole
Travel Warning Regarding Unlawful Presence under these conditions is granted on a case-by-case
basis for temporary entry, according to such
Before you apply for an Advance Parole Document, conditions as prescribed.
read this travel warning carefully. 2. A person in the United States may file this
A. If you have been unlawfully present in the United application on your behalf. In so doing, he or she
States for more than 180 days but less than one year should complete Part 1 of the form with
and you leave before removal proceedings are started information about him or herself.
against you, you may be inadmissible for three years
from the date of departure. B. If you are in the United States and seek advance
parole:
B. If you have been unlawfully present in the United
States for one year or more, you may be inadmissible 1. You may apply if you have an adjustment- of- status
for ten years from the date of departure regardless of application pending and you seek to travel abroad
whether you left before, during or after removal for emergent personal or bona fide business reasons;
proceedings. or
C. Unlawful presence is defined as being in the United 2. You may apply if you have been granted Temporary
States without having been inspected and admitted or Protected Status or another another immigration
paroled, or after the period of authorized stay has status that allows you to return to that status after a
expired. brief, casual, and innocent absence (as defined in
8 CFR 244.1) from the United States.
D. However, certain immigration benefits and time spent
in the United States while certain applications are
3. You may apply if you are classified as a refugee or
pending may place you in a period of authorized stay.
asylee and you seek to travel abroad for emergent
These include, but are not limited to, a properly filed
personal or bona fide business reasons, or you are
adjustment of status application, Temporary Protected
traveling to Canada to apply for a U.S. immigrant
Status (TPS), deferred enforced departure (DED),
visa. NOTE: If a refugee or asylee who returns to
asylum, and withholding of removal.
the United States with an Advance Parole
E. Although advance parole may allow you to return to Document is paroled into the United States at a port
the United States, your departure may trigger the of entry upon return, he or she will not be returned
three-or ten-year bar, if you accrued more than 180 to his or her refugee or asylee status. A refugee or
days of unlawful presence BEFORE the date you asylee who returns to the United States with a valid
were considered to be in a period of authorized stay. Refugee Travel Document may be admitted to the
Form I-131 Instructions (Rev. 02/26/08)Y Page 3
United States to resume his or her refugee or asylee status. For All applications must include a copy of an official
additional information on Refugee Travel Documents, see photo identity document showing your photo,
Pages two and three of these instructions. name and date of birth. (Example: a valid
government- issued driver's license; passport identity
page; Form I-551, Permanent Resident Card, or any
WARNING: If you have a pending application for asylum,
other official identity document.) The copy must
and you return to the country of claimed persecution, it will be
clearly show the photo and identity information. A
presumed that you abandoned your asylum application, unless
Form I-94, Arrival/Departure Document, is not
you can show that there were compelling reasons for your
acceptable as a photo identity document.
return. See 8 C.F.R. § 208.8.

C. An Advance Parole document may not be issued If you are applying for :
to you if:
A. Re-entry Permit
1. You held J-1 nonimmigrant status and are
You must attach:
subject to the two-year foreign residence
requirement as a result of that status; or 1. A copy of the front and back of your Form
I-551, Permanent Resident Card; or
2. You are in exclusion, deportation, removal, or
recission proceedings. 2. If you have not yet received your Form I-551, a
copy of the biographic page(s) of your passport
D. If you travel before the advance parole and a copy of the visa page showing your initial
document is issued, your application will be admission as a permanent resident, or other
deemed abandoned if: evidence that you are a permanent resident; or
1. You depart from the United States; or 3. A copy of the Form I-797, Notice of Action,
2. The person seeking advance parole attempts to approval notice of an application for
enter the United States before a decision is made replacement of your Permanent Resident Card
on the application. or temporary evidence of permanent resident
status.
Note: Do not use this form if you are seeking
release from immigration custody and you want to If you are applying for a:
remain in the United States as a parolee. You
should contact U.S. Immigration and Customs
B. Refugee Travel Document
Enforcement (ICE) about your request.
You must attach a copy of the document issued to
you by USCIS showing your refugee or asylee
General Instructions status and the expiration date of such status.

Step 1. Fill Out the Form I-131


C. Advance Parole Document
1. Type or print legibly in black ink.
1. If you are in the United States, you must attach:
2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and a. A copy of any document issued to you by
sign each sheet. USCIS showing your present status in the
3. Answer all questions fully and accurately. State that an United States; and
item is not applicable with "N/A." If the answer is none,
write "none." b. An explanation or other evidence showing
Step 2. General Requirements the circumstances that warrant issuance of an
1. Initial Evidence advance parole document; or

We may request additional information or evidence, or we c. If you are an applicant for adjustment of
may request that you appear at a USCIS office for an status, a copy of a USCIS receipt as evidence
interview or for fingerprinting. (See Biometric Services that you filed the adjustment application;
Requirement.) You must file your application with all the
required evidence. If you do not submit the required evidence,
it will delay the issuance of the document you are requesting.

Form I-131 Instructions (Rev. 02/26/08)Y Page 4


d. If you are traveling to Canada to apply for an The photos must have a white to off-white background,
immigrant visa, a copy of the U.S. consular be printed on thin paper with a glossy finish, and be
appointment letter. unmounted and unretouched.
NOTE: Because of the current USCIS scanning
2. If you are applying for a person who is outside the process, if a digital photo is submitted, it needs to be
United States, you must attach: produced from a high resolution camera, that has at
least 3.5 mega pixels of resolution.
a. A statement of how and by whom medical care,
transportation, housing, and other expenses and Passport-style photos must be 2" x 2." The photos
subsistence needs will be met; and must be in color with full face, frontal view on a white
to off-white background. Head height should measure
b. An Affidavit of Support (Form I-134), with 1" to 1 3/8" from top of hair to bottom of chin, and eye
evidence of the sponsor's occupation and ability height is between 1 1/8" to 1 3/8" from bottom of
to provide necessary support; and photo. Your head must be bare unless you are wearing
a headdress as required by a religious order of which
c. A statement explaining why a U.S. visa cannot you are a member. Using pencil or felt pen, lightly
be obtained, including when and where attempts print your name and Alien Receipt Number on the back
were made to obtain a visa; and of the photo.

d. A statement explaining why a waiver of B. If the person seeking advance parole is outside the
inadmissibility cannot be obtained to allow United States:
issuance of a visa, including when and where 1. If you are applying for an Advance Parole
attempts were made to obtain a waiver, and a Document and you are outside the United States, do
copy of any DHS decision on your waiver not submit the photographs with your application.
request; and Prior to issuing the parole document, the U.S.
Embassy or consulate or DHS office abroad will
e. A copy of any decision on an immigrant petition
provide you with information regarding the
filed for the person, and evidence regarding any
photograph requirements.
pending immigrant petition; and
2. If you are filing this application for an Advance
f. A complete description of the emergent reasons Parole Document for another person, submit the
explaining why advance parole should be required photographs of the person to be paroled.
authorized and including copies of any evidence
you wish considered, and indicating the length of 3. Biometric Services Requirement
time for which the parole is requested.
If you are between age 14 through 79 and you are applying
g. Two completed fingerprint cards (FD-258). You for a Refugee Travel Document or Re-entry Permit, you must
must indicate your Alien Registration Number be fingerprinted as part of USCIS biometric services
(A#) on the fingerprint card and ensure that the requirements. After you have filed this application, USCIS
completed cards are not bent, folded, or creased. will notify you in writing of the time and location where you
The fingerprint cards must be prepared by a U.S. must go to be fingerprinted. If necessary, USCIS may also
Embassy or consulate, USCIS office, or take your photograph and signature. Failure to appear to be
U.S. Military Installation. fingerprinted or for other biometric services may result in a
denial of your application. All applicants for Re-entry Permit
2. Photographs and/or Refugee Travel Documents between the ages of 14
through 79 are required to pay the additional $80 biometric
A. If you are outside the United States and filing for a fee. (See "What is the Filing Fee" on page eight).
refugee travel document, or if you are in the United
States and filing for advance parole document.

You must submit two identical color photographs of


yourself taken within 30 days of the filing of this
application.

Form I-131 Instructions (Rev. 02/26/08)Y Page 5


Invalidation of Travel Document 2. Re-entry Permits
Any travel document obtained by making a material false
representation or concealment in this application will be If you are a Lawful Permanent Resident or a Conditional
invalid. Permanent Resident and are applying for a Re-entry
Permit, file your Form I-131 with the Nebraska Service
A travel document will also be invalid if you are ordered
Center at the address below:
removed or deported from the United States.
In addition, a Refugee Travel Document will be invalid if the USCIS Nebraska Service Center
United Nations Convention of July 28, 1951, shall cease to P.O. Box 87131
apply or shall not apply to you as provided in Article 1C, D, E, Lincoln, NE 68501-7131
or F of the Convention.
3. Advance Parole
Copies. Unless specifically required that an original
document be filed with an application or petition, an ordinary A. For adjustment of status applications (Form I-485)
legible photocopy may be submitted. Original documents filed with USCIS Chicago Lockbox Facility:
submitted when not required will remain a part of the record,
Submit Form I-131 either concurrently with Form
even if the submission was not required.
I-485 or alone to the same address you used to file your
Translations. Any document containing foreign language I-485 application. (A complete list of the adjustment of
submitted to USCIS shall be accompanied by a full English status applications filed with USCIS Chicago Lockbox
language translation, which the translator has certified as Facility is found on Form I-485.)
complete and accurate, and by the translator's certification that
he or she is competent to translate from the foreign language USCIS Lockbox Addresses:
into English.
For United States Postal Service (USPS) deliveries:
Expedite Request Instructions.
USCIS
Expedited applications for Re-entry Permit or Refugee
P.O. Box 805887
Travel Document. When mailing in this request, please
Chicago, IL 60680-4120
notate the outside of the envelope with the word
EXPEDITE. It is recommended that two pre-paid, self- For private courier (non-USPS) deliveries:
addressed express mailers, e-mail addresses, and a fax
number be provided with any expedite request for the Re- USCIS
entry Permit or Refugee Travel Document. If the expedite Attn: FBASI
request is granted and you provide prepaid, self-addressed 427 S. LaSalle - 3rd Floor
express mailers, we will use the pre-paid mailers to send Chicago, IL 60605-1029
you the ASC appointment notice and travel document
upon completion. If you do not provide pre-paid mailers, B. For battered spouses and children applying for
the appointment notice and travel document will be sent adjustment of status:
via regular mail. If you are filing as a battered or abused spouse or child
and you are filing your I-131 concurrently with Form
Where To File? I-485, send both forms to the address you will use to
file Form I-485. If you are requesting advanced parole
E-Filing Form I-131 based on a pending I-485, file your Form I-131 using
Certain Form I-131 filings may be electronically filed (e-filed) the same address you used to file Form I-485.
with USCIS. Please view our website at www.uscis.gov for a C. For special immigrant international employees:
list of who is eligible to e-file this form and instructions.
If you are a special immigrant international
1. Travel Documents organization employee or eligible relative and you are
applying for advance parole concurrently with Form
If you are applying for a Refugee Travel Document based
I-485, use the filing address listed on Form I-485 for
on your refugee or asylum status or you are a permanent
both forms. If you are filing a Form I-131 based on a
resident as a direct result of your refugee or asylee status in
pending Form I-485, file Form I-131 with the
the United States, file your Form I-131 with the Nebraska
Nebraska Service Center using the following address:
Service Center at the below address:

USCIS Nebraska Service Center USCIS Nebraska Service Center


P.O. Box 87131 P.O. Box 87131
Lincoln, NE 68501-7131 Lincoln, NE 68501-7131
Form I-131 Instructions (Rev. 02/26/08)Y Page 6
D. For aliens granted refugee or asylee status who have 1. Nebraska Service Center filings:
filed or will file an adjustment of status application:
File your Form I-131 with the Nebraska Service
If you have been granted refugee or asylee status and Center if you live in the following states: Alaska,
you are applying for advance parole concurrently with Arizona, California, Colorado, Guam, Hawaii,
Form I-485, use the filing address listed on Form I-485 Idaho, Nevada, Illinois, Indiana, Iowa, Kansas,
for both forms. If you are filing a Form I-131 based on Michigan, Minnesota, Missouri, Montana,
a pending Form I-485, file Form I-131 with the Service Nebraska, North Dakota, Ohio, Oregon, South
Center where your Form I-485 is pending. (See Dakota, Utah, Washington, Wisconsin, or
addresses to the Nebraska and Texas Service Centers Wyoming.
below.)
USCIS Nebraska Service Center
E. For Immigrant Investors: P.O. Box 87131
If you are an immigrant investor and you are applying Lincoln, NE 68501-7131
for advance parole concurrently with Form I-485, use
2. Texas Service Center filings:
the filing address listed on Form I-485 for both forms.
If you are filing a Form I-131 based on a pending Form File your Form I-131 with the Texas Service
I-485, file Form I-131 with the Texas Service Center Center if you live in the following states:
using the following address: Alabama, Arkansas, Connecticut, Delaware,
Florida, Georgia, Kentucky, Louisiana, Maine,
USCIS Texas Service Center
Maryland, Massachusetts, Mississippi, New
P.O. Box 851182
Hampshire, New Jersey, New Mexico, New
Mesquite, TX 75185-1182
York, North Carolina, Pennsylvania, Puerto Rico,
F. For applicants covered under the Haitian Refugee Rhode Island, South Carolina, Oklahoma,
Immigrant Fairness Act (HRIFA): Tennessee, Texas, Vermont, Virginia, U.S.
Virgin Islands, West Virginia, and the District of
If you are either the dependent spouse or child of a Columbia.
HRIFA principal or a HRIFA principal who has a Form
I-485 pending, you may file your Form I-131 using the USCIS Texas Service Center
following address: P.O. Box 851182
Mesquite, TX 75185-1182
USCIS Nebraska Service Center
P.O. Box 87245 G. For individuals with Temporary Protected
Lincoln, NE 68501-7245 Status (TPS)
For dependent spouse or dependent child covered If you have been granted Temporary Protected Status
under the Haitian Refugee Immigrant Fairness Act and you are applying for advance parole, mail Form
(HRIFA) outside the United States: If you are the I-131 to the Vermont Service Center, regardless of
spouse or child of a principal HRIFA applicant and are where you live in the United States.
seeking advance parole to enter the United States to USCIS Vermont Service Center
file for adjustment of status as a permanent resident, Attn: I-131
you may file your Form I-131 using the following 75 Lower Welden Street
address:
USCIS Nebraska Service Center St. Albans, VT 05479-0001
P.O. Box 87245
H. Beneficiaries outside of the United States seeking
Lincoln, NE 68501-7131
parole due to extraordinary, emergent,
G. For other adjustment- of- status applications (Form humanitarian circumstances should mail Form
I-485) filed at a USCIS Service Center including the I-131 to the following address:
following:
U.S. Citizenship and Immigration Services
1. Based on an underlying Form I-140 petition; Attn: Chief, International Operations Division
2. Based on an underlying Form I-360 petition not (Humanitarian Parole)
previously mentioned; or 20 Massachusetts Avenue, NW, Room 3300
3. Others not previously mentioned. Washington, DC 20529
If you are applying for advance parole concurrently
with Form I-485, use the filing address listed on Form
I-485 for both forms. If you are filing a Form I-131
based on a pending Form I-485, file Form I-131 with
the Nebraska Service Center or Texas Service Center,
depending on where you live.
Form I-131 Instructions (Rev. 02/26/08)Y Page 7
I. Questions Regarding Form I-131 Notice to Those Making Payment by Check. If you send us
a check, it will be converted into an electronic funds transfer
For additional information about Form I-131, including
(EFT). This means we will copy your check and use the
how to file your application or filing locations not
account information on it to electronically debit your account
mentioned, call the USCIS National Customer Service
for the amount of the check. The debit from your account will
Center at 1-800-375-5283 or visit our website at
usually take 24 hours and will be shown on your regular
www.uscis.gov.
account statement.

You will not receive your original check back. We will


What Is the Filing Fee?
destroy your original check, but we will keep a copy of it. If
The fee for this application is $305 and may not be waived, the EFT cannot be processed for technical reasons, you
(see NOTE that follows for when this fee may not apply). The authorize us to process the copy in place of your original
biometric fee is $80 for applicants ages 14 through 79 who check. If the EFT cannot be completed because of insufficient
request a Refugee Travel Document or Re-Entry Permit, funds, we may try to make the transfer up to two times.
unless the applicant resides outside the United States at the
time of filing their form. See 8 CFR 103.2(e)(4)(ii)(A)). The How to Check If the Fees Are Correct
application fee and biometrics services fee may be paid with The form fee on this form is current as of the edition date
one $385 check. Persons financially unable to pay the appearing in the lower right corner of this page. However,
required biometric services fee may submit a fee waiver because USCIS fees change periodically, you can verify if the
request, with supporting documentation, as described in 8 fees are correct by following one of the steps below:
CFR 103.7(c). USCIS will inform you regarding the approval
1. Visit our website at www.uscis.gov, select
or denial of your fee waiver request.
"Immigration Forms," and check the appropriate fee;
NOTE: If you filed a Form I-485, Application to Register 2. Review the Fee Schedule included in your form
Permanent Residence or Adjust Status, on or after July 30, package, if you called us to request the form; or
2007, and you paid the I-485 application fee required, then no 3. Telephone our National Customer Service Center at
fee is required to file a request for Advance Parole or for a 1-800-375-5283 and ask for the fee information.
Refugee Travel Document on Form I-131. You may file the
I-131 for Advance Parole or for a Refugee Travel Document
concurrently with your I-485, or you may submit the I-131 for
Address Changes
Advance Parole or a Refugee Travel Document at a later date.
If you file Form I-131 for advance parole or a refugee travel If you change your address and you have an application or
document separately, you must also submit a copy of your petition pending with USCIS, you may change your address
Form I-797C, Notice of Action, receipt as evidence that you online at www.uscis.gov, click on "Change your address with
filed and paid the fee for the Form I-485 required on or after USCIS," and follow the prompts. Or you may complete and
July 30, 2007. mail Form AR-11, Alien's Change of Address Card, to:
Use the following guidelines when you prepare your check or U.S. Citizenship and Immigration Services
money order for the Form I-131 fee: Change of Address
P.O. Box 7134
1. The check or money order must be drawn on a bank or
London, KY 40742-7134
other financial institution located in the United States and
must be payable in U.S. currency; and For commercial overnight or fast freight services only, mail to:
2. Make the check or money order payable to U.S. U.S. Citizenship and Immigration Services
Department of Homeland Security, unless: Change of Address
1084-I South Laurel Road
A. If you live in Guam and are filing your petition there,
London, KY 40744
make it payable to Treasurer, Guam.
B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to Commissioner
of Finance of the Virgin Islands.

NOTE: Please spell out U.S. Department of Homeland


Security; do not use the initials "USDHS" or "DHS."

Form I-131 Instructions (Rev. 02/26/08)Y Page 8


Processing Information USCIS Forms and Information
Any Form I-131 that is not signed or accompanied by the To order USCIS forms, call our toll-free number at 1-800-
correct fee(s) will be rejected with a notice that the Form 870-3676. You can also get USCIS forms and information on
I-131 is deficient. You may correct the deficiency and immigration laws, regulations, and procedures by telephoning
resubmit the Form I-131. An application or petition is not our National Customer Service Center at 1-800-375-5283 or
considered properly filed until accepted by USCIS. visiting our Internet website at www.uscis.gov.

Initial processing. Once a Form I-131 has been accepted, it As an alternative to waiting in line for assistance at your local
will be checked for completeness, including submission of the USCIS office, you can now schedule an appointment through
required initial evidence. If you do not completely fill out the our Internet-based system, InfoPass. To access the system,
form, or file it without required initial evidence, you will not visit our website. Use the InfoPass appointment scheduler and
establish a basis for eligibility and we may deny your Form follow the screen prompts to set up your appointment.
I-131. InfoPass generates an electronic appointment notice that
appears on the screen.
Requests for more information or interview. We may
request more information or evidence, or we may request that
you appear at a USCIS office for an interview. We may also Penalties
request that you submit the originals of any copy. We will
return these originals when they are no longer required. If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this Form I-131, we will
Decision. The decision on a Form I-131 involves a deny the Form I-131 and may deny any other immigration
determination of whether you have established eligibility for benefit.
the requested benefit. You will be notified of the decision in In addition, you will face severe penalties provided by law and
writing. may be subject to criminal prosecution.

What If You Claim Nonresident Alien Status


Privacy Act Notice
on Your Federal Income Tax Return?
If you are an alien who has established residence in the United We ask for the information on this form, and associated
States after having been admitted as an immigrant or adjusted evidence, to determine if you have established eligibility for
status to that of an immigrant, and are considering the filing of the immigration benefit for which you are filing. Our legal
a nonresident alien tax return or the non-filing of a tax return right to ask for this information can be found in the
on the ground that you are a nonresident alien, you should Immigration and Nationality Act, as amended. We may
carefully review the consequences of such actions under the provide this information to other government agencies. Failure
Immigration and Nationality Act. to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-131.
If you file a nonresident alien tax return or fail to file a tax
return, you may be regarded as having abandoned residence
Paperwork Reduction Act
in the United States and as having lost your permanent
resident status under the Act. As a consequence, you may be An agency may not conduct or sponsor an information
ineligible for a visa or other document for which permanent collection and a person is not required to respond to a
resident aliens are eligible. collection of information unless it displays a currently valid
You may also be inadmissible to the United States if you seek OMB control number. The public reporting burden for this
admission as a returning resident, and you may become collection of information is estimated at one hour and 55
ineligible for adjustment of status as a permanent resident, or minutes per response, including the time for reviewing
naturalization on the basis of your original entry. 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 Management Division, 111
Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
Washington, DC 20529. OMB No. 1615-0013. Do not mail
your application to this address.

Form I-131 Instructions (Rev. 02/26/08)Y Page 9


OMB No. 1615-0013; Expires 02/28/09
Department of Homeland Security
U. S. Citizenship and Immigration Services I-131, Application for Travel Document
DO NOT WRITE IN THIS BLOCK FOR USCIS USE ONLY (except G-28 block below)
Document Issued Action Block Receipt
Reentry Permit
Refugee Travel Document
Single Advance Parole
Multiple Advance Parole
Valid to:
If Reentry Permit or Refugee Travel Document Hand Delivered
Document, mail to: On By
Address in Part 1
American embassy/consulate To be completed by Attorney/Representative, if any.
at: Attorney State License #
Overseas DHS office
at: Check box if G-28 is attached.

Part 1. Information about you. (Please type or print in black ink.)


1. A # 2. Date of Birth (mm/dd/yyyy) 3. Class of Admission 4. Gender
Male Female
5. Name (Family name in capital letters) (First) (Middle)

6. Address (Number and Street) Apt. #

City State or Province Zip/Postal Code Country

7. Country of Birth 8. Country of Citizenship 9. Social Security # (if any.)

Part 2. Application type (check one).


a. I am a permanent resident or conditional resident of the United States and I am applying for a reentry permit.

b. I now hold U.S. refugee or asylee status and I am applying for a refugee travel document.
c. I am a permanent resident as a direct result of refugee or asylee status and I am applying for a refugee travel document.

d. I am applying for an advance parole document to allow me to return to the United States after temporary foreign travel.

e. I am outside the United States and I am applying for an advance parole document.

f. I am applying for an advance parole document for a person who is outside the United States. If you checked box "f", provide
the following information about that person:

1. Name (Family name in capital letters) (First) (Middle)

2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Country of Citizenship

5. Address (Number and Street) Apt. # Daytime Telephone # (area/country code)

City State or Province Zip/Postal Code Country

Form I-131 (Rev. 02/26/08)Y


Part 3. Processing information.
1. Date of Intended Departure (mm/dd/yyyy) 2. Expected Length of Trip

3. Are you, or any person included in this application, now in


exclusion, deportation, removal or recission proceedings? No Yes (Name of DHS office):
If you are applying for an Advance Parole Document, skip to Part 7.
4. Have you ever before been issued a reentry permit or refugee travel? No Yes (Give the following information
for the last document issued to you):
Date Issued (mm/dd/yyyy): Disposition (attached, lost, etc.):
5. Where do you want this travel document sent? (Check one)
a. To the U.S. address shown in Part 1 on the first page of this form.
b. To an American embassy or consulate at: City: Country:

c. To a DHS office overseas at: City: Country:


d. If you checked "b" or "c", where should the notice to pick up the travel document be sent?
To the address shown in Part 2 on the first page of this form.
To the address shown below:
Address (Number and Street) Apt. # Daytime Telephone # (area/country code)

City State or Province Zip/Postal Code Country

Part 4. Information about your proposed travel.


Purpose of trip. If you need more room, continue on a seperate sheet(s) of paper. List the countries you intend to visit.

Part 5. Complete only if applying for a reentry permit.


Since becoming a permanent resident of the United States (or during the less than six months two to three years
past five years, whichever is less) how much total time have you spent six months to one year three to four years
outside the United States? one to two years more than four years
Since you became a permanent resident of the United States, have you ever filed a federal income tax
return as a nonresident, or failed to file a federal income tax return because you considered yourself to be a
nonresident? (If "Yes," give details on a separate sheet(s) of paper.) Yes No

Part 6. Complete only if applying for a refugee travel document.


1. Country from which you are a refugee or asylee:

If you answer "Yes" to any of the following questions, you must explain on a separate sheet(s) of paper.
2. Do you plan to travel to the above named country? Yes No
3. Since you were accorded refugee/asylee status, have you ever:
a. returned to the above named country? Yes No
b. applied for and/or obtained a national passport, passport renewal or entry permit of that country? Yes No
c. applied for and/or received any benefit from such country (for example, health insurance benefits). Yes No

4. Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act:
a. reacquired the nationality of the above named country? Yes No
b. acquired a new nationality? Yes No
c. been granted refugee or asylee status in any other country? Yes No

Form I-131 (Rev. 02/26/08)Y Page 2


Part 7. Complete only if applying for advance parole.
On a separate sheet(s) of paper, please explain how you qualify for an advance parole document and what circumstances warrant
issuance of advance parole. Include copies of any documents you wish considered. (See instructions.)

1. For how many trips do you intend to use this document? One trip More than one trip

2. If the person intended to receive an advance parole document is outside the United States, provide the location (city and country)
of the American embassy or consulate or the DHS overseas office that you want us to notify.

City Country

3. If the travel document will be delivered to an overseas office, where should the notice to pick up the document be sent:
To the address shown in Part 2 on the first page of this form.
To the address shown below:

Address (Number and Street) Apt. # Daytime Telephone # (area/country code)

City State or Province Zip/Postal Code Country

Read the information on penalties in the instructions before completing this section. If you are filing
Part 8. Signature. for a reentry permit or refugee travel document, you must be in the United States to file this application.

I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with
it are all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit I am seeking.
Signature Date (mm/dd/yyyy) Daytime Telephone Number (with area code)

Please Note: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not
be found eligible for the requested document and this application may be denied.

Part 9. Signature of person preparing form, if other than the applicant. (Sign below.)
I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge.
Signature Print or Type Your Name

Firm Name and Address Daytime Telephone Number (with area code)

Fax Number (if any.) Date (mm/dd/yyyy)

Form I-131 (Rev. 02/26/08)Y Page 3


OMB No. 1615-0014; Exp. 04-30-07
Department of Homeland Security
U.S. Citizenship and Immigration Services I-134, Affidavit of Support

Instructions
I. Execution of Affidavit. B. Statement of your employer on business stationery,
revealing:
A separate affidavit must be submitted for each person. As
the sponsor, you must sign the affidavit in your full, true 1. Date and nature of employment;
and correct name and affirm or make it under oath.
2. Salary paid;
If you are in the United States, the affidavit may be
sworn to or affirmed before an officer of U.S. Citizenship 3. Whether the position is temporary or permanent.
and Immigration Services (USCIS) without the payment of
fee, or before a notary public or other officers authorized C. If self-employed:
to administer oaths for general purposes, in which case the
official seal or certificate of authority to administer oaths 1. Copy of last income tax return filed; or
must be affixed.
2. Report of commercial rating concern.
If you are outside the United States, the affidavit
must be sworn to or notice affirmed before a U.S. D. List containing serial numbers and denominations of
consular or immigration officer. bonds and name of record owner(s).

How you submit the form depends on whether the alien you
III. Sponsor and Alien Liability.
are sponsoring is in or outside the United States and what type
of application is being submitted. See the instructions Effective October 1, 1980, amendments to section 1614(f) of
provided with the corresponding application for detailed the Social Security Act and Part A of Title XVI of the Social
information on how to submit this affidavit of support form. Security Act establish certain requirements for determining
the eligibility of aliens who apply for the first time for
II. Supporting Evidence. Supplemental Security Income (SSI) benefits.

Effective October 1, 1981, amendments to section 415 of the


As the sponsor, you must show you have sufficient income
Social Security Act established similar requirements for
and/or financial resources to assure that the alien you are
determining the eligibility of aliens who apply for the first
sponsoring will not become a public charge while in the
time for Aid to Families with Dependent Children (AFDC),
United States.
currently administered under Temporary Assistance for Needy
Families (TANF). Effective December 22, 1981, amendents to
Evidence should consist of copies of any or all of the
the Food Stamp Act of 1977 affect the eligibility of alien
following documentation listed below that are applicable to
participation in the Food Stamp Program.
your situation.
These amendments require that the income and resources of
Failure to provide evidence of sufficient income and/or
any person who, as the sponsor of an alien's entry into the
financial resources may result in the denial of the alien's
United States, executes an affidavit of support or similar
application for a visa or his or her removal from the United
agreement on behalf of the alien, and the income and
States.
resources of the sponsor's spouse (if living with the sponsor)
shall be deemed to be the income and resources of the alien
The sponsor must submit in duplicate evidence of income
under formulas for determining eligibility for SSI, TANF and
and resources, as appropriate:
Food Stamp benefits during the three years following the
alien's entry into the United States.
A. Statement from an officer of the bank or other financial
institutions where you have deposits, identifying the
following details regarding your account: Documentation on Income and Resources.

1. Date account opened; An alien applying for SSI must make available to the Social
Security Administration documentation concerning his / her
2. Total amount deposited for the past year; income and resources and those of the sponsor, including
information that was provided in support of the corresponding
3. Present balance. application.

Form I-134 (Rev. 02/28/07)Y


An alien applying for TANF or Food Stamps must make VI. Privacy Act Notice.
similar information available to the State public assistance
agency. We ask for the information on this form and associated
evidence to determine if you have established eligibility for
The Secretary of Health and Human Services and the the immigration benefit you are seeking. We may provide this
Secretary of Agriculture are authorized to obtain copies of information to other government agencies. Failure to provide
any such documentation submitted to USCIS or the U.S. this information and any requested evidence may delay a final
Department of State and to release such documentation to a decision or result in denial of your request.
State public assistance agency.
Authority for the collection of the information requested on
this form is contained in 8 U.S.C. 1182(a)(4),1183(a),1184(a)
Joint and Several Liability Issues. and 1258.

Sections 1621(e) of the Social Security Act and The information will be used principally by USCIS, or by any
subsection 5(i) of the Food Stamp Act also provide that an consular officer to whom it may be furnished, to support an
alien and his or her sponsor shall be jointly and severally alien's application for benefits under the Immigration and
liable to repay any SSI, TANF or Food Stamp benefits that are Nationality Act and specifically the assertion that he or she
incorrectly paid because of mis-information provided by a has adequate means of financial support and will not become a
sponsor or because of a sponsor's failure to provide public charge. Submission of the information is voluntary.
information, except where the sponsor was without fault or
where good cause existed. However, failure to provide the information may result in the
denial of the alien's application.
Incorrect payments that are not repaid will be withheld from
any subsequent payments for which the alien or sponsor are The information may also as a matter of routine use be
otherwise eligible under the Social Security Act or Food disclosed to other federal, state, local and foreign law
Stamp Act. enforcement and regulatory agencies, including the
Department of Health and Human Services, Department of
These provisions do not apply to SSI, TANF or Food Agriculture, Department of State, Department of Defense and
Stamp eligibility of aliens admitted as refugees, granted any component thereof ( if the deponent has served or is
asylum or Cuban/ Haitian entrants as defined in section serving in the armed forces of the United States), Central
501(e) of P.L. 96-422, and to dependent children of the Intelligence Agency, and individuals and organizations during
sponsor or sponsor's spouse. the course of any investigation to elicit further information
required to carry out USCIS functions.
IV. Information and USCIS Forms.
VII. Paperwork Reduction Act Notice.
For information on immigration laws, regulations and
procedures or to order USCIS forms, call our National You are not required to respond to this form unless it displays
Customer Service Center at 1-800-375-5283 or visit our a currently valid OMB control number.
website at www.uscis.gov.
We try to create forms and instructions that are accurate, can
be easily understood and impose the least possible burden on
V. Use InfoPass for Appointments. you to provide us with information. Often this is difficult
because some immigration laws are very complex.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through The estimated average time to complete and file this notice is
our internet-based system, InfoPass. To access the system, 15 minutes.
visit our website at www.uscis.gov. Use the InfoPass
appointment scheduler and follow the screen prompts to set up If you have comments regarding the accuracy of this estimate,
your appointment. InfoPass generates an electronic or suggestions for making this form simpler, you may write to:
appointment notice that appears on the screen. Print the notice U.S. Citizenship and Immigration Services, Regulatory
and take it with you to your appointment. The notice gives the Management Division, 111 Massachusetts Avenue, N.W., 3rd
time and date of your appointment, along with the address of Floor, Suite 3008, Washington, DC 20529. Do not mail your
the USCIS office. completed affidavit of support to this address.

Form I-134 (Rev. 02/28/07)Y Page 2


OMB No. 1615-0014; Exp. 04-30-07
Department of Homeland Security
U.S. Citizenship and Immigration Services I-134, Affidavit of Support

(Answer all items. Type or print in black ink.)


I, residing at
(Name) (Street and Number)

(City) (State) (Zip Code if in U.S.) (Country)


Being duly sworn depose and say:

1. I was born on at
(Date-mm/dd/yyyy) (City) (Country)
If you are not a native born U.S. citizen, answer the following as appropriate:
a. If a U.S.citizen through naturalization, give certificate of naturalization number
b. If a U.S. citizen through parent(s) or marriage, give citizenship certificate number
c. If U.S. citizenship was derived by some other method, attach a statement of explanation.
d. If a lawfully admitted permanent resident of the United States, give "A" number

2. I am years of age and have resided in the United States since (date)
3. This affidavit is executed on behalf of the following person:
Name (Family Name) (First Name) (Middle Name) Gender Age

Citizen of (Country) Marital Status Relationship to Sponsor

Presently resides at (Street and Number) (City) (State) (Country)

Name of spouse and children accompanying or following to join person:


Spouse Gender Age Child Gender Age

Child Gender Age Child Gender Age

Child Gender Age Child Gender Age

4. This affidavit is made by me for the purpose of assuring the U.S. Government that the person(s) named in
item (3) will not become a public charge in the United States.
5. I am willing and able to receive, maintain and support the person(s) named in item 3. That I am ready and willing to
deposit a bond, if necessary, to guarantee that such person(s) will not become a public charge during his or her stay in the
United States, or to guarantee that the above named person(s) will maintain his or her nonimmigrant status, if admitted temporarily
and will depart prior to the expiration of his or her authorized stay in the United States.

6. I understand this affidavit will be binding upon me for a period of three (3) years after entry of the person(s) named in
item (3) and that the information and documentation provided by me may be made available to the Secretary of Health and Human
Services and the Secretary of Agriculture, who may make it available to a public assistance agency.

7. I am employed as or engaged in the business of with


(Type of Business) (Name of Concern)

at
(Street and Number) (City) (State) (Zip Code)

I derive an annual income of: (If self-employed, I have attached a copy of my last income
tax return or report of commercial rating concern which I certify to be true and correct
to the best of my knowledge and belief. See instructions for nature of evidence of net worth to be
submitted.) $

I have on deposit in savings banks in the United States: $


I have other personal property, the reasonable value of which is: $
Form I-134 (Rev. 02/28/07) Y
I have stocks and bonds with the following market value, as indicated on the attached list,
which I certify to be true and correct to the best of my knowledge and belief: $

I have life insurance in the sum of: $

With a cash surrender value of: $

I own real estate valued at: $

With mortgage(s) or other encumbrance(s) thereon amounting to: $

Which is located at:


(Street and Number) (City) (State) (Zip Code)
8. The following persons are dependent upon me for support: (Place an "x" in the appropriate column to indicate
whether the person named is wholly or partially dependent upon you for support.)

Name of Person Wholly Dependent Partially Dependent Age Relationship to Me

9. I have previously submitted affidavit(s) of support for the following person(s). If none, state none.
Name Date submitted

10. I have submitted a visa petition(s) to U.S. Citizenship and Immigration Services (USCIS) on behalf of the
following person(s). If none, state none.
Name Relationship Date submitted

11. I intend do not intend to make specific contributions to the support of the person(s) named in item 3.
(If you check "intend," indicate the exact nature and duration of the contributions. For example, if you intend to furnish
room and board, state for how long and, if money, state the amount in U.S. dollars and state whether it is to be given in a lump
sum, weekly or monthly, and for how long.

Oath or Affirmation of Sponsor.


I acknowledge that I have read Part lll of the Instructions, Sponsor and Alien Liability, and am aware of my responsibilities
as a sponsor under the Social Security Act, as amended, and the Food Stamp Act, as amended.

I swear (affirm) that I know the contents of this affidavit signed by me and that the statements are true and correct.

Signature of sponsor

Subscribed and sworn to (affirmed) before me this day of ,

at . My commission expires on

Signature of Officer Administering Oath Title


If the affidavit is prepared by someone other than the sponsor, please complete the following: I declare that this document
was prepared by me at the request of the sponsor and is based on all information of which I have knowledge.

(Signature) (Address) (Date)


Form I-134 (Rev. 02/28/07)YPage 2
OMB No. 1615-0015; Exp. 10/31/08

Department of Homeland Security


Instructions for I-140, Immigrant
U.S. Citizenship and Immigration Services Petition for Alien Worker

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

6. An unskilled worker (requiring less than two years of


What Is the Purpose of This Form? specialized training or experience) to perform labor for
which qualified workers are not available in the United
This form is used to petition U.S. Citizenship and Immigration States.
Services (USCIS) for an immigrant visa based on
employment. In addition, a person may file this petition on his or her own
behalf if he or she:

1. Has extraordinary ability in the sciences, arts, education,


Who May File Form I-140?
business, or athletics demonstrated by sustained national or
international acclaim, whose achievements have been
A U.S. employer may file this petition for: recognized in the field; or
1. An outstanding professor or researcher, with at least three 2. Is a member of the profession holding an advanced degree
years of experience in teaching or research in the academic or is claiming exceptional ability in the sciences, arts, or
area, who is recognized internationally as outstanding: business, and is seeking an exemption of the requirement of
a job offer in the national interest (NIW).
A. In a tenured or tenure-track position at a university or
institution of higher education to teach in the academic
area, or
General Instructions
B. In a comparable position at a university or institution of
higher education to conduct research in the area, or Step 1. Fill Out Form I-140
C. In a comparable position to conduct research for a 1. Type or print legibly in black ink.
private employer that employs at least three persons in
full-time research activities and which achieved 2. If extra space is needed to complete any item, attach a
documented accomplishments in an academic field. continuation sheet, indicate the item number, and date and
sign each sheet.
2. An alien who, in the three years preceding the filing of this
petition, has been employed for at least one year by a firm 3. Answer all questions fully and accurately. State that an
or corporation or other legal entity and who seeks to enter item is not applicable with "N/A." If the answer is none,
the United States to continue to render services to the same write "none."
employer, or to a subsidiary or affiliate, in a capacity that is
managerial or executive. Step 2. General Requirements

3. A member of the professions holding an advanced degree Initial Evidence


or an alien with exceptional ability in the sciences, arts, or
business who will substantially benefit the national 1. If you are filing for an alien of extraordinary ability in
economy, cultural or educational interests, or welfare of the the sciences, arts, education, business, or athletics:
United States. You must file your petition with evidence that the alien has
4. A skilled worker (requiring at least two years of sustained national or international acclaim and that the
specialized training or experience in the skill) to perform achievements have been recognized in the field of
labor for which qualified workers are not available in the expertise.
United States.
A. Evidence of a one-time achievement (i.e., a major,
5. A member of the professions with a baccalaureate degree. internationally recognized award); or

Form I-140 Instructions (Rev. 05/16/08) Y


B. At least three of the following: specified in the petition. Such evidence shall consist of
at least two of the following:
1. Receipt of lesser nationally or internationally
recognized prizes or awards for excellence in the 1. Receipt of major prizes or awards for outstanding
field of endeavor; achievement in the academic field;

2. Membership in associations in the field which 2. Membership in associations in the academic field
require outstanding achievements as judged by that require outstanding achievements of their
recognized national or international experts; members;

3. Published material about the alien in professional or 3. Published material in professional publications
major trade publications or other major media; written by others about the alien's work in the
academic field;
4. Participation on a panel or individually as a judge of
4. Participation on a panel, or individually, as the
the work of others in the field or an allied field;
judge of the work of others in the same or an allied
5. Original scientific, scholarly, artistic, athletic, or academic field;
business-related contributions of major significance 5. Original scientific or scholarly research
in the field; contributions to the academic field; or
6. Authorship of scholarly articles in the field in 6. Authorship of scholarly books or articles in
professional or major trade publications or other scholarly journals with international circulation in
major media; the academic field.
7. Display of the alien's work at artistic exhibitions or B. Evidence the beneficiary has at least three years of
showcases; experience in teaching and/or research in the academic
field; and
8. Evidence that the alien has performed in a leading
or critical role for organizations or establishments C. If you are a university or other institution of higher
that have distinguished reputations; education, a letter indicating that you intend to employ
the beneficiary in a tenured or tenure-track position as
9. Evidence that the alien has commanded a high a teacher or in a permanent position as a researcher in
salary or other high remuneration for services; the academic field; or
10. Evidence of commercial successes in the D. If you are a private employer, a letter indicating that you
performing arts, as shown by box office receipts or intend to employ the beneficiary in a permanent research
record, casette, compact disk, or video sales. position in the academic field, and evidence that you
employ at least three full-time researchers and have
C. If the above standards do not readily apply to the achieved documented accomplishments in the field.
alien's occupation, you may submit comparable
evidence to establish the alien's eligibility; and 3. A U.S. employer filing for a multinational executive or
manager must file the petition with a statement which
D. Evidence that the alien is coming to the United States demonstrates that:
to continue work in the area of expertise. Such
evidence may include letter(s) from prospective A. If the worker is now employed outside the United
employer(s), evidence of prearranged commitments States, he or she has been employed outside the United
such as contracts, or a statement from the alien States for at least one year in the past three years in an
detailing plans on how he or she intends to continue executive or managerial capacity by the petitioner or
work in the United States. by its parent, branch, subsidiary, or affiliate; or, if the
worker is already employed in the United States, he or
2. A U.S. employer filing for an outstanding professor or she was employed outside the United States for at least
researcher must file the petition with: one year in the three years preceding admission as a
nonimmigrant in an executive or managerial capacity
A. Evidence that the professor or researcher is recognized by the petitioner or by its parent, branch, subsidiary, or
internationally as outstanding in the academic field affiliate;

Form I-140 Instructions (Rev. 05/16/08) Y Page 2


B. The prospective employer in the United States is the f. Evidence of recognition for achievements and
same employer or a subsidiary or affiliate of the firm or significant contributions to the industry or field
corporation or other legal entity by which the alien was by peers, governmental entities, or professional or
employed abroad; business organizations.

C. The prospective United States employer has been 3. If the above standards do not readily apply to the
doing business for at least one year; and alien's occupation, you may submit comparable
evidence to establish the alien's eligibility.
D. The alien is to be employed in the United States in a
managerial or executive capacity. A description of the
5. A U.S. employer filing for a skilled worker must file the
duties to be performed should be included.
petition with:
4. A U.S. employer filing for a member of the professions
A. A labor certification (see General Evidence), and
with an advanced degree or a person with exceptional
ability in the sciences, arts, or business must file the B. Evidence that the alien meets the educational, training,
petition with: or experience and any other requirements of the labor
A. A labor certification (see General Evidence), or a certification (the minimum requirement is two years of
request for a waiver of a job offer because the training or experience).
employment is deemed to be in the national interest,
6. A U.S. employer filing for a professional must file the
with documentation provided to show that the
petition with:
beneficiary's presence in the United States would be in
the national interest; and either: A. A labor certification (see General Evidence);
1. An official academic record showing that the alien B. Evidence that the alien holds a U.S. baccalaureate
has a U.S. advanced degree or an equivalent foreign degree or equivalent foreign degree, and
degree, or an official academic record showing that
the alien has a U.S. baccalaureate degree or an C. Evidence that a baccalaureate degree is required for
equivalent foreign degree and letters from current or entry into the occupation.
former employers showing that the alien has at least
five years of progressive post baccalaureate 7. A U.S. employer filing for an unskilled worker must file
experience in the specialty; or the petition with:
2. At least three of the following: A. A labor certification (see General Evidence), and
a. An official academic record showing that the B. Evidence that the beneficiary meets any education,
alien has a degree, diploma, certificate, or similar training, or experience requirements required in the
award from an institution of learning relating to labor certification.
the area of exceptional ability;

b. Letters from current or former employers General Evidence


showing that the alien has at least ten years of
full-time experience in the occupation for which 1. Labor certification
he or she is being sought;
Petitions for certain classifications must be filed with an
c. A license to practice the profession or original individual labor certification from the U.S.
certification for a particular profession or Department of Labor (DOL) or with documentation to
occupation; establish that the alien qualifies for one of the shortage
d. Evidence that the alien has commanded a salary, occupations designated in Group I or II of the DOL's
or other remuneration for services that Schedule A. If an individual labor certification is required,
demonstrates exceptional ability; then the original individual labor certification must be
submitted with the petition, unless the original labor
e. Evidence of membership in professional certification has already been provided to USCIS in
associations; or support of a different petition.

Form I-140 Instructions (Rev. 05/16/08) Y Page 3


A labor certification establishes that there are insufficient NOTE: Individual labor certifications issued by the
U.S. workers who are able, willing, qualified, and Department of Labor must be submitted in the original, unless
available to fill the position being offered to the alien at the the original labor certification has already been provided to
time and place where the alien is to be employed, and that USCIS in support of a different petition.
the employment of the alien, if qualified, will not
adversely affect the wages and working conditions of
similarly employed U.S. workers. Application for labor Where To File?
certification is currently made on Form ETA-9089. Labor
certification applications filed before March 28, 2005 were
filed on Form ETA-750. If the alien is to be employed in Updated Filing Address Information
a Schedule A, Group I or II shortage occupation, then you
may file a fully completed, uncertified Form ETA-9089 in The filing addresses provided on this form reflect the most
duplicate with your petition for determination by USCIS current information as of the date this form was last printed.
that the alien belongs to the shortage occupation. If you are filing Form I-140 more than 30 days after the latest
edition date shown in the lower right-hand corner, please visit
See 20 CFR 656 or the DOL website, http://www. us online at www.uscis.gov before you file, and check the
foreignlaborcert.doleta.gov, for further information about Forms and Fees page to confirm the correct filing address and
obtaining an individual labor certification or about version currently in use. Check the edition date located in the
Schedule A, Group I or II shortage occupations. lower right-hand corner of the form. If the edition date on
your Form I-140 matches the edition date listed for Form
NOTE: Individual labor certifications issued by the I-140 on the online Forms and Fees page, your version is
Department of Labor must be submitted in the original, current and will be accepted by USCIS. If the edition date on
unless the original labor certification has already been the online version is later, download a copy and use the
provided to USCIS in support of a different petition. online version. If you do not have Internet access, call
Customer Service at 1-800-375-5283 to verify the current
2. Ability to pay wage
filing address and edition date. Improperly filed forms will
Petitions which require job offers must be accompanied by be rejected, and the fee returned with instructions to
evidence that the prospective U.S. employer has the ability resubmit the entire filing using the current form
to pay the proffered wage. Such evidence shall be in the instructions.
form of copies of annual reports, federal tax returns, or
audited financial statements. Where to File
In a case where the prospective U.S. employer employs
E-Filing Form I-140
100 or more workers, a statement from a financial officer
of the organization which establishes ability to pay the
Certain Form I-140 filings may be electronically filed (e-
wage may be submitted. In appropriate cases, additional
filed) with USCIS. Please view our website at
evidence, such as profit/loss statements, bank account
www.uscis.gov for a list of who is eligible to e-file this form
records, or personnel records, may be submitted.
and instructions.

Translations. Any document containing foreign language Premium Processing


submitted to USCIS shall be accompanied by a full English
language translation that the translator has certified as If you are requesting Premium Processing Services for Form
complete and accurate, and by the translator's certification that I-140, you must also file Form I-907, Request for Premium
he or she is competent to translate from the foreign language Processing Service. Send the Forms I-140 and I-907 together
into English. to the address listed in the Form I-907 filing instructions.
NOTE: Before you file the I-907/I-140 package, please
Copies. Unless specifically required that an original check the Premium Processing Service page, a link to which
document be filed with an application or petition, an ordinary can be found on the “Services & Benefits” page, on the
legible photocopy may be submitted. Original documents USCIS website at www.uscis.gov to determine whether you
submitted when not required will remain a part of the record, may request Premium Processing for the requested
even if the submission was not required. classification.

Form I-140 Instructions (Rev. 05/16/08) Y Page 4


Premium Processing Service for a Form New Jersey, New Mexico, New York, North Carolina,
I-140 that Is Pending South Carolina, Oklahoma, Pennsylvania, Puerto Rico,
Rhode Island, Tennessee, Texas, Vermont, Virginia, U.S.
If you have already filed Form I-140 and you wish to request Virgin Islands, or West Virginia.
Premium Processing Service, file Form I-907 with the Service
Center where your Form I-140 is pending. See Form I-907 for For Form I-140 filed alone, or concurrently with Form I-485,
further instructions. Include a copy of Form I-797, Notice of Application to Register Permanent Residence or Adjust Status,
Action, or a copy of the transfer notice, if applicable, showing mail your forms package to:
the location of the relating petition. To ensure that Form I-907
is matched up with the pending Form I-140, you must fully USCIS Texas Service Center
answer questions 1 through 5 in Part 2 of Form I-907. If this P.O. Box 852135
information is not provided, Form I-907 will be rejected. Mesquite, TX 75185

Processing Form I-140 Note on E-Filing


All I-140 forms are filed either at the Nebraska Service Center If you are e-filing this application, it will automatically be
or the Texas Service Center, depending on the location of the routed to the appropriate Service Center, and you will receive
beneficiary's permanent employment. Before you file, note the a receipt indicating the location to which it was routed. This
different filing addresses. Failure to follow these instructions location may not necessarily be the same center shown in the
may result in your application or petition being rejected, filing addresses listed above. For e-filed applications, it is
delayed, or denied. very important to review your filing receipt and make specific
note of the receiving location. All further communication,
Nebraska Service Center Filings including submission of supporting documents, should be
directed to the receiving location indicated on your e-filing
File Form I-140 with the Nebraska Service Center if the receipt.
beneficiary will be employed permanently in:

Alaska, Arizona, California, Colorado, Guam, Hawaii, What Is the Filing Fee?
Idaho, Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Missouri, Montana, Nebraska, Nevada, North
Dakota, Ohio, Oregon, South Dakota, Utah, Washington, The filing fee for a Form I-140 is $475.
Wisconsin, or Wyoming.
Use the following guidelines when you prepare your check or
For Form I-140 filed alone, mail the form to: money order for the Form I-140 fee:

USCIS Nebraska Service Center 1. The check or money order must be drawn on a bank or
P.O. Box 87140 other financial institution located in the United States and
Lincoln, NE 68501-7140 must be payable in U.S. currency; and

For Form I-140 filed concurrently with Form I-485, 2. Make the check or money order payable to U.S.
Application to Register Permanent Residence or Adjust Status, Department of Homeland Security, unless:
mail your forms package to:
A. If you live in Guam and are filing your petition there,
USCIS Nebraska Service Center make it payable to Treasurer, Guam.
P.O. Box 87485
B. If you live in the U.S. Virgin Islands and are filing your
Lincoln, NE 68501-7485
petition there, make it payable to Commissioner of
Finance of the Virgin Islands.
Texas Service Center Filings
NOTE: Please spell out U.S. Department of Homeland
File Form I-140 with the Texas Service Center if the Security; do not use the initials "USDHS" or "DHS."
beneficiary will be employed permanently in:

Alabama, Arkansas, Connecticut, Delaware, the District of Notice to Those Making Payment by Check. If you send us
Columbia, Florida, Georgia, Kentucky, Louisiana, Maine, a check, it will be converted into an electronic funds transfer
Maryland, Massachusetts, Mississippi, New Hampshire, (EFT). This means we will copy your check and use the

Form I-140 Instructions (Rev. 05/16/08) Y Page 5


account information on it to electronically debit your account
for the amount of the check. The debit from your account will Processing Information
usually take 24 hours, and will be shown on your regular
account statement. Any Form I-140 that is not signed or accompanied by the
correct fee will be rejected with a notice that the Form
You will not receive your original check back. We will I-140 is deficient. You may correct the deficiency and
destroy your original check, but we will keep a copy of it. If resubmit the Form I-140. An application or petition is not
the EFT cannot be processed for technical reasons, you considered properly filed until accepted by USCIS.
authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times. Initial Processing. Once a Form I-140 has been accepted, it
will be checked for completeness, including submission of the
required initial evidence. If you do not completely fill out the
How to Check If the Fees Are Correct form, or file it without required initial evidence, you will not
The form fee on this form is current as of the edition date establish a basis for eligibility, and we may deny your Form
appearing in the lower right corner of this page. However, I-140.
because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below: Requests for More Information or Interview. We may
request more information or evidence, or we may request that
1. Visit our website at www.uscis.gov, select "Immigration you appear at a USCIS office for an interview. We may also
Forms," and check the appropriate fee; request that you submit the originals of any copy. We will
return these originals when they are no longer required.
2. Review the Fee Schedule included in your form package, if
you called us to request the form; or
Decision. The decision on a Form I-140 involves a
3. Telephone our National Customer Service Center at determination of whether you have established eligibility for
1-800-375-5283 and ask for the fee information. the requested benefit. You will be notified of the decision in
writing.

Address Changes Meaning of Petition Approval. Approval of a petition


means you have established that the person you are filling for
is eligible for the requested classification.
If you change your address and you have an application or
petition pending with USCIS, you may change your address This is the first step towards permanent residence. However,
online at www.uscis.gov, click on "Change your address with this does not in itself grant permanent residence or
USCIS," and follow the prompts, or you may complete and employment authorization. You will be given information
mail Form AR-11, Alien's Change of Address Card, to: about the requirements for the person to receive an immigrant
visa or to adjust status after your petition is approved.
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134 Instructions for Industry and Occupation Codes
London, KY 40742-7134
NAICS Code. The North American Industry Classification
For commercial overnight or fast freight services only, mail to: System (NAICS) code can be obtained from the U.S.
Department of Commerce, U.S. Census Bureau at (www.
U.S. Citizenship and Immigration Services census.gov/epcd/www/naics.html). Enter the code from left to
Change of Address right, one digit in each of the six boxes. If you use a code that
1084-I South Laurel Road is less than six digits, enter the code left to right and then add
London, KY 40744 zeros in the remaining unoccupied boxes.

Form I-140 Instructions (Rev. 05/16/08) Y Page 6


The code sequence 33466 would be entered as:
Penalties
3 3 4 6 6 0
If you knowingly and willfully falsify or conceal a material
The code sequence 5133 would be entered as: fact or submit a false document with this Form I-140, we will
deny the Form I-140 and may deny any other immigration
5 1 3 3 0 0 benefit.

In addition, you will face severe penalties provided by law and


SOC Code. The Standard Occupational Classification (SOC) may be subject to criminal prosecution.
System codes can be obtained from the U.S. Department of
Labor, Bureau of Labor Statistics (http://stats.bls.gov/soc/
socguide.htm). Enter the code from left to right, one digit in Privacy Act Notice
each of the six boxes. If you use a code which is less than six
digits, enter the code left to right and then add zeros in the
We ask for the information on this form, and associated
remaining unoccupied boxes.
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
The code sequence 19-1021 would be entered as:
right to ask for this information can be found in the
1 9 1 0 2 1 Immigration and Nationality Act, as amended. We may
provide this information to other Government agencies.
The code sequence 15-100 would be entered as: Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of your
1 5 1 0 0 0 Form I-140.

Paperwork Reduction Act


USCIS Forms and Information
An agency may not conduct or sponsor an information
To order USCIS forms, call our toll-free number at 1-800- collection and a person is not required to respond to a
870-3676. You can also get USCIS forms and information on collection of information unless it displays a currently valid
immigration laws, regulations, and procedures by telephoning OMB control number. The public reporting burden for this
our National Customer Service Center at 1-800-375-5283 or collection of information is estimated at 60 minutes per
visiting our Internet website at www.uscis.gov. response, including the time for reviewing instructions and
completing and submitting the form. Send comments
As an alternative to waiting in line for assistance at your local regarding this burden estimate or any other aspect of this
USCIS office, you can now schedule an appointment through collection of information, including suggestions for reducing
our internet-based system, InfoPass. To access the system, this burden, to: U.S. Citizenship and Immigration Services,
visit our website. Use the InfoPass appointment scheduler and Regulatory Management Division, 111 Massachusetts
follow the screen prompts to set up your appointment. Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
InfoPass generates an electronic appointment notice that OMB No. 1615-0015. Do not mail your application to this
appears on the screen. address.

Form I-140 Instructions (Rev. 05/16/08) Y Page 7


OMB No. 1615-0015; Exp. 10/31/08
Department of Homeland Security Form I-140, Immigrant
U.S. Citizenship and Immigration Services Petition for Alien Worker
START HERE - Please type or print in black ink. For USCIS Use Only
Part 1. Information about the person or organization filing this petition. If Returned Receipt
an individual is filing, use the top name line. Organizations should use the second line.
Family Name (Last Name) Given Name (First Name) Full Middle Name Date

Company or Organization Name Date


Resubmitted
Address: (Street Number and Name) Suite #
Date
Attn:
Date
City State/Province Reloc Sent

Country Zip/Postal Code Date

IRS Tax # U.S. Social Security # (if any) E-Mail Address (if any) Date
Reloc Rec'd

Part 2. Petition type. Date


This petition is being filed for: (Check one.)
a. An alien of extraordinary ability. Date
b. An outstanding professor or researcher. Classification:
c. A multinational executive or manager. 203(b)(1)(A) Alien of Extraordinary
Ability
d. A member of the professions holding an advanced degree or an alien of exceptional 203(b)(1)(B) Outstanding Professor or
ability (who is NOT seeking a National Interest Waiver). Researcher
e. A professional (at a minimum, possessing a bachelor's degree or a foreign degree 203(b)(1)(C) Multi-National Executive or
equivalent to a U.S. bachelor's degree) or a skilled worker (requiring at least two years of Manager
specialized training or experience). 203(b)(2) Member of Professions w/Adv.
f. (Reserved.) Degree or Exceptional Ability
203(b)(3)(A)(i) Skilled Worker
g. Any other worker (requiring less than two years of training or experience).
203(b)(3)(A)(ii) Professional
h. Soviet Scientist.
203(b)(3)(A)(iii) Other Worker
i. An alien applying for a National Interest Waiver (who IS a member of the professions
holding an advanced degree or an alien of exceptional ability). Certification:
National Interest Waiver (NIW)
Part 3. Information about the person you are filing for. Schedule A, Group I
Family Name (Last Name) Given Name (First Name) Full Middle Name Schedule A, Group II
Priority Date Consulate
Address: (Street Number and Name) Apt. #
Concurrent Filing:
C/O: (In Care Of)
I-485 filed concurrently.
City State/Province
Remarks
Country Zip/Postal Code E-Mail Address (if any)

Daytime Phone # (with area/country codes) Date of Birth (mm/dd/yyyy) Action Block

City/Town/Village of Birth State/Province of Birth Country of Birth

Country of Nationality/Citizenship A # (if any) U.S. Social Security # (if any)


To Be Completed by
Attorney or Representative, if any.
If Date of Arrival (mm/dd/yyyy) I-94 # (Arrival/Departure Document) Fill in box if G-28 is attached
in to represent the applicant.
the Current Nonimmigrant Status Date Status Expires (mm/dd/yyyy)
U.S. ATTY State License #

Form I-140 (Rev. 05/16/08) Y


Part 4. Processing Information.
1. Please complete the following for the person named in Part 3: (Check one)
Alien will apply for a visa abroad at the American Embassy or Consulate at:
City Foreign Country

Alien is in the United States and will apply for adjustment of status to that of lawful permanent resident.
Alien's country of current residence or, if now in the U.S., last permanent residence abroad.

2. If you provided a U.S. address in Part 3, print the person's foreign address:

3. If the person's native alphabet is other than Roman letters, write the person's foreign name and address in the native alphabet:

4. Are any other petition(s) or application(s) being filed with this Form I-140?
Form I-485 Form I-765
No Yes-(check all that apply)
Form I-131 Other - Attach an explanation.
5. Is the person you are filing for in removal proceedings? No Yes-Attach an explanation.
6. Has any immigrant visa petition ever been filed by or on behalf of this person? No Yes-Attach an explanation.

If you answered yes to any of these questions, please provide the case number, office location, date of decision and disposition of the decision on a
separate sheet(s) of paper.

Part 5. Additional information about the petitioner.


1. Type of petitioner (Check one.)
Employer Self Other (Explain, e.g., Permanent Resident, U.S. citizen or any other person filing on behalf of the alien.)

2. If a company, give the following:


Type of Business Date Established (mm/dd/yyyy) Current Number of Employees

Gross Annual Income Net Annual Income NAICS Code

DOL/ETA Case Number


3. If an individual, give the following:
Occupation Annual Income

Part 6. Basic information about the proposed employment.


1. Job Title 2. SOC Code

3. Nontechnical Description of Job

4. Address where the person will work if different from address in Part 1.

5. Is this a full-time position? 6. If the answer to Number 5 is "No," how many hours per week for the position?
Yes No

7. Is this a permanent position? 8. Is this a new position? 9. Wages per week


Yes No Yes No $

Form I-140 (Rev. 05/16/08) Y Page 2


Part 7. Information on spouse and all children of the person for whom you are filing.
List husband/wife and all children related to the individual for whom the petition is being filed. Provide an attachment of additional family
members, if needed.

Name (First/Middle/Last) Relationship Date of Birth (mm/dd/yyyy) Country of Birth

Part 8. Signature. Read the information on penalties in the instructions before completing this section. If someone helped you prepare this
petition, he or she must complete Part 9.

I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it are all true and
correct. I authorize U.S. Citizenship and Immigration Services to release to other government agencies any information from my USCIS (or former
INS) records, if USCIS determines that such action is necessary to determine eligibility for the benefit sought.
Petitioner's Signature Daytime Phone Number (Area/Country Codes) E-Mail Address

Print Name Date (mm/dd/yyyy)

NOTE: If you do not fully complete this form or fail to submit the required documents listed in the instructions, a final decision on your petition
may be delayed or the petition may be denied.

Part 9. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this petition at the request of the above person and it is based on all information of which I have knowledge.
Attorney or Representative: In the event of a Request for Evidence (RFE), may the USCIS contact you by Fax or E-mail? Yes No
Signature Print Name Date (mm/dd/yyyy)

Firm Name and Address

Daytime Phone Number (Area/Country Codes) Fax Number (Area/Country Codes) E-Mail Address

Form I-140 (Rev.05/16/08) Y Page 3


OMB No. 1615-0095; Expires 10/31/08

Department of Homeland Security


Form I-290B, Notice
U.S. Citizenship and Immigration Services of Appeal or Motion

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of
paper and indicate the part and number of the item to which the answer refers.

When Should I Use Form I-290B? General Instructions

Form I-290B is used to file an appeal or motion on any Step 1. Fill Out Form I-290B
decision under the immigration laws in any type of proceeding
over which the Board of Immigration Appeals (BIA) does not 1. Type or print legibly in black ink.
have appellate jurisdiction. The appeal or motion must be
2. If extra space is needed to complete any item, attach a
filed with USCIS in accordance with the regulations at
continuation sheet, indicate the item number, and date and
8 C.F.R. § 103.3 and § 103.5.
sign each sheet.
The form must be filed within 30 calendar days after service
of the decision. If the decision is mailed, the form must be 3. Answer all questions fully and accurately. State that an
filed within 33 days. If the appeal relates to a revocation of an item is not applicable with "N/A." If the answer is none,
immigrant petition approval, the appeal must be filed within write "none."
15 calendar days after service of the decision, 18 days if the
decision was mailed. The date of service is normally the date This form is divided into Parts 1 through 4. The following
of the decision. information should help you fill out the form.

Late filed appeals and motions will be rejected. Part 1. Information About You (Individual/Business/
Organization filing appeal or motion.)
The form may be used in the following circumstances:
1. Family Name (Last name) - Give your legal name. If
1. To file an appeal with the Administrative Appeals Office you have two last names, include both and use a hyphen
(AAO); or (-) between the names, if appropriate.
2. To file a motion to reconsider a decision of USCIS (either 2. Name of Business or Organization - Give the
the AAO or a field office); or complete name, without abbreviations.
3. To file a motion to reopen a decision of USCIS (either the 3. Mailing Address - Give your complete mailing
AAO or a field office). address.
When a decision on a petition is appealed or a request for a 4. Daytime Phone Number - Give a phone number with
motion is made, the petitioner, an authorized official of a area code where you can be reached during the day.
petitioning employer, or the petitioner's attorney or
representative must sign this form. (In the case of self- 5. Fax Number - Give a fax number with area code.
petitioners and applicants for certain waivers, the self-
petitioner or waiver applicant must sign the form.) 6. E-mail Address - If you have an E-mail address please
provide it.

Who May Not File Form I-290B? If you are acting as an attorney or representative - check the
box provided and complete the rest of Part 1 as follows:
If you are the beneficiary of a visa petition or the beneficiary's 1. Family Name (Last name) - Give your legal name. If
attorney or representative, you may not file an appeal or you have two last names, include both and use a hyphen
motion. (-) between the names, if appropriate.

Form I-290B (Rev. 03/04/08) N


2. Business/Organization/School Name - Give the You may submit a brief and evidence with this form.
complete name, without abbreviations, if the party for Or you may send these materials to the AAO within 30
whom you are filing is other than an individual. days of the date you sign this form. You must send any
materials you submit after filing the appeal to:
3. A # - This is your client's USCIS (INS) file number. It
begins with an "A" and can be found on a Permanent USCIS Administrative Appeals Office
Resident Card or on correspondence that has been U.S. Citizenship and Immigration Services
received from the Department of Homeland Security 20 Massachusetts Avenue, N.W., Room 3000
(DHS) or USCIS. If they do not have an A #, leave this Washington, DC 20529
blank.
If you need more than 30 days, you must explain why
Part 2 - Information About the Appeal or Motion in a separate letter attached to this form. The AAO
may grant more time only for good cause.
You must clearly indicate if you are filing an appeal or a
motion. The adverse decision will indicate whether you 2. Oral Argument:
may file an appeal or a motion. The requirements for
motions to reopen and motions to reconsider are located at You may request oral argument before the AAO in
8 C.F.R. § 103.5. Washington, D.C. in a separate letter attached to this
form. The letter must explain specifically why an oral
Part 3 - Basis for the Appeal or Motion argument is necessary, i.e., why your argument cannot
Your appeal or motion will be dismissed if you do not be adequately addressed in writing.
complete this part. If additional space is needed, attach a If your request is granted, the AAO will contact you
separate sheet(s) of paper. about setting the date and time. The U.S. Government
Part 4 - Signature of Person Filing the Appeal/Motion or does not furnish interpreters for oral argument.
His or Her Authorized Representative
Motions
You or your legal representative must sign and submit the
Form I-290B. A Form G-28, Notice of Entry of Although a petitioner may be permitted additional time to
Appearance as Attorney or Representative, must be submit a brief and/or evidence to support an appeal, no
attached if signed by a legal representative. such provision applies to motions. Any additional
evidence must be submitted concurrent with the motion.
Step 2. General requirements
Translations. Any document containing foreign language
Your appeal or motion must include the following items. submitted to the Service shall be accompanied by a full
English language translation which the translator has certified
Your signed and completed Form I-290B as complete and accurate, and by the translator's certification
NOTE: If you wish, you may be represented at no expense to that he or she is competent to translate from the foreign
the U.S. Government by an attorney or other duly authorized language into English.
representative. Your attorney or representative must submit a
Form G-28, Notice of Entry of Appearance as Attorney or
Representative, with the appeal or motion. If the appeal or What Is the Filing Fee?
motion is filed by an attorney or representative without a
properly executed Form G-28, it will be dismissed or rejected. The filing fee for a Form I-290B is $585.
NOTE: The fee will be the same when an appeal or motion is
Appeals
taken from the denial of a petition with one or multiple
1. Brief beneficiaries, provided that they are all covered by the same
petition, and therefore, the same decision.
You do not need to submit a brief in support of your
appeal, but you may submit one if you so choose. You The fee will not be refunded, regardless of the action taken in
may also submit additional evidence. your case.

Form I-290B (Rev. 03/04/08) N Page 2


Use the following guidelines when you prepare your check or
money order for the Form I-290B fee: Where to File?
1. The check or money order must be drawn on a bank or You must file your appeal or motion with the USCIS office
other financial institution located in the United States that made the unfavorable decision within 30 calendar days
and must be payable in U.S. currency; and after service of the decision (33 days if your decision was
2. Make the check or money order payable to U.S. mailed). If you are appealing the revocation of an immigrant
Department of Homeland Security, unless: petition approval, you must file the appeal within 15 days of
the revocation decision (18 days if the decision was mailed.)
A. If you live in Guam and are filing your petition The date of service is normally the date of the decision.
there, make it payable to Treasurer, Guam.
Do not send your appeal directly to the Administrative
B. If you live in the U.S. Virgin Islands and are filing Appeals Office (AAO). Submit an original appeal or motion
your petition there, make it payable to only. Additional copies are not required.
Commissioner of Finance of the Virgin Islands.
C. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S. Address Changes
consulate or embassy for instructions on the
method of payment. While your appeal is pending, if you change your address,
send a written notice of your change of address to the
NOTE: Please spell out U.S. Department of Homeland Administrative Appeals Office (AAO). Include the type of
Security; do not use the initials "USDHS" or "DHS." case that was denied and any available tracking number
(receipt number and/or A-number). Mail the notice to:
Notice to Those Making Payment by Check. If you send us
a check, it will be converted into an electronic funds transfer USCIS Administrative Appeals Office
(EFT). This means we will copy your check and use the U.S. Citizenship and Immigration Services
account information on it to electronically debit your account 20 Massachusetts Avenue, N.W., Room 3000
for the amount of the check. The debit from your account will Washington, DC 20529
usually take 24 hours, and will be shown on your regular If you change your address after you file a motion, where you
account statement. send your notice depends on where your motion is pending. If
You will not receive your original check back. We will your motion has been forwarded to the AAO, send a written
destroy your original check, but we will keep a copy of it. If notice of your change of address to the above address. If your
the EFT cannot be processed for technical reasons, you motion has remained with the office where you submitted it,
authorize us to process the copy in place of your original send the notice to that office. Include the type of case that was
check. If the EFT cannot be completed because of insufficient denied and any available tracking number (receipt number
funds, we may try to make the transfer up to two times. and/or A-number).

How to Check If the Fees Are Correct.


Processing Information
The form fee on this form is current as of the edition date
appearing in the lower right corner of this page. However, An appeal or motion that is not signed or is not accompanied
because USCIS fees change periodically, you can verify if the by the proper fee will be dismissed or rejected with a notice
fees are correct by following one of the steps below: that the appeal is deficient. If completed timely, you may
correct the deficiency and resubmit the appeal. However, an
1. Visit our website at www.uscis.gov, select "Immigration
appeal or motion is not considered properly filed until it is
Forms" check the appropriate fee;
accepted by USCIS.
2. Review the Fee Schedule included in your form package, if
Once the appeal or motion is accepted, it will be reviewed. If
you called us to request the form; or
you do not have any standing to file the appeal or motion, or
3. Telephone our National Customer Service Center at the decision is not appealable or filed timely, the appeal or
1-800-375-5283 and ask for the fee information. motion will be dismissed or rejected without further review.

Form I-290B (Rev. 03/04/08) N Page 3


Decision. You will be notified in writing of any action taken
on your appeal or motion. Privacy Act Notice

We ask for the information on this form, and associated


USCIS Forms and Information evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
To order USCIS forms, call our toll-free number at 1-800- right to ask for this information can be found in the
870-3676. You can also get USCIS forms and information on Immigration and Nationality Act, as amended. We may
immigration laws, regulations, and procedures by telephoning provide this information to other government agencies. Failure
our National Customer Service Center at 1-800-375-5283 or to provide this information, and any requested evidence, may
visiting our Internet website at www.uscis.gov. delay a final decision or result in denial of your Form I-290B.

As an altenative to waiting in line for assistance at your local


USCIS office, you can now schedule an appointment through
Paperwork Reduction Act
our internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment. An agency may not conduct or sponsor an information
InfoPass generates an electronic appointment notice that collection and a person is not required to respond to a
appears on the screen. collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 90 minutes per
Penalties response, including the time for reviewing instructions and
completing and submitting the form. Send comments
If you knowingly and willfully falsify or conceal a material regarding this burden estimate or any other aspect of this
fact or submit a false document with this Form I-290B, we collection of information, including suggestions for reducing
will deny the Form I-290B and may deny any other this burden, to: U.S. Citizenship and Immigration Services,
immigration benefit. Regulatory Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
In addition, you will face severe penalties provided by law and OMB No. 1615-0009. Do not mail your application to this
may be subject to criminal prosecution. address.

Form I-290B (Rev. 03/04/08) N Page 4


OMB No. 1615-0095; Expires 10/31/08

Department of Homeland Security Form I-290B, Notice


U.S. Citizenship and Immigration Services of Appeal or Motion

In the Matter of: File Number: A -

START HERE - Please Type or Print (Use black ink) For USCIS Use Only
Part 1. Information About You (Individual/Business/Organization filing Returned Receipt
appeal or motion)
Family Name Given Name Middle Name Date

Date
Name of Business/Organization (if applicable)
Resubmitted

Mailing Address - Street Number and Name Apt. # Date

C/O (in care of): Date


Reloc Sent
City State or Province Zip/Postal Code
Date

Country Daytime Phone # (Area/Country Code) Date


( ) Reloc Rec'd
Fax # (Area/Country Code) E-Mail Address (if any)
( ) Date

I am an attorney or representative. If you check this box, you must provide the
Date
following information about the person or organization for whom you are
appearing. (NOTE: You must attach a Form G-28, Notice of Entry of Appearance Remarks
as Attorney or Representative.)
Family Name Given Name Middle Name

Complete Name of Business/Organization/School (if applicable)

A # (if any) Daytime Phone # (Area/Country Code)


( )
Fax # (Area/Country Code) E-mail Address (if any)
( )

Part 2. Information About the Appeal or Motion.


Check the box below that best describes your request. (Check one box.)
A. I am filing an appeal. My brief and/or additional evidence is attached.
B. I am filing an appeal. My brief and/or additional evidence will be submitted to the AAO within 30 days.
C. I am filing an appeal. No supplemental brief and/or additional evidence will be submitted.
D. I am filing a motion to reopen a decision. My brief and/or additional evidence is attached.
E. I am filing a motion to reconsider a decision. My brief is attached.
F. I am filing a motion to reopen and a motion to reconsider a decision. My brief and/or additional evidence is attached.

Form I-290B (Rev. 03/04/08) N


In the Matter of: File Number: A -

Part 2. Information About the Appeal or Motion (Continued)


Information on the relating application/petition.
Application/Petition Form # Receipt # Date of Denial (mm/dd/yyyy) USCIS Office Where Decision Issued

Part 3. Basis for the Appeal or Motion


Motion to Reopen: The motion must state new facts and must be supported by affidavits and/or documentary evidence.
Motion to Reconsider: The motion must be supported by citations to appropriate statutes, regulations or precedent decisions.
Appeal: Provide a statement explaining any erroneous conclusion of law or fact in the decision being appealed.

Part 4. Signature of Person Filing the Appeal/Motion or His or Her Authorized Representative
Signature Signer's Printed Name Date (mm/dd/yyyy)

Make sure your appeal or motion is complete before filing.

Form I-290B (Rev. 03/04/08) N Page 2


OMB No. 1615-0020; Expires 10/31/08

Department of Homeland Security


Instructions for Form I-360, Petition for
U.S. Citizenship and Immigration Services Amerasian, Widow(er), or Special Immigrant
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper and
indicate the part and number of the item to which the answer refers.
The filing addresses provided on this form reflect the most current information as of the date this form was last printed. If you are
filing Form I-360 more than 30 days after the latest edition date shown in the lower right-hand corner, please visit our website at
www.uscis.gov before you file, and check the Immigration Forms page to confirm the correct filing address and version currently in
use. Check the edition date located in the lower right-hand corner of the form. If the edition date on your Form I-360 matches the
edition date listed for Form I-360 on the online Immigration Forms page, your version is current and will be accepted by USCIS. If the
edition date on the online version is later, download a copy and use the online version. If you do not have Internet access, call the
National Customer Service Center at 1-800-375-5283 to verify the current filing address and edition date. Improperly filed forms
will be rejected, and the fee returned, with instructions to resubmit the entire filing using the current form instructions.

The petition must be filed with:


What Is the Purpose of This Form? 1. Copies of evidence showing that the person who is subject
of this petition was born in one of the above countries
This petition is used to classify an alien as: between those dates. If he or she was born in Vietnam, you
1. An Amerasian; must also submit a copy of his or her Vietnamese
identification card, or an affidavit explaining why it is not
2. A Widow or Widower; available;
3. A Battered or Abused Spouse or Child of a U.S. Citizen or 2. Copies of evidence establishing the parentage of the
Lawful Permanent Resident; or person, and that the biological father was a U.S. citizen.
Examples of documents that may be submitted are: birth or
4. A special immigrant is defined as one of the following; baptismal records or other religious documents; local civil
A. Religious Worker; records; an affidavit, correspondence, or evidence of
financial support from the father; photographs of the father
B. Panama Canal Company Employee, Canal Zone (especially with the child); or, absent other documents,
Government Employee, U.S. Government in the Canal affidavits from knowledgeable witnesses that detail the
Zone Employee; parentage of the child and how they know such facts;
C. Physician;
D. International Organization Employee or Family 3. A photograph of the person;
Member; 4. If the person is married, submit a copy of the marriage
E. Juvenile Court Dependent; certificate, and proof of the termination of any prior
marriages;
F. Armed Forces Member; or The sponsorship documents noted below are also required.
G. Afghanistan or Iraq national who supported the U.S. You may file these documents with the petition or wait until
Armed Forces as a translator. USCIS reviews the petition and requests them. However, not
filing them with the petition will add to the overall processing
time.
Who May File This Form I-360? 1. An Affidavit of Financial Support executed by the sponsor
with the evidence of financial ability required by that form.
Please note that the original sponsor remains financially
Amerasian responsible for the Amerasian if any subsequent sponsor
Any person who is 18 or older, including the alien, or a U.S. fails in this area;
corporation may file this petition for a beneficiary who was
2. Copies of evidence showing that the sponsor is at least 21
born in Korea, Vietnam, Laos, Kampuchea, or Thailand after
years old and is a U.S. citizen or permanent resident;
December 31, 1950, and before October 22, 1982, and was
fathered by a U.S. citizen. 3. Fingerprints of the sponsor taken by USCIS as part of the
required biometric services,

Form I-360 Instructions (Rev. 10/15/07)Y


Widow/Widower of a U.S. Citizen Special Immigrant Religious Worker
You may file this petition for yourself if: Any person, including the alien, may file this petition for an
alien who for the past two years has been a member of a
1. You were married for at least two years to a U.S. citizen
religious denomination which has a bona fide nonprofit,
who is now deceased and who was a U.S. citizen at the
religious organization in the United States, and who has been
time of death;
carrying on the vocation, professional work, or other work
2. Your citizen spouse's death was less than two years ago; described below, continuously for the past two years; and
seeks to enter the United States to work solely:
3. You were not legally separated from your citizen spouse at
the time of death; and 1. As a minister of that denomination; or in a professional
capacity in a religious vocation or occupation for that
4. You have not remarried.
organization; or
The petition must be filed with: 2. In a religious vocation or occupation for the organization or
1. A copy of your marriage certificate to the U.S. citizen and its nonprofit affiliate.
proof of termination of any prior marriages of either of
NOTE: All special immigrant religious workers, other than
you;
ministers, immigrating to the United States as special
2. Copies of evidence that your spouse was a U.S. citizen, immigrant religious workers must immigrate (i.e., enter the
such as a birth certificate if born in the United States, United States) or adjust status to permanent residence (i.e.,
Naturalization Certificate or Certificate of Citizenship have their Form I-360 and Form I-485 approved) before
issued by USCIS; Form FS-240, Report of Birth Abroad of October 1, 2008.
a Citizen of the United States; or a U.S. passport which was
valid at the time of the citizen's death; and The petition must be filed with:
3. A copy of the death certificate of your U.S. citizen spouse. 1. A letter from the authorized official of the religious
organization establishing that the proposed services and
Special Immigrant Juvenile alien qualify as above;

Any person, including the alien, may file this petition for an 2. A letter from the authorized official of the religious
alien who: organization attesting to the alien's membership in the
religious denomination and explaining, in detail, the
1. Is unmarried and less than 21 years old; person's religious work and all employment during the past
2. Has been declared dependent upon a juvenile court in the two years and the proposed employment; and
United States, or who such a court has legally committed
3. Evidence establishing that the religious organization, and
to, or placed under the custody of an agency or department
any affiliate which will employ the person, is a bona fide
of a State, and who has been found eligible for long-term
nonprofit religious organization in the United States that is
foster care; and
exempt from taxation under section 501(c)(3) of the
3. Has been the subject of administrative or judicial Internal Revenue Code of 1986.
proceedings in which it was determined that it would not
be in the juvenile's best interests to be returned to the Special immigrant based on employment with the
juvenile's or his or her parent's country of nationality or last Panama Canal Company, Canal Zone Government
habitual residence. or U.S. Government in the Canal Zone
The petition must be filed with: Any person may file this petition for an alien who, at the time
1. A copy of the juvenile's birth certificate or other evidence the Panama Canal Treaty of 1977 entered into force, either:
of his or her age; 1. Was resident in the Canal Zone and had been employed by
2. Copies of the court or administrative document(s) upon the Panama Canal Company, or Canal Zone Government
which the claim to eligibility is based. for at least one year; or

NOTE: After a special immigrant juvenile becomes a 2. Was a Panamanian national and either honorably retired
permanent resident, his or her parent(s) may not receive any from U.S. Government employment in the Canal Zone with
immigration benefit based on the relationship to the juvenile. a total of 15 or more years of faithful service; or

Form I-360 Instructions (Rev. 10/15/07)Y Page 2


3. Was employed for 15 years and since honorably retired; or The petition must be filed with:
was an employee of the Panama Canal Company or Canal
Zone Government, had performed faithful service for five 1. A letter from the international organization demonstrating
years or more as an employee, and whose personal safety, that it is a qualifying organization and explaining the
or the personal safety of his or her spouse or child, is in circumstances of qualifying employment and the
danger as a direct result of the special nature of his or her immigration status held by the person the petition is for;
employment and as a direct result of the Treaty. and
2. Copies of evidence documenting the relationship between
The petition must be filed with: the person this petition is for and the employee.
1. A letter from the Panama Canal Company, Canal Zone
Government, or U.S. Government agency employing the Armed Forces Member
person in the Canal Zone, indicating the length and You may file this petition for yourself if:
circumstances of employment and any retirement or
termination; and 1. You have served honorably on active duty in the U.S.
Armed Forces after October 15, 1978;
2. Copies of evidence to establish any claim of danger to
personal safety. 2. You originally lawfully enlisted outside the United States
under a treaty or agreement in effect on October 1, 1991,
Special Immigrant Physician for a period or periods aggregating:
Any person may file this petition for an alien who: A. Twelve years, and were never separated from such
service except under honorable conditions; or
1. Graduated from a medical school or qualified to practice
medicine in a foreign state; B. Six years, are now on active duty, and have reenlisted
to incur a total active duty service obligation of at least
2. Was fully and permanently licensed to practice medicine in 12 years;
a State of the United States on January 9, 1978, and was
practicing medicine in a State on that date; 3. You are a national of an independent state which maintains
a treaty or agreement allowing nationals of that state to
3. Entered the United States as an "H" or "J" nonimmigrant enlist in the U.S. Armed Forces each year; and
before January 9, 1978; and
4. The executive department under which you have served or
4. Has been continuously present in the United States and are serving has recommended you for this special
continuously engaged in the practice or study of medicine immigrant status.
since the date of such entry.
The petition must be filed with:
The petition must be filed with:
1. Certified proof issued by the authorizing official of the
1. Letters from the person's employers, detailing his or her executive department in which you are serving or have
employment since January 8, 1978, including the current served which certifies that you have the required honorable
employment; and active duty service and/or commitment; and
2. Copies of relevant documents that demonstrate that the 2. Your birth certificate.
person filed for meets all the above criteria.
Afghanistan or Iraq National Supporting
Special Immigrant International Organization U.S. Armed Forces as a Translator
Employee or family member
You may file this petition for yourself if:
Certain long-term "G" and "N" nonimmigrant employees of a
qualifying international organization entitled to enjoy 1. You are a national of Afghanistan or Iraq;
privileges, exemptions, and immunities under the International
2. You worked directly with the U.S. Armed Forces as a
Organizations Immunities Act, and certain relatives of such an
translator for a period of at least 12 months;
employee, may be eligible to apply for classification as a
Special Immigrant. To determine eligibility, contact the 3. You have obtained a favorable written recommendation
qualifying international organization or your local USCIS from a general or flag officer in the chain of command of
office. the U.S. Armed Forces unit that you supported; and

Form I-360 Instructions (Rev. 10/15/07)Y Page 3


4. Before filing this petition, you were cleared by a B. Your citizen or lawful permanent resident parent while
background check and screening, as determined by a residing with that parent;
general or flag officer in the chain of command of the U.S.
5. Are a person of good moral character;
Armed Forces unit that you supported.
6. Are a person whose removal or deportation would result in
The petition must be filed with: extreme hardship to yourself, or to your child if you are a
spouse; and if you
1. A copy of your passport or birth certificate, showing that
you are a national of Afghanistan or Iraq; 7. Are a spouse who entered into the marriage to the citizen
or lawful permanent resident abuser in good faith.
2. A favorable written recommendation from a general or flag
officer in the chain of command of the U.S. Armed Forces NOTE: Divorce or other legal termination of the marriage to
unit that you supported; the abuser after the self-petition is properly filed with USCIS
will not be the sole basis for denial or revocation of an
3. Documentation establishing that you have worked as a approved self-petition. If you remarry before you become a
translator directly for the U.S. Armed Forces for a period of lawful permanent resident, however, your self-petition will be
at least 12 months; denied or the approval revoked.
4. Evidence of having cleared a background check and Your self-petition may be filed with any credible relevant
screening by the U.S. Armed Forces. This can be in the evidence of eligibility. The determination of what evidence is
form of a written letter attesting to the clearance signed by credible and the weight to be given that evidence is within the
a member of the U.S. Armed Forces unit that you sole discretion of USCIS; therefore, you are encouraged to
supported; and provide the following documentation:
5. A properly signed Form I-360 in Part 9, Signature, by the 1. Evidence of the abuser's U.S. citizenship or lawful
petitioner. permanent resident status;
2. Marriage and divorce decrees, birth certificates, or other
If you are physically present in the United States, you must
evidence of your legal relationship to the abuser;
also submit a copy of the front and back of your Form I-94,
Arrival/Departure Document. This is the document you 3. One or more documents showing that you and the abuser
received upon arrival in the United States. have resided together in the United States in the past, such
as employment records, utility receipts, school records,
Self-Petitioning Battered or Abused Spouse or Child hospital or medical records, birth certificates of children,
of a U.S. Citizen or Lawful Permanent Resident mortgages, rental records, insurance policies, or affidavits;

You may self-petition for immediate relative or family- 4. One or more documents showing that you are now residing
sponsored immigrant classification if you: in the United States, such as the documents listed above;

1. Are now the spouse or child of an abusive U.S. citizen or 5. Evidence of the abuse, such as reports and affidavits from
lawful permanent resident; police, judges, and other court officials, medical personnel,
school officials, clergy, social workers, and other social
2. Are eligible for immigrant classification based on that service agency personnel. If you have an order of
relationship; protection, or have taken other legal steps to end the abuse,
you should submit copies of those court documents;
3. Are now residing in the United States or have resided in the
United States with the U.S. citizen or lawful permanent 6. If you are more than 14 years of age, your affidavit of good
resident abuser in the past; moral character accompanied by a local police clearance,
state-issued criminal background check, or similar report
4. Have been battered by or have been the subject of extreme from each locality or state in the United States or abroad in
cruelty perpetrated by: which you have resided for six or more months during the
three-year period immediately preceding the filing of your
A. Your U.S. citizen or lawful permanent resident spouse
self-petition;
during the marriage, or are the parent of a child who
has been battered by or has been the subject of extreme 7. Affidavits, birth certificates of children, medical reports,
cruelty perpetrated by your abusive citizen or lawful and other relevant credible evidence of the extreme
permanent resident spouse during your marriage; hardship that would result if you were to be removed or
deported; and

Form I-360 Instructions (Rev. 10/15/07)Y Page 4


8. If you are a spouse, proof that one spouse has been listed Copies. Unless specifically required that an original
as the other's spouse on insurance policies, property leases, document be filed with an application or petition, an ordinary
income tax forms, or bank accounts; and testimony or legible photocopy may be submitted. Original documents
other evidence regarding your courtship, wedding submitted when not required will remain a part of the record,
ceremony, shared residence, and experiences showing that even if the submission was not required.
your marriage was entered in good faith.
NOTE: A self-petitioning battered or abused spouse or child
of a U.S. citizen or lawful permanent resident may submit any
Where To File?
relevant credible evidence in place of the suggested evidence.
Where the Form I-360 is submitted depends on where you live
Public Service Information and/or the catagory you are filing under. See the following
instructions to determine where to file the petition. For
The National Domestic Violence Hotline provides
Service Center and Lockbox mailing addresses, go to
information, crisis intervention, and referrals to local service
"Mailing Addresses" at the end of this section.
providers, including legal assistance organizations, to victims
of domestic violence or anyone calling on their behalf at
1-800-799-7233 or TDD at 1-800-787-3244 TTD. Amerasian
The hotline services are available 24 hours a day, seven (7) 1. If the beneficiary lives outside the United States, Form
days a week, toll-free from anywhere in the United States, I-360 may be filed at the USCIS office overseas or at the
Puerto Rico, or the U.S. Virgin Islands. The staff and U.S. Embassy or consulate having jurisdiction over the
volunteers speak both English and Spanish and have access to beneficiary's current place of residence.
translators in 139 languages.
2. Form I-360 may also be filed at the USCIS office having
jurisdiction over the beneficiary's intended place of
residence in the United States by submitting this petition to
General Instructions
the USCIS Lockbox.

Step 1. Fill Out Form I-360 Widow or Widower


1. Type or print legibly in black ink. 1. If you are filing only Form I-360, it must be filed at the
2. If extra space is needed to complete any item, attach a Vermont Service Center.
continuation sheet, indicate the item number, and date and
2. Form I-360 may also be filed concurrently with Form
sign each sheet.
I-485. Concurrent Form I-360/I-485 widow/widower
3. Answer all questions fully and accurately. State that an filings must be filed with the USCIS Lockbox.
item is not applicable with "N/A." If the answer is none,
write "none." 3. If you live outside the United States, you may file Form
I-360 at the USCIS office or U.S. Embassy or consulate
4. Every petition must be properly signed, and accompanied that has jurisdiction over the area where you live.
by the proper fee. If you are under 14 years of age, your
parent or guardian may sign the petition. Special Immigrant Juvenile Court Dependent

Step 2. General requirements Form I-360 may be filed alone or concurrently with Form
I-485 at the USCIS Lockbox.
Translations. Any document containing foreign language
submitted to USCIS shall be accompanied by a full English Religious Worker or Minister
language translation which the translator has certified as
complete and accurate, and by the translator's certification that Form I-360 must be filed at the California Service Center,
he or she is competent to translate from the foreign language regardless of where you live or work. It cannot be filed
into English. concurrently with Form I-485.

Form I-360 Instructions (Rev. 10/15/07)Y Page 5


Special Immigrant International Organization Louisiana, Maine, Maryland, Massachusetts, Mississippi,
Employee or Family Member New Hampshire, New Jersey, New Mexico, New York,
North Carolina, South Carolina, Oklahoma, Pennsylvania,
Form I-360 must be filed with the Nebraska Service Center, Puerto Rico, Rhode Island, Tennessee, Texas, Vermont,
regardless of where you live. It may be filed alone or Virginia, U.S. Virgin Islands, or West Virginia, file this
concurrently with Form I-485. petition with the Vermont Service Center.

Armed Forces Member If you live in Alaska, Arizona, California, Colorado,


Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,
1. If you live outside the United States, file Form I-360 at the Michigan, Minnesota, Missouri, Montana, Nebraska,
USCIS office or U.S. Embassy or consulate abroad that has Nevada, North Dakota, Ohio, Oregon, South Dakota, Utah,
jurisdiction over the area where you live. Washington, Wisconsin, or Wyoming, file this petition
2. If you live in the United States, file Form I-360 with the with the California Service Center.
Vermont or California Service Center depending on the
place where you live, or you may file it concurrently with
Form I-485 at the USCIS Lockbox.
Mailing Addresses

Afghan and Iraqi Translators Service Center Addresses:


Form I-360 must be filed at the Nebraska Service Center, California Service Center:
regardless of where you live. It cannot be filed concurrently
with Form I-485. USCIS
California Service Center
International Broadcasters P.O. Box 10360
Laguna Niguel, CA 92607-0360
Form I-360 must be filed at the Vermont Service Center,
regardless of where you live or work. It cannot be filed
concurrently with Form I-485. Nebraska Service Center
USCIS
Self-Petitioning Battered or Abused Spouse or Child Nebraska Service Center
Form I-360 must be filed at the Vermont Service Center, P.O. Box 87360
regardless of where you live. In some cases it may be filed Lincoln, NE 68501-7360
concurrently with Form I-485 (see note below).
Vermont Service Center
NOTE: Form I-485 may be filed concurrently with Form
I-360 if the abusive spouse or parent is a U.S. citizen. USCIS
Otherwise, an immigrant visa number must be immediately Vermont Service Center
available to file the I-485 concurrently. 75 Lower Welden Street
St. Albans, VT 05479-0001
For other categories including:
USCIS Lockbox Addresses
1. Panama Canal Company Employment;
USCIS
2. Canal Zone Government Employment;
P.O. Box 805887
3. U.S. Government in Canal Zone Employment; or Chicago, IL 60680-4120

4. Special Immigrant Physician.

File Form I-360 with the California Service Center or the


Vermont Service Center, depending on where you live:
If you live in Alabama, Arkansas, Connecticut, Delaware,
the District of Columbia, Florida, Georgia, Kentucky,

Form I-360 Instructions (Rev. 10/15/07)Y Page 6


How to Check If the Fees Are Correct
What Is the Filing Fee?
The form and biometric fees on this form are current as of the
edition date appearing in the lower right corner of this page.
The filing fee for Form I-360 is $375, except there is no fee if
However, because USCIS fees change periodically, you can
filing for an Amerasian, a Special Immigrant Juvenile or as a
verify if the fees are correct by following one of the steps
self-petitioning battered or abused spouse, parent, or child of a
below:
U.S. citizen, or lawful permanent resident.
1. Visit our website at www.uscis.gov, select
An additional biometric fee of $80 is required when filing this
"Immigration Forms," and check the appropriate fee;
Form I-360 on behalf of an Amerasian. After you submit
Form I-360, USCIS will notify you about when and where you 2. Review the Fee Schedule included in your form
will need to go for biometric services. package, if you called us to request the form, or
You may submit one check or money order for both the 3. Telephone our National Customer Service Center at
application and biometric fees, for a total of $455. 1-800-375-5283 and ask for the fee information.

Use the following guidelines when you prepare your check or NOTE: If your Form I-360 requires payment of a biometric
money order for Form I-360, and the biometric service fee if service fee for USCIS to take your fingerprints, photograph, or
applicable: signature, you can use the same procedure to obtain the correct
biometric fee.
1. The check or money order must be drawn on a bank or
other financial institution located in the United States, and
must be payable in U.S. currency; and Address Changes
2. Make the check or money order payable to U.S.
Department of Homeland Security, unless: If you change your address and you have an application or
petition pending with USCIS, you may change your address
A. If you live in Guam and are filing your petition online at www.uscis.gov, click on "Change your address with
there, make it payable to Treasurer, Guam. USCIS," and follow the prompts. Or you may complete and
mail Form AR-11, Alien's Change of Address Card, to:
B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to U.S. Citizenship and Immigration Services
Commissioner of Finance of the Virgin Islands. Change of Address
P.O. Box 7134
NOTE: Please spell out U.S. Department of Homeland London, KY 40742-7134
Security; do not use the initials "USDHS" or "DHS."
For commercial overnight or fast freight services only, mail to:
Notice to Those Making Payment by Check. If you send us
a check, it will be converted into an electronic funds transfer U.S. Citizenship and Immigration Services
(EFT). This means we will copy your check and use the Change of Address
account information on it to electronically debit your account 1084-I South Laurel Road
for the amount of the check. The debit from your account will London, KY 40744
usually take 24 hours and will be shown on your regular
account statement.

You will not receive your original check back. We will Processing Information
destroy your original check, but we will keep a copy of it. If
the EFT cannot be processed for technical reasons, you Any Form I-360 that is not signed or accompanied by the
authorize us to process the copy in place of your original correct fee will be rejected with a notice that Form I-360 is
check. If the EFT cannot be completed because of deficient. You may correct the deficiency and resubmit the
insufficient funds, we may try to make the transfer up to two Form I-360. An application or petition is not considered
times. properly filed until accepted by USCIS.

Form I-360 Instructions (Rev. 10/15/07)Y Page 7


Initial processing. Once a Form I-360 has been accepted, it
will be checked for completeness, including submission of the Penalties
required initial evidence. If you do not completely fill out the
form, or file it without required initial evidence, you will not If you knowingly and willfully falsify or conceal a material
establish a basis for eligibility, and we may deny your petition. fact or submit a false document with this Form I-360, we will
deny Form I-360 and may deny any other immigration benefit.

Requests for more information or interview. We may


request more information or evidence, or we may request that In addition, you will face severe penalties provided by law and
you appear at a USCIS office for an interview. We may also may be subject to criminal prosecution.
request that you submit the originals of any copy. We will
return these originals when they are no longer required.
Privacy Act Notice
Decision. If you establish that the person this petition is for
We ask for the information on this form, and associated
is eligible for the requested classification, we will approve the
evidence, to determine if you have established eligibility for
petition. We will send it to the U.S. Embassy or consulate for
the immigration benefit for which you are filing. Our legal
visa issuance, unless he or she is in the United States and
right to ask for this information can be found in the
appears eligible and intends to apply for adjustment to
Immigration and Nationality Act, as amended. We may
permanent resident status while here. If you do not establish
provide this information to other government agencies. Failure
eligibility, we will deny the petition. We will notify you in
to provide this information, and any requested evidence, may
writing of our decision.
delay a final decision or result in denial of your Form I-360.

USCIS Forms and Information


Paperwork Reduction Act
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and An agency may not conduct or sponsor an information
information on immigration laws, regulations, and procedures collection and a person is not required to respond to a
by telephoning our National Customer Service Center at collection of information unless it displays a currently valid
1-800-375-5283 or visiting our Internet website at www.uscis. OMB control number. The public reporting burden for this
gov. collection of information is estimated at 2 hours per response,
including the time for reviewing instructions, completing and
As an altenative to waiting in line for assistance at a USCIS submitting the form. Send comments regarding this burden
office, you can now schedule an appointment through our estimate or any other aspect of this collection of information,
Internet-based system. To access the system, visit our including suggestions for reducing this burden, to: U.S.
website. Use the InfoPass appointment scheduler and follow Citizenship and Immigration Services, Regulatory
the screen prompts to set up your appointment. InfoPass Management Division, 111 Massachusetts Avenue, N.W., 3rd
generates an electronic appointment notice that appears on the Floor, Suite 3008, Washington, DC 20529. OMB No.
screen. 1615-0020. Do not mail your application to this address.

Form I-360 Instructions (Rev. 10/15/07)Y Page 8


OMB No. 1615-0020; Expires 10/31/08

Department of Homeland Security I-360, Petition for Amerasian,


U.S. Citizenship and Immigration Services Widow(er), or Special Immigrant

START HERE - Please type or print in black ink For USCIS Use Only
Part 1. Information about person or organization filing this Returned Receipt
petition. (Individuals should use the top name line; organizations should
use the second line.) If you are a self-petitioning spouse or child and do not
want USCIS to send notices about this petition to your home, you may
show an alternate mailing address here. If you are filing for yourself and do
not want to use an alternate mailing address, skip to Part 2. Resubmitted

Family Name Given Name Middle Name

Company or Organization
Name Reloc Sent
Address - C/O

Street Number Apt.


and Name #
State or Reloc Rec'd
City
Province
Country Zip/Postal
Code
U.S. Social A# IRS Tax # Petitioner/
Security # (if any) Applicant
Interviewed
Part 2. Classification Requested (check one):
Beneficiary
a. Amerasian Interviewed
b. Widow(er) of a U.S. citizen who died within the past two (2) years
I-485 Filed Concurrently
c. Special Immigrant Juvenile
Bene "A" File Reviewed
d. Special Immigrant Religious Worker
e. Special Immigrant based on employment with the Panama Canal Company, Canal Classification
Zone Government or U.S. Government in the Canal Zone
f. Special Immigrant Physician Consulate
g. Special Immigrant International Organization Employee or family member
h. Special Immigrant Armed Forces Member Priority Date
i. Self-Petitioning Spouse of Abusive U.S. Citizen or Lawful Permanent Resident
j. Self-Petitioning Child of Abusive U.S. Citizen or Lawful Permanent Resident Remarks:
k. Other, explain:

Part 3. Information about the person this petition is for


Family Name Given Name Middle Name Action Block

Address - C/O

Street Number Apt.


and Name #
City State or
Province
Country Zip/Postal
Code
Date of Birth Country of To Be Completed by
(mm/dd/yyyy) Birth
Attorney or Representative, if any
U.S. Social A# Fill in box if G-28 is attached to
Security # (if any)
represent the applicant
Marital Status: Single Married Divorced Widowed
Complete the items below if this person is in the United States: VOLAG#
Date of Arrival I-94#
(mm/dd/yyyy) ATTY State License #
Current Nonimmigrant Expires on
Status (mm/dd/yyyy)
Form I-360 (Rev. 10/15/07)Y
Part 4. Processing Information
Below give information on U.S. consulate you want notified if this petition is approved and if any requested adjustment of status cannot be granted.
American Consulate: City Country

If you gave a United States address in Part 3, print the person's foreign address below. If his or her native alphabet does not use Roman letters, print
his or her name and foreign address in the native alphabet.
Name Address

Gender of the person this petition is for Male Female


Are you filing any other petitions or applications with this one? No Yes (How many? )
Is the person this petition is for in deportation or removal proceedings? No Yes (Explain on a separate sheet of paper)
Has the person this petition is for ever worked in the U.S. without permission? No Yes (Explain on a separate sheet of paper)
Is an application for adjustment of status attached to this petition? No Yes

Part 5. Complete only if filing for an Amerasian


Section A. Information about the mother of the Amerasian
Family Name Given Name Middle Name

Living? No (Give date of death ) Yes (complete address line below) Unknown (attach a full explanation)
Address

Section B. Information about the father of the Amerasian: If possible, attach a notarized statement from the father regarding parentage.
Explain on separate paper any question you cannot fully answer in the space provided on this form.
Family Name Given Name Middle Name

Date of Birth Country of


(mm/dd/yyyy) Birth
Living? No (Give date of death ) Yes (complete address line below) Unknown (attach a full explanation)
Home Address

Home Work
Phone # ( ) Phone # ( )
At the time the Amerasian was conceived:
The father was in the military (indicate branch of service below and give service number here):

Army Air Force Navy Marine Corps Coast Guard


The father was a civilian employed abroad. Attach a list of names and addresses of organizations which employed him at that time.
The father was not in the military, and was not a civilian employed abroad. (Attach a full explanation of the circumstances.)

Part 6. Complete only if filing for a Special Immigrant Juvenile Court Dependent
Section A. Information about the Juvenile
List any other
names used.

Answer the following questions regarding the person this petition is for. If you answer "No," explain on a separate sheet of paper.

Is he or she still dependent upon the juvenile court or still legally committed to or under the custody of an agency
or department of a state? No Yes
Does he or she continue to be eligible for long-term foster care? No Yes

Form I-360 (Rev. 10/15/07)Y Page 2


Part 7. Complete only if filing as a Widow/Widower, a Self-petitioning Spouse of an Abuser,
or as a Self-petitioning Child of an Abuser
Section A. Information about the U.S. citizen husband or wife who died or about the U.S. citizen or lawful permanent resident abuser
Family Name Given Name Middle Name

Date of Birth Country of Date of Death


(mm/dd/yyyy) Birth (mm/dd/yyyy)
He or she is now, or was at time of death a (check one): U.S. citizen through naturalization (Show A #)

U.S. citizen born in the United States. U.S. lawful permanent resident (Show A #)

U.S. citizen born abroad to U.S. citizen parents. Other, explain

Section B. Additional Information about you.


How many times How many times was the person in Give the date and place where you and the person in Section A
have you been married? Section A married? were married. (If you are a self-petitioning child, write: "N/A")

When did you live with the person named in Section A? From (Month/Year) until (Month/Year)

If you are filing as a widow/widower, were you legally separated at the time of the U.S citizens's death? No Yes, (attach explanation).
Give the last address at which you lived together with the person named in Section A, and show the last date that you lived together with that
person at that address:

If you are filing as a self-petitioning spouse, have any of your children filed separate self-petitions? No Yes (show child(ren)'s full names):

Part 8. Information about the spouse and children of the person this petition is for
A widow/widower or a self-petitioning spouse of an abusive citizen or lawful permanent resident should also list the children of the deceased spouse
or of the abuser.
A. Family Name Given Name Middle Name Date of Birth
(mm/dd/yyyy)
Country of Birth Relationship Spouse A#
Child
B. Family Name Given Name Middle Name Date of Birth
(mm/dd/yyyy)
Country of Birth Relationship A#
Child
C. Family Name Given Name Middle Name Date of Birth
(mm/dd/yyyy)
Country of Birth Relationship A#
Child

D. Family Name Given Name Middle Name Date of Birth


(mm/dd/yyyy)
Country of Birth Relationship A#
Child

E. Family Name Given Name Middle Name Date of Birth


(mm/dd/yyyy)
Country of Birth Relationship A#
Child

Form I-360 (Rev. 10/15/07)Y Page 3


Part 8. Information about the spouse and children of the person this petition is for (Continued)
F. Family Name Given Name Middle Name Date of Birth
(mm/dd/yyyy)
Country of Birth Relationship A#
Child
G. Family Name Given Name Middle Name Date of Birth
(mm/dd/yyyy)
Country of Birth Relationship A#
Child

H. Family Name Given Name Middle Name Date of Birth


(mm/dd/yyyy)
Country of Birth Relationship A#
Child

Read the information on penalties in the instructions before completing this part. If you are going to file this petition at
Part 9. Signature a USCIS office in the United States, sign below. If you are going to file it at a U.S. consulate or USCIS office overseas,
sign in front of a USCIS or consular official.

I certify, or, if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America, that this petition
and the evidence submitted with it is all true and correct. If filing this on behalf at an organization, I certify that I am empowered to do so by that
organization. I authorize the release of any information from my records, or from the petitioning organization's records, that U.S. Citizenship and
Immigration Services needs to determine eligibility for the benefit being sought.
Signature Date

Signature of USCIS Print Name Date


or Consular Official

NOTE: If you do not completely fill out this petition or fail to submit required documents listed in the instructions, the person(s) filed for may not
be found eligible for a requested benefit and the petition may be denied.

Part 10. Signature of person preparing form, if other than above (Sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature Print Your Name Date

Firm Name
and Address

Form I-360 (Rev. 10/15/07)Y Page 4


OMB No. 1615-0023; Expires 09/30/08

Department of Homeland Security


Instructions for I-485, Application to Register
U.S. Citizenship and Immigration Services Permanent Residence or Adjust Status

Updated filing Address Information


The filing addresses provided on this form reflect the most current information as of the date this form was last printed. If you are
filing Form I-485 more than 30 days after the latest edition date shown in the lower right-hand corner, please visit our website at
www.uscis.gov before you file, and check the Forms and Fees page to confirm the correct filing address and version currently in use.
Check the edition date located at the lower right-hand corner of the form. If the edition date on your Form I-485 matches the edition
date listed for Form I-485 on the online Forms and Fees page, your version is current and will be accepted by USCIS. If the edition
date on the online version is later, download a copy and use the online version. If you do not have Internet access, call the National
Customer Service Center at 1-800-375-5283 to verify the current filing address and edition date. Improperly filed forms will be
rejected, and the fee returned with instructions to resubmit the entire filing using the current form instructions.

B. If the spouse or child is residing abroad, the person


What Is the Purpose of This Form? adjusting status in the United States should file the
Form I-824, Application for Action on an
This form is used by a person who is in the United States to Approved Application or Petition, concurrently
apply to U.S. Citizenship and Immigration Services (USCIS) with the principal's adjustment of status application to
to adjust to permanent resident status or register for permanent allow the derivatives to immigrate to the United
residence. States without delay if the principal's adjustment-of-
status application is approved. The fee submitted
This form may also be used by certain Cuban nationals to
with the Form I-824 will not be refunded if the
request a change in the date that their permanent residence
principal's adjustment is not granted.
began.
3. Based on admission as the fiancé(e) of a U.S.
Who May File This Form I-485? citizen and subsequent marriage to that citizen.
A. You may apply to adjust status if you were admitted to
1. Based on an immigrant petition.
the United States as the K-1 fiancé(e) of a U.S. citizen
You may apply to adjust your status if: and you married that citizen within 90 days of your
entry.
A. An immigrant visa number is immediately available to
you based on an approved immigrant petition; or B. If you were admitted as the K-2 child of such a
fiancé(e), you may apply to adjust status based on
B. You are filing this application with a completed your parent's adjustment application.
relative petition, special immigrant juvenile petition,
or special immigrant military petition which, if 4. Based on asylum status.
approved, would make an immigrant visa number
immediately available to you. You may apply to adjust status after you have been
granted asylum in the United States if you have been
2. Based on being the spouse or child (derivative) - physically present in the United States for one year after
at the time another adjustment applicant the grant of asylum, provided you still qualify as an
(principal) files to adjust status or at the time a asylee or as the spouse or child of a refugee.
person is granted permanent resident status in an 5. Based on refugee status.
immigrant category that allows derivative status
for spouses and children. You may apply to adjust status after you have been
admitted as a refugee and have been physically present in
A. If the spouse or child is in the United States, the the United States for one year following your admission,
individual derivatives may file their Form I-485 provided that your status has not been terminated.
adjustment-of-status applications concurrently with
6. Based on Cuban citizenship or nationality.
the Form I-485 for the principal applicant, or file the
Form I-485 at anytime after the principal is approved, You may apply to adjust status if:
if a visa number is available.
A. You are a native or citizen of Cuba, were admitted or
paroled into the United States after January 1, 1959,
and thereafter have been physically present in the
United States for at least one year; or

Form I-485 Instructions (Rev. 05/27/08)Y


B. You are the spouse or unmarried child of a Cuban 1. An immediate relative of a U.S. citizen (parent,
described above and regardless of your nationality, spouse, widow, widower, or unmarried child under
you were admitted or paroled after January 1, 1959, 21 years old);
and thereafter have been physically present in the
United States for at least one year. 2. A K-1 fiancé(e) or a K-2 fiancé(e) dependent who
married the U.S. petitioner within 90 days of
7. Applying to change the date on which your admission; or
permanent residence began.
3. An H or I nonimmigrant or special immigrant
If you were granted permanent residence in the United (foreign medical graduates, international
States prior to November 6, 1966, and are a native or organization employees, or their derivative family
citizen of Cuba, or you are the spouse or unmarried child members);
of such an individual, you may ask to change the date your 7. You were admitted as a K-1 fiancé(e), but did not marry
lawful permanent residence began to your date of arrival in the U.S. citizen who filed the petition for you, or you
the United States or May 2, 1964, whichever is later. were admitted as the K-2 child of a fiancé(e) and your
parent did not marry the U.S. citizen who filed the
8. Based on continuous residence since
petition;
before January 1, 1972.
8. You are or were a J-1 or J-2 exchange visitor and are
You may apply for permanent residence if you have subject to the two-year foreign residence requirement and
continuously resided in the United States since before you have not complied with or been granted a waiver of
January 1, 1972. This is known as "Registry." the requirement;

9. Other basis of eligibility. 9. You have A, E, or G nonimmigrant status or have an


occupation that would allow you to have this status,
If you are not included in the above categories, but believe unless you complete Form I-508 (I-508F for French
you may be eligible for adjustment or creation of record of nationals) to waive diplomatic rights, privileges, and
permanent residence, contact our National Customer immunities and, if you are an A or G nonimmigrant,
Service Center at 1-800-375-5283 for information on how unless you submit a completed Form I-566;
to use the Internet to make an application at your local
USCIS office. 10. You were admitted to Guam as a visitor under the Guam
visa waiver program;
10. Who Is Not Eligible to Adjust Status.
11. You were admitted to the United States as a visitor under
Unless you are applying for creation of record based on the Visa Waiver Program, unless you are applying
continuous residence since before January 1, 1972, or because you are an immediate relative of a U.S. citizen
adjustment of status under a category in which special (parent, spouse, widow, widower, or unmarried child
rules apply (such as 245(i) adjustment, asylum under 21 years old); or
adjustment, Cuban adjustment, special immigrant juvenile
12. You are already a conditional permanent resident.
adjustment, or special immigrant military personnel
adjustment), you are not eligible for adjustment of
status if any of the following apply to you: General Instructions
A. You entered the United States in transit without a visa;
Fill Out Form I-485
B. You entered the United States as a nonimmigrant
crewman; 1. Type or print legibly in black ink.
C. You were not admitted or paroled following inspection 2. If extra space is needed to complete any item, attach a
by an immigration officer; continuation sheet, indicate the item number, and date and
sign each sheet.
D. Your authorized stay expired before you filed this
application; 3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
E. You were employed in the United States without
write "none."
USCIS authorization prior to filing this application;
4. You must file your application with the required Initial
F. You failed to maintain your nonimmigrant status, Evidence described below. Your application must be
other than through no fault of your own or for properly signed and filed with the correct fee. If you are
technical reasons; unless you are applying because under 14 years of age, your parent or guardian may sign
you are: your application.

Form I-485 Instructions (Rev. 05/27/08)Y Page 2


Translations. Any document containing foreign language NOTE that unless a traffic incident was alcohol or
submitted to USCIS shall be accompanied by a full English drug-related, you do not need to submit
language translation which the translator has certified as documentation for traffic fines and incidents that did
complete and accurate, and by the translator's certification that not involve an actual arrest if the only penalty was a
he or she is competent to translate from the foreign language fine of less than $500 and/or points on your driver's
into English. license.
2. Birth certificate.
Copies. Unless specifically required that an original
document be filed with an application or petition, an ordinary Submit a copy of your foreign birth certificate or other
legible photocopy may be submitted. Original documents record of your birth that meets the provisions of secondary
submitted when not required will remain a part of the record, evidence found in Title 8, Code of Federal Regulations
even if the submission was not required. (CFR), 103.2(b)(2).
Initial Evidence. 3. Copy of passport page with nonimmigrant visa.
You must file your application with the following evidence: If you have obtained a nonimmigrant visa(s) from a U.S.
Embassy or consulate abroad within the last year, submit
1. Criminal history. a photocopy(ies) of the page(s) of your passport
A. If you have ever been arrested or detained by any law containing the visa(s).
enforcement officer for any reason, and no charges
4. Photos.
were filed, submit:
An original official statement by the arresting agency You must submit two identical color photographs of
or applicable court order confirming that no charges yourself taken within 30 days of the filing of this
were filed. application. The photos must have a white to off-white
background, be printed on thin paper with a glossy
B. If you have ever been arrested or detained by any law finish, and be unmounted and unretouched.
enforcement officer for any reason, and charges were
filed, or if charges were filed against you without an Passport-style photos must be 2" x 2." The photos must
arrest, submit: be in color with full face, frontal view on a white to off-
white background. Head height should measure 1" to 1
An original or court-certified copy of the complete
3/8" from top of hair to bottom of chin, and eye height is
arrest record and/or disposition for each incident (e.g.,
between 1 1/8" to 1 3/8" from bottom of photo. Your
dismissal order, conviction record, or acquittal order).
head must be bare unless you are wearing a headdress as
C. If you have ever been convicted or placed in an required by a religious order of which you are a member.
alternative sentencing program or rehabilitative Using pencil or felt pen, lightly print your name and
program (such as a drug treatment or community Alien Receipt Number on the back of the photo.
service program), submit:
5. Biometric services.
1. An original or court-certified copy of the
sentencing record for each incident, and If you are between the ages of 14 and 79, you must be
fingerprinted as part of the USCIS biometric services
2. Evidence that you completed your sentence, requirement. After you have filed this application, USCIS
specifically: will notify you in writing of the time and location where
a. An original or certified copy of your probation you must go to be fingerprinted. If necessary, USCIS
or parole record, or may also take your photograph and signature. Failure to
appear to be fingerprinted or for other biometric services
b. Evidence that you completed an alternative may result in a denial of your application.
sentencing program or rehabilitative program.
D. If you have ever had any arrest or conviction vacated, 6. Police clearances.
set aside, sealed, expunged, or otherwise removed If you are filing for adjustment of status as a member of a
from your record, submit: special class described in an I-485 supplement form,
1. An original or court-certified copy of the court please read the instructions on the supplement form to see
order vacating, setting aside, sealing, expunging, or if you need to obtain and submit police clearances, in
otherwise removing the arrest or conviction, or addition to the required fingerprints, with your
application.
2. An original statement from the court that no record
exists of your arrest or conviction.

Form I-485 Instructions (Rev. 05/27/08)Y Page 3


7. Medical examination. B. Employment Letter.

When required, submit a medical examination report on If your adjustment-of-status application is related to an
the form you have obtained from USCIS. employment-based visa petition (Form I-140), you
must submit a letter on the letterhead of the petitioning
A. Individuals applying for adjustment of status employer which confirms that the job on which the
through a USCIS Service Center. visa petition is based is still available to you. The
letter must also state the salary that will be paid.
1. General:
If you are filing your adjustment-of-status NOTE: The affidavit of support and/or employment
application with a USCIS Service Center, include letter are not required if you are applying for creation of a
your medical examination report with the record based on continuous residence since before
application, unless you are a refugee. January 1, 1972, asylum or refugee adjustment, or a
2. Refugees: Cuban citizen or a spouse or unmarried child of a Cuban
If you are applying for adjustment of status one citzen who was admitted after January 1, 1959.
year after you were admitted as a refugee, you
only need to submit a vaccination supplement with 15. Evidence of eligibility.
your adjustment-of-status application, not the A. Based on an immigrant petition.
entire medical report, unless there were medical
grounds of inadmissibility that arose during the Attach a copy of the approval notice for an immigrant
initial examination that you had overseas. petition that makes a visa number immediately
available to you, or submit a complete relative,
B. Individuals applying for adjustment of status special immigrant juvenile, or special immigrant
through a local USCIS office. military petition that, if approved, will make a visa
number immediately available to you.
If you are filing your adjustment-of-status application
with a local USCIS office, include your medical B. Based on admission as the K-1 fiancé(e) of a U. S.
examination report with the application. citizen and subsequent marriage to that citizen.

8. Fiancé(e)s. Attach a copy of the fiancé(e) petition approval


notice, a copy of your marriage certificate, and your
If you are a K-1 fiancé(e) or K-2 dependent who had a Form 1-94.
medical examination within the past year as required for
the nonimmigrant fiancé(e) visa, you only need to submit C. Based on asylum status.
a vaccination supplement, not the entire medical report. Attach a copy of the letter or Form 1-94 that shows
You may include the vaccination supplement with your the date you were granted asylum.
adjustment-of-status application.
D. Based on continuous residence in the United
9. Persons not required to have a States since before January 1, 1972.
medical examination.
Attach copies of evidence that shows continuous
The medical report is not required if you are applying for residence since before January 1, 1972.
creation of a record for admission as a lawful permanent
resident under section 249 of the INA as someone who has 16. Based on Cuban citizenship or nationality.
continuously resided in the United States since January 1, Attach evidence of your citizenship or nationality, such as
1972 (registry applicant). a copy of your passport, birth certificate, or travel
13. Form G-325A, Biographic Information Sheet. document.

You must submit a completed Form G-325A if you are 17. Based on derivative status as the spouse or child
between 14 and 79 years of age. of another adjustment applicant or person
granted permanent residence based on issuance
14. Affidavit of Support/Employment Letter.
of an immigrant visa.
A. Affidavit of Support.
Submit an Affidavit of Support (Form I-864) if your File your application with the application of the other
adjustment-of-status application is based on your applicant, or with evidence that the application is pending
entry as a fiancé(e), a relative visa petition (Form with USCIS or was approved, or with evidence that your
I-130) filed by your relative, or an employment-based spouse or parent was granted permanent residence based
visa petition (Form I-140) related to a business that is on an immigrant visa, and:
five percent or more owned by your family.

Form I-485 Instructions (Rev. 05/27/08)Y Page 4


If you are applying as the spouse of that person, also 10. Applicants eligible under the Cuban Adjustment Act of
attach a copy of your marriage certificate and copies of November 2, 1965.
documents showing the legal termination of all other
marriages by you and your spouse; 11. Diversity lottery winner eligible to file Form I-485;

If you are applying as the child of that person, attach also 12. Public Interest Parolees from certain former Soviet and
a copy of your birth certificate and, if the other person is Southeast Asian countries filing Form I-485 under Public
not your parent, submit copies of evidence (such as a Law 101-167 (the "Lautenberg Amendment");
marriage certificate and documents showing the legal
13. Registry applicant filing Form I-485 based on birth in the
termination of all other marriages and an adoption decree)
United States to a foreign diplomatic officer;
to demonstrate that you qualify as his or her child.
14. Former diplomat filing Form I-485 under Section 13 of
18. Other basis for eligibility. the Immigration and Nationality Act;

Attach copies of documents proving that you are eligible 15. Registry applicant filing Form I-485 based on continuous
for the classification. residence in the U.S. since before January 1, 1972, or

16. Applicants who are beneficiaries of Private Bills:


Where Should You File Form I-485?
USCIS Lockbox Addresses:
Form I-485 USCIS Lockbox Filing Address for For U.S. Postal Service (USPS) deliveries:
Local Office Filings:
USCIS
If you are applying for adjustment of status under one of the P.O. Box 805887
eligibility categories listed below, file your Form I-485, Chicago, IL 60680-4120
Application to Register Permanent Residence or Adjust
Status, with the USCIS Lockbox Facility. For courier/express deliveries:

1. Spouse, parent, unmarried son/daughter under age 21 of USCIS


a U.S. citizen with an approved or concurrently filed Attn: FBAS
Form I-130; 131 South Dearborn - 3rd Floor
Chicago, IL 60603-5517
2. Beneficiary of an approved Form I-130 filed by a
qualifying relative;
Form I-485 Service Center Filing Addresses:
3. Qualifying derivative, family-based beneficiary;
1. Form I-485 is Based on an Underlying Form I-140,
4. K-1 Fiancé(e) (and K-2 dependents) whose Form I-485 is Immigrant Petition for Alien Worker:
based on an approved Form I-129F;
Adjustment-of-status applications filed based on a
5. Applicants who are beneficiaries of an approved Form concurrently filed, pending, or approved Form I-140 must
I-360, Petition for Amerasian, Widow(er), or Special be filed with the Nebraska Service Center or the Texas
Immigrant, as a battered spouse or child; Service Center, depending on where the applicant lives. If
you wish to concurrently file your Form I-485 and Form
6. Widow/widower of a U.S. citizen with an approved or I-140, an immigrant visa number must be immediately
concurrently filed Form I-360; available at the time of filing.

7. Special Immigrant Military filing Form I-485 based on NOTE: To facilitate acceptance and processing of Form
honorable active duty service in the U.S. Armed Forces I-485 when Form I-140 has already been approved,
with an approved or concurrently filed Form I-360; submit a copy of the I-140 approval notice. If Form I-140
is pending, submit copies of the Form I-140 receipt notice
8. Special Immigrant juvenile with a pending or and the page of the DOL labor certification showing the
concurrently filed Form I-360; priority date (if labor certification is required) or just a
copy of the Form I-140 receipt notice (but only if a labor
9. Amerasians with an approved or concurrently filed Form
certification is not required).
I-360;

Form I-485 Instructions (Rev. 05/27/08)Y Page 5


NOTE: You cannot concurrently file forms I-360 and
If you live in the following states: Alaska, Arizona,
I-485 for the following classifications:
California, Colorado, Guam, Hawaii, Idaho, Illinois,
Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, 1. Religious Worker or Minister;
Montana, Nebraska, Nevada, North Dakota, Ohio, 2. Panama Canal Company Employment;
Oregon, South Dakota, Utah, Washington, Wisconsin, or
3. U.S. Government in Canal Zone Employment;
Wyoming, the mailing address you should use is:
4. Special Immigrant Physician; or
5. International Broadcasters.
USCIS
Nebraska Service Center If you live in the following states: Alaska, Arizona,
P. O. Box 87485 California, Colorado, Guam, Hawaii, Idaho, Illinois,
Lincoln, NE 68501-7485 Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri,
Montana, Nebraska, Nevada, North Dakota, Ohio,
If you live in the following states: Alabama, Arkansas, Oregon, South Dakota, Utah, Washington, Wisconsin, or
Connecticut, Florida, Georgia, Kentucky, Louisianna, Wyoming, send your application to the Nebraska Service
Maine, Maryland, Massachusetts, Mississippi, New Center:
Hampshire, New Jersey, New Mexico, New York, North
Carolina, South Carolina, Oklahoma, Pennsylvania, USCIS
Puerto Rico, Rhode Island, Tennessee, Texas, Vermont, Nebraska Service Center
Virginia, U.S. Virgin Islands, West Virginia, or P.O. Box 87485
Washington, DC, the mailing address you should use is: Lincoln, NE 68501-7485

USCIS If you live in the following states: Alabama, Arkansas,


Texas Service Center Connecticut, Florida, Georgia, Kentucky, Louisianna,
P. O. Box 851804 Maine, Maryland, Massachusetts, Mississippi, New
Mesquite, TX 75185-1804 Hampshire, New Jersey, New Mexico, New York, North
Carolina, South Carolina, Oklahoma, Pennsylvania,
2. Form I-485 is Based on an Underlying Form I-360, Puerto Rico, Rhode Island, Tennessee, Texas, Vermont,
Petition for Amerasian, Widow(er), or Special Virginia, U.S. Virgin Islands, West Virginia, or
Immigrant: Washington, DC, send your application to the Texas
Service Center:
A. Filing Address for International Organization
Employee or Family Member: USCIS
Texas Service Center
Adjustment-of-status applications filed based on a
P.O. Box 851804
concurrently filed, pending, or approved Form I-360
Mesquite, TX 75185-1804
for International Organization Employee or eligible
family member must be filed with the Nebraska 3. Form I-485 is Based on an Underlying Form I-526,
Service Center (see address below). Immigrant Petition by Alien Entrepreneur:

B. Filing Address for Afghan and Iraqi Translators: If you are an immigrant investor with an approved Form
I-526, you must file Form I-485 with the Texas Service
Adjustment-of-status applications filed based on an Center, regardless of where the business enterprise is
approved Form I-360 for Afghan and Iraqi located.
Translators must be filed with the Nebraska Service
Center (see address below). You cannot concurrently NOTE: You cannot concurrently file forms I-526 and I-485.
file Forms I-360 and I-485 for this classification.
USCIS
C. Filing Address for Other I-360 Categories: Texas Service Center
P.O. Box 851804
Other adjustment-of-status applications filed based on Mesquite, TX 75185-1804
an approved Form I-360 for the following
classifications must be filed with the Nebraska 4. Filing Address for Asylee Adjustment-of-Status
Service Center or the Texas Service Center, Applicants:
depending on where the applicant lives. All asylee adjustment of status applications must be filed
with the Nebraska Service Center or the Texas Service
Center, depending on where the applicant lives. If you are

Form I-485 Instructions (Rev. 05/27/08)Y Page 6


filing Form I-131, Application for Travel Document, to USCIS
enable you to travel outside the United States while your Nebraska Service Center
adjustment-of-status application is pending, you should P.O. Box 87245
indicate that you are requesting a refugee travel document. Lincoln, NE 68501-7245
The relating Form I-131 for a Refugee Travel document is
Questions Regarding Form I-485
filed with the Nebraska Service Center, regardless of the
Form I-485 filing location. For additional information about Form I-485, including how
to file your application or filing locations not mentioned, call
If you live in the following states: Alaska, Arizona, the USCIS National Customer Service Center at
California, Colorado, Guam, Hawaii, Idaho, Illinois, 1-800-375-5283 or visit our website at www.uscis.gov.
Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri,
Montana, Nebraska, Nevada, North Dakota, Ohio,
Oregon, South Dakota, Utah, Washington, Wisconsin-or
What Is the Filing Fee?
Wyoming, the mailing address you should use is:
The filing fee for a Form I-485 is $930.
USCIS
Nebraska Service Center
An additional biometric fee of $80 is required when filing this
P.O. Box 87485
Form I-485. After you submit Form I-485, USCIS will notify
Lincoln, NE 68501-7485
you about when and where to go for biometric services.
If you live in the following states: Alabama, Arkansas, The fee is $930 only (no biometrics fee required) for
Connecticut, Delaware, Florida, Georgia, Kentucky, applicants under 14 years who submits Form I-485
Louisiana, Maine, Maryland, Massachusetts, Mississippi, independent from other family members.
New Hampshire, New Jersey, New Mexico, New York,
North Carolina, South Carolina, Oklahoma, Pennsylvania, The fee for a child under the age fourteen years will be $600
Puerto Rico, Rhode Island, Tennessee, Texas, Vermont, when submitted concurrently for adjudication with the
Virginia, U.S. Virgin Islands, West Virginia, or application of a parent under sections 201(b)(A)(i), 203(a)(2)
Washington, DC, send your application to the Texas (A), and 203(d) of the INA.
Service Center:
You may submit one check or money order for both the
USCIS application and biometric fees, for a total of $1010.
Texas Service Center Use the following guidelines when you prepare your check or
P.O. Box 852211 money order for the Form I-485 and the biometric service fee:
Mesquite, TX 75185-2211
1. The check or money order must be drawn on a bank or
5. Filing Address for Refugee Adjustment of Status other financial institution located in the United States and
Applicants: must be payable in U.S. currency; and

All refugee adjustment of status applications must be filed 2. Make the check or money order payable to U.S.
with the Nebraska Service Center: Department of Homeland Security, unless:

USCIS A. If you live in Guam and are filing your petition there,
Nebraska Service Center make it payable to Treasurer of Guam.
P.O. Box 87209
B. If you live in the U.S. Virgin Islands and are filing
Lincoln, NE 68501-7209
your petition there, make it payable to Commissioner
of Finance of the Virgin Islands.
6. Filing Address for HRIFA Dependents: NOTE: Effective July 30, 2007, if you file Form I-485 to
Only the dependents spouse and children of the principal adjust your status as a permanent resident, no additional fee is
granted legal status under HRIFA are eligible to apply required to also file an application for employment
for benefits under HRIFA. The filing period for principal authorization on Form I-765 and/or advance parole on Form
HRIFA applicants has closed. All HRIFA applications I-131. You may file these forms concurrently. If you choose
for dependents must be filed at the Nebraska Service to file the I-765 and/or I-131 separately after the effective
Center. date, you must also submit a copy of your I-797C, Notice of
Action, receipt as evidence of the filing of an I-485.

Form I-485 Instructions (Rev. 05/27/08)Y Page 7


NOTE: Please spell out U.S. Department of Homeland
Security; do not use the initials "USDHS" or "DHS."
Processing Information

Notice to Those Making Payment by Check. If you send us Any application that is not signed or is not accompanied by
a check, it will be converted into an electronic funds transfer the correct application fee will be rejected with a notice that
(EFT). This means we will copy your check and use the the application is deficient. You may correct the deficiency
account information on it to electronically debit your account and resubmit the application. An application is not
for the amount of the check. The debit from your account will considered properly filed until accepted by USCIS.
usually take 24 hours and will be shown on your regular
account statement. Initial processing.
Once an application has been accepted, it will be checked for
You will not receive your original check back. We will
completeness, including submission of the required initial
destroy your original check, but we will keep a copy of it. If
evidence. If you do not completely fill out the form or file it
the EFT cannot be processed for technical reasons, you
without required initial evidence, you will not establish a
authorize us to process the copy in place of your original
basis for eligibility, and we may deny your application.
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times. Requests for more information or interview.
How to Check If the Fees Are Correct We may request more information or evidence, or we may
request that you appear at a USCIS office for an interview.
The form and biometric fees on this form are current as of the We may also request that you submit the originals of any
edition date appearing in the lower right corner of this page. copy. We will return these originals when they are no longer
However, because USCIS fees change periodically, you can required.
verify if the fees are correct by following one of the steps
below: Interview.
1. Visit our website at www.uscis.gov, select After you file your application, you may be notified to appear
"Immigration Forms," and check the appropriate fee; at a USCIS office to answer questions about the application.
You will be required to answer these questions under oath or
2. Review the Fee Schedule included in your form affirmation. You must bring your Arrival-Departure Record
package, if you called us to request the form or (Form I-94) and any passport or official travel document you
have to the interview.
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information. Decision.
NOTE: If your Form I-485 requires payment of a biometric You will be notified in writing of the decision on your
service fee for USCIS to take your fingerprints, photograph, or application.
signature, you can use the same procedure to obtain the correct
biometric fee. Selective Service Registration.
If you are a male at least 18 years old, but not yet 26 years
Address Changes old, and required according to the Military Selective Service
Act to register with the Selective Service System, USCIS will
If you change your address and you have an application or help you register.
petition pending with USCIS, you may change your address
on line at www.uscis.gov, click on "Change your address with When your signed application is filed and accepted by
USCIS," and follow the prompts or by completing and mailing USCIS, we will transmit to the Selective Service System your
Form AR-11, Alien's Change of Address Card, to: name, current address, Social Security number, date of birth,
and the date you filed the application. This action will enable
U.S. Citizenship and Immigration Services the Selective Service System to record your registration as of
Change of Address the filing date of your application.
P.O. Box 7134
London, KY 40742-7134 If USCIS does not accept your application and, if still so
required, you are responsible to register with the Selective
For commercial overnight or fast freight services only, mail to:
Service System by using other means, provided you are under
26 years of age. If you have already registered, the Selective
U.S. Citizenship and Immigration Services Service System will check its records to avoid any duplication.
Change of Address
1084-I South Laurel Road
London, KY 40744
Form I-485 Instructions (Rev. 05/27/08)Y Page 8
(NOTE: Men 18 through 25 years old who are applying If you become inadmissible under section 212(a)(9)(B)(i) of
for student financial aid, government employment, or job the Act while your adjustment-of-status application is
training benefits should register directly with the Selective pending, you will need a waiver of inadmissibility under
Service System or such benefits may be denied. Men can section 212(a)(9)(B)(v) of the Act before your adjustment-of-
register at a local post office or on the internet at status application can be approved. This waiver, however, is
http://www.sss.gov). granted on a case-by-case basis and in the exercise of
discretion. It requires a showing of extreme hardship to your
Travel outside the United States for adjustment-of- U.S. citizen or lawful permanent resident spouse or parent,
status applicants under sections 209 and 245 of the unless you are a refugee or asylee. For refugees and asylees,
Act, and Registry applicants under section 249 of the the waiver may be granted for humanitarian reasons to assure
Act. family unity or if it is otherwise in the public interest.

Your departure from the United States (including brief visits to


Canada or Mexico) constitutes an abandonment of your Penalties
adjustment-of-status application, unless you are granted
permission to depart and you are inspected upon your return to If you knowingly and willfully falsify or conceal a material
the United States. Such permission to travel is called ''advance fact or submit a false document with this Form I-485, we will
parole.'' To request advance parole, you must file Form I-131, deny the Form I-485 and may deny any other immigration
Application for Travel Document, with the appropriate fee at benefit.
the USCIS office where you applied for adjustment of status.
In addition, you will face severe penalties provided by law and
1. Exceptions. may be subject to criminal prosecution.

A. H, L, V, or K3/K4 nonimmigrants:
If you are an H, L,V, or K3/K4 nonimmigrant who
Privacy Act Notice
continues to maintain his or her status, you may travel
on a valid H, L, V or K3/K4 visa without obtaining We ask for the information on this form, and associated
advance parole. evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
B. Refugees and Asylees: right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
If you are applying for adjustment of status one year provide this information to other government agencies. Failure
after you were admitted as a refugee or one year after to provide this information, and any requested evidence, may
you were granted asylum, you may travel outside the delay a final decision or result in denial of your Form I-485.
United States on your valid refugee travel document, if
you have one, without the need to obtain advance
parole.
Paperwork Reduction Act
2. Warning:
An agency may not conduct or sponsor an information
Travel outside of the United States may trigger the three collection and a person is not required to respond to a
and ten year bar to admission under section 212(a)(9)(B)(i) collection of information unless it displays a currently valid
of the Act for adjustment applicants, but not registry OMB control number. The public reporting burden for this
applicants. This ground of inadmissibility is triggered if collection of information is estimated at 5 hours and 15
you were unlawfully present in the United States (i.e., you minutes per response, including the time for reviewing
remained in the United States beyond the period of instructions, and completing and submitting the form. Send
authorized stay) for more than 180 days before you applied comments regarding this burden estimate or any other aspect
for adjustment of status and you travel outside of the of this collection of information, including suggestions for
United States while your adjustment of status application is reducing this burden, to: U.S. Citizenship and Immigration
pending. Services, Regulatory Management Division, 111
Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
NOTE: Only unlawful presence that was accrued on or Washington, DC 20529. OMB No. 1615-0023. Do not mail
after April 1, 1997, counts towards the three and ten year your application to this address.
bar under section 212(a)(9)(B)(i) of the Act.)

Form I-485 Instructions (Rev. 05/27/08)Y Page 9


OMB No. 1615-0023; Expires 09/30/08

Department of Homeland Security I-485, Application to Register


U.S. Citizenship and Immigration Services Permanent Residence or Adjust Status

START HERE - Please type or print in black ink. For USCIS Use Only
Returned Receipt
Part 1. Information about you.
Family Name Given Name Middle Name

Address- C/O
Resubmitted
Street Number Apt. #
and Name
City
Reloc Sent
State Zip Code

Date of Birth (mm/dd/yyyy) Country of Birth:

Country of Citizenship/Nationality:
Reloc Rec'd
U.S. Social Security # A # (if any)

Date of Last Arrival (mm/dd/yyyy) I-94 #


Applicant
Current USCIS Status Expires on (mm/dd/yyyy) Interviewed

Part 2. Application Type. (Check one.)


Section of Law
I am applying for an adjustment to permanent resident status because:
Sec. 209(b), INA
a. An immigrant petition giving me an immediately available immigrant visa number has been Sec. 13, Act of 9/11/57
approved. (Attach a copy of the approval notice, or a relative, special immigrant juvenile, or Sec. 245, INA
special immigrant military visa petition filed with this application that will give you an Sec. 249, INA
Sec. 1 Act of 11/2/66
immediately available visa number, if approved.)
Sec. 2 Act of 11/2/66
b. My spouse or parent applied for adjustment of status or was granted lawful permanent Other
residence in an immigrant visa category that allows derivative status for spouses and children.
c. I entered as a K-1 fiancé(e) of a U.S. citizen whom I married within 90 days of entry, or I am Country Chargeable
the K-2 child of such a fiancé(e). (Attach a copy of the fiancé(e) petition approval notice and
the marriage certificate).
d. I was granted asylum or derivative asylum status as the spouse or child of a person granted Eligibility Under Sec. 245
asylum and am eligible for adjustment. Approved Visa Petition
Dependent of Principal Alien
e. I am a native or citizen of Cuba admitted or paroled into the United States after January 1, Special Immigrant
1959, and thereafter have been physically present in the United States for at least one year. Other
f. I am the husband, wife, or minor unmarried child of a Cuban described above in (e), and I am
residing with that person, and was admitted or paroled into the United States after January 1, Preference
1959, and thereafter have been physically present in the United States for at least one year.
Action Block
g. I have continuously resided in the United States since before January 1, 1972.

h. Other basis of eligibility. Explain (for example, I was admitted as a refugee, my status has not
been terminated, and I have been physically present in the United States for one year after
admission). If additional space is needed, use a separate piece of paper.

I am already a permanent resident and am applying to have the date I was granted permanent
residence adjusted to the date I originally arrived in the United States as a nonimmigrant or To be Completed by
parolee, or as of May 2, 1964, whichever date is later, and: (Check one.) Attorney or Representative, if any
Fill in box if G-28 is attached to represent the
applicant.
i. I am a native or citizen of Cuba and meet the description in (e) above.
VOLAG #
j. I am the husband, wife, or minor unmarried child of a Cuban and meet the description in (f)
above. ATTY State License #

Form I-485 (Rev. 05/27/08) Y


Part 3. Processing Information.
A. City/Town/Village of Birth Current Occupation

Your Mother's First Name Your Father's First Name

Give your name exactly as it appears on your Arrival/Departure Record (Form I-94)

Place of Last Entry Into the United States (City/State) In what status did you last enter? (Visitor, student, exchange
alien, crewman, temporary worker, without inspection, etc.)

Were you inspected by a U.S. Immigration Officer? Yes No


Nonimmigrant Visa Number Consulate Where Visa Was Issued

Date Visa Was Issued Marital


(mm/dd/yyyy) Gender: Male Female Status: Married Single Divorced Widowed

Have you ever before applied for permanent resident status in the U.S.? No Yes. If you checked "Yes," give date and place of
filing and final disposition.

B. List your present husband/wife, all of your sons and daughters (If you have none, write "none." If additional space is needed, use separate paper).
Family Name Given Name Middle Initial Date of Birth (mm/dd/yyyy)

Country of Birth Relationship A Applying with you?


# Yes No
Family Name Given Name Middle Initial Date of Birth (mm/dd/yyyy)

Country of Birth Relationship A Applying with you?


# Yes No
Family Name Given Name Middle Initial Date of Birth (mm/dd/yyyy)

Country of Birth Relationship A Applying with you?


# Yes No
Family Name Given Name Middle Initial Date of Birth (mm/dd/yyyy)

Country of Birth Relationship A Applying with you?


# Yes No
Family Name Given Name Middle Initial Date of Birth (mm/dd/yyyy)

Country of Birth Relationship A Applying with you?


# Yes No
C. List your present and past membership in or affiliation with every organization, association, fund, foundation, party, club, society, or similar group
in the United States or in other places since your 16th birthday. Include any foreign military service in this part. If none, write "none." Include the
name(s) of organization(s), location(s), dates of membership from and to, and the nature of the organization(s). If additional space is needed, use a
separate piece of paper.

Form I-485 (Rev. 05/27/08) Y Page 2


Part 3. Processing Information. (Continued)
Please answer the following questions. (If your answer is "Yes" on any one of these questions, explain on a separate piece of paper and refer to
"What Are the General Filing Instructions? Initial Evidence" to determine what documentation to include with your application. Answering "Yes"
does not necessarily mean that you are not entitled to adjust status or register for permanent residence.)
1. Have you ever, in or outside the United States:

a. Knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested? Yes No
b. Been arrested, cited, charged, indicted, fined, or imprisoned for breaking or violating any law or ordinance,
Yes No
excluding traffic violations?
c. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No
d. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? Yes No
2. Have you received public assistance in the United States from any source, including the U.S.Government or any State, Yes No
county, city, or municipality (other than emergency medical treatment), or are you likely to receive public assistance in the
future?
3. Have you ever:
a. Within the past ten years been a prostitute or procured anyone for prostitution, or intend to engage in such activities Yes No
in the future?
b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Yes No
c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? Yes No
d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit trafficking of
Yes No
any controlled substance?

4. Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or
Yes No
funds for, or have you through any means ever assisted or provided any type of material support to any person or
organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or any
other form of terrorist activity?

5. Do you intend to engage in the United States in:

a. Espionage? Yes No
b. Any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United
Yes No
States, by force, violence, or other unlawful means?
c. Any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or
Yes No
sensitive information?

6. Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party? Yes No

7. Did you, during the period from March 23, 1933, to May 8, 1945, in association with either the Nazi Government of
Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, Yes No
assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion?

8. Have you ever engaged in genocide, or otherwise ordered, incited, assisted, or otherwise participated in the killing of any
person because of race, religion, nationality, ethnic origin, or political opinion? Yes No

9. Have you ever been deported from the United States, or removed from the United States at government expense, excluded
Yes No
within the past year, or are you now in exclusion, deportation, removal, or recission proceedings?
10. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of
fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or Yes No
procured, a visa, other documentation, entry into the United States or any immigration benefit?

11. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces? Yes No
12. Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and
have not yet complied with that requirement or obtained a waiver? Yes No

13. Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child? Yes No
14. Do you plan to practice polygamy in the United States?
Yes No

Form I-485 (Rev. 05/27/08) Y Page 3


(Read the information on penalties in the instructions before completing this section. You must file this application
Part 4. Signature.
while in the United States.)

Your registration with U.S. Citizenship and Immigration Services.


"I understand and acknowledge that, under section 262 of the Immigration and Nationality Act (Act), as an alien who has been or will
be in the United States for more than 30 days, I am required to register with U.S. Citizenship and Immigration Services. I understand
and acknowledge that, under section 265 of the Act, I am required to provide USCIS with my current address and written notice of
any change of address within ten days of the change. I understand and acknowledge that USCIS will use the most recent address that
I provide to USCIS, on any form containing these acknowledgements, for all purposes, including the service of a Notice to Appear
should it be necessary for USCIS to initiate removal proceedings against me. I understand and acknowledge that if I change my
address without providing written notice to USCIS, I will be held responsible for any communications sent to me at the most recent
address that I provided to USCIS. I further understand and acknowledge that, if removal proceedings are initiated against me and I
fail to attend any hearing, including an initial hearing based on service of the Notice to Appear at the most recent address that I
provided to USCIS or as otherwise provided by law, I may be ordered removed in my absence, arrested, and removed from the
United States."

Selective Service Registration.


The following applies to you if you are a male at least 18 years old, but not yet 26 years old, who is required to register with
the Selective Service System: "I understand that my filing this adjustment-of-status application with U.S. Citizenship and
Immigration Services authorizes USCIS to provide certain registration information to the Selective Service System in accordance
with the Military Selective Service Act. Upon USCIS acceptance of my application, I authorize USCIS to transmit to the Selective
Service System my name, current address, Social Security Number, date of birth, and the date I filed the application for the purpose of
recording my Selective Service registration as of the filing date. If, however, USCIS does not accept my application, I further
understand that, if so required, I am responsible for registering with the Selective Service by other means, provided I have not yet
reached age 26."

Applicant's Certification
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration
Services (USCIS) needs to determine eligibility for the benefit I am seeking.

Signature Print Your Name Date Daytime Phone Number

( )

NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for
the requested document and this application may be denied.

Part 5. Signature of person preparing form, if other than above. (sign below)

I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge.
Signature Print Your Full Name Date Phone Number
(Include Area Code)

( )
Firm Name E-Mail Address (if any)
and Address

Form I-485 (Rev. 05/27/08) Y Page 4


OMB No. 1615-0023; Expires 09/30/08

Department of Homeland Security Instructions for Supplement A to Form I-485,


U.S. Citizenship and Immigration Services Adjustment of Status Under Section 245(i)
Instructions
NOTE: Use this form only if you are applying to U.S. Citizenship and Immigration Services (USCIS) to adjust status to that
of a lawful permanent resident under section 245(i) of the Immigration and Nationality Act.

What Is the Purpose of This Form?

Section 245 of the Immigration and Nationality Act (the Act) allows the Attorney General in his or her discretion to adjust the status
of an alien to that of a lawful permanent resident (LPR), in lieu of consular visa processing, while the alien remains in the United
States. In order to be eligible, the alien must have been inspected and admitted or paroled, be eligible for an immigrant visa and
admissible for permanent residence, have an immigrant visa immediately available and, with some exceptions, have maintained
lawful nonimmigrant status. The alien must also not have engaged in unauthorized employment and must not be ineligible to adjust
status under section 245(c) of the Act. If you meet all of these requirements, you do not have to submit this form when applying
for adjustment of status to that of LPR.

Section 245(i) of the Act allows certain aliens to file for adjustment of status upon payment of a penalty fee of $1,000, even though
some of the conditions required by section 245(a) and (c) of the Act are not met. Aliens in the United States who have an
immigrant visa immediately available, but who entered the United States without inspection, remained in the United States
past the period of admission, worked unlawfully, or are otherwise ineligible for adjustment of status under section 245(c) of
the Act must submit this form along with Form I-485, Application to Register Permanent Residence or Adjust Status.

NOTE: If you are applying to adjust as the spouse or unmarried minor child of a U.S. citizen or the parent of a U.S. citizen child at
least 21 years of age, and if you were inspected and lawfully admitted to the United States other than in C-1 or S nonimmigrant
status, you do not need to file this form.

Who May Use Supplement A to Adjust Status to That of LPR Under Section 245(i)?

1. You may apply for adjustment of status to that of LPR under section 245(i) if you:

A. Are physically present in the United States when the application is submitted; and

B. Have an immigrant visa number immediately available; and

C. Are admissible to the United States for permanent residence; and

D. Are the beneficiary of an approvable-when-filed visa petition, or an application for labor certification filed on or before
April 30, 2001; and

E. Pay a $1,000 penalty fee (unless exempted).

2. In addition, you must fall within one of the categories noted below:

A. Alien crewmen;

B. Aliens who work without authorization;

C. Aliens in unlawful immigrant status;

D. Aliens who fail to continuously maintain a lawful status since entry into the United States;

E. Aliens who were admitted in transit without visa;

Form I-485 Supplement A Instructions (Rev. 05/27/08)Y


F. Aliens admitted as nonimmigrant visitors under section 212(l) of the Act or under the Visa Waiver Program;

G. Aliens admitted as a nonimmigrant described in section 101(a)(15)(S) of the Act; or

H. Aliens seeking employment-based adjustment of status who are not in lawful nonimmigrant status.

What Documentation Must You Include If You Are Submitting This Form With Form I-485?

You do not need to submit documentation in addition to the documentation required by the instructions on Form I-485 unless you are
the beneficiary of a visa petition or application for labor certification properly filed on your behalf after January 14, 1998, and on or
before April 30, 2001. Aliens using section 245(i) because they are beneficiaries of a visa petition or application for labor
certification filed after January 14, 1998, and on or before April 30, 2001, should submit documentation along with this form
that demonstrates physical presence in the United States on December 21, 2000.

What Documentation Demonstrates Your Physical Presence on December 21, 2000?

Documentation of your physical presence in the United States on December 21, 2000, can consist of Federal, State, or local
government-issued documents or other documents establishing your physical presence on that date. If one document does not
establish your physical presence, you should submit documentation establishing your physical presence in the United States prior to
and after December 21, 2000. In some cases, a single document may suffice to establish the applicant's physical presence on
December 21, 2000. In most cases, however, the alien may need to submit several documents because most applicants may not
possess documentation that contains the exact date of December 21, 2000. In such instances, the applicant should submit sufficient
documentation establishing the applicant's physical presence in the United States prior to and after December 21, 2000. If you submit
affidavits, they should be accompanied by supporting documentation. USCIS will evaluate all documentation on a case-by-case basis.

Who Does Not Need to Use Supplement A to Form I-485?

1. You do not have to submit Supplement A to Form I-485 if you:

A. Are already an LPR; or

B. Have continuously maintained lawful immigration status in the United States since November 5, 1986; or

C. Are applying to adjust status as the spouse or unmarried minor child of a U.S. citizen or the parent of a U.S. citizen child at
least 21 years of age, and you were inspected and lawfully admitted to the United States other than in C-1 or S nonimigrant
status.
2. In addition, you do not have to submit Supplement A to Form I-485 if you are filing for an immigration benefit other than
adjustment of status to that of LPR or if you are applying for adjustment of status to that of LPR because you:

A. Were granted asylum in the United States; or

B. Have continuously resided in the United States since January 1, 1972; or

C. Entered as a K-1 fiancé(e) of a U.S. citizen; or

D. Have an approved Form I-360, Petition for Amerasian, Widow(er), Battered or Abused Spouse or Child, or Special
Immigrant, and are applying for adjustment as a special immigrant juvenile court dependent, or as a special immigrant who
has served in the U.S. Armed Forces, or as a battered or abused spouse or child; or

E. Are a special immigrant retired international organization employee or family member; or

F. Are a special immigrant physician; or

Form I-485 Supplement A Instructions (Rev. 05/27/08)Y Page 2


G. Are a public interest parolee, who was denied refugee status, and are from the former Soviet Union, Vietnam, Laos, or
Cambodia (a "Lautenberg Parolee" under Public Law 101-167); or

H. Are eligible under the Immigration Nursing Relief Act.

Where To File?

You must file this form at the same USCIS office or location where you must submit the related Form I-485.

What Are the Filing Fees for Form I-485 and Supplement A to Form I-485?

The fees for this form when filed along with Form I-485 are:

1. A filing fee of $930 is required with Form I-485 for applicants over the age of 14 years and $600 for applicants under 14.

2. An additional biometric fee of $80 is required when filing this Form I-485 Supplement A. Applicants younger than 14 years or
older than 79 do not have to pay the biometric services fee. After you submit Form I-485 Supplement A, USCIS will notify you
about when and where to go for biometric services.

3. A $1,000 penalty fee is required with the Supplement A Form.

4. If you filed Form I-485 separately, attach a copy of your filing receipt and pay only the additional sum of $1,000.

There are two categories of applicants who do not need to pay the $1,000 fee associated with Supplement A to Form I-485:

A. Applicants under the age of 17 years; and

B. Applicants who are an unmarried son or daughter of a legalized alien and less than 21 years of age, or the spouse of a
legalized alien, and have attached a copy of a USCIS receipt or approval notice for a properly filed Form I-817, Application
for Family Unity Benefits.

You may submit one check or money order for both the application and biometric fees, for a total of $2,010.

Use the following guidelines when you prepare your check or money order for the Form I-485 Supplement A and the biometric
service fee:

1. The check or money order must be drawn on a bank or other financial institution located in the United States and must be payable
in U.S. currency; and

2. Make the check or money order payable to U.S. Department of Homeland Security, unless:

A. If you live in Guam and are filing your petition there, make it payable to Treasurer, Guam.

B. If you live in the U.S. Virgin Islands and are filing your petition there, make it payable to Commissioner of Finance of
the Virgin Islands.

C. If you live outside the United States, Guam, or the U.S. Virgin Islands, contact the nearest U.S. Embassy or consulate for
instructions on the method of payment.

NOTE: Please spell out U.S. Department of Homeland Security; do not use the initials "USDHS" or "DHS."

Notice to Those Making Payment by Check. If you send us a check, it will be converted into an electronic funds transfer (EFT).
This means we will copy your check and use the account information on it to electronically debit your account for the amount of the
check. The debit from your account will usually take 24 hours and will be shown on your regular account statement.

Form I-485 Supplement A Instructions (Rev. 05/27/08)Y Page 3


You will not receive your original check back. We will destroy your original check, but we will keep a copy of it. If the EFT cannot
be processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be
completed because of insufficient funds, we may try to make the transfer up to two times.

How to Check If the Fees Are Correct


The form and biometric fees on this form are current as of the edition date appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if the fees are correct by following one of the steps below:

1. Visit our website at www.uscis.gov, select "Immigration Forms," and check the appropriate fee;

2. Review the Fee Schedule included in your form package, if you called us to request the form; or

3. Telephone our National Customer Service Center at 1-800-375-5283 and ask for the fee information.

NOTE: If your Form I-485 Supplement A requires payment of a biometric service fee for USCIS to take your fingerprints,
photograph, or signature, you can use the same procedure to obtain the correct biometric fee.

Address Changes

If you change your address and you have an application or petition pending with USCIS, you may change your address online at
www.uscis.gov, click on "Change your address with USCIS," and follow the prompts. Or you may complete and mail Form AR-11,
Alien's Change of Address Card, to:

U.S. Citizenship and Immigration Services


Change of Address
P.O. Box 7134
London, KY 40742-7134

For commercial overnight or fast freight services only, mail to:

U.S. Citizenship and Immigration Services


Change of Address
1084-I South Laurel Road
London, KY 40744

Processing Information

Any Form I-485 Supplement A that is not signed or accompanied by the correct fee will be rejected with a notice that the
Form I-485 Supplement A is deficient. You may correct the deficiency and resubmit the Form I-485 Supplement A. An application
or petition is not considered properly filed until accepted by USCIS.

Initial processing. Once a Form I-485 Supplement A has been accepted, it will be checked for completeness, including submission
of the required initial evidence. If you do not completely fill out the form, or file it without required initial evidence, you will not
establish a basis for eligibility and we may deny your Form I-485 Supplement A.

Requests for more information or interview. We may request more information or evidence, or we may request that you
appear at a USCIS office for an interview. We may also request that you submit the originals of any copy. We will return these
originals when they are no longer required.

Decision. The decision on a Form I-485 Supplement A involves a determination of whether you have established eligiblity for the
requested benefit. You will be notified of the decision in writing.

Form I-485 Supplement A Instructions (Rev. 05/27/08)Y Page 4


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.

As an altenative 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. 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.

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with this Form I-485 Supplement A, we
will deny the Form I-485 Supplement A and may deny any other immigration benefit.

In addition, you will face severe penalties provided by law and may be subject to criminal prosecution.

Privacy Act Notice

We ask for the information on this form, and associated evidence, to determine if you have established eligibility for the immigration
benefit for which you are filing. Our legal right to ask for this information can be found in the Immigration and Nationality Act, as
amended. We may provide this information to other government agencies. Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of your Form I-485 Supplement A.

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
13 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 Management Division, 111 Massachusetts Avenue, N.W., 3rd Floor, Suite
3008, Washington, DC 20529. OMB No. 1615-0023. Do not mail your application to this address.

Checklist.
I signed the form at Part D.
I included the appropriate fees (if any).
If I checked box b or d in Question 1, Part B, I included evidence of my physical presence in the United States on
December 21, 2000.

Form I-485 Supplement A Instructions (Rev. 05/27/08)Y Page 5


OMB No. 1615-0023; Expires 09/30/08

Department of Homeland Security Supplement A to Form I-485,


U.S. Citizenship Immigration and Service Adjustment of Status Under Section 245(i)
NOTE: Use this form only if you are applying to adjust status to that of a lawful permanent resident under section 245(i) of
the Immigration and Nationality Act.
Part A. Information about you. For USCIS Use Only
Last Name First Name Middle Name Action Block

Address: In Care Of

Street Number and Name Apt. #

City State Zip Code

Alien Registration Number (A #) if any Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship/Nationality

Telephone Number E-Mail Address, if any


( )

Part B. Eligibility. (Check the correct response.)


1. I am filing Supplement A to Form I-485 because:
a. I am the beneficiary of a visa petition filed on or before January 14, 1998.
b. I am the beneficiary of a visa petition filed on or after January 15, 1998, and on or before April 30, 2001.
c. I am the beneficiary of an application for a labor certification filed on or before January 14, 1998.
d. I am the beneficiary of an application for a labor certification filed on or after January 15, 1998, and on or before April 30, 2001.
If you checked box b or d in Question 1, you must submit evidence demonstrating that you were physically present in the
United States on December 21, 2000.
2. And I fall into one or more of these categories: (Check all that apply to you.)
a. I entered the United States as an alien crewman;
b. I have accepted employment without authorization;
c. I am in unlawful immigration status because I entered the United States without inspection or I remained in the United
States past the expiration of the period of my lawful admission;
d. I have failed (except through no fault of my own or for technical reasons) to maintain, continuously, lawful status;
e. I was admitted to the United States in transit without a visa;
f. I was admitted as a nonimmigrant visitor without a visa;
g. I was admitted to the United States as a nonimmigrant in the S classification; or
h. I am seeking employment-based adjustment of status and am not in lawful nonimmigrant status.

Part C. Additional eligibility information.


1. Are you applying to adjust status based on any of the below reasons?
a. You were granted asylum in the United States;
b. You have continuously resided in the United States since January 1, 1972;
c. You entered as a K-1 fiancé(e) of a U.S. citizen;
d. You have an approved Form I-360, Petition for Amerasian, Widow(er), Battered or Abused Spouse or Child, or Special
Immigrant, and are applying for adjustment as a special immigrant juvenile court dependent or a special immigrant who has
served in the U.S. armed forces, or a battered or abused spouse or child;
e. You are a native or citizen of Cuba, or the spouse or child of such alien, who was not lawfully inspected or admitted to the
United States;
f. You are a special immigrant retired international organization employee or family member;
g. You are a special immigrant physician;
Form I-485 Supplement A (Rev. 05/27/08)Y
Part C. Additional eligibility information. (Continued.)
h. You are a public interest parolee, who was denied refugee status, and are from the former Soviet Union, Vietnam, Laos or
Cambodia (a "Lautenberg Parolee" under Public Law 101-167); or
i. You are eligible under the Immigration Nursing Relief Act.
No. I am not applying for adjustment of status for any of these reasons. (Go to next question.)
Yes. I am applying for adjustment of status for any one of these reasons. (If you answered "Yes," do not file this form.)
2. Do any of the following conditions describe you?
a. You are already a lawful permanent resident of the United States.
b. You have continuously maintained lawful immigration status in the United States since November 5, 1986.
c. You are applying to adjust status as the spouse or unmarried minor child of a U.S. citizen or the parent of a U.S. citizen
child at least 21 years of age, and you were inspected and lawfully admitted to the United States.

No. None of these conditions describe me. (Go to Part D. Signature.)


Yes. If you answered "Yes," do not file this form.

Part D. Signature. Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit being sought.

Signature Print Name Date

Part E. Signature of person preparing form, if other than above. Read the information on penalties in the instructions
before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that I prepared this form at the request of the above
person and that to the best of my knowledge the contents of this application are all true and correct.
Signature Print Name Date

Firm Name and Address Daytime Phone Number (Area Code and Number)

( )

E-Mail Address, if any

Form I-485 Supplement A (Rev. 05/27/08Y)Y Page 2


OMB No. 1615-0026; Exp. 09/30/08

Department of Homeland Security


Instructions for I-526, Immigrant
U.S. Citizenship and Immigration Services Petition by Alien Entrepreneur

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

What Is The Purpose of This Form I-526? General Instructions.


This form is for use by an entrepreneur to petition the U.S. Fill Out the Form I-526
Citizenship and Immigration Services (USCIS) for status as an 1. Type or print legibly in black ink.
immigrant to the United States pursuant to section 203(b)(5)
of the Immigration and Nationality Act, as amended. That 2. If extra space is needed to complete any item, attach a
section of the law pertains to immigrant visas for an investor continuation sheet, indicate the item number, and date and
in a new commercial enterprise. sign each sheet.
3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
Who May File Form I-526? write "none."
You may file this petition for yourself if you have established Initial Evidence Requirements.
a new commercial enterprise: The following evidence must be filed with your petition:
1. In which you will engage in a managerial or policy- 1. Evidence that you have established a lawful business entity
making capacity, and under the laws of the jurisdiction in the United States in
which it is located, or, if you have made an investment in
2. In which you have invested or are actively in the an existing business, evidence that your investment has
process of investing the amount required for the area caused a substantial (at least 40 percent) increase in the net
in which the enterprise is located, and worth of the business, the number of employees, or both.
3. Which will benefit the U.S. economy, and Such evidence shall consist of copies of articles of
incorporation, certificate of merger or consolidation,
4. Which will create full-time employment in the partnership agreement, certificate of limited partnership,
United States for at least ten U.S. citizens, joint venture agreement, business trust agreement, or other
permanent residents, or other immigrants authorized similar organizational document; a certificate evidencing
to be employed, other than yourself, your spouse, authority to do business in a state or municipality, or if
your sons or daughters, or any nonimmigrant aliens. such is not required, a statement to that effect; or evidence
that the required amount of capital was transferred to an
The establishment of a new commercial enterprise may include: existing business resulting in a substantial increase in the
net worth or number of employees, or both.
1. Creation of a new business;
This evidence must be in the form of stock purchase
2. The purchase of an existing business with simultaneous agreements, investment agreements, certified financial
or subsequent restructuring or reorganization resulting reports, payroll records or other similar instruments,
in a new commercial enterprise; or agreements or documents evidencing the investment and
the resulting substantial change.
3. The expansion of an existing business through
investment of the amount required, so that a substantial 2. Evidence, if applicable, that your enterprise has been
change (at least 40 percent) in either the net worth, established in a targeted employment area. A targeted
number of employees, or both, results. employment area is defined as a rural area or an area which
has experienced high unemployment of at least 150 percent
The amount of investment required in a particular area is set of the national average rate. A rural area is an area not
by regulation. Unless adjusted downward for targeted areas within a metropolitan statistical area or not within the outer
or upward for areas of high employment, the amount of boundary of any city or town having a population of
investment shall be $1,000,000 (one million dollars). You 20,000 or more.
may obtain additional information from our website at www.
uscis.gov, or an American embassy or consulate abroad. 3. Evidence that you have invested or are actively in the
process of investing the amount required for the area in
which the business is located.

Form I-526 (Rev. 07/30/07)Y


Such evidence may include, but need not be limited to, Louisiana, Mississippi, Maine, Maryland, Massachusetts, New
copies of bank statements, evidence of assets that have Hampshire, New Jersey, New Mexico, New York, North
been purchased for use in the enterprise, evidence of Carolina, South Carolina, Oklahoma, Pennsylvania, Puerto
property transferred from abroad for use in the enterprise, Rico, Rhode Island, Tennessee, or Texas, Vermont, the U.S.
evidence of monies transferred or committed to be Virgin Islands, Virginia or West Virginia, mail the petition to:
transferred to the new commercial enterprise in exchange
for shares of stock, any loan or mortgage, promissory USCIS Texas Service Center
note, security agreement, or other evidence of borrowing P.O. Box 852135
that is secured by assets of the petitioner. Mesquite, TX 75185-2135
4. Evidence that capital is obtained through lawful means. If the new commercial enterprise is located, or will principally
The petition must be accompanied, as applicable, by: be doing business in: Alaska, Arizona, California, Colorado,
foreign business registration records, tax returns of any Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,
kind filed within the last five years in or outside the Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada,
United States, evidence of other sources of capital, or North Dakota, Ohio, Oregon, South Dakota, Utah,
certified copies of any judgment, pending governmental Washington, Wisconsin or Wyoming, mail the petition to:
civil or criminal actions, or private civil actions against the
petitioner from any court in or outside the United States USCIS California Service Center
within the past 15 years. P.O. Box 10140
Laguna Niguel, CA 92607-0526
5. Evidence that the enterprise will create at least ten full-
time positions for U.S. citizens, permanent residents, or
aliens lawfully authorized to be employed (except What Is the Filing Fee?
yourself, your spouse, sons, or daughters, and any
nonimmigrant aliens). Such evidence may consist of The filing fee for the Form I-526 is $1,435.00.
copies of relevant tax records, Forms I-9, or other similar Use the following guidelines when you prepare your check or
documents, if the employees have already been hired, or a
money order for the Form I-526:
business plan showing when such employees will be hired
within the next two years. 1. The check or money order must be drawn on a bank or
other financial institution located in the United States
6. Evidence that you are or will be engaged in the
management of the enterprise, either through the exercise and must be payable in U.S. currency; and
of day-to-day managerial control or through policy
2. Make the check or money order payable to U.S.
formulation. Such evidence may include a statement of
Department of Homeland Security, unless:
your position title and a complete description of your
duties, evidence that you are a corporate officer or hold a
seat on the board of directors, or, if the new enterprise is a A. If you live in Guam and are filing your petition
partnership, evidence that you are engaged in either direct there, make it payable to Treasurer, Guam.
management or policy-making activities. B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to
Translations. Any document containing foreign language
Commissioner of Finance of the Virgin Islands.
submitted to the Service shall be accompanied by a full
English language translation which the translator has certified C. If you live outside the United States, Guam, or the
as complete and accurate, and by the translator's certification U.S. Virgin Islands, contact the nearest U.S.
that he or she is competent to translate from the foreign consulate or embassy for instructions on the
language into English. method of payment.

Copies. Unless specifically required that an original document NOTE: Please spell out U.S. Department of Homeland
be filed with an application or petition, an ordinary legible Security; do not use the initials "USDHS" or "DHS."
photocopy may be submitted. Original documents submitted
when not required will remain a part of the record, even if the
submission was not required. How to Check If the Fees Are Correct.
The form fee on this form is current as of the edition date
appearing in the lower right corner of this page. However,
Where To File? because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below:
If the new commercial enterprise is located, or will principally
1. Visit our website at www.uscis.gov, select
be doing business in: Alabama, Arkansas, Connecticut,
"Immigration Forms" and check the appropriate fee;
Delaware, District of Columbia, Florida, Georgia, Kentucky,

Form I-526 (Rev. 07/30/07)Y Page 2


2. Review the Fee Schedule included in your form Approval.
package, if you called us to request the form; or If you have established that you qualify for investor status, the
petition will be approved. If you have requested that the
3. Telephone our National Customer Service Center at petition be forwarded to an American embassy or consulate
1-800-375-5283 and ask for the fee information. abroad, the petition will be sent there unless that consulate
does not issue immigrant visas. If you are in the United States
and state that you will apply for adjustment of status, and the
Address Changes. evidence indicates you are not eligible for adjustment, the
If you change your address and you have an application or petition will be sent to an American embassy or consulate
petition pending with USCIS, you may change your address abroad. You will be notified in writing of the approval of the
petition and where it has been sent, and the reason for sending
on-line at www.uscis.gov, click on "Change your address with
it to a place other than the one
USCIS" and follow the prompts or by completing and mailing
requested, if applicable.
Form AR-11, Alien's Change of Address Card, to:
U.S. Citizenship and Immigration Services Meaning of petition approval.
Change of Address Approval of a petition shows only that you have established
P.O. Box 7134 that you have made a qualifying investment. It does not
London, KY 40742-7134 guarantee that the American embassy or consulate will issue
the immigrant visa. There are other requirements that must be
For commercial overnight or fast freight services only, mail to: met before a visa can be issued. The American embassy or
consulate will notify you of those requirements. Immigrant
U.S. Citizenship and Immigration Services status granted based on this petition will be conditional. Two
Change of Address years after entry, the conditional investor will have to apply
1084-I South Laurel Road for the removal of conditions based on the ongoing nature of
London, KY 40744 the investment.

Denial.
Processing Information. If you have not established that you qualify for the benefit
sought, the petition will be denied. You will be notified in
writing of the reasons for the denial.
Acceptance.
Any petition that is not signed or accompanied by the correct
fee will be rejected with a notice that it is deficient. You may USCIS Forms and Information.
correct the deficiency and resubmit the petition. However, a
petition is not considered properly filed until accepted by To order USCIS forms, call our toll-free number at
USCIS. 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
Initial processing.
1-800-375-5283 or visiting our internet website at www.uscis.
Once the Form I-526 has been accepted, it will be checked for
gov.
completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it
without required initial evidence, you will not establish a As an altenative to waiting in line for assistance at your local
basis for eligibility and we may deny your Form I-526. USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler and
Requests for more information or interview. follow the screen prompts to set up your appointment.
We may request more information or evidence or we may InfoPass generates an electronic appointment notice that
request that you appear at a USCIS office for an interview. appears on the screen.
We may also request that you submit the originals of any
copy. We will return these originals when they are no longer
required. Penalties.
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this request, we will
Decision. The decision on the Form I-526 involves a
deny the benefit you are filing for, and may deny any other
determination of whether you have established eligibility for
immigration benefit.
the requested benefit. You will be notified of the decision in
writing. In addition, you will face severe penalties provided by law,
and may be subject to criminal prosecution.

Form I-526 (Rev. 07/30/07)Y Page 3


Privacy Act Notice.
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies.
Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of
your Form I-526.

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 15 minutes
per response, including the time for reviewing instructions,
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 Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
OMB No. 1615-0026. Do not mail your application to this
address.

Form I-526 (Rev. 07/30/07)Y Page 4


OMB No. 1615-0026; Exp. 09/30/08
Department of Homeland Security I-526, Immigrant Petition
U.S. Citizenship and Immigration Services by Alien Entrepreneur

Do Not Write in This Block - For USCIS Use Only (Except G-28 Block Below)
Classification Action Block Fee Receipt

Priority Date
To be completed by Attorney or Representative, if any
G-28 is attached
Attorney's State License No.

Remarks:
START HERE - Type or print in black ink.
Part 1. Information about you.
Family Given Middle
Name Name Name
Address:
In care of
Number and
Street Apt. #
State or Zip/Postal
City Province Country Code
Date of Birth Country Social Security # A#
(mm/dd/yyyy) of Birth (if any) (if any)
If you are in the United States, provide Date of Arrival
the following information: (mm/dd/yyyy) I-94 #
Current Date Current Status Daytime Phone #
Nonimmigrant Status Expires (mm/dd/yyyy) with Area Code

Part 2. Application type. (Check one)


a. This petition is based on an investment in a commercial enterprise in a targeted employment area for which the required
amount of capital invested has been adjusted downward.
b. This petition is based on an investment in a commercial enterprise in an area for which the required amount of capital invested
has been adjusted upward.
c. This petition is based on an investment in a commercial enterprise that is not in either a targeted area or in an upward
adjustment area.

Part 3. Information about your investment.

Name of commercial enterprise in which funds are invested

Street
Address
Phone # Business organized as
with Area Code (corporation, partnership, etc.)
Kind of business Date established
(e.g. furniture manufacturer) (mm/dd/yyyy) IRS Tax #

RECEIVED: ________________ RESUBMITTED: ____________ RELOCATED: SENT ________________ REC'D ____________

Form I-526 (Rev. 07/30/07)Y


Part 3. Information about your investment. (Continued.)
Date of your initial Amount of your
investment (mm/dd/yyyy) initial investment $

Your total capital investment Percentage of the


in the enterprise to date $ enterprise you own

If you are not the sole investor in the new commercial enterprise, list on separate paper the names of all other parties (natural and non-
natural) who hold a percentage share of ownership of the new enterprise and indicate whether any of these parties is seeking
classification as an alien entrepreneur. Include the name, percentage of ownership and whether or not the person is seeking classification
under section 203(b)(5). NOTE: A "natural" party would be an individual person and a "non-natural" party would be an entity such as a
corporation, consortium, investment group, partnership, etc.
If you indicated in Part 2 that the enterprise is in a targeted employment area
or in an upward adjustment area, name the county and state: County State

Part 4. Additional information about the enterprise.


Type of Enterprise (check one):
New commercial enterprise resulting from the creation of a new business.
New commercial enterprise resulting from the purchase of an existing business.
New commercial enterprise resulting from a capital investment in an existing business.

Composition of the Petitioner's Investment:

Total amount in U.S. bank account ...................................................................................... $

Total value of all assets purchased for use in the enterprise................................................. $

Total value of all property transferred from abroad to the new enterprise........................... $

Total of all debt financing.................................................................................................... $

Total stock purchases........................................................................................................... $

Other (explain on separate paper)........................................................................................ $

Total $
Income:

When you made the investment......... Gross $ Net $

Now.................................................... Gross $ Net $


Net worth:

When you made investment............... Gross $ Now $

Form I-526 (Rev. 07/30/07)Y Page 2


Part 5. Employment creation information.
Number of full-time employees in the enterprise in U.S. (excluding you, your spouse, sons and daughters)
When you made your initial investment? Now Difference

How many of these new jobs were How many additional new jobs will be
created by your investment? created by your additional investment?
What is your position, office or title with the new commercial enterprise?

Briefly describe your duties, activities and responsibilities.

What is your salary? $ What is the cost of your benefits? $

Part 6. Processing information.


Check One:
The person named in Part 1 is now in the United States and an application to adjust status to permanent resident will be filed
if this petition is approved.
If the petition is approved and the person named in Part 1 wishes to apply for an immigrant visa abroad, complete the
following for that person:

Country of nationality:
Country of current residence or, if now in the
United States, last permanent residence abroad:

If you provided a United States address in Part 1, print the person's foreign address:

If the person's native alphabet is other than Roman letters, write the foreign address in the native alphabet:

Is a Form I-485, Application for Adjustment of Status, attached to this petition? Yes No

Are you in deportation or removal proceedings? Yes (Explain on separate paper) No


Have you ever worked in the United States without permission? Yes (Explain on separate paper) No

Part 7. Signature. Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is
all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs
to determine eligibility for the benefit I am seeking.

Signature Date
NOTE: If you do not completely fill out this form or fail to the submit the required documents listed in the instructions, you may not be
found eligible for the immigration benefit you are seeking and this petition may be denied.
Part 8. Signature of person preparing form, if other than above. (Sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Print Your
Signature Name Date

Firm Name
Daytime phone #
Address with area code

Form I-526 (Rev. 07/30/07)Y Page 3


OMB No. 1615-0003; Expires 12/31/08

Department of Homeland Security


Instructions for Form I-539, Application
U.S. Citizenship and Immigration Services to Extend/Change Nonimmigrant Status

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

NOTE: You have the option of submitting this paper version of Form I-539 according to form's instructions or you may file the
application electronically. To file electronically, visit our Internet website at www.uscis.gov and follow the instructions on e-filing.
Whether you submit this paper form or e-file, U.S. Citizenship and Immigration Services (USCIS) recommends that you retain a copy
of your application and supporting documents for your records.

Multiple Applicants
What Is the Purpose of This Form?
You may include your spouse and your unmarried children
You should use this form if you are one of the nonimmigrants under age 21 years as co-applicants in your application for the
listed below and wish to apply to U.S. Citizenship and same extension or change of status, if you are all now in the
Immigration Services (USCIS) for an extension of stay, or a same status or they are all in derivative status.
change to another nonimmigrant status.
Nonimmigrant Categories
In certain situations, you may use this form to apply for an
initial nonimmigrant status. This form may be used by the following nonimmigrants listed
You may also use this form if you are a nonimmigrant F-1, or in alphabetical order:
M-1 student applying for reinstatement.
1. An A, Ambassador, Public Minister, or
Career Diplomatic or Consular Officer
When Should I Use Form I-539? and their immediate family members
You must submit a copy, front and back, of the Form I-94
You must submit an application for extension of stay, or of each person included in the application and a Form
change of status before your current authorized stay expires. I-566, Interagency Record of Individual Requesting
We suggest you file at least 45 days before your stay expires, Change, Adjustment to, or from, A to G Status; or
or as soon as you determine your need to change status. Requesting A, G or NATO Dependent Employment
Failure to file before the expiration date may be excused if you Authorization, certified by the U.S. Department of State to
demonstrate when you file the application that: indicate your accredited status.
1. The delay was due to extraordinary circumstances beyond NOTE: An A-1 or A-2 nonimmigrant is not required to
your control; pay a fee with the Form I-539 application.
2. The length of the delay was reasonable;
2. An A-3, Attendant or Servant of
3. You have not otherwise violated your status;
an A Nonimmigrant and the A-3's
4. You are still a bona fide nonimmigrant; and immediate family members
5. You are not in removal proceedings. You must submit a copy, front and back, of Form I-94 of
each person included in the application.

Who May File This Form I-539? The application must be filed with:
A. A copy of your employer's Form I-94 or approval
Extension of Stay or Change of Status notice demonstrating A status;
Nonimmigrants in the United States may apply for an B. An original letter from your employer describing your
extension of stay or a change of status on this form, except as duties and stating that he or she intends to personally
noted in these instructions under the heading, "Who May Not employ you, and arrangements you have made to
File This Form I-539." depart from the United States; and

Form I-539 Instructions (Rev. 12/31/07) Y


C. An original Form I-566, certified by the U.S. 5. An F-1, Academic Student
Department of State, indicating your employer's
continuing accredited status. To request a change to F-1 status or to apply for
reinstatement as an F-1 student, you must submit your
3. A B-1, Visitor for Business or original Form I-94, as well as the original Form I-94 of
B-2, Visitor for Pleasure each person included in the application.

If you are filing for an extension/change, you must file Your application must include your original Form I-20
your application with the original Form I-94 of each (Certificate of Eligibility for Nonimmigrant Student)
person included in your application. In addition, you must issued by the school where you will study. To request
submit a written statement explaining in detail: either a change or reinstatement, you must submit
documentation that demonstrates your ability to pay for
A. The reasons for your request; your studies, and support yourself while you are in the
B. Why your extended stay would be temporary, including United States.
what arrangements you have made to depart from the
F-1 Extensions
United States; and
C. Any effect the extended stay may have on your foreign Do not use this form to request an extension. For
employment or residency. information concerning extensions, contact your
designated school official at your institution.
If you are applying for an extension/change of B-1, Visitor F-1 Reinstatement
for pleasure, you must designate your desired status using
the following classification in Part 2.1.b of Form I-539: You will only be considered for reinstatement as an F-1
A. B-1A, non-immigrant who is the personal or domestic student if you establish:
servant of a nonimmigrant employer; A. That the violation of status was due solely to
B. B-1B, nonimmigrant domestic servant of a U.S. citizen; circumstances beyond your control or that failure to
reinstate you would result in extreme hardship;
C. B-1C, non-immigrant who is employed by a foreign
airline; B. You are pursuing or will pursue a full course of study;

D. B-1D, non-immigrant who is a missionary; C. You have not been employed without authorization;
and
E. B-1, all other visa classifications not designated above.
D. You are not in removal proceedings.
4. Dependents of an E, Treaty Trader or Investor,
or Australian Specialty Occupation Worker 6. A G, Designated Principal Resident
If you are filing for an extension/change of status as the Representative of a Foreign Government
dependent of an E, this application must be submitted with: and his or her immediate family members
You must submit a copy, front and back, of Form I-94 for
A. Form I-129, Petition for Alien Worker, filed for that E each person included in the application, and a Form I-566,
or a copy of the filing receipt noting that the petition is certified by the U.S. Department of State to indicate your
pending with USCIS; accredited status.
B. A copy of the E's Form I-94 or approval notice NOTE: A G-1 through G-4 nonimmigrant is not required
showing that he or she has already been granted status to pay a fee with the I-539 application.
to the period requested on your application; and
The application must also be filed with:
C. Evidence of relationship (example: birth or marriage
certificate). A. A copy of your employer's Form I-94 or approval
notice demonstrating G status;
NOTE: An employer or investor should file Form I-129
to request an extension/change to E status for an employee, B. An original letter from your employer describing your
prospective employee, or the investor. Dependents of E duties and stating that he or she intends to personally
employees should file for an extension/change of status on employ you and arrangements you have made to depart
this form, not Form I-129. from the United States; and
Form I-539 Instructions (Rev. 12/31/07) Y Page 2
7. Dependents of an H, Temporary Worker If a J-1 exchange visitor is subject to the foreign residence
requirement, the J-2 dependant is also subject as a
If you are filing for an extension/change of status as the derivative to this requirement. If the J-1 exchange visitor
dependent of an employee who is an H temporary worker, obtains a waiver of the foreign residence requirement, the
this application must be submitted with: J-2 dependant is also exempt from the requirement. Under
certain limited circumstances, a J-2 dependant may be
A. Form I-129 filed for that employee or a copy of the independently eligible for a waiver of the foreign residence
filing receipt noting that the petition is pending with requirement.
USCIS;

B. A copy of the employee's Form I-94 or approval notice A former J nonimmigrant (either a J-1 principal or a J-2
showing that he or she has already been granted status dependant) subject to the foreign residence requirement,
to the period requested on your application; and who is currently maintaining another nonimmigrant visa
status, continues to be subject to the foreign residence
C. Evidence of relationship (example: birth or marriage requirement. As noted above, the former J nonimmigrant is
certificate). ineligible for a change of status until he or she fulfills the
foreign residence requirement or obtains the appropriate
NOTE: An employer should file Form I-129 to request an waiver.
extension/change to H status for an employee or
prospective employee. Dependents of such employees If you are a current or former J nonimmigrant, you must
should file for an extension/change of status on this form, provide information about this status, including the dates
not on Form I-129. you maintained status as a J-1 exchange visitor or a J-2
8. A J-1, Exchange Visitor dependant. Willful failure to disclose this information (or
If you are requesting a change of status to J-1 other relevant information) can result in your application
nonimmigrant classification, your application must be filed being denied. Please provide proof of this status along with
with an original DS-2019, Certificate of Eligibility for your application, such as a copy of Form DS-2019,
Exchange Visitor Status. You must also submit your Certificate of Eligibility for Exchange Visitor Status, or a
original Form I-94, as well as the original Form I-94 for copy of your passport that includes the J visa stamp.
each person included in the application.
9. Dependents of an L, Intracompany Transferee
J-1 Extensions
If you are filing for an extension/change of status as the
If you are a J-1 exchange visitor seeking an extension of dependent of an employee who is an L intracompany
nonimmigrant status, contact the responsible officer of transferee, this application must be submitted with:
your program for information about this procedure. A. The Form I-129 filed for that employee, or a copy of
the filing receipt noting that the petition is pending
J-1 Reinstatement with USCIS;

If you are a J-1 exchange visitor seeking reinstatement, B. A copy of the employee's Form I-94 or approval notice
you may need to apply to the U.S. Department of State's showing that he or she has already been granted status
Office of Education and Cultural Affairs for such approval. to the period requested on your application; and
Contract the responsible officer at your sponsoring
C. Evidence of relationship (example: birth or marriage
program for information on the restatement filing
certificate).
procedure.

Notice to J Nonimmigrants NOTE: An employer should file Form I-129 to request an


extension/change to L status for an employee or
A J-1 exchange visitor whose status is for the purpose of prospective employee. Dependents of such employees
receiving graduate medical education or training, and who should file for an extension/change of status on this form,
has not received the appropriate waiver, is ineligible for not on Form I-129.
change of status except to a nonimmigrant T or U visa. In
addition, a J-1 exchange visitor who is subject to the
foreign residence requirement, and who has not received a
waiver of that requirement, is only eligible for a change of
status to a nonimmigrant A, G, T, or U visa.

Form I-539 Instructions (Rev. 12/31/07) Y Page 3


10. An M-1, Vocational or Non-Academic Student
To request a change to or extension of M-1 status, or apply B. A copy of the employee's Form I-94 or approval notice
for reinstatement as an M-1 student, you must submit your showing that he or she has already been granted status
original Form I-94, as well as the original Form I-94 of to the period requested on your application; and
each person included in the application. C. Evidence of relationship (example: birth or marriage
M-1 Reinstatement certificate).

A. The violation of status was due solely to circumstances 13. TD Dependents of TN Nonimmigrants
beyond your control or that failure to reinstate you TN nonimmigrants are citizens of Canada or Mexico who
would result in extreme hardship; are coming as business persons to the United States to
engage in business activities at a professional level
B. You are pursuing or will pursue a full course of study;
pursuant to the North American Free Trade Agreement
C. You have not been employed without authorization; (NAFTA). The dependents (spouse or unmarried minor
and children) of a TN nonimmigrant are designated as TD
nonimmigrants. A TD nonimmigrant may accompany or
D. You are not in removal proceedings.
follow to join the TN professional. TD nonimmigrants
NOTE: If you are an M-1 student, you are not eligible for may not work in the United States.
a change to F-1 status, and you are not eligible for a change
Form I-539 shall be used by a TD nonimmigrant to request
to any H status if the training you received as an M-1 helps
an extension of stay or by an applicant to request a change
you qualify for the H status. Also, you may not be granted
of nonimmigrant status to TD classification.
a change to M-1 status for training to qualify for H status.
If you are filing for an extension/change of status as the
11. Dependents of a P, Artists, dependent of an employee who is classified as a TN
Athletes and Entertainers nonimmigrant, this application must be submitted with:
If you are filing for an extension/change of status as the A. Form I-129 filed for that employee or a copy of the
dependent of an employee who is classified as a P filing receipt noting that the petition is pending with
nonimmigrant, this application must be submitted with: USCIS;
A. The Form I-129 filed for that employee or a copy of
B. A copy of the employee's Form I-94 or approval notice
the filing receipt noting that the petition is pending
showing that he or she has already been granted status
with USCIS;
to the period requested on your application; and
B. A copy of the employee's Form I-94 or approval notice C. Evidence of relationship (example: birth or marriage
showing that he or she has already been granted status certificate).
to the period requested on your application; and
C. Evidence of relationship (example: birth or marriage
14. A V, Spouse or Child of a Lawful Permanent
certificate). Resident

NOTE: An employer should file Form I-129 to request an Use this Form I-539 if you are physically present in the
extension/change to P status for an employee or United States and wish to request initial status or change
prospective employee. Dependents of such employees status to a V nonimmigrant, or to request an extension of
should file for an extension/change of status on this form, your current V nonimmigrant status.
not on Form I-129. Applicants should follow the instructions on this form and
the attached instructions to Supplement A to Form I-539,
12. Dependents of an R, Religious Worker Filing Instructions for V Nonimmigrants. The supplement
If you are filing for an extension/change of status as the contains additional information and the location where V
dependent of an employee who is classified as an R applicants must file their applications.
nonimmigrant, this application must be submitted with:

A. The Form I-129 filed for that employee or a copy of


the filing receipt noting that the petition is pending
with USCIS;

Form I-539 Instructions (Rev. 12/31/07) Y Page 4


NOTE: In addition to the $300 application fee required to 1. An alien in transit (C) or in transit without a visa (TWOV);
file Form I-539, V applicants are required to pay a $80
2. A crewman (D); or
biometric services fee for USCIS to take their fingerprints.
3. A fiance'(e) or dependent of a fiance'(e) (K)(1) or (K)(2).
If necessary, USCIS may also take the V applicant's A spouse (K-3) of a U.S. citizen and their children (K-4),
photograph and signature as part of the biometric services. accorded such status pursuant to the LIFE Act, may not
change to another nonimmigrant status.
Notice to V Nonimmigrants EXCEPTION: A K-3 and K-4 are eligible to apply for an
The Legal Immigration Family Equity Act (LIFE), signed extension of status. They should file for an extension during
into law on December 21, 2000, created a new V visa. the processing of Form I-130 filed on their behalf and up to
This nonimmigrant status allows certain persons to reside completion of their adjustment of status application.
legally in the United States and to travel to and from the NOTE: Any nonimmigrant (A to V) may not change their
United States while they wait to obtain lawful permanent status to K-3 or K-4.
residence.
In order to be eligible for a V visa, all of the following General Instructions
conditions must be met:
A. You must be the spouse or the unmarried child of a Step 1. Fill Out Form I-539
lawful permanent resident; 1. Type or print legibly in black ink.
B. A Form I-130, Petition for Alien Relative, must have 2. If extra space is needed to complete any item, attach a
been filed for you by your permanent resident spouse continuation sheet, indicate the item number, and date and
on or before December 21, 2000; and sign each sheet.
C. You must have been waiting for at least three years 3. Answer all questions fully and accurately. State that an
after Form I-130 was filed for you; item is not applicable with "N/A." If the answer is none,
Or you must be the unmarried child (under 21 years of write "none."
age) of a person who meets the three requirements listed
above. Step 2. General requirements

V visa holders will be eligible to adjust to lawful Required Documentation - Form I-94, Nonimmigrant
permanent resident status once an immigrant visa becomes Arrival/ Departure Record. You are required to submit with
available to them. While they are waiting, V visa holders your Form I-539 application the original or copy, front and
may be authorized to work following their submission and back, of Form I-94 of each person included in your
USCIS approval of their Form I-765, Application for application. If the original Form I-94 or required copy cannot
Employment Authorization. be submitted with this application, include a Form I-102,
Application for Replacement/Initial Nonimmigrant Arrival/
WARNING: Be advised that persons in V status who Departure Document, with the required fee.
have been in the United States illegally for more than 180 Valid Passport. If you were required to have a passport to be
days may trigger the grounds of inadmissibility regarding admitted into the United States, you must maintain the validity
unlawful presence (for the applicable 3-year or 10-year bar of your passport during your nonimmigrant stay. If a required
to admission) if they leave the United States. Their passport is not valid when you file Form I-539 application,
departure may prevent them from adjusting status as a submit an explanation with your form.
permanent resident.
Additional Evidence. You may be required to submit
additional evidence noted in these instructions.
Who May Not File This Form I-539?
Translations. Any document containing foreign language
You may not be granted an extension or change of status if submitted to USCIS shall be accompanied by a full English
you were admitted under the Visa Waiver Program or if your language translation which the translator has certified as
current status is: complete and accurate, and by the translator's certification that
he or she is competent to translate from the foreign language
into English.

Form I-539 Instructions (Rev. 12/31/07) Y Page 5


Copies. Unless specifically required that an original B. Filing Form I-539 separately from the principal and
document be filed with an application or petition, an ordinary the principal's case is pending: If the principal's
legible photocopy may be submitted. Original documents Form I-129 (which includes a request for change of
submitted when not required will remain a part of the record, status or extension of stay) is pending, file Form I-539
even if the submission was not required. with the same Service Center where the principal's
Form I-129 is pending. Include a copy of Form I-129
filing receipt (or transfer notice) to show the pending
Where To File? Form I-129 location.
C. Filing Form I-539 separately from the principal and
1. With some exceptions, Form I-539 is generally filed with the principal's case is approved: If the principal's
the California Service Center or the Vermont Service Form I-129 (which included a request for change of
Center. status or extension of stay) has already been approved,
California Service Center fillings cover the following file Form I-539 with the Service Center which
states: Alaska, Arizona, California, Colorado, Guam, approved the principal's I-129 petition. Include a copy
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, of the Form I-129 approval notice to show the
Minnesota, Missouri, Montana, Nebraska, Nevada, North approved Form I-129 location.
Dakota, Ohio, Oregon, South Dakota, Utah, Washington,
D. F-1 and M-1 students applying for F-1 and M-1
Wisconsin, or Wyoming.
reinstatement: File Form I-539 with the California
The mailing address is: Service Center or the Vermont Service Center,
depending on the State in which the educational
USCIS California Service Center
institution you attend or plan to attend is located.
P.O. Box 10539
Laguna Niguel, CA 92607-1053 E. All other applicants for change of status or
Vermont Service Center filings cover the following states: extension of stay (not listed above or in the
Alabama, Arkansas, Connecticut, Delaware, Florida, exceptions): File Form I-539 with the California
Georgia, Kentucky, Louisiana, Maine, Maryland, Service Center or the Vermont Service Center,
Massachusetts, Mississippi, New Hampshire, New Jersey, depending on the State where you live.
New Mexico, New York, North Carolina, Oklahoma, 3. Exceptions
Pennsylvania, Puerto Rico, Rhode Island, South Carolina,
Tennessee, Texas, Vermont, Virginia, U.S. Virgin Islands, A. R-2 Religious Worker Dependents:
West Virginia, and the District of Columbia.
File Form I-539 with the California Service Center,
The address for Vermont Service Center filings is: regardless of where the principal is/will be employed.
USCIS Vermont Service Center B. H-1 C Nurses dependents:
ATTN: I-539 File Form I-539 with the California Service Center,
75 Lower Welden Street regardless of where the principal is/will be employed.
St. Albans, VT 05479
C. TD dependents of TN principals (Free Trade-
2. Applicants for change of status to E-1, E-2, E-3, H-4, Canada and Mexico), H-4 dependents of H-1B1
L-2, O-3, or P-4 as the dependent spouse or child or for principals (Free Trade-Singapore and Chile), and
an E-1, E-2, E-3, H-4, L-2, O-3, P-4, or TD extension, as E-3 dependents of E-3 principals (Free Trade-
the dependent spouse or child. Australia):
File Form I-539 with the Vermont Service Center,
A. Filing Form I-539 at the same time as the principal: regardless of where the principal is/will be employed.
If your Form I-539 for change of status or extension of
stay is filed at the same time as the principal's Form D. Dependents of Major League Sports Athletes or
I-129, Petition for Nonimmigrant Worker, (which Support Personnel:
includes a request for change of status or extension of
stay), send the entire Form I-129/I-539 package to the
Vermont Service Center or the California Service
Center, depending on the State where the principal is or
will be employed temporarily.

Form I-539 Instructions (Rev. 12/31/07) Y Page 6


File with the Vermont Service Center. This covers F. V Nonimmigrants
major league athletes, minor league sports, and any Follow the filing instructions on Form I-539,
affiliates associated with the major leagues in baseball, Supplement A, Filing Instructions for V
hockey, soccer, basketball, and football. Support Nonimmigrants.
personnel includes: coaches, trainers, broadcasters,
referees, linesmen, umpires, and interpreters. G. Updated Filing Address Information
E. A, G and NATO: The filing addresses provided on this form reflect the
1. For change of status requests to A, G, or NATO most current information as of the date this form was
classification for employment with an embassy, last printed.
international organization, or NATO, mail Form
I-539 through your embassy, international If you are filing Form I-539 more than 30 days after
organization, or NATO to: U.S. Department of the latest edition date shown in the lower right-hand
State, Office of Protocol, 3507 International Place, corner, visit us online at www.uscis.gov before you
N.W., Suite 242, Washington, DC 20008. file, and check the Immigration Forms page to confirm
the correct filing address and version currently in use.
2. For change of status requests to G classification for Check the edition date located in the lower right-hand
employment with a foreign government's mission to corner of the form. If the edition date on your Form
the United Nations or with the United Nations I-539 matches the edition date listed for Form I-539 on
Secretariat, mail Form I-539 through the foreign the online forms page, your version is current and will
government's mission or the UN Secretariat to: be accepted by USCIS. If the edition date on the
U.S. Mission to the United Nations, 799 United online version is later, download a copy and use the
Nations Plaza, New York, NY 10017. online version. If you do not have Internet access, call
3. For a dependent spouse or child requesting a change Customer Service at 1-800-375-5283 to verify the
of status to a NATO classification based on the current filing address and edition date.
principal's classification as a NATO nonimmigrant, H. Note on E-Filing
mail Form I-539 to: NATO/HQ SACT Legal
Affairs, 7857 Blandy Road, Suite 100, Norfolk, VA If you are e-filing this application, it will automatically
23551. If you or the principal or the principal be routed to the appropriate Service Center, and you
NATO nonimmigrant through whom you derive will receive a receipt indicating the location to which it
your status are posted at a national component or as was routed. This location may not necessarily be the
an exchange officer, please submit Form I-539 to same center shown in the filing addresses listed above.
your embassy for proper filing through official For e-filed applications, it is very important to review
diplomatic channels. your filing receipt and make specific note of the
receiving location.
4. For a change of status from A, G, or NATO
classifications to another nonimmigrant All further communication, including submission of
classification, file Form I-539 with USCIS Service supporting documents, should be directed to the
Center designated to handle the new nonimmigrant receiving location indicated on your e-filing receipt.
classification sought. You must submit with Form
I-539 an endorsement by the U.S. Department of
State Visa Office, or a USUN official at Part 7 on What Is the Filing Fee?
the Form I-566 (interagency Record of Request-A,
G, or NATO Dependent Employment Authorization The filing fee for a Form I-539 is $300 except for certain A
or Change/Adjustment to Extend/Change and G nonimmigrants who are not required to pay a fee, as
Nonimmigrant Status). noted in these instructions.
An additional biometric fee of $80 is required when filing this
5. For extensions of stay for A-3, G-5, or NATO-7
Form I-539 for V nonimmigrant status. After you submit
nonimmigrants, submit your application through
Form I-539, USCIS will notify you about when and where to
your embassy or international organization, or
go for biometric services.
NATO command for proper filing through official
diplomatic channels. If biometric services are required, you may submit one check
or money order for both the application and biometric fees, for
a total of $380.

Form I-539 Instructions (Rev. 12/31/07) Y Page 7


Use the following guidelines when you prepare your check or Address Changes
money order for the Form I-539 and the biometric service fee,
if applicable: If you change your address and you have an application or
petition pending with USCIS, you may change your address
1. The check or money order must be drawn on a bank or online at www.uscis.gov, click on "Change your address with
other financial institution located in the United States and USCIS" and follow the prompts. Or you may complete and
must be payable in U.S. currency; and mail Form AR-11, Alien's Change of Address Card, to:
2. Make the check or money order payable to U.S. U.S. Citizenship and Immigration Services
Department of Homeland Security, unless: Change of Address
A. If you live in Guam and are filing your petition P.O. Box 7134
there, make it payable to Treasurer, Guam. London, KY 40742-7134

B. If you live in the U.S. Virgin Islands and are filing For commercial overnight or fast freight services only, mail to:
your petition there, make it payable to
Commissioner of Finance of the Virgin Islands. U.S. Citizenship and Immigration Services
Change of Address
NOTE: Please spell out U.S. Department of Homeland 1084-I South Laurel Road
Security; do not use the initials "USDHS" or "DHS." London, KY 40744

Notice to Those Making Payment by Check. If you send us


Processing Information
a check, it will be converted into an electronic funds transfer
(EFT). This means we will copy your check and use the
Any Form I-539 that is not signed or accompanied by the
account information on it to electronically debit your account
correct fee will be rejected with a notice that the Form
for the amount of the check. The debit from your account will
I-539 is deficient. You may correct the deficiency and
usually take 24 hours, and will be shown on your regular
resubmit the Form I-539. An application or petition is not
account statement.
considered properly filed until accepted by USCIS.
You will not receive your original check back. We will
Initial processing. Once a Form I-539 has been accepted, it
destroy your original check, but we will keep a copy of it. If
will be checked for completeness, including submission of the
the EFT cannot be processed for technical reasons, you
required initial evidence. If you do not completely fill out the
authorize us to process the copy in place of your original
form, or file it without required initial evidence, you will not
check. If the EFT cannot be completed because of insufficient
establish a basis for eligibility, and we may deny your Form
funds, we may try to make the transfer up to two times.
I-539.
How to Check If the Fees Are Correct Requests for more information or interview. We may
The form and biometric fees on this form are current as of the request more information or evidence, or we may request that
edition date appearing in the lower right corner of this page. you appear at a USCIS office for an interview. We may also
However, because USCIS fees change periodically, you can request that you submit the originals of any copy. We will
verify if the fees are correct by following one of the steps return these originals when they are no longer required.
below: Decision. The decision on a Form I-539 involves a
1. Visit our website at www.uscis.gov, select determination of whether you have established eligiblity for
"Immigration Forms," and check the appropriate fee; the requested benefit. You will be notified of the decision in
writing.
2. Review the Fee Schedule included in your form
package, if you called us to request the form; or
3. Telephone our National Customer Service Center at USCIS Forms and Information
1-800-375-5283 and ask for the fee information.
To order USCIS forms, call our toll-free number at
NOTE: If your Form I-539 requires payment of a biometric
1-800-870-3676. You can also get USCIS forms and
service fee for USCIS to take your fingerprints, photograph, or
information on immigration laws, regulations, and procedures
signature, you can use the same procedure to obtain the correct
by telephoning our National Customer Service Center at
biometric fee.
1-800-375-5283 or visiting our Internet website at www.uscis.
gov.

Form I-539 Instructions (Rev. 12/31/07) Y Page 8


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. 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.

Penalties

If you knowingly and willfully falsify or conceal a material


fact or submit a false document with this Form I-539, we will
deny Form I-539 and may deny any other immigration benefit.

In addition, you will face severe penalties provided by law and


may be subject to criminal prosecution.

Privacy Act Notice

We ask for the information on this form, and associated


evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies.
Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of
your Form I-539.

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 45 minutes per
response, including the time for reviewing instructions,
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 Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
OMB No. 1615-0003. Do not mail your application to this
address.

Form I-539 Instructions (Rev. 12/31/07) Y Page 9


OMB No. 1615-0003; Expires 12/31/08
Department of Homeland Security I-539, Application to Extend/
U.S. Citizenship and Immigration Services Change Nonimmigrant Status
START HERE - Please type or print in black ink. For USCIS Use Only
Part 1. Information about you Returned Receipt
Family Name Given Name Middle Name
Date
Address -
In care of - Resubmitted
Street Number Apt. #
and Name Date
City State Zip Code Daytime Phone #

Reloc Sent
Country of Birth Country of Citizenship

Date of Birth U. S. Social Security # (if any) A # (if any) Date


(mm/dd/yyyy)
Date of Last Arrival I-94 #
Into the U.S. Reloc Rec'd
Current Nonimmigrant Status Expires on
(mm/dd/yyyy) Date
Part 2. Application type (See instructions for fee.)
1. I am applying for: (Check one.) Applicant
a. An extension of stay in my current status. Interviewed
b. A change of status. The new status I am requesting is: on
c. Reinstatement to student status
Date
2. Number of people included in this application: (Check one.)
a. I am the only applicant. Extension Granted to (Date):
b. Members of my family are filing this application with me.
The total number of people (including me) in the application is:
(Complete the supplement for each co-applicant.) Change of Status/Extension Granted
Part 3. Processing information New Class: From (Date):
1. I/We request that my/our current or requested status be extended until To (Date):
(mm/dd/yyyy):
If Denied:
2. Is this application based on an extension or change of status already granted to your
spouse, child, or parent? Still within period of stay
No Yes. USCIS Receipt # S/D to:
3. Is this application based on a separate petition or application to give your spouse,
child, or parent an extension or change of status? No Yes, filed with this I-539. Place under docket control

Yes, filed previously and pending with USCIS. Receipt #: Remarks:


4. If you answered "Yes" to Question 3, give the name of the petitioner or applicant:

If the petition or application is pending with USCIS, also give the following data: Action Block

Office filed at Filed on (mm/dd/yyyy)

Part 4. Additional information


1. For applicant #1, provide passport information: Valid to: (mm/dd/yyyy)
Country of Issuance
2. Foreign Address: Street Number and Name Apt. # To Be Completed by
Attorney or Representative, if any
City or Town State or Province Fill in box if G-28 is attached to
represent the applicant.
Country Zip/Postal Code
ATTY State License #

Form I-539 (Rev. 12/31/07)Y


3. Answer the following questions. If you answer "Yes" to any question, please describe the circumstances in
detail and explain on a separate sheet(s) of paper. Yes No

a. Are you, or any other person included on the application, an applicant for an immigrant visa?

b. Has an immigrant petition ever been filed for you or for any other person included in this application?

c. Has a Form I-485, Application to Register Permanent Residence or Adjust Status, ever been filed by you or
by any other person included in this application?

d. 1. Have you or any other person, included in this application, ever been arrested or convicted of any criminal
offense since last entering the United States?
d. 2. Have you EVER ordered, incited, called for, commited, assisted, helped with, or otherwise participated in
any of the following:

(a) Acts involving torture or genocide?


(b) Killing any person?
(c) Intentionally and severely injuring any person?
(d) Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?
(e) Limiting or denying any person's ability to exercise religious beliefs?
d. 3. Have you EVER:
(a) Served in, been a member of, assisted in, or participated in any military unit, paramilitary
unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or
insurgent organization?
(b) Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation
that involved detaining persons?
d. 4. Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of
any kind in which you or other persons used any type of weapon against any person or threatened to
do so?
d. 5. Have you EVER assisted or participated in selling or providing weapons to any person who to your
knowledge used them against another person, or in transporting weapons to any person who to your
knowledge used them against another person?

d. 6. Have you EVER received any type of military, paramilitary, or weapons training?

e. Have you, or any other person included in this application, done anything that violated the terms of the
nonimmigrant status you now hold?
f. Are you, or any other person included in this application, now in removal proceedings?

g. Have you, or any other person included in this application, been employed in the United States since last
admitted or granted an extension or change of status?

1. If you answered "Yes" to Question 3f, give the following information concerning the removal proceedings on the attached
page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the name of the person in removal
proceedings and information on jurisdiction, date proceedings began, and status of proceedings.
2. If you answered "No" to Question 3g, fully describe how you are supporting yourself on the attached page entitled "Part 4.
Additional information. Page for answers to 3f and 3g." Include the source, amount, and basis for any income.
3. If you answered "Yes" to Question 3g, fully describe the employment on the attached page entitled "Part 4. Additional
information. Page for answers to 3f and 3g." Include the name of the person employed, name and address of the employer,
weekly income, and whether the employment was specifically authorized by USCIS.

Form I-539 (Rev. 12/31/07)Y Page 2


Yes No
h. Are you currently or have you ever been a J-1 exchange visitor or a J-2 dependent of a J-1 exchange visitor?

If yes, you must provide the dates you maintained status as a J-1 exchange visitor or J-2 dependent. Willful failure to disclose
this information (or other relevant information) can result in your application being denied. Also, please provide proof of
your J-1 or J-2 status, such as a copy of Form DS-2019, Certificate of Eligibility for Exchange Visitor Status, or a copy of
your passport that includes the J visa stamp.

Part 5. Applicant's Statement and Signature (Read the information on penalties in the instructions before completing this
section. You must file this application while in the United States).
Applicant's Statement (Check One):

I can read and understand English, and have read Each and every question and instruction on this
and understand each and every question and form, as well as my answer to each question, has
instruction on this form, as well as my answer to been read to me by the person named below in
each question. , a language in which
I am fluent. I understand each and every question
and instruction on this form, as well as my
answer to each question.
Applicant's Signature
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit I am seeking.

Signature Print your Name Date

Daytime Telephone Number E-Mail Address

NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for
the requested benefit and this application may be denied.

Part 6. Interpreter's Statement

Language used:
I certify that I am fluent in English and the above-mentioned language. I further certify that I have read each and every question and
instruction on this form, as well as the answer to each question, to this applicant in the above-mentioned language, and the applicant
has understood each and every instruction and question on the form, as well as the answer to each question.

Signature Print Your Name Date

Firm Name Daytime Telephone Number


(If Applicable) (Area Code and Number)

Address Fax Number (Area Code and Number) E-Mail Address

Form I-539 (Rev. 12/31/07)Y Page 3


Part 7. Signature of Person Preparing Form, if Other than Above (Sign Below)

Signature Print Your Name Date

Firm Name Daytime Telephone Number


(If Applicable) (Area Code and Number)

Address Fax Number (Area Code and Number) E-Mail Address

I declare that I prepared this application at the request of the above person and it is based on all information of which I have
knowledge.
Part 4. (Continued) Additional information. Page for answers to 3f and 3g.

If you answered "Yes" to Question 3f in Part 4 on Page 3 of this form, give the following information concerning the removal
proceedings. Include the name of the person in removal proceedings and information on jurisdiction, date proceedings began, and
status of proceedings.

If you answered "No" to Question 3g in Part 4 on Page 3 of this form, fully describe how you are supporting yourself. Include the
source, amount and basis for any income.

If you answered "Yes" to Question 3g in Part 4 on Page 3 of this form, fully describe the employment. Include the name of the
person employed, name and address of the employer, weekly income, and whether the employment was specifically authorized by
USCIS.

Form I-539 (Rev. 12/31/07)Y Page 4


Supplement -1
Attach to Form I-539 when more than one person is included in the petition or application.
(List each person separately. Do not include the person named in the Form I-539.)
Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)

Date of Arrival (mm/dd/yyyy) I-94 #

Current Nonimmigrant Status: Expires on (mm/dd/yyyy)

Country Where Passport Issued Expiration Date (mm/dd/yyyy)

Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)

Date of Arrival (mm/dd/yyyy) I-94 #

Current Nonimmigrant Status: Expires on (mm/dd/yyyy)

Country Where Passport Issued Expiration Date (mm/dd/yyyy)

Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)

Date of Arrival (mm/dd/yyyy) I-94 #

Current Nonimmigrant Status: Expires on (mm/dd/yyyy)

Country Where Passport Issued Expiration Date (mm/dd/yyyy)

Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)

Date of Arrival (mm/dd/yyyy) I-94 #

Current Nonimmigrant Status: Expires on (mm/dd/yyyy)

Country Where Passport Issued Expiration Date (mm/dd/yyyy)

Family Name Given Name Middle Name Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)

Date of Arrival (mm/dd/yyyy) I-94 #

Current Nonimmigrant Status: Expires on (mm/dd/yyyy)

Country Where Passport Issued Expiration Date (mm/dd/yyyy)

If you need additional space, attach a separate sheet(s) of paper.


Place your name, A #, if any, date of birth, form number, and application date at the top of the sheet(s) of paper.
Form I-539 (Rev. 12/31/07)Y Page 5
OMB No. 1615-0028; Expires 08/31/08

Department of Homeland Security


Instructions for I-600, Petition to Classify
U.S. Citizenship and Immigration Services Orphan as an Immediate Relative

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

D. Proxy adoption abroad.


What Is the Purpose of This Form?
If both the petitioner and spouse or the unmarried
petitioner did not personally see and observe the child
To classify an alien orphan who either is, or will be, adopted
prior to or during the adoption proceedings abroad,
by a U.S. citizen as an immediate relative of the U.S. citizen
the petitioner (and spouse, if married) must submit a
to allow the child to enter the U.S. The petition is filed by the
statement indicating the petitioner's (and, if married,
U.S. citizen who is adopting the child.
the spouse's) willingness and intent to readopt the child
in the United States.
Who May File This Form I-600? If requested by USCIS, the petitioner must submit a
statement by an official of the State in which the child
1. Eligibility. will reside that readoption is permissible in that State
In addition, evidence of compliance with the
A. Child. preadoption requirements, if any, of that State must be
submitted.
Under immigration law, an orphan is an alien child
who has no parents because of the death or E. Preadoption requirements.
disappearance of abandonment or desertion by, or
separation or loss from both parents. If the orphan has not been adopted abroad, the
petitioner and spouse or the unmarried petitioner must
An orphan is also an alien child who has only one establish that:
parent who is not capable of taking care of the orphan
and who has in writing irrevocably released the alien 1. The child will be adopted in the United States by the
for emigration and adoption. petitioner and spouse jointly or by the unmarried
petitioner, and that
A petition to classify an alien as an orphan may not be
filed on behalf of a child in the United States, unless 2. The preadoption requirements, if any, of the State of
that child is in parole status and has not been adopted the orphan's proposed residence have been met.
in the United States.
2. Filing Petition for Known Child.
The petition must be filed before the child's 16th
birthday. An orphan petition for a child who has been identified
must be submitted on a completed Form I-600 with the
B. Parent(s). certification of the petitioner executed and required fee. If
the petitioner is married, the Form I-600 must also be
The petition may be filed by a married U.S. citizen and signed by the petitioner's spouse.
spouse or unmarried U.S. citizen at least 25 years of
age. The spouse does not need to be a U.S. citizen, but The petition must be accompanied by the following:
must be in lawful immigration status.
A. Proof of U.S. citizenship of the petitioner.
C. Adoption abroad. If a U.S. citizen by birth in the United States, submit a
copy of the birth certificate, issued by the civil
If the orphan was adopted abroad, it must be registrar, vital statistics office or other civil authority.
established that both the married petitioner and spouse If a birth certificate is not available, submit a statement
or the unmarried petitioner personally saw and from the appropriate civil authority certifying that a
observed the child prior to or during the adoption birth certificate is not available. In such a situation,
proceedings. The adoption decree must show that a secondary evidence must be submitted, including:
married petitioner and spouse adopted the child jointly
or that an unmarried petitioner was at least 25 years of 1. Church records bearing the seal of the church
age at the time of the adoption. showing the baptism, dedication or comparable rite

Form I-600 Instructions (Rev. 07/30/07) Y


occurred within two months after birth and showing NOTE: Proof of the lawful immigration status of the
the date and place of the petitioner's birth, date of petitioner's spouse, if applicable, must be submitted. If
the religious ceremony and the names of the parents; the spouse is not a U.S. citizen, proof of the spouse's
lawful immigration status, such as Form I-551,
2. School records issued by the authority (preferably Permanent Resident Card; Form I-94, Arrival-
the first school attended) showing the date of Departure Record; or a copy of the biographic pages of
admission to the school, the petitioner's birth date the spouse's passport and the nonimmigrant visa pages
or age at the time, the place of birth and the names showing an admission stamp may be submitted.
of the parents;
3. Census records (state or federal) showing the B. Proof of marriage of petitioner and spouse.
name, place of birth, date of birth or age of the The married petitioner must submit a copy of the
petitioner listed; certificate of marriage and proof of termination of all
4. Affidavits. If a required document cannot be prior marriages of himself or herself and spouse. In
obtained, you must submit either an original written the case of an unmarried petitioner who was previously
statement from the governmental agency that married, submit proof of termination of all prior
should have the record, verifying that the record marriages.
does not exist or a citation to the Department of NOTE: If any change occurs in the petitioner's marital
State Foreign Affairs Manual indicating that such status while the case is pending, immediately notify
records are generally not available. Only then may the USCIS office where the petition was filed.
you submit written affidavits sworn to or affirmed
by two persons who were living at the time and C. Proof of age of orphan.
who have personal knowledge of the event. Each
affidavit must contain the affiant's full name, The petitioner should submit a copy of the orphan's
address, date and place of birth, and signature. The birth certificate if obtainable; if not obtainable, submit
affidavit must also explain the affiant's relationship an explanation together with the best available
to you, full information concerning event and evidence of birth.
complete details of how the affiant acquired the
information. D. Copies of the death certificate(s) of the child's
parent (s) if applicable.
5. An unexpired U.S. passport, initially issued for ten
years may also be submitted as proof of U.S.
Citizenship. E. A certified copy of adoption decree together with
certified translation, if the orphan has been lawfully
If the petitioner was born outside the United States, adopted abroad.
submit a copy of one of the following:
1. Certificate of Naturalization or Certificate of F. Evidence that the sole or surviving parent is
Citizenship issued by the U.S. Citizenship and incapable of providing for the orphan's care and has
Immigration Services (USCIS) or former in writing irrevocably released the orphan for
Immigration and Naturalization Service (INS); immigration and adoption, if the orphan has only one
parent.
2. Form FS-240, Report of Birth Abroad of a Citizen
of the United States, issued by an American G. Evidence that the orphan has been unconditionally
embassy; abandoned to an orphanage, if the orphan has been
placed in an orphanage by his or her parent or parents.
3. An unexpired U.S. passport initially issued for ten
years; or
H. Evidence that the preadoption requirements, if any
4. An original statement from a U.S. consular officer of the state of the orphan's proposed residence have
verifying the applicant's U.S. citizenship with a been met, if the child is to be adopted in the United
valid passport. States.

Form I-600 Instructions (Rev. 07/30/07) Y Page 2


If is not possible to submit this evidence upon initial filing NOTE: Having committed any crime of moral
of the petition under the laws of the State of proposed turpitude or a drug-related offense does not
residence, it may be submitted later. The petition, necessarily mean that a petitioner or petitioner's
however, will not be approved without it. spouse will be found ineligible to adopt an orphan.
However, failure to disclose such information may
I. Home Study. result in denial of this application and/or any
subsequent petition for an orphan.
The home study must include a statement or
attachment recommending or approving the adoption 2. An assessment of the financial ability of the
or proposed adoption and be signed by an official of petitioner and petitioner's spouse, if applicable.
the responsible State agency in the State of the
3. A detailed description of the living
proposed residence or of an agency authorized by that
accommodations where the petitioner and
State. In the case of a child adopted abroad, the
petitioner's spouse currently reside(s).
statement or attachment must be signed by an official
of an appropriate public or private adoption agency that 4. If the petitioner and petitioner's spouse are residing
is licensed in the United States. abroad at the time of the home study, a description
of the living accommodations where the child will
The home study must be prepared by an entity
reside in the United States with the petitioner and
(individual or organization) licensed or otherwise
petitioner's spouse, if known.
authorized under the law of the State of the orphan's
proposed residence to conduct research and preparation 5. An assessment of the physical, mental and
for a home study, including the required personal emotional capabilities of the petitioner and
interviews. petitioner's spouse in relation to rearing and
educating the child.
If the recommending entity is licensed, the
recommendation must state that it is licensed, where it
is licensed, its license number, if any, and the period of Filing Petition for Known Child Without Full
validity of the license. Documentation on Child or Home Study.

However, the research, including the interview and the When a child has been identified but the documentary
preparation of the home study, may be done by an evidence relating to the child or the home study is not yet
individual or group in the United States or abroad that available, an orphan petition may be filed without that
is satisfactory to the recommending entity. evidence or home study.

A responsible State agency or licensed agency may The evidence outlined in Instructions 2A and 2B (Proof of
accept a home study made by an unlicensed or foreign U.S. citizenship of the petitioner and Documentation of
agency and use that home study as a basis for a marriage of petitioner and spouse), however, must be
favorable recommendation. submitted.
If the necessary evidence relating to the child or the home
The home study must provide an assessment of the
study is not submitted within one year from the date of
capabilities of the prospective adoptive parent(s) to
submission of the petition, the petition will be considered
properly parent the orphan and must include a
abandoned and the fee will not be refunded. Any further
discussion of the following areas:
proceeding will require the filing of a new petition.
1. An explanation regarding any history of abuse or
violence or any complaints, charges, citations, Translations. Any document containing foreign language
arrests, convictions, prison terms, pardons submitted to the Service shall be accompanied by a full
rehabilitation decrees for breaking or violating any English language translation which the translator has certified
law or ordinance by the petitioner(s) or any as complete and accurate, and by the translator's certification
additional adult member of the household over age that he or she is competent to translate from the foreign
18. language into English.

Form I-600 Instructions (Rev. 07/30/07) Y Page 3


Copies. Unless specifically required that an original
document be filed with an application or petition, an ordinary
What Is the Filing Fee?
legible photocopy may be submitted. Original documents
submitted when not required will remain a part of the record, A fee of $670.00 must be submitted for filing this petition.
even if the submission was not required. However, a fee is not required for this petition if you filed an
advance processing application (Form I-600A) within the
previous 18 months and it was approved or is still pending.
General Instructions.
In addition to the fee for the application, there is a $80.00
1. Type or print legibly in black ink. biometric services fee for fingerprinting every adult person
living in the household in the United States where the child
2. If extra space is needed to complete any item, attach will reside.
a continuation sheet, indicate the item number, and
date and sign each sheet. For example, if a petition is filed by a married people residing
in the United States with one additional adult member in their
household, the total fee that must be submitted would be
Where To File? $910.00 ($670.00 for the petition and $240.00 for biometric
services for fingerprinting the three adults).
A petitioner residing in the United States should send the
completed petition to the USCIS office having jurisdiction NOTE: If the prospective adoptive parents and any other
over his or her place of residence. A petitioner residing adult members of the household reside abroad at the time of
outside the United States should consult the nearest American filing, they are exempt from paying the USCIS biometric
embassy or consulate designated to act on the petition. services fee. However, they may have to pay the
fingerprinting fee charged by the U.S. consular office or
military installation.
Biometrics Services.
When more than one petition is submitted by the same
petitioner on behalf of orphans who are siblings, only one
As part of the USCIS biometric services requirements, the
Form I-600 petition and fee for biometric services is required,
following persons must be fingerprinted in connection with
unless re-fingerprinting is ordered. If the orphans are not
this petition:
siblings, a separate filing fee must be submitted for each
1. The petitioner and petitioner's spouse, if applicable, and additional Form I-600 petition.
2. Each additional adult member the petitioner's household, The fee will not be refunded, whether the petition is approved
18 years of age or older. NOTE: Submit a copy of the or not. Do not mail cash. All checks or money orders,
birth certificate of each household member over 18. whether U.S. or foreign, must be payable in U.S. currency at a
If necessary, USCIS may also take a photograph and signature financial institution in the United States. When a check is
of those named above as part of the biometric services. drawn on the account of a person other than yourself, write
your name on the face of the check. If the check is not
Petitioners residing in the United States. After filing this honored, USCIS will charge you $30.00.
petition, USCIS will notify each person in writing of the time
Pay by check or money order in the exact amount. Make the
and location where they must go to be fingerprinted. Failure
check or money order payable to the Department of
to appear to be fingerprinted or for other biometric services
Homeland Security, unless:
may result in denial of the petition.
A. You live in Guam, make the check or money order payable
Petitioners residing abroad. Completed fingerprint cards to the "Treasurer, Guam" or ;
(Forms FD-258) must be submitted with the petition. Do not,
bend, fold or crease completed fingerprint cards. Fingerprint B. You live in the U.S. Virgin Islands, make your check or
cards must be prepared by a U.S. embassy or consulate, money order payable to the "Commissioner of Finance of
USCIS office or military installation. the Virgin Islands."

Form I-600 Instructions (Rev. 07/30/07) Y Page 4


How to Check If the Fees Are Correct. If unmarried, the prospective petitioner must be at least 24
years of age, provided that he or she will be at least 25 at the
The form and biometric fees on this form are current as of the
time of the adoption and the completed petition on behalf of a
edition date appearing in the lower right corner of this page.
child is filed.
However, because USCIS fees change periodically, you can
verify if the fees are correct by following one of the steps The request must be on Form I-600A, Application for
below: Advance Processing of Orphan Petition, and accompanied by
the evidence requested on that form.
1. Visit our website at www.uscis.gov, select "Immigration
Forms" and check the appropriate fee; After a child or children are located and/or identified, a
separate Form I-600 must be filed for each child. If only one
2. Review the Fee Schedule included in your form package, if
Form I-600 is filed, a new fee is not required, provided the
you called us to request the form; or
form is filed while the advance processing application (Form
3. Telephone our National Customer Service Center at I-600A) application is pending or within 18 months of the
1-800-375-5283 and ask for the fee information. approval of the advance processing application.
NOTE: If your Form I-600 requires payment of a biometric When Child/Children Are Located and/or Identified.
service fee for USCIS to take your fingerprints, photograph or
signature, you can use the same procedure to obtain the correct A separate Form I-600, Petition to Classify Orphan as an
biometric fee. Immediate Relative, must be filed for each child.
Generally, Form I-600 should be submitted at the USCIS
Address Changes. office where the advance processing application was filed.
If a prospective petitioner goes abroad to adopt or locate a
If you change your address and you have an application or child in one of the countries noted below, he or she should file
petition pending with USCIS, you may change your address Form I-600 at the USCIS office having jurisdiction over the
on-line at www.uscis.gov, click on "Change your address with place where the child is residing or will be located, unless the
USCIS" and follow the prompts or by completing and mailing case is retained at the stateside office.
Form AR-11, Alien's Change of Address Card, to:
USCIS has offices in the following countries: Austria, China,
U.S. Citizenship and Immigration Services Cuba, the Dominican Republic, El Salvador, Germany, Ghana,
Change of Address Great Britain, Greece, Guatemala, Haiti Honduras, India, Italy,
P.O. Box 7134 Jamaica, Kenya, Korea, Mexico, Pakistan, Panama, Peru, the
London, KY 40742-7134 Philippines, Russia, South Africa, Thailand and Vietnam.
If a prospective petitioner goes abroad to any country not
For commercial overnight or fast freight services only, mail
listed above to adopt or locate a child he or she should file
to:
Form I-600 at the American embassy or consulate having
U.S. Citizenship and Immigration Services jurisdiction over the place where the child is residing or will
Change of Address be located, unless the case is retained at the Stateside office.
1084-I South Laurel Road
London, KY 40744 Any Form I-600 that is not signed or accompanied by the
correct fee, will be rejected with a notice that the Form
I-600 is deficient. You may correct the deficiency and
Processing Information. resubmit the Form I-600. An application or petition I-600 is
not considered properly filed until accepted by USCIS.
Submitting Advance Processing Application for
Initial processing. Once a Form I-600 has been accepted, it
Orphan Child Not Yet Identified.
will be checked for completness, including submission of the
A prospective petitioner may request advance processing required initial evidence. If you do not completely fill out the
when the child has not been identified or when the prospective form, or file it without required initial evidence, you will not
petitioner and/or spouse is or are going abroad to locate or establish a basis for eligibility and we may deny your Form
adopt a child. I-600.

Form I-600 Instructions (Rev. 07/30/07) Y Page 5


Requests for more information or interview. We may
request more information or evidence, or we may request that
you appear at a USCIS office for an interview. We may also
request that you submit the originals of any copy. We will
return these originals when they are no longer required.

Decision. The decision on a Form I-600 involves a


determination of whether you have established eligiblity for
the requested benefit. You will be notified of the decision in
writing.

Penalties.

If you knowingly and willfully falsify or conceal a material


fact or submit a false document with this Form I-600, we will
deny the Form I-600 and may deny any other immigration
benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

Privacy Act Notice.

We ask for the information on this form, and associated


evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-600.

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 30 minutes per
response, including the time for reviewing instructions,
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 Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
OMB No. 1615-0028. Do not mail your application to this
address.

Form I-600 Instructions (Rev. 07/30/07) Y Page 6


OMB No. 1615-0028; Expires 08/31/08
Department of Homeland Security I-600, Petition to Classify Orphan
U.S. Citizenship and Immigration Services as an Immediate Relative
Do not write in this block. (For USCIS Use Only.)
TO THE SECRETARY OF STATE:
Fee Stamp
The petition was filed by:
Married petitioner Unmarried petitioner

The petition is approved for orphan:


Adopted abroad Coming to U.S. for adoption.
Preadoption requirements have been
met.

Remarks:
File number

DATE OF
ACTION
DD
DISTRICT

Type or print legibly in black ink. Complete a separate petition for each child.
Petition is being made to classify the named orphan as an immediate relative
Block I - Information about petitioner. 8. If you are now married, give the following information:
1. My name is: (Last) (First) (Middle) Date and place of present marriage (mm/dd/yyyy)

2. Other names used (including maiden name if appropriate): Name of present spouse (include maiden name of wife)

3. I reside in the U.S. at: (C/O if appropriate) (Apt. No.) Date of birth of spouse (mm/dd/yyyy) Place of birth of spouse

(Number and Street) (Town or City) (State) (Zip Code) Number of prior marriages of spouse

4. Address Abroad (if any): (Number and Street) (Apt. No.) My spouse resides With me Apart from me
(provide address below)
(Town or city) (Province) (Country) (Apt. No.) (No. and Street) (City) (State) (Country)

5. I was born on: (mm/dd/yyyy) 9. I am a citizen of the United States through:


Birth Parents Naturalization
In: (Town or City) (State or Province) (Country) If acquired through naturalization, give name under which naturalized,
number of naturalization certificate, and date and place of naturalization:
6. My telephone number is: (Include Area Code)

7. My marital status is: If not, submit evidence of citizenship. See Instruction 2.a(2).
Married
If acquired through parentage, have you obtained a certificate in your
Widowed own name based on that acquisition?
Divorced No Yes
Single Have you or any person through whom you claimed citizenship ever lost
I have never been married. U.S. citizenship?
I have been previously married time(s). No Yes (If Yes, attach detailed explanation.)

Received Trans. In Ret'd Trans. Out Completed

Form I-600 (Rev. 07/30/07)Y


Block II - Information about orphan beneficiary.
10. Name at Birth (First) (Middle) (Last) 20. To petitioner's knowledge, does the orphan have any physical or mental
affliction? Yes No
11. Name at Present (First) (Middle) (Last) If "Yes," name the affliction.

12. Any other names by which orphan is or was known. 21. Who has legal custody of the child?

13. Gender Male 14. Date of birth (mm/dd/yyyy) 22. Name of child welfare agency, if any, assisting in this case:
Female
15. Place of Birth (City) (State or Province) (Country) 23. Name of attorney abroad, if any, representing petitioner in this case.

16. The beneficiary is an orphan because (check one): Address of above.


He or she has no parents.
He or she has only one parent who is the sole or surviving parent.
24. Address in the United States where orphan will reside.
17. If the orphan has only one parent, answer the following:
a. State what has become of the other parent:
25. Present address of orphan.

b. Is the remaining parent capable of providing for the orphan's


support? Yes No 25. If orphan is residing in an institution, give full name of institution.
c. Has the remaining parent in writing irrevocably released the
orphan for emigration and adoption? Yes No 26. If orphan is not residing in an institution, give full name of person with
18. Has the orphan been adopted abroad by the petitioner and spouse with whom residing.
jointly or the unmarried petitioner? Yes No
If yes, did the petitioner and spouse or unmarried petitioner 27. Give any additional information necessary to locate orphan, such as
personally see and observe the child prior to or during the name of district, section, zone or locality in which orphan resides.
adoption proceedings? Yes No
Date of adoption (mm/dd/yyyy)

Place of adoption

19. If either answer in Question 18 is "No," answer the following:


a. Do petitioner and spouse jointly or does the unmarried petitioner
intend to adopt the orphan in the United States?
Yes No 28. Location of American embassy or consulate where application for visa
b. Have the preadoption requirements, if any, of the orphan's will be made.
proposed State of residence been met?
Yes No (City in Foreign Country) (Foreign Country)
c. If b is answered "No," will they be met later?
Yes No

Certification of petitioner. Certification of married prospective petitioner's spouse.


I certify, under penalty of perjury under the laws of the United States of I certify, under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct and that I will care for an America, that the foregoing is true and correct and that my spouse and I
orphan or orphans properly if admitted to the United States. will care for an orphan or orphans properly if admitted to the United States.
(Signature of Petitioner) (Signature of Petitioner)

Executed on (Date) Executed on (Date)

Signature of person preparing form, if other than petitioner.


I declare that this document was prepared by me at the request of the petitioner and is
based entirely on information of which I have knowledge.
(Signature)

Street Address and Room or Suite No./City/State/Zip Code

Executed on (Date)

Form I-600 (Rev. 07/30/07)Y Page 2


OMB No. 1615-0028; Expires 08/31/08

Department of Homeland Security


Instructions for I-600A, Application for
U.S. Citizenship and Immigration Services Advance Processing of Orphan Petition

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

An orphan is also a child who has only one parent who


What Is the Purpose of This Form? is not capable of taking care of the orphan and who
has, in writing, irrevocably released the orphan for
This form is used by a U.S. citizen who plans to adopt a emigration and adoption.
foreign-born orphan but does not have a specific child in A petition to classify an alien as an orphan (Form
mind. "Advance Processing" enables USCIS to first I-600) may not be filed on behalf of a child who is
adjudicate the application that relates to the qualifications of present in the United States, unless that child is in
the applicant(s) as a prospective adoptive parent(s). parole status and has not been adopted in the United
Additionally, this form may be used in cases where the child is States.
known and the prospective adoptive parent(s) are traveling to The petition must be filed before the child's 16th
the country where the child is located. However, it is birthday.
important that prospective adoptive parent(s) be aware that the
child must remain in the foreign country where he or she is B. Adoption abroad.
located until the processing is completed. If the orphan was adopted abroad, it must be
NOTE: This Form I-600A application is not a petition to established that both the married applicant and spouse
classify an orphan as an immediate relative. Form I-600, or the unmarried applicant personally saw and
Petition to Classify Orphan as an Immediate Relative, is used observed the child prior to or during the adoption
for that purpose. proceedings. The adoption decree must show that a
married prospective adoptive parent and spouse
adopted the child jointly or that an unmarried
What Are the Eligibility Requirements? prospective parent was at least 25 years of age at the
time of the adoption and filing of Form I-600.
1. Eligibility for advance processing application (Form
I-600A). C. Proxy adoption abroad.

An application for advance processing may be filed by a If both the applicant and spouse or the unmarried
married U.S. citizen and spouse. The spouse of the applicant did not personally see and observe the child
applicant does not need to be a U.S. citizen; however, he or prior to or during the adoption proceedings abroad the
she must be in a lawful immigration status. An application applicant (and spouse, if married) must submit a
for advance processing may also be filed by an unmarried statement indicating the applicant's (and, if married the
U.S citizen who is at least 24 years of age provided that he spouse's) willingness and intent to readopt the child in
or she will be at least 25 at the time of adoption and the the United States. If requested, the applicant must
filing of an orphan petition on behalf of a child. submit a statement by an official of the state in which
the child will reside that readoption is permissible in
2. Eligibility for orphan petition (Form I-600). that State. In addition, evidence must be submitted to
show compliance with the preadoption requirements, if
In addition to the requirements concerning the citizenship
any, of that State.
and age of the applicant described in the above paragraph
noted by Number 1 when a child is located and identified
D. Preadoption requirements.
the following eligibility requirements will apply:
If the orphan has not been adopted abroad, the
A. Child. applicant and spouse or the unmarried applicant must
Under U.S. immigration law, an orphan is an alien establish that the child will be adopted in the United
child who has no parents because of the death or States by the prospective applicant and spouse jointly
disappearance of, abandonment or desertion by, or or by the unmarried prospective applicant, and that the
separation or loss from both parents. preadoption requirements, if any, of the State of the
orphan's proposed residence have been met.

Form I-600A Instructions (Rev. 07/30/07)Y


5. An unexpired U.S. passport, initially issued for ten
General Instructions. years, may also be submitted as proof of U.S
citizenship.
Step 1. Fill Out the Form I-600A
B. If the prospective adoptive parent was born outside
1. Type or print legibly in black ink. the United States, submit a copy of one of the
2. If extra space is needed to complete any item, attach a following:
continuation sheet, indicate the item number, and date and 1. Certificate of Naturalization or Certificate of
sign each sheet. Citizenship issued the by U.S. Citizenship and
3. Answer all questions fully and accurately. State that an Immigration Services (USCIS) or the former
item is not applicable with "N/A." If the answer is none, Immigration and Naturalization Service (INS);
write "none."
2. Form FS-240, Report of Birth Abroad of a Citizen
of the United States, issued by an American
Step 2. General requirements
embassy;
Initial Evidence 3. An unexpired U.S. passport initially issued for ten
1. Proof of U. S. citizenship of the prospective adoptive years; or
parent(s). 4. An original statement from a U.S. consular officer
A. If a U.S. citizen by birth in the United States, submit a verifying the applicant's U.S. citizenship with a
copy of the birth certificate issued by the civil registrar, valid passport.
vital statistics office or other civil authority. If a birth
NOTE: Proof of the lawful immigration status of the
certificate is not available, submit a statement from the
applicant's spouse, if applicable, must be submitted. If
appropriate civil authority certifying that a birth
the spouse is not a U.S. citizen, proof of her or his
certificate is not available. In such a situation
lawful immigration status, such as Form I-551,
secondary evidence must be submitted, including:
Permanent Resident Card; Form I-94, Arrival-
1. Church records bearing the seal of the church Departure Record; or a copy of the biographic pages of
showing the baptism, dedication or comparable rite the spouse's passport and the nonimmigrant visa pages
occurred within two months after birth and showing showing an admission stamp may be submitted.
the date and place of the prospective adoptive
parent's birth, date of the religious ceremony and the 2. Proof of marriage of applicant and spouse.
names of the parents;
The married applicant must submit a copy of the certificate
2. School Records issued by the authority (preferably of marriage and proof of termination of all prior marriages
the first school attended) showing the date of of himself or herself and spouse. In the case of an
admission to the school, prospective adoptive unmarried applicant who was previously married, submit
parent's date of birth or age at the time, the place of proof of termination of all prior marriages.
birth and the names of the parents;
NOTE: If any change occurs in the applicant'(s) marital
3. Census records (state or federal) showing the name status while the application is pending, immediately notify
place of birth, date of birth or age of the prospective the USCIS office where the application was filed.
adoptive parent listed;
4. Affidavits sworn to or affirmed by two persons who 3. Home Study.
were living at the time and who have personal You must submit a home study prepared according to the
knowledge of the date and place of birth in the requirements specified in 8 CFR 204.3(e) by a person who
United States of the prospective adoptive parent. is authorized under 8 CFR 204.3(b) to prepare the home
Each affidavit should contain the following study. If you do not submit the home study with your Form
information regarding the person making the I-600A, it must be submitted not more than one year after
affidavit: his or her full name, address, date and you file the Form I-600A. The home study must have been
place of birth and relationship to the prospective completed, or updated, not more than 6 months before the
adoptive parent, if any and full information date it is submitted to USCIS.
concerning the event and complete details of how
the affiant acquired knowledge of the birth; or
Form I-600A Instructions (Rev. 07/30/07)Y Page 2
In order to prepare a home study, the person must be E. Criminal history.
licensed or otherwise authorized under the law of the State 3. Living accommodations.
of the child's proposed residence to prepare home studies for 4. Handicapped or special needs orphan.
adoptions. The home study preparer may be a public agency 5. Summary of the counseling given and plans for post-
with authority under State law for adoption matters, or a placement counseling.
public or private adoption agency licensed in the State of the 6. Specific approval of the prospective adoptive parents for
child's proposed residence. The home study preparer may adoption.
also be in individual, if the person is, as an individual, 7. Home study preparer's certification and statement of
licensed or otherwise authorized to prepare home studies for authority to conduct home studies.
adoption under the law of the State of the child's proposed 8. Review of home study by the appropriate State agency, if
residence. required, and by a private or public adoption agency
licensed in theUnited States, if you live abroad and will
If you live abroad and will adopt the child abroad, the home adopt abroad.
study may be prepared by an agency or individual who is
licensed or authorized to prepare home studies under the law NOTE: You must include all information concerning any criminal
history, even if an arrest, indictment, other criminal charge, or
of the country in which you reside, or under the law of any
conviction has been expunged, sealed, pardoned, or ameliorated in
State in the United States. In addition to having a home any other way. Having committed any crime of moral turpitude or a
study preparer that meets this requirement, the home study drug-related offense does not necessarily mean that the prospective
must, before it is submitted to USCIS, be reviewed and adoptive parent(s) will be found not qualified to adopt an orphan.
favorably recommended by a public adoption agency in any However, failure to disclose such information may result in denial of
State in the United States or by a private agency licensed or this application and/or any subsequent petition for an orphan.
otherwise authorized in any State to place children for
adoption. Translations. Any document containing foreign language
submitted to the Service shall be accompanied by a full
NOTE: USCIS does not enforce foreign licensing laws. So English language translation which the translator has certified
if your home study is prepared abroad by a home study as complete and accurate, and by the translator's certification
preparer licensed in the United States, and is reviewed and that he or she is competent to translate from the foreign
favorably recommended by a public or private adoption language into English.
agency licensed in theUnited States, you may submit it to
Copies. Unless specifically required that an original
USCIS and USCIS will accept it. The country in which you
document be filed with an application or petition, an ordinary
reside, however, may have its own laws concerning who
legible photocopy may be submitted. Original documents
may conduct adoption home studies in that country. You
submitted when not required will remain a part of the record,
may want to verify whether a person licensed to conduct
even if the submission was not required.
home studies in a State in the United States is permitted,
under the law of the country in which you reside, to conduct
home studies in that country. Where To File?

The home study must provide an assessment of the A prospective adoptive parent residing in the United States
capabilities of the prospective adoptive parent(s) to provide should send the completed application to the USCIS office
proper parental care to an adopted orphan in light of the having jurisdiction over his or her place of residence. A
requirements stated in 8 CFR 204.3(e). The home study prospective adoptive parent residing outside the United States
must include a discussion of the following elements: should consult the nearest American consulate for the overseas
or stateside USCIS office designated to act on the application.
1. Personal interview(s) and home visit(s).
2. Assessment of the capabilities of the prospective
What Is the Filing Fee?
adoptive parents to properly parent the orphan, including:
The filing fee for a Form I-600A is $670.00.
A. Assessment of the physical, mental, and emotional
capabilities of the prospective adoptive parents to In addition to the fee for the application, there is a $80.00
properly parent the orphan. biometric services fee for fingerprinting every adult person
B. Assessment of the finances of the prospective doptive living in the household in the United States where the child
parents will reside.
C. History of abuse and/or violence.
D. Previous rejection for adoption or prior unfavorable
home study.

Form I-600A Instructions (Rev. 07/30/07)Y Page 3


For example, if an application is filed by a married couple 1. The check or money order must be drawn on a bank or
residing in the United States with one additional adult member other financial institution located in the United States and
in their household, the total fees that must be submitted would must be payable in U.S. currency; and
be $910.00 ($670.00 for the petition and $240.00 for the
biometric services fees for fingerprinting the three adults). 2. Make the check or money order payable to U.S.
Department of Homeland Security, unless:
USCIS will allow for a one time re-fingerprinting at no- A. If you live in Guam and are filing your petition
charge to the prospective adoptive parents and household there, make it payable to Treasurer, Guam.
members, who are at least 18 years of age upon expiration of
the fingerprint validity period of 15 months. Also, if the B. If you live in the U.S. Virgin Islands and are filing
prospective adoptive parents have not yet filed a Form I-600, your petition there, make it payable to
and make a written to extend the approval period of a Form Commissioner of Finance of the Virgin Islands.
I-600A, it is not necessary for them to pay the biometrics fee NOTE: Please spell out U.S. Department of Homeland
again to be fingerprinted in connection with the extension Security; do not use the initials "USDHS" or "DHS."
request.
Biometric services. As part of the USCIS biometric services
Notice to Those Making Payment by Check. If you send us
requirement, the following persons must be fingerprinted in
a check, it will be converted into an electronic funds transfer
connection with this application:
(EFT). This means we will copy your check and use the
1. The married prospective adoptive parent and spouse, if account information on it to electronically debit your account
applicable, and for the amount of the check. The debit from your account will
usually take 24 hours, and will be shown on your regular
2. Each additional adult member 18 years of age or older, of account statement.
the prospective adoptive parent(s)' household. NOTE:
Submit a copy of the birth certificate of each qualifying You will not receive your original check back. We will
household member over 18. destroy your original check, but we will keep a copy of it. If
the EFT cannot be processed for technical reasons, you
If necessary, USCIS may also take each person's photograph authorize us to process the copy in place of your original
and signature as part of the biometric services. check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times.
Petitioners residing in the United States. After filing this
petition, USCIS will notify each person in writing of the time
How to Check If the Fees Are Correct.
and location where they must go to be fingerprinted. Failure to
appear to be fingerprinted or for other biometric services may
result in denial of this application. The form and biometric fees on this form are current as the the
edition date appearing in the lower right corner of this page.
Petitioners residing abroad. Completed fingerprint cards However, because USCIS fees change periodically, you can
(Forms FD-258) must be submitted with this application. Do verify if the fees are correct by following one of the steps
not bend, fold or crease the completed fingerprint cards. The below:
fingerprint cards must be prepared by a U.S. embassy or
consulate, USCIS office or U.S. military installation. 1. Visit our website at www.uscis.gov, select
"Immigration Forms" check the appropriate fee;
NOTE: If the prospective adoptive parent(s) and any other
adult members of the household are residing abroad at the 2. Review the Fee Schedule included in your form
time of filing, they are exempt from paying the biometric package, if you called us to request the form or
services fee for fingerprinting. However, they may have to
pay fingerprinting fees charged by the U.S. Department of
3. Telephone our National Customer Service Center at
State or military installation.
1-800-375-5283 and ask for the fee information.
You may submit one check or money order for both the
application and biometric fees. NOTE: If your Form I-600A requires payment of a biometric
service fee for USCIS to take your fingerprints, photograph or
Use the following guidelines when you prepare your check or
signature, you can use the same procedure to obtain the correct
money order for the Form I-600A and the biometric service
biometric fee.
fee:

Form I-600A Instructions (Rev. 07/30/07)Y Page 4


Generally, Form I-600 should be submitted at the USCIS
Address Changes. office where the advance processing application, Form
I-600A, was filed. Prospective adoptive parent(s) going
If you change your address and you have an application or abroad to adopt or locate a child may file Form I-600 with
petition pending with USCIS, you may change your address either the USCIS office or American consulate or embassy
on-line at www.uscis.gov, click on "Change your address with having jurisdiction over the place where the child is residing
USCIS" and follow the prompts or by completing and mailing or will be located, unless the case is being retained at the
Form AR-11, Alien's Change of Address Card, to: USCIS office stateside.

U.S. Citizenship and Immigration Services Certification. The "Certification of Prospective Adoptive
Change of Address Parent" block of Form I-600A must be executed by the
P.O. Box 7134 prospective adoptive parent. The spouse, if applicable, must
London, KY 40742-7134 execute the "Certification of Married Prospective Adoptive
Parent Spouse" block on Page 2 of the form. Failure to do so
For commercial overnight or fast freight services only, mail will result in the rejection of the Form I-600A.
to:
Any Form I-600A that is not signed or accompanied by the
U.S. Citizenship and Immigration Services correct fee, will be rejected with a notice that the Form
Change of Address I-600A is deficient. You may correct the deficiency and
1084-I South Laurel Road resubmit the Form I-600A. An application or petition is not
London, KY 40744 considered properly filed until accepted by USCIS.

Initial processing. Once a Form I-600A has been accepted,


Processing Information. it will be checked for completeness, including submission of
the required initial evidence. If you do not completely fill out
the form, or file it without required initial evidence, you will
What Should You Do After Locating and/or not establish a basis for eligibility and we may deny your
Identifying a Child or Children? Form I-600A.

Form I-600, Petition to Classify Orphan as an Immediate Requests for more information or interview. We may
Relative, is filed when a child has been located and/or request more information or evidence, or we may request that
identified for the prospective adoptive parent(s). A new fee is you appear at a USCIS office for an interview. We may also
not required if Form I-600 is filed within 18 months from the request that you submit the originals of any copy. We will
approval date of the Form I-600A application. return these originals when they are no longer required.

If approved in the home study for more than one orphan, the
prospective adoptive parent(s) may file a petition for each of Decision. The decision on a Form I-600A involves a
the additional children to the maximum number approved. If determination of whether you have established eligiblity for
the orphans are siblings, no additional filing fee is required. the requested benefit. You will be notified of the decision in
However, if the orphans are not siblings, an additional filing writing.
fee is required for each orphan beyond the first orphan.
Extension of the Form I-600A approval period. If
A fee of $670.00 must be submitted for filing this petition. USCIS has approved your Form I-600A, and you have not
However, a fee is not required for this petition if you filed an yet filed a Form I-600 based on that approval, you may
advance processing application (Form I-600A) within the make one request, without fee, to have USCIS extend the
previous 18 months and it was approved or is still pending. approval period for your Form I-600A. You must submit a
written request to the USCIS office that adjudicated the
NOTE: Approval of an advance processing application does initial I-600A. The request must be received no earlier than
not guarantee that the orphan petition(s) will be approved. 90 days prior to the expiration of the Form I-600A approval,
Form I-600 must be accompanied by all the evidence required but before the Form I-600A approval notice expires. For
by the instructions of that form, except where provided instance, if your Form I-600A approval notice is valid until
previously with Form I-600A. December 31, you may not file the request before October
3, but must file it no later than December 31.

Form I-600A Instructions (Rev. 07/30/07)Y Page 5


The written request must explicitly request a one-time, no-
Privacy Act Notice.
charge extension to the current I-600A approval. You must
submit an amended/updated home study and any other
supporting documentation of any changes in the household. We ask for the information on this form, and associated
The home study amendment/update must address each issue evidence, to determine if you have established eligibility for
under 204.3(e) and indicate whether anything has changed the immigration benefit for which you are filing. Our legal
on any item. The home study must also address any right to ask for this information can be found in the
changes to the I-600A answers and must say whether Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
approval is still recommended.
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-600A.
Requesting a change of country. If you had USCIS
send the approval notice for your Form I-600A to the
Department of State office in a particular country, but now Paperwork Reduction Act.
wish to adopt a child from a different country, you may
make one request, without fee, to have a new approval An agency may not conduct or sponsor an information
notice sent to the Department of State office in the new collection and a person is not required to respond to a
country. You must submit a written request to the USCIS collection of information unless it displays a currently valid
office that adjudicated the initial I-600A. You should also OMB control number. The public reporting burden for this
submit an updated or amended home study that addresses collection of information is estimated at 30 minutes per
the change in country and whether the home study preparer response, including the time for reviewing instructions,
recommends approval of the change, and that also addresses completing and submitting the form. Send comments
any other changes since your Form I-600A was approved. regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
If you have received one free change of country, then you this burden, to: U.S. Citizenship and Immigration Services,
must submit a properly completed Form I-824, Application Regulatory Management Division, 111 Massachusetts
for Action on Approved Petitioner or Application, with the Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
fee specified in 8 CFR 103.7(b), to obtain any additional OMB No. 1615-0028. Do not mail your application to this
change of country address.

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.
As an altenative 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. 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.

Penalties.

If you knowingly and willfully falsify or conceal a material


fact or submit a false document with this Form I-600A, we
will deny the Form I-600A and may deny any other
immigration benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

Form I-600A Instructions (Rev. 07/30/07)Y Page 6


OMB No. 1615-0028; Expires 08/31/08
Department of Homeland Security I-600A, Application for Advance
U.S. Citizenship and Immigration Services Processing of Orphan Petition
Do not write in this block. For USCIS Use Only.
It has been determined that the:
Married Unmarried Fee Stamp

prospective adoptive parent will furnish proper care to


a beneficiary orphan if admitted to the United States.
There:
are are not
preadoptive requirements in the State of the child's proposed
residence.
The following is a description of the preadoption requirements, if any, DATE OF FAVORABLE
of the State of the child's proposed residence: DETERMINATION
DD
DISTRICT

The preadoption requirements, if any,: File number of applicant, if applicable.


have been met. have not been met.

Please type or print legibly in black ink.


This application is made by the named prospective adoptive parent for advance processing of an orphan petition.

BLOCK I - Information about the prospective adoptive parent. 8. If you are now married, give the following information:
1. My name is: (Last) (First) (Middle) Date and place of present marriage (mm/dd/yyyy)

2. Other names used (including maiden name if appropriate): Name of present spouse (include maiden name of wife)

3. I reside in the U.S. at: (C/O if appropriate) (Apt. No.) Date of birth of spouse (mm/dd/yyyy) Place of birth of spouse

(Number and Street) (Town or City) (State) (Zip Code) Number of prior marriages of spouse

4. Address abroad (If any): (Number and Street) (Apt. No.) My spouse resides With me Apart from me
(provide address below)
(Town or City) (Province) (Country) (Apt. No.) (No. and Street) (City) (State) (Country)

5. I was born on: (mm/dd/yyyy) 9. I am a citizen of the United States through:


Birth Parents Naturalization
In: (Town or City) (State or Province) (Country) If acquired through naturalization, give name under which naturalized,
number of naturalization certificate, and date and place of naturalization.
6. My telephone number is: (Include Area Code)

7. My marital status is: If not, submit evidence of citizenship. See Instruction 2.a(2).
Married If acquired through parentage, have you obtained a certificate in your
Widowed own name based on that acquisition?
Divorced No Yes
Single Have you or any person through whom you claimed citizenship ever lost
I have never been married. United States citizenship?
I have been previously married ___________ time(s). No Yes (If Yes, attach detailed explanation.)

Received Trans. In Ret'd Trans. Out Completed

Form I-600A (Rev. 07-30-07) Y


BLOCK II - General information.
10. Name and address of organization or individual assisting you in 14. Will the child come to the United States for adoption after compliance
locating or identifying an orphan with the preadoption requirements, if any, of the State of proposed
(Name) residence?
Yes No
(Address) 15. If the answer to Question 14 is "No," will the child be adopted abroad
after having been personally seen and observed by you and your
spouse, if married?
11. Do you plan to travel abroad to locate or adopt a child?
Yes No
Yes No 16. Where do you wish to file your orphan petition?
12. Does your spouse, if any, plan to travel abroad to locate or adopt a The USCIS office located at
child?
Yes No
The American Embassy or Consulate at
13. If the answer to Question 11 or 12 is "Yes," give the
following information:
a. Your date of intended departure 17. Do you plan to adopt more than one child?
Yes No
b. Your spouse's date of intended departure If "Yes," how many children do you plan to adopt?
c. City, province

Certification of prospective adoptive parent. Certification of married prospective adoptive parent spouse.
I certify, under penalty of perjury under the laws of the United States I certify, under penalty of perjury under the laws of the United States of
of America, that the foregoing is true and correct and that I will care America, that the foregoing is true and correct and that my spouse and I
for an orphan/orphans properly if admitted to the United States. will care for an orphan/orphans properly if admitted to the United States.

(Signature of Prospective Adoptive Parent) (Signature of Prospective Adoptive Parent Spouse)

Executed on (Date) Executed on (Date)

Signature of person preparing form, if other than petitioner.


I declare that this document was prepared by me at the request of the
petitioner and is based entirely on information of which I have knowledge.

(Signature)

Street Address and Room or Suite No./City/State/Zip Code

Executed on (Date)

Form I-600A (Rev. 07/30/07)Y Page 2


OMB No. 1615-0029; Expires 02/28/09
Department of Homeland Security Instructions for I-601, Application for Waiver
U.S. Citizenship and Immigration Services of Grounds of Inadmissibility
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

I. INA section 212(a)(9)(C)(Unlawfully Present After


What Is the Purpose of This Form? Previous Immigration Violations) for a VAWA self-
petitioner.
An alien who is ineligible to be admitted to the United States If the application is filed to waive a communicable
as an immigrant or to adjust status in the United States, and disease of public health significance, and the applicant is
certain nonimmigrant applicants who are inadmissible, must incompetent to file, a qualified family member listed in
file this form to seek a waiver of certain grounds of "Specific Filing Instructions, 1. Applicants With
inadmissibility. Communicable Diseases," may file the waiver application
on the applicant's behalf.
Who May File This Form?
Note: Except as provided in Title 8, Code of Federal
1. An immigrant visa applicant; Regulations (CFR), part 204.313(g)(1)(ii) for convention
adoption cases, if you seek a waiver of grounds of
2. Any applicant for adjustment of status;
inadmissibility in connection with your application for an
3. A K-1 or K-2 nonimmigrant visa applicant (see immigrant visa or adjustment of status and the waiver is
Special Instructions); granted, the waiver is valid indefinitely even if you do not
4. A K-3, K-4, or V nonimmigrant visa applicant; obtain your immigrant visa, immigrant admission, or
adjustment of status, or if you otherwise lose your legal
5. A Temporary Protected Status (TPS) applicant;
permanent resident status. If you obtained the waiver in
6. A Nicaraguan Adjustment and Central American connection with an application for lawful permanent residence
Relief Act (NACARA) applicant; on a conditional basis pursuant to section 216 of the Act, the
7. A Haitian Refugee Immigrant Fairness Act (HRIFA) validity of the waiver automatically ceases with the
applicant; termination of such residence; no separate notification of
termination of the waiver is needed, and the termination of the
8. A Violence Against Women Act (VAWA)
waiver cannot be appealed. However, if the immigration judge
self-petitioner
determines that you are not removable based on the
who is inadmissible to the United States pursuant to the termination of your conditional resident status, the waiver will
Immigration Nationality Act (INA) section 212 and who seeks become effective again. Also, a waiver granted in relation to a
a waiver of the following grounds of inadmissibility: TPS application is only valid for the TPS application.
A. Health-related grounds (INA section 212(a)(1));
B. Certain criminal grounds (INA section 212(a)(2)); General Instructions
C. Immigrant Membership in Totalitarian Party (INA
section 212(a)(3)(D)); Step 1. Fill Out Form I-601
D. Immigration fraud or misrepresentation (INA section 1. When filling out the form, type or print legibly in black ink.
212(a)(6)(C)) except that a waiver under INA section 2. If extra space is needed to complete any item, attach a
212(i) is not available, if you are inadmissible based continuation sheet, indicate the item number, and date and
on a false claim to be a U.S. citizen (INA section sign each sheet.
212(a)(6)(C)(ii)), and if you made your false claim on 3. Answer all questions fully and accurately. If the answer is
or after September 30, 1996; not applicable write "N/A." If the answer is none, write
E. Smugglers (INA section 212(a)(6)(E)) and Being "none."
Subject of Civil Penalty (INA section 212(a)(6)(F)); 4. Applicant's Signature. Pursuant to 8 CFR 103.2(a)(2), you
F. The Three-year or Ten-year bar (INA section or the qualified family member filing the application on
212(a)(9)(B)); your behalf must sign this application personally. A parent
or legal guardian may also sign the application for someone
G. Certain ground of inadmissibility, if filed by an
under the age of 14, and a duly appointed legal guardian
applicant for TPS;
may sign for an adult who is incompetent to sign the
H. INA section 212(a)(9)(A)(Aliens Previously application.
Removed) and (9)(C)(Unlawfully Present After 5. Preparer's Signature. If an individual, other than the
Previous Immigration Violations), if filed by a applicant, or a qualified family member prepared the
NACARA or HRIFA adjustment applicant; application, that individual must sign and date the
application and provide the information requested.
Form I-601 Instructions (Rev. 02/28/08)Y
6. Any documentation submitted to the U.S. Citizenship and - Indicate "Child" in item B.4 (Relationship to Applicant); and
Immigration Services (USCIS) that is in a foreign language - Indicate "Prospective LPR" in item B.5 (Immigration
or which contains foreign language must be accompanied Status).
by a full and complete English translation. The translator
must certify that he or she is fluent in English and the If, upon review of your application, USCIS determines that
language contained in the document, and that he or she is you will be eligible for a immigrant waiver from
competent to translate from the foreign language into inadmissibility once you have (or your parent has) celebrated
English. The translator must furthermore certify that the a bona fide marriage to the U.S. citizen who filed the K visa
translation is complete and accurate. petition, USCIS will conditionally approve the waiver
7. The application has to be signed by the applicant and application. The condition imposed on the approval is that
submitted with the required fee. If the application is not you (or your parent) and the U.S. citizen who filed the K visa
properly signed and submitted with the required fee, the petition celebrate a bona fide marriage within the statutory
application will be returned as incomplete. Please see time frame of three (3) months from the day of your (or your
"Specific Instructions" for additional reasons why the parent's) admission. Despite the conditional approval, USCIS
application may be rejected. may ultimately deny Form I-601 if you (or your parent) do
not marry the U.S. citizen who filed the K visa petition and if
you (or your parent) do not seek and receive permanent
Specific Instructions residence on the basis of that marriage.
Note: If this form is approved, the waiver that is granted will
apply ONLY for those grounds of inadmissibility and those Applicants Seeking a Waiver of Health-Related Grounds
crimes, incidents, events, or conditions that you have included of Inadmissibility
in your application. For this reason, it is important that you
disclose all grounds of inadmissibility for which you seek a 1. Applicants With Communicable Diseases
waiver.
If you have a communicable disease that has been determined
Special Note to K-1 and K-2 Nonimmigrant Visa to be of public health significance, you must complete the
Applicants application and provide the information as requested in the
Because you do not yet have the requisite relationship to a form.
citizen or lawful permanent resident of the United States to Communicable diseases of public health significance are
qualify for a waiver, you must enter one of the following in defined in 42 CFR 34.2(b) and include but are not limited to:
Block B:
A. Class A Tuberculosis condition, as per U.S. Department
If you are a fiancé(e) of a U.S. citizen: of Health and Human Services (HHS) regulations;
- Complete items B.1, B.2, B.3, and B.5 with information B. Human Immunodeficiency Virus (HIV) Infection;
regarding the U.S. citizen who filed a fiancé(e) petition on C. Chancroid;
your behalf; and
- Indicate "Prospective Spouse" in item B.4 (Relationship to D. Gonorrhea;
Applicant). E. Granuloma inguinale;

If you are the child of a fiancé(e) of a U.S. citizen and will F. Lymphogranuloma venerum;
be less than 18 years old when your parent marries such G. Syphilis, infectious stage;
person: H. Leprosy, infectious;
- Complete items B.1, B.2, B.3, and B.5 with information I. Any other communicable disease as determined by
regarding the U.S. citizen who filed a fiancé(e) petition on the U.S. Secretary of Health and Human Services and
your parent's behalf; and as defined at 42 CFR 34.2(b).
- Indicate "Prospective Step-child" in item B.4 (Relationship
The application may be approved if:
to Applicant)
A. You are the spouse, parent, the unmarried son or daughter,
If you are the child of a fiancé(e) of a U.S. citizen, and will
or the minor unmarried lawfully adopted child of a U.S.
be at least 18 years but less than 21 years old when your
citizen or of an alien lawfully admitted for
parent marries such person:
permanent residence, or of an alien who has been issued
- Complete items B.1, B.2, and B.3 with information an immigrant visa, or if you are the fiancé(e) of a U.S. citizen
regarding your parent who will marry the U.S. citizen who or the fiancé(e)'s child; or
filed a fiancé(e) petition on your parent's behalf; and
B. You are a VAWA self-petitioner.
Form I-601 Instructions (Rev. 02/28/08)Y Page 2
For specific information pertaining to applicants with a Class B. Findings regarding your current physical condition,
A Tuberculosis condition as per HHS regulations, or HIV, including, if applicable, reports of chest X-rays and a
please see number two (2) or three (3) below. serologic test, if you are 15 years of age or older, and
2. Applicants With Class A Tuberculosis Condition as other pertinent diagnostic tests; and
Per HHS Regulations C. Findings regarding the current mental or physical
If you have been diagnosed with a Class A Tuberculosis condition, including a detailed prognosis that should
condition as per HHS regulations, page three (3) of this specify, based on a reasonable degree of medical
form must be completed. certainty, the possibility that the harmful behavior is
If page three (3) of the application is not completed, the likely to recur or that other harmful behavior associated
application will be returned to you without further action. with the disorder is likely to occur; and

3. Applicants With HIV Infection D. A recommendation concerning treatment that is


reasonably available in the United States and that can
If you have an HIV infection, page four (4) of this form must reasonably be expected to significantly reduce the
be completed. likelihood that the physical or mental disorder will
result in harmful behavior in the future.
If page four (4) of the application is not completed, the
application will be returned to you without further action. The The medical report will be referred to the U.S. Public Health
information provided in page four (4) must establish that the Service for review and, if found acceptable, you will be
danger to the public health of the United States and the required to submit such additional assurances as the U.S.
possibility of the spread of infection created by your admission Public Health Service may deem necessary in your particular
to the United States is minimal. In addition, you must establish case.
that no government agency will incur any cost for your
5. Applicants Seeking to Waive the Vaccination Requirement
treatment without that agency's prior consent.
If you seek an exemption from the vaccination requirement
4. Applicants With Physical or Mental Disorder and because the vaccination would be against your religious beliefs
Associated Harmful Behavior (INA section 212(a)(1)(A) or moral convictions, you should file this form. You should
(iii)) establish with evidence that:
If you have a physical or mental disorder and behavior A. You are opposed to vaccinations in any form;
associated with the disorder that may pose, has posed, or will B. The objection is based on religious belief or moral
pose a threat to the property, safety, or welfare of you or conviction; and
others, you should file this form, and a waiver may be granted
pursuant to INA section 212(g)(3). You should also submit C. The belief or conviction is sincere.
this form if you have a history of such a physical or mental Applicants Seeking a Waiver of Certain Criminal
disorder and a history of behavior associated with the disorder Grounds of Inadmissibility and Immigration Fraud or
that has posed a threat to your property, safety, or welfare or Misrepresentation Pursuant to INA Sections 212(h) and (i)
the property, safety, or welfare of others, and if the behavior is
likely to recur or to lead to other harmful behavior. 1. Criminal Grounds
In addition to this form, you must submit a complete medical If you are found to be inadmissible based on criminal grounds,
history and a report that addresses the following: you may seek a waiver of inadmissibility for the following:

A. Your physical or mental disorder, and the behavior A. A crime involving moral turpitude (other than a purely
associated with the disorder that poses, posed, or political offense);
may pose in the future a threat to the property, safety,
B. A controlled substance violation according to the laws
or welfare of you or other individuals. The report
and regulations of any country insofar as it relates to
should also provide details of any hospitalization,
a single offense of simple possession of 30 grams or
institutional care, or any other treatment you may
less of marijuana;
have received in relation to this physical or mental
disorder; C. Two (2) or more convictions other than purely
political ones, for which the aggregate sentences to
confinement were five (5) years or more;

Form I-601 Instructions (Rev. 02/28/08)Y Page 3


D. Prostitution; For information about how you can establish extreme
hardship, please see "What Evidence Should Be Submitted
E. Unlawful commercialized vice whether or not related With the Application?" (Page six (6)).
to prostitution; and
F. Certain aliens involved in serious criminal activity, Applicants Seeking a Waiver for Immigrant Membership
who have asserted immunity from prosecution. in a Totalitarian Party (INA section 212(a)(3)(D)(i))
With the application, you will have to establish that: If you are inadmissible for having been a member of or
A. You are inadmissible only because of your affiliated with the Communist or any other totalitarian party
participation in prostitution, including having procured (or subdivision or affiliate thereof) whether domestic or
others for prostitution or having received the proceeds foreign, you may apply for a waiver pursuant to INA section
of prostitution, but that you have been rehabilitated 212(a)(3)(D)(iv), if you are the parent, spouse, son, daughter,
and your admission to the United States will not be brother, or sister of a citizen of the United States or a spouse,
contrary to the national welfare, safety, or security of son, or daughter of an alien lawfully admitted for permanent
the United States; OR residence, or if you are the fiancé(e) of a U.S. citizen. The
B. At least 15 years have passed since the activity or waiver may be granted for humanitarian purposes, to assure
event that makes you inadmissible, that you have family unity, or when it is otherwise in the public interest, if
been rehabilitated, and that your admission to the you are not a threat to the security of the United States.
United States or the issuance of the immigrant visa
Applicants Seeking a Waiver for Smuggling under INA
will not be contrary to the national welfare, safety, or
section 212(a)(6)(E) and Being Subject of Civil Penalty
security of the United States; OR
(INA section 212(a)(6)(F))
C. Your qualifying U.S. citizen or legal permanent
resident relative (spouse, son, daughter, If you are inadmissible for having engaged in alien smuggling
parent), or K visa petitioner would experience (INA section 212(a)(6)(E)(i), you may apply for a waiver
extreme hardship if you were denied admission; OR pursuant to INA section 212(d)(11) that may be granted for
humanitarian purposes, to assure family unity, or when it is
D. You are an approved VAWA self-petitioner. otherwise in the public interest, if you have encouraged,
For information about how you can establish extreme induced, assisted, abetted, or aided only an individual who at
hardship, please see "What Evidence Should Be Submitted the time of such action was your spouse, parent, son, or
With the Application?" (Page six (6)). daughter (and no other individual) to enter the United States
in violation of the law, and;
Note: If you are convicted of a violent or dangerous crime,
the waiver may not be approved unless there is an 1. If you are an alien lawfully admitted for permanent
extraordinary circumstance, such as one involving national residence who temporarily proceeded abroad
security or foreign policy consideration, or if the denial of voluntarily and not under an order of removal and who
your admission would result in exceptional and extremely is otherwise admissible to the United States as a
unusual hardship. Even if that standard is met, your waiver returning resident under INA section 211(b); or
may still be denied. See 8 CFR 212.7(d).
2. Immigration Fraud or Misrepresentation 2. If you are seeking admission or adjustment of status as
If you are inadmissible because you have sought to procure an an immediate relative as an immigrant under INA
immigration benefit by fraud or misrepresenting a material section 203(a)(Preference allocation for family-
fact (INA section 212(a)(6)(C)(i)), you may seek a waiver by sponsored immigrants based on the first, second or
filing this form. This waiver may be approved if you can third preference, but not the fourth preference) or as
establish that: the fiancé(e) (or his or her child(ren) of a U.S. citizen.
A. Your qualifying U.S. citizen or legal permanent
resident relative (spouse, parent), or the K visa If you are inadmissible because you have been the subject of
petitioner would experience extreme hardship if a final order for violation of INA section 247C, you may
you were denied admission; apply for a waiver pursuant to INA section 212(d)(12) that
OR may be granted for humanitarian purposes or to assure family
B. You are a VAWA self-petitioner, and that you, your unity, if no previous civil money penalty was imposed against
U.S. citizen or lawful permanent resident you under INA section 247C, and the offense was committed
parent or child may experience extreme hardship if solely to assist, aid, or support your spouse or child (and not
you were denied admission. another individual), and

Form I-601 Instructions (Rev. 02/28/08)Y Page 4


1. If you are an alien lawfully admitted for permanent
residence who temporarily proceeded abroad NACARA and HRIFA Applicants Seeking a Waiver
voluntarily and not under an order of deportation or From Inadmissibility Based on Prior Removal (INA
removal and who is otherwise admissible to the United Section 212(a)(9)(A)) or Unlawful Presence After Previous
States as a returning resident under INA section 211(b); Immigration Violations (INA Section 212(a)(9)(C))
or
2. If you are seeking admission or adjustment of status If you are a NACARA or HRIFA applicant for adjustment of
under INA section 201(b)(2)(A) as an immediate status pursuant to section 202 of NACARA or section 902 of
relative, as an immigrant under INA section 203(a) HRIFA, who is inadmissible under INA section 212(a)(9)(A)
(Preference allocation for family-sponsored or INA section 212(a)(9)(C) of the Act, you may apply for a
immigrants) or as the fiancé(e) (or his or her child(ren) waiver of these grounds of inadmissibility while present in the
of a U.S. citizen. United States. You seek this waiver by filing Form I-601,
rather than Form I-212 that is used to obtain "Consent to
Applicants Seeking a Waiver of Inadmissibility Based
Reapply" under INA section 212(a)(9)(A)(iii) or (C)(ii).
on the Three-Year or Ten-Year Bar Pursuant to INA
Section 212(a)(9)(B)(v)
When adjudicating your waiver application, USCIS will
consider the same factors that would be considered if you
If you are inadmissible because you have been unlawfully
were seeking "Consent to Reapply." Factors that may be
present in the United States in excess of either 180 days
considered include, but are not limited to:
(three (3)-year bar) or one (1) year (10-year bar), you may
seek a waiver by filing this form. A. The length of time you have lived in the United
The waiver may be granted if: States, whether lawfully or unlawfully;
A. Your qualifying U.S. citizen or legal permanent B. Whether you have any criminal records;
resident relative (spouse, parent), or the K visa C. Your immigration history in the United States;
petitioner would experience extreme hardship if you D. Your family ties to U.S. citizens or to aliens living
were denied admission. lawfully in the United States;
For TPS applicants and VAWA self-petitioners, see special E. Whether the denial of your application will impose
instructions below. hardship on you or on these relatives, and the degree
For information about how you can establish extreme of that hardship;
hardship, please see "What Evidence Should Be Submitted F. Whether granting your waiver application is likely
With the Application?" (Page six (6)). to result in your ability to immigrate lawfully;

TPS Applicants Seeking a Waiver of Grounds of G. Your employment history in the United States and
Inadmissibility Pursuant to INA Section 244 the continued need for your services;
H. Whether you are a person of good moral character;
If you are a TPS applicant applying for a waiver of any
I. Any other factor that you believe USCIS should
grounds of inadmissibility listed in INA section 212, your
consider in deciding your case.
waiver may be granted for humanitarian purposes to assure
family unity or when it is otherwise in the public interest. In addition to this form, you should submit a brief statement
indicating why USCIS should grant your waiver application,
No waiver of inadmissibility is available to TPS applicants for and any documentary evidence that may be available to
the following grounds of inadmissibility: support your factual claims. Although hardship to a relative
who is a U.S. citizen or an alien who is living lawfully in the
A. INA Section 212(a)(2)(A), (B) or (C) (except for a
United States, is not specifically required by statute, this
single offense of simple possession of 30 grams or less
factor can play a significant role in establishing why USCIS
of marijuana);
should grant your application.
OR
For information about how you can establish hardship, please
B. INA Section 212(a)(3)(A), (B), (C), or (E). see "What Evidence Should Be Submitted With the
Application?" (Page six (6)).
Note: A waiver that is granted in relation to an application for
TPS is valid only for purposes of your application for TPS. If
you seek an immigrant visa or adjustment of status, you may
need to apply for an additional waiver at that time.

Form I-601 Instructions (Rev. 02/28/08)Y Page 5


B. You may be exempt from inadmissibility under INA
Approved I-360 VAWA Self-Petitioner and His or Her section 212(a)(9)(B)(i) if you, the approved VAWA
Child(ren) Seeking a Waiver of Inadmissibility Pursuant self-petitioner, can establish a "substantial
to Section 212(a)(9)(C)(iii) connection" between the battery or extreme cruelty
that is the basis for your VAWA claim and the
The INA provides special forms of relief for an approved violation of your prior nonimmigrant admission.
VAWA self-petitioner and his or her child(ren) who are
In order to claim any of these exceptions, you should submit
applying for adjustment of status or an immigrant visa but
evidence of the "substantial connection" with your Form
who are inadmissible under certain provisions of INA section
I-485, Application to Register Permanent Residence or Adjust
212(a)(6)(A)(i), section 212(a)(9)(B)(i), or section
Status, or your immigrant visa application. If you are
212(a)(9)(C)(i). You should only file this Form I-601 to
inadmissible under INA section 212(a)(6)(A)(i), and entered
seek a waiver of inadmissibility pursuant to INA section
on or before April 1, 1997, you do not need to provide
212(a)(9)(C)(i); you do not need to file this form, if you are
evidence of the "substantial connection." Also, because INA
inadmissible under INA sections 212(a)(6)(A)(i) or 212(a)
section 212(a)(6)(A)(i) inadmissibility ends when you depart
(9)(B)(i), as explained in the "Note" below.
the United States, you do not have to submit evidence of a
If you are inadmissible under INA section 212(a)(9)(C)(i): "substantial connection" with an immigrant visa application.
INA section 212(a)(9)(C)(i) makes inadmissible an alien who
is unlawfully present for more than one (1) year, in the What Evidence Should Be Submitted With the Application?
aggregate, or who has been ordered removed, and
subsequently enters or attempts to reenter without being Please pay close attention to the qualifying family
admitted. USCIS has discretion to waive this ground of relationship that you have to establish if you apply for a
inadmissibility under INA section 212(a)(9)(C)(iii) for an hardship waiver. While the relationships appear to be
approved VAWA self-petitioner, and his or her child(ren), if similar, the various waiver provisions contain different
the VAWA self-petitioner can establish a "connection" qualifying family relationships.
between the battery or extreme cruelty that is the basis for the
VAWA claim, the unlawful presence and departure, or the Also, please pay close attention to the requirements that
removal, and his or her subsequent unlawful entry or need to be established to have a particular ground of
attempted reentry into the United States. If you seek such a inadmissibility waived, as listed in the "Specific
waiver, complete Form I-601 and attach evidence that shows Instructions."
the connection between the battery or extreme cruelty that is In support of your application, you should provide evidence
the basis for your VAWA claim, the unlawful presence and that establishes why you may qualify for a waiver of
your departure, or your removal from the United States, and inadmissibility. Depending on the type of waiver, this
your unlawful entry or attempted reentry into the United information and evidence may include but is not limited to:
States.
A. Affidavits from you or other individuals in support of
Note: You do not need to file Form I-601 if you are an your application;
approved VAWA self-petitioner and his or her child(ren)
B. Police reports from any country you lived in;
seeking adjustment of status, and if you are inadmissible
under INA section 212(a)(6)(A)(i) (Presence in the United C. Complete court records regarding any
States without admission or parole, or arrival in the conviction or charge from any country;
United States other than at an open port of entry) or INA D. If applicable, evidence of rehabilitation;
section 212(a)(9)(B) (Three-year bar or Ten-year bar to E. Any evidence you may wish to submit to establish
admissibility because of prior unlawful presence). Under that your admission to the United States would not
INA section 212(a)(6)(A)(ii) or INA section 212(a)(9)(B)(iii) be against national welfare or national security;
(IV), an approved VAWA self-petitioner and his or her
F. Medical reports;
child(ren) can claim exceptions from these grounds of
inadmissibility. G. If you are applying for a waiver because you are the
spouse, parent, son, or daughter of a U.S. citizen or an
A. You may be exempt from inadmissibility under INA alien lawfully admitted for permanent residence, or
section 212(a)(6)(A)(i) if you, the approved VAWA the fiancé(e) of a U.S. citizen, you have to attach
self-petitioner, can establish a "substantial evidence that demonstrates your denial of admission
connection" between the battery or extreme cruelty would result in extreme hardship to the U.S. citizen
that is the basis for your VAWA claim and your or legal permanent resident spouse, son, daughter or
unlawful arrival in the United States. parent, or your U.S. citizen fiancé(e). Such evidence
can include but is not limited to:
Form I-601 Instructions (Rev. 02/28/08)Y Page 6
1. Evidence establishing the family relationship 3. If you are in the United States and your I-485 is
(birth certificate, marriage certificate, etc.); currently pending, you should file the I-601 with the
USCIS office or Service Center where your I-485 is
2. Presence of legal permanent resident or
CURRENTLY pending.
U.S. citizen family ties to the United States;
4. If you are in removal proceedings, you should file
3. The qualifying relative's family ties this application with the office of the Executive
outside the United States; Office for Immigration Review (EOIR) with
jurisdiction over your case, and according to the
4. Country conditions in the country you
instructions that are provided to you in court. For
would have to relocate and the qualifying
information about EOIR, please visit EOIR's website
relative's family ties to that country;
at www.usdoj.gov/eoir.
5. The financial impact of departure from the
United States;
What Is the Filing Fee?
6. Significant health conditions, and if
appropriate, what type of treatment and No fee is required, if you are filing this application to have
suitable medical care is available in that waived the following grounds of inadmissibility:
country;
1. Class A Tuberculosis condition, as per HHS
7. The impact of separation; regulations; or
8. Other conditions that impact the 2. A physical or mental disorder with associated
relocation, such as economic and social harmful behavior or a history of such a disorder that
conditions impacting quality of life, is likely to recur.
technical skills, etc.
All other applications must be accompanied by a fee of $545.
H. If you are a VAWA self-petitioner and you seek a The fee cannot be refunded, regardless of the action taken on
waiver under INA section 212(a)(9)(C)(iii), submit the application. Do not mail cash. All fees must be
any evidence that you believe establishes a submitted in the exact amount.
connection between the battery or extreme cruelty
that is the basis for the VAWA claim, your unlawful Note: As stated on page 2 of these instructions, the approval
presence and your departure, or your removal, and of a Form I-601 waives only those events and the resulting
your unlawful return or attempted unlawful return. grounds of inadmissibility that you have specifically
Note: Your application should be supported by documentary identified in the application. You should specify on this Form
evidence, or you should have a detailed explanation why such I-601 every ground of inadmissibility for which you seek a
evidence cannot be obtained. Mere assertions will not suffice. waiver. You may file just one application, and pay just one
Medical assertions should be supported by a professional's filing fee, if you request more than one type of waiver or a
statement. waiver for more than one event or condition that makes you
inadmissible. If you do not include all applicable events or
grounds of inadmissibility in your application, you may need
Where To File? to file an additional Form I-601 and pay an additional fee to
request any additional waiver(s).
The application and supporting documents should be taken or
mailed to the following locations: Use the following guidelines when you prepare your check or
money order for the Form I-601 fee:
1. If you are outside the United States, you should 1. The check or money order must be drawn on a bank or
submit Form I-601 to the U.S. Embassy or consulate other financial institution located in the United States
where you are applying for a visa. and must be payable in U.S. currency; and
2. Make the check or money order payable to U.S.
2. If you are in the United States and filing Form I-601 Department of Homeland Security, unless:
together with Form I-485, Application To Register
Permanent Residence or Adjust Status, you should A. If you live in Guam and are filing your petition
file the I-485/I-601 at the filing location specified on there, make it payable to Treasurer, Guam.
the I-485. Please see I-485 filing instructions.

Form I-601 Instructions (Rev. 02/28/08)Y Page 7


B. If you live in the U.S. Virgin Islands and are filing For commercial overnight or fast freight services only, mail
your petition there, make it payable to to:
Commissioner of Finance of the Virgin Islands.
U.S. Citizenship and Immigration Services
C. If you live outside the United States, Guam, or the Change of Address
U.S. Virgin Islands, contact the nearest U.S. 1084-I South Laurel Road
Embassy or consulate for instructions on the London, KY 40744
method of payment.

Note: Please spell out U.S. Department of Homeland Processing Information


Security; do not use the initials "USDHS" or "DHS."
Any Form I-601 that is not signed or accompanied by the
Notice to Those Making Payment by Check. If you send us correct fee will be rejected with a notice that the Form
a check, it will be converted into an electronic funds transfer I-601 is deficient. You may correct the deficiency and
(EFT). This means we will copy your check and use the resubmit the Form I-601. An application or petition is not
account information on it to electronically debit your account considered properly filed until accepted by USCIS.
for the amount of the check. The debit from your account will
usually take 24 hours and will be shown on your regular Initial processing. Once a Form I-601 has been accepted, it
account statement. will be checked for completeness, including submission of the
required initial evidence. If you do not completely fill out the
You will not receive your original check back. We will form, or file it without required initial evidence, you will not
destroy your original check, but we will keep a copy of it. If establish a basis for eligibility, and we may deny your Form
the EFT cannot be processed for technical reasons, you I-601.
authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient Requests for more information or interview. We may
funds, we may try to make the transfer up to two times. request more information or evidence, or we may request that
you appear at a USCIS office for an interview. We may also
How to Check If the Fees Are Correct. request that you submit the originals of any copy. We will
The form fee on this form is current as of the edition date return these originals when they are no longer required.
appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if the Decision. The decision on a Form I-601 involves a
fees are correct by following one of the steps below: determination of whether you have established eligibility for
1. Visit our website at www.uscis.gov, select the requested benefit. You will be notified of the decision in
"Immigration Forms" and check the appropriate fee; writing.

2. Review the Fee Schedule included in your form


USCIS Forms and Information
package, if you called us to request the form; or
To order USCIS forms, call our toll-free number at
3. Telephone our National Customer Service Center at
1-800-870-3676. You can also get USCIS forms and
1-800-375-5283 and ask for the fee information.
information on immigration laws, regulations, and procedures
by telephoning our National Customer Service Center at
Address Changes 1-800-375-5283 or visiting our Internet website at www.uscis.
gov.
If you change your address and you have an application or
As an altenative to waiting in line for assistance at your local
petition pending with USCIS, you may change your address
USCIS office, you can now schedule an appointment through
on-line at www.uscis.gov, click on "Change your address with
our Internet-based system, InfoPass. To access the system,
USCIS," and follow the prompts. Or you may complete and
visit our website. Use the InfoPass appointment scheduler and
mail Form AR-11, Alien's Change of Address Card, to:
follow the screen prompts to set up your appointment.
U.S. Citizenship and Immigration Services InfoPass generates an electronic appointment notice that
Change of Address appears on the screen.
P.O. Box 7134
London, KY 40742-7134

Form I-601 Instructions (Rev. 02/28/08)Y Page 8


Penalties

If you knowingly and willfully falsify or conceal a material


fact or submit a false document with this Form I-601, we will
deny the Form I-601 and may deny any other immigration
benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

Privacy Act Notice

We ask for the information on this form, and associated


evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-601.

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 90 minutes per
response, including the time for reviewing instructions,
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 Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
OMB No. 1615-0029. Do not mail your application to this
address.

Form I-601 Instructions (Rev. 02/28/08)Y Page 9


OMB No. 1615-0029; Expires 02/28/09

Department of Homeland Security I-601, Application for Waiver


U.S. Citizenship and Immigration Services of Grounds of Inadmissibility

Do not write in this block. For Government use only.


212 (a) (1) 212 (a) (6) Fee Stamp
212 (a) (2) 212 (a) (9)
212 (a) (3)
TPS Applicant: (specify ground(s))
A. Information about applicant 11. Applicant was previously in the United States, as follows:
1. Family Name (Surname In CAPS) (First) (Middle) City and State From (Date) To (Date) Immigration Status

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State/Country) (Zip/Postal Code)

Telephone Number E-Mail Address

4. Date of Birth (mm/dd/yyyy) 5. USCIS File Number


A-
6. City/Province-State of Birth

7a. Country of Birth 7b. Country of


Citizenship/Nationality

8. Date of Visa Application 9. Visa Applied for at:

12. Applicant's U.S. Social Security Number (if any)


10. Reason for Inadmissibility: (Please include a statement explaining the acts,
convictions, and medical conditions that make you inadmissible. If you
seek a waiver of inadmissibility because you have a Class A Tuberculosis
condition (as per HHS regulations), you must complete page 3 of this B. Information about relative, through whom applicant claims
form. If you seek a waiver because you have a HIV infection, you must eligibility for a waiver
complete page 4 of this form. Applicants with physical or mental disorders
must attach the information requested in the instructions.) 1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

Telephone Number E-Mail Address

4. Relationship to Applicant 5. Immigration Status

FOR USCIS USE ONLY. DO Initial receipt Resubmitted Relocated Completed


NOT WRITE IN THIS AREA.
Received Sent Approved Denied Returned

Copy Form I-601 (Rev. 02/28/08)Y


C. Information about applicant's other relatives in the United Preparer's Address Date
States (List only U.S. citizens and permanent residents)

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

Applicant's Signature and Certification.


I certify under penalty of perjury under the laws of the United States that this
application and the evidence submitted with it are all true and correct to the best
of my knowledge and abilities. I authorize the release of any information from
my records that the U.S. Citizenship and Immigration Services (USCIS) needs
to determine my eligibility for this waiver.

Signature of Applicant or Qualified Relative / Legal Guardian Date

Preparer's Signature and Certification.


I declare that this document was prepared by me at the request of the applicant
or qualified relative/legal guardian of the applicant, and it is based on all
information of which I have knowledge and/or was provided to me by the above
named person in response to the exact questions contained on this form. I have
not knowingly withheld any information.

Preparer's Signature Date

Copy Form I-601 (Rev. 02/28/08)Y Page 2


To Be Completed for Applicants With Class A
Tuberculosis Condition (As Per HHS Regulations).
A. Statement by Applicant C. Applicant's Sponsor in the United States
Upon admission to the United States I will: Arrange for medical care of the applicant and have the physician
complete Section B.
1. Go directly to the physician or health facility named in
Section B;
If medical care will be provided by a physician who checked Box 2
or 3, in Section B, have Section D completed by the local or State
2. Present all X-rays used in the visa medical examination to
Health Officer who has jurisdiction in the United States area where
substantiate diagnosis;
the applicant plans to reside.
3. Submit to such examinations, treatment, isolation, and
medical regimen as may be required; and If medical care will be provided by a physician who checked Box
4, in Section B, forward this form directly to the military facility at
4. Remain under the prescribed treatment or observation, the address provided in Section B.
whether on inpatient or outpatient basis, until discharged.
Address in the United States where the alien plans to reside:
Signature of Applicant
Address (Number and Street) (Apt #)
Date
City, State and Zip Code

B. Statement by Physician or Health Facility


(May be executed by a private physician, health department or D. Endorsement of Local or State Health Officer
other public or private health facility, or military hospital.)
Endorsement signifies recognition of the physician or facility for
I agree to supply any treatment or observation necessary for the the purpose of providing care for tuberculosis. If the facility or
proper management of the alien's tuberculosis condition. physician who signed his or her name in Section B is not in your
health jurisdiction and not familiar to you, you may want to contact
I agree to submit Form CDC 75.18, "Report on Alien with the health officer responsible for the jurisdiction of the facility or
Tuberculosis Waiver," to the health officer named in Section D: physician prior to endorsing.
1. Within 30 days of the alien's reporting for care, indicating
presumptive diagnosis, test results, and plans for future Endorsed by: Signature of Health Officer
care of the alien; or

2. 30 days after receiving Form CDC 75.18, if the alien has


Date
not reported.
Satisfactory financial arrangements have been made. (This
statement does not relieve the alien from submitting evidence, as Enter below the name and address of the Local Health
required by consul, to establish that the alien is not likely to Department where the "Notice of Arrival of Alien with
become a public charge.) Tuberculosis Waiver" should be sent when the alien arrives in the
United States.
I represent (enter an "X" in the appropriate box and give the
complete name and address of the facility below.)
Official Name of Department
1. Local Health Department
2. Other Public or Private Facility
3. Private Practice Address (Number and Street) (Room/Suite Number)
4. Military Hospital

Name of Facility (Please type or print in black ink) City, State and Zip Code

Address (Number and Street) (Room/Suite Number) NOTE: If further assistance is needed, contact the USCIS office
with jurisdiction over the intended place of U.S. residence of the
applicant.
City, State and Zip Code
If you are approved for a waiver and after admission to the United States
you fail to comply with the terms, conditions, and controls that were
Signature of Physician Date imposed, you may be subject to removal under Immigration and
Nationality Act (INA) section 237(a).
Form I-601 (Rev. 02/28/08)Y Page 3
To Be Completed for Applicants With
Human Immunodeficiency Virus (HIV) Infection
A. Statement About Applicant C. Applicant's Sponsor in the United States
Upon admission to the United States I will: Arrange for medical care of the applicant and have the
1. Go directly to the physician or health facility named in physician of facility complete Section B.
Section B; If medical care will be provided by a physician who
2. Present copies of diagnostic tests used in the visa checked box 2 or 3 in Section B, have Section D
examination to substantiate diagnosis; completed by the local or State Health Officer who has
3. Submit to counseling and such examinations, treatment, jurisdiction in the area where the applicant plans to reside
and medical regimen as may be required; and in the United States.
4. Remain under prescribed treatment or observation, If medical care will be provided by a physician who
whether on inpatient or outpatient basis, until discharged. checked box 4 in Section B, forward this form directly to
Signature of Applicant the military facility at the address provided in Section B.
Address where the alien plans to reside in the United States:

Date
B. Statement by Physician or Health Facility Address (Number & Street) APT No.
(May be executed by a private physician, health department,
or other public or private facility, or military hospital.)
I agree to supply counseling and any treatment or City, State, & Zip Code
observation necessary for the proper management of the
alien's HIV infection condition.
D. Endorsement of Local or State Health Officer
I agree to submit a copy of my evaluation of the alien's Endorsement signifies recognition of the physician or
condition to the health officer named in Section D and to the facility for the purpose of providing care for HIV infection.
Division of Quarantine (E03), Centers for Disease Control If the facility or physician who signed in Section B is not in
and Prevention (CDC), Atlanta Georgia 30333: your health jurisdiction and is not familiar to you, you may
1. Within 30 days of the alien's reporting for care, indicating wish to contact the health officer responsible for the
plans for future care of the alien; or jurisdiction of the facility or physician prior to endorsing.
2. A report that the alien has not reported within 30 days
Endorsed by: Signature of Health Officer
after receiving a notice from the Division of Quarantine,
CDC.
Satisfactory financial arrangements have been made. (This Date
statement does not relieve the alien from submitting
evidence, as required by consul, to establish that the alien is Enter below the name and address of the Local Health
not likely to become a public charge.) Department to which the "Notice of Arrival of Alien with
I represent (enter an "x" in the appropriate box and give the HIV infection Waiver" should be sent when the alien
complete name and address of the facility below:) arrives in the United States.
Official Name of Department
1. Local Health Department
2. Other Public or Private Facility Address (Number & Street) APT No.
3. Private Practice
4. Military Hospital City, State, & Zip Code
Name of Physician or Facility (Please type or print)
Please read instructions with care.
Address (Number & Street)
NOTE: If further assistance is needed, contact the USCIS
office with jurisdiction over the intended place of U.S.
City, State, & Zip Code
residence of the applicant.

Signature of Physician If you are approved for a waiver and after admission to the
United States you fail to comply with the terms, conditions, and
controls that were imposed, you may be subject to removal
Date under Immigration and Nationality Act (INA) section 237(a).
Form I-601 (Rev. 02/28/08)Y Page 4
OMB No. 1615-0029; Expires 02/28/09

Department of Homeland Security I-601, Application for Waiver


U.S. Citizenship and Immigration Services of Grounds of Inadmissibility

Do not write in this block. For Government use only.


212 (a) (1) 212 (a) (6) Fee Stamp
212 (a) (2) 212 (a) (9)
212 (a) (3)
TPS Applicant: (specify ground(s))
A. Information about applicant 11. Applicant was previously in the United States, as follows:
1. Family Name (Surname In CAPS) (First) (Middle) City and State From (Date) To (Date) Immigration Status

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State/Country) (Zip/Postal Code)

Telephone Number E-Mail Address

4. Date of Birth (mm/dd/yyyy) 5. USCIS File Number


A-
6. City/Province-State of Birth

7a. Country of Birth 7b. Country of


Citizenship/Nationality

8. Date of Visa Application 9. Visa Applied for at:

12. Applicant's U.S. Social Security Number (if any)


10. Reason for Inadmissibility: (Please include a statement explaining the acts,
convictions, and medical conditions that make you inadmissible. If you
seek a waiver of inadmissibility because you have a Class A Tuberculosis
condition (as per HHS regulations), you must complete page 3 of this B. Information about relative, through whom applicant claims
form. If you seek a waiver because you have a HIV infection, you must eligibility for a waiver
complete page 4 of this form. Applicants with physical or mental disorders
must attach the information requested in the instructions.) 1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

Telephone Number E-Mail Address

4. Relationship to Applicant 5. Immigration Status

FOR USCIS USE ONLY. DO Initial Receipt Resubmitted Relocated Completed


NOT WRITE IN THIS AREA.
Received Sent Approved Denied Returned

AGENCY COPY Form I-601 (Rev. 02/28/08)Y Page 5


C. Information about applicant's other relatives in the United
States (List only U.S. citizens and permanent residents)

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

1. Family Name (Surname in CAPS) (First) (Middle)

2. Address (Number and Street) (Apartment Number)

3. (Town or City) (State) (Zip/Postal Code)

4. Relationship to Applicant 5. Immigration Status

USCIS Use Only: Additional Information and Instructions

Signature and Title of Requesting Officer

Address Date

AGENCY COPY Form I-601 (Rev. 02/28/08)Y Page 6


OMB No. 1615-0033; Expires 08/31/09

I-693, Report of Medical


Department of Homeland Security
U.S. Citizenship and Immigration Services Examination and Vaccination Record

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if you have one, at the top of each sheet
and indicate the number of the item that refers to your answer.

Step 5 - Submit Form I-693 in the sealed envelope to USCIS


Section I. Applicant's Instructions according to the instructions on Form I-485,
Application to Register Permanent Residence or
Adjust Status. USCIS will return the form to you
What Is the Purpose of Form I-693? and/or request another Form I-693 if it is not in an
envelope or if the envelope has been opened or
Generally, all applicants filing for adjustment of status to that
altered.
of a permanent resident must submit a Form I-693 completed
by a designated civil surgeon. Form I-693 is used to report
NOTE: The civil surgeon will ask you to verify your
results of a medical examination to U.S. Citizenship and
identity. Take a government-issued photo identification to
Immigration Services (USCIS). The examination is required
your appointment. (Example: your valid unexpired passport or
to establish that you are not inadmissible to the United States
driver's license.) For applicants under 14 years, USCIS will
on public health grounds. A list of those health grounds can be
accept other proof of identity that shows name, date and place
found in section 212(a)(1) of the Immigration and Nationality
of birth, parents' full names, and any other identifying
Act. The list is also available in Question 7 of Section III,
information about the applicant. Acceptable documents
Frequently Asked Questions.
include birth certificates (with translations, if necessary) or
The results of your medical examination are confidential and affidavits. Also take any vaccination records you may have to
are used for immigration purposes only. When required to do the appointment.
so by law, the civil surgeon may share your results with public
health authorities.
How Do I Find a Designated Civil Surgeon in
NOTE: If you are applying for adjustment of status at least the Area Where I Live?
one year after your first admission to the United States as a
refugee or as a "K" or "V" nonimmigrant visa holder, see To find a designated civil surgeon in your area, you can call
Questions 1-3 in Section III, Frequently Asked Questions, the USCIS National Customer Service Center (NCSC) at
before proceeding any further. 1-800-375-5283 and follow the instructions in the automated
menu. Service is available in English and Spanish. A list of
the designated civil surgeons in your area can also be
How Do I File Form I-693? generated by going to the civil surgeon page from the USCIS
website at www.uscis.gov and clicking on the Civil Surgeon
A separate Form I-693 is required for each applicant. There is Locator link.
no filing fee for this form. Follow these steps:

Step 1 - Carefully read all these instructions, including How Do I Fill Out My Portion of Form I-693?
Section III, Frequently Asked Questions.
1. Use black ink only. Type or print clearly. If an item does
Step 2 - Call a designated physician (also known as a civil
not apply to you, write "N/A" unless the specific
surgeon) to make an appointment.
instruction states otherwise.
Step 3 - Fill out Part 1 of the form. Do not sign the form. 2. You should fill out only Part 1. The civil surgeon and
any other doctors, clinics, or health departments receiving
Step 4 - Attend your medical exam appointment and all
a referral are required to complete Parts 2 through 6.
follow-up exams, as may be required. Sign Form
I-693 in front of the civil surgeon. A. Part 1 - Information about you - Fill this part out
before your medical exam appointment.
B. Family name (Last Name) - Use your legal name. If
you have two last names, include both and use a
hyphen (-) between the names, if appropriate.

Form I-693 (Rev. 06/05/08)N


C. Home address - Give your physical street address. In this regard, you must take reasonable steps to ensure
This must include a street number and name or a rural that the person appearing for the medical exam is the same
route number. Do not put a post office box (P.O. Box) person applying for the requested immigration benefit. All
number here. applicants must present a valid government-issued photo
D. Date of birth - Use eight numbers to show your date identification. The law imposes severe penalties for
of birth (example: May 1, 1979, should be written knowingly and willfully falsifying or concealing a
05/01/1979). material fact or using any false documents in connection
E. Place of birth - Give the name of the city/town/ with this medical exam.
village where you were born. 2. Follow HHS Guidelines. USCIS has designated you as a
F. Country of birth - Give the name of the country civil surgeon with the understanding that you will perform
where you were born. the medical exam according to U.S. Department of Health
G. A-number - This is your alien registration file and Human Services' regulations. These regulations
number. If you are not sure if you have one, look at include the specific guidelines found in the Technical
any letters or notices you have received from the Instructions for the Medical Examination of Aliens in the
Department of Homeland Security (DHS). Look for a United States (Technical Instructions), published by the
number that begins with a letter "A" and is followed Centers for Disease Control and Prevention (CDC) in
by 8 or 9 numbers (example: A 000 000 000). If you Atlanta, Georgia. The Technical Instructions are available
do not have one or if you cannot remember what it is, on the CDC's website at http://www.cdc.gov/ncidod/dq/
leave this space blank. civil.htm. CDC also posts periodic updates to the
H. U.S. Social Security # - If you do not have a U.S. Technical Instructions at http://www.cdc.gov/ncidod/dq/
Social Security Number, leave this blank. updates.htm.
I. Certification - Do not sign here until the civil surgeon 3. Give Pre-Test and Post-Test Counseling for HIV/
tells you to do so. AIDS. All civil surgeons must give pre-test counseling to
any applicant who is tested for HIV. The pre-test
counseling must include an explanation of the purpose of
How Do I Submit Form I-693 to USCIS? the test and basic information about HIV. Civil surgeons
must also provide post-test counseling to all applicants
1. The civil surgeon is required to give you the completed who test HIV positive. You must provide information to
Form I-693 in a sealed envelope. Do not accept the form the applicant about the test results, the prognosis, the
from the civil surgeon if it is not in a sealed envelope. ways the applicant can protect himself or herself from
USCIS will return the form to you if it is not in an opportunistic infections, the ways the applicant can
envelope or if the envelope has been opened or altered. protect others from HIV transmission, and referrals for
counseling and early medical intervention. You will find
2. Adjustment of status applicants: If you are applying specific instructions about these pre-test and post-test
for adjustment of status, submit Form I-693 according to requirements in CDC's Technical Instructions.
the instructions on Form I-485, Application to Register
for Permanent Residence or Adjust Status. 4. Make Referrals and File Case Reports, as Required.
According to CDC's Technical Instructions, you are
3. Other applicants: Follow the instructions on or included
required to:
with the application form or the instructions given to you
by the office requesting the medical exam. A. Refer the applicant to the local health department if
the chest X-ray suggests TB or other circumstances
are present as described in CDC's Technical
Section II. Civil Surgeon's Instructions Instructions. NOTE: CDC also recommends referral
to the local health department when the chest X-ray is
normal or not suggestive of TB, but the applicant has a
What Are My Responsibilities as a Designated Civil tuberculin skin test reaction of >10 mm, in order to
Surgeon? evaluate the possible need for preventive therapy.
1. Truthfully and Accurately Report the Results. You are
responsible for reporting the results of the medical exam
and all laboratory reports on Form I-693 where indicated,
and for signing the civil surgeon's certification provided
on the form.

Form I-693 (Rev. 06/05/08)N Page 2


B. Ensure that any applicant diagnosed with syphilis is 5. Part 6 - Health Department Identifying Information.
treated with the standard treatment regimen described If you are a State or local health department that is
in CDC's Technical Instructions. completing the vaccination record on behalf of a refugee,
you must complete this part.
C. Ensure that testing and therapy are given for
diagnoses of chancroid, gonorrhea, granuloma
inguinale, or lymphogranuloma venereum. How Do I Complete Form I-693 If I
D. Refer the applicant to a Hansen's disease specialist Need to Make a Referral?
for evaluation to confirm a suspected diagnosis of
Advise the applicant that the appropriate follow-up must be
Hansen's disease (leprosy).
obtained before medical clearance can be granted. In Part 3,
E. File a case report with the appropriate public health include the name, address, and telephone number of the
authorities if: (1) the applicant tests positive for HIV onward physician or public health service facility that will
infection; and (2) a case report is required by local conduct further evaluation or provide treatment. Specify the
laws or regulations. You must also advise the type of examination and additional tests or treatment the
applicant that a case report is being filed. applicant should receive. Complete the identifying
information in Part 5, but do not sign or date. Make a copy
of the Form I-693 for your records and give the original form
How Do I Fill Out My Portion of This Form? to the applicant in a sealed envelope.

The applicant fills out Part 1 of Form I-693 before the


medical exam appointment. You, the civil surgeon, are What Do I Do After the Medical Exam and
responsible for ensuring the remaining parts are completed Follow-Up (If Required) Are Completed?
and signed, as follows.
You and the applicant should sign your respective
1. Part 2 - Medical examination - You must fill out this certifications. After the medical exam (and any follow-up if
part and provide the results of each component of the required) is complete, write the results in Part 2 of the Form
medical exam relating to: communicable disease of I-693 as they relate to the specific component of the medical
public health significance, vaccinations, physical or exam. The applicant should sign the certification in Part 1 and
mental disorder with associated harmful behavior, and you should sign the civil surgeon's certification in Part 5. All
substance or drug abuse/substance or drug addiction. In signatures on the form must be originals (no stamps or
Part 2, you must also include the results of any lab work facsimiles). Do not sign the form or have the applicant sign
or other studies required to determine whether the the form until the applicant has met all health follow-up
applicant is inadmissible on health grounds. You must requirements.
instruct applicants who have had a tuberculin skin test
(TST) to return to your office within 48-72 hours to have Give the results to the applicant. Give the completed Form
the TST read. I-693 to the applicant in a sealed envelope. On the front of the
envelope write in capital letters: "DO NOT OPEN. FOR
2. Part 3 - Referral to Health Department or Other USCIS USE ONLY." On the back of the envelope, write
Doctor/Facility. If you refer the applicant to a local your initials across the line where the flap of the envelope and
health department or to another physician or clinic, you the envelope meet. Then, with clear cellophane tape, place the
must also fill out Part 3. Also see Part 5. tape with half on the flap of the envelope and half on the
3. Part 4 - Physician or Health Department Receiving envelope across the envelope's entire width (and across your
the Referral. If you refer the applicant for further tests initials). USCIS will not accept Form I-693 if it is not in a
or evaluation, the health care professional receiving the sealed envelope or if the envelope is altered in any way. Also,
referral must fill out and sign Part 4. you should keep a copy of the I-693 for your records.
4. Part 5 - Civil Surgeon's Certification. You must sign Return all supporting medical documents to the applicant
the certification after the initial medical exam and all and give them a copy of the vaccination record. Return all
referrals/follow-up examinations (if required) have been supporting medical documents, including chest X-rays (if
completed. Complete the identifying information in this obtained), directly to the applicant. In addition, give the
part before referring an applicant for further tests or applicant a copy of the completed vaccination record in
evaluation. Do not sign and date this part until the Part 2. This will serve as the applicant's official vaccination
referral/follow-up evaluation (if required) has been record and may be retained by the applicant for future use in
completed and the applicant has been medically cleared. establishing compliance with vaccination
requirements. (Example: school, day care, employment, etc.)
Form I-693 (Rev. 06/05/08)N Page 3
B. V-2 child of a V-1 spouse of a permanent resident, or
Section III. Frequently Asked Questions as a

1. What if I am a refugee and already had a medical C. V-3 child of a V-2 unmarried son or daughter of a V-1
spouse of a permanent resident, and
exam overseas?
If you were admitted to the United States as a refugee and D. You received a medical examination prior to admission
are now applying for adjustment of status one year or obtaining V status, then-
following your first admission, you do not need to repeat a. You are not required to have another medical
the entire medical exam you had overseas, unless a Class examination as long as your Form I-485,
A medical condition was found during that exam. Application to Register Permanent Residence or
Adjust Status, is filed within one year of your
If a complete medical exam is not required, you only need
overseas medical examination.
to comply with the vaccination requirements. This means
you only need to complete Part 1, Information about you, b. You will, however, be required to Part 1,
and the vaccination section of Part 2, not Form Information about you, and submit the vaccination
I-693. Contact your State or local refugee health section of Part 2 with your adjustment of status
coordinator to find out whether it may be possible for you application. A designated civil surgeon must
to have the vaccination portion of Form I-693 completed complete the vaccination section and Part 5, the
by a State or local health department. The State or local Civil Surgeon's Certification.
health department must also complete Part 6 of the Form.
4. May any doctor perform the required medical
2. What if I am a K nonimmigrant visa holder and
exam?
already had a medical exam overseas?
Only a doctor who has been specially designated by
If you were admitted as a: USCIS as a civil surgeon may perform the medical exam.
A. K-1 fiancé(e) or a K-2 child of a K-1 fiancé(e), or as a USCIS will not accept a Form I-693 completed by a doctor
who is not a currently designated civil surgeon.
B. K-3 spouse of a U.S. citizen or a K-4 child of a K-3
spouse of a U.S. citizen, and
5. How do I know whether a doctor is a designated
C. You received a medical examination prior to civil surgeon?
admission, then-
You can obtain a list of the designated civil surgeons by
a. You are not required to have another medical calling the USCIS National Customer Service Center at
examination as long as your Form I-485, 1-800-375-5283, visiting the civil surgeon page from the
Application to Register Permanent Residence or USCIS website at www.uscis.gov and clicking on the
Adjust Status, is filed within one year of your Civil Surgeon Locator link, or by visiting your local
overseas medical examination. USCIS office.
NOTE: If you choose to visit your local USCIS office,
b. You will, however, be required to complete Part
you must first get an InfoPass appointment. For
1, Information about you, and submit the
information on InfoPass, visit the USCIS website at www.
vaccination section of Part 2 with your
uscis.gov.
adjustment of status application. A designated
civil surgeon must complete the vaccination
section and Part 5, the Civil Surgeon's 6. Who pays for the medical exam?
Certification. The applicant is responsible for paying all costs of the
medical exam, including the cost of any follow-up tests or
3. What if I am a V nonimmigrant visa holder and
treatment that may be required. Payments are made
already had a medical exam overseas?
directly to the civil surgeon or other health care facility.
If you were admitted to the United States or obtained
status while in the United States as a:
A. V-1 spouse of a permanent resident or awaiting a V-1
visa, or as a

Form I-693 (Rev. 06/05/08)N Page 4


7. What are the medical grounds of inadmissibility? If you are found to have a communicable disease of public
The medical grounds of inadmissibility under U.S. health significance, the civil surgeon will advise you how to
immigration laws are divided into four categories obtain any necessary treatment. It also may be necessary for
communicable diseases of public health significance, lack you to apply for a waiver of inadmissibility. USCIS will
of required vaccinations, physical or mental disorders with advise you if this is necessary. To obtain more information
harmful behavior, and drug abuse/drug addiction. The about this waiver, visit the USCIS website at www.uscis.gov.
civil surgeon is required to perform a general physical
exam and specific evaluations, as described below. Vaccination Requirements
All applicants for adjustment of status must present
Communicable Diseases of documents showing they have been vaccinated against a broad
Public Health Significance range of vaccine-preventable diseases. The civil surgeon will
The civil surgeon is required to perform specific tests for TB, review your vaccination history with you to determine
syphilis, and human immunodeficiency virus (HIV) infection. whether you have all the required vaccinations. Make sure you
The medical exam also indicates an evaluation for other take your vaccination records with you to your appointment
sexually transmitted diseases and Hansen's Disease (leprosy). with the civil surgeon.

NOTE: Please do not attempt to meet the requirements before


To test for: Then: you are evaluated by the civil surgeon, in case it is not
medically appropriate for you to have one or more of the
Tuberculosis All applicants two years of age and older are required vaccines.
(TB) required to have a tuberculin skin test (TST)
given by the Mantoux technique. (Civil By law, the required vaccines include: mumps, measles,
surgeons may require an applicant rubella, polio, tetanus and diphtheria toxoids, pertussis,
younger than two years to undergo a TST influenza, hepatitis B, haemophilus influenzae type B,
if there is evidence of contact with a varicella, pneumococcal, rotavirus, hepatitis A,
person known to have tuberculosis or meningococcal, human papillomavirus, zoster, and any other
other reason to suspect tuberculosis.) vaccinations recommended by the Advisory Committee for
After the skin test, the applicant will need to Immunization Practices (ACIP).
return to the civil surgeon within 48 to 72
If you never received or are unable to prove you received
hours to have the results read. If you have a
certain vaccines, the civil surgeon can administer them to you.
reaction of four millimeters or less,
After evaluation by the civil surgeon, you also have the option
generally you will not need any further tests
of asking your family doctor to administer those vaccines to
for TB. A chest X-ray is required when the
you and showing the records to the civil surgeon to note on
reaction to the TST is five millimeters or
Form I-693.
more. The civil surgeon will explain the
medical requirements to you in more detail. If you initially did not have documents proving you received
all the required vaccines but later submit those documents, or
Syphilis All applicants age 15 and older must have a if the civil surgeon certifies that it is not medically appropriate
blood test for syphilis. Civil surgeons may for you to have one or more of the missing vaccine(s), USCIS
require applicants under age 15 to be tested may grant you a waiver based on the civil surgeon's
if there is reason to suspect the possibility certification on the vaccination supplement.
of infection.
HHS has determined that a vaccine is "not medically
HIV All applicants age 15 or older must have a appropriate" if : (a) the vaccine is not recommended for your
blood test for HIV. Civil surgeons can specific age group; (b) there is a medical reason why it would
require applicants under age 15 to be tested not be safe to have the vaccine (for example, allergies to eggs
for HIV if there is reason to suspect the and yeast, pregnancy, hypersensitivity to prior vaccines, or
possibility of infection. Civil surgeons are other medical reasons); or (c) you are unable to complete the
required to provide pre-test counseling to all entire series of a required vaccine within a reasonable amount
applicants who take the HIV test. Civil of time.
surgeons are also required to provide post-
test counseling to any applicant who tests
positive for HIV.

Form I-693 (Rev. 06/05/08)N Page 5


If you object to receiving the recommended vaccinations If the civil surgeon determines you have a medical condition
because of your sincerely held religious beliefs or moral of drug addiction/abuse, you are not eligible to apply for a
convictions, you may apply for a waiver of these waiver unless you are applying for adjustment of status one
requirements. If you hold these objections, inform the civil year after you were admitted as a refugee, or you are applying
surgeon that you will apply for a waiver. If the waiver for adjustment of status one year after you were granted
application is denied, you may be ineligible for the asylum. If you are ineligible to apply for a waiver, but are
immigration benefit that you are seeking. To obtain more later found by the civil surgeon to be in remission from the
information about these waivers, visit the USCIS website at drug abuse or drug addiction (as determined by HHS), you
www.uscis.gov. may proceed with your adjustment of status application, if
eligible.
Physical or Mental Disorders
Are all physical or mental disorders considered Section IV. USCIS Information
health-related grounds of inadmissibility?
No. The emphasis is more on the behavior associated with the
physical or mental disorder, instead of the physical or mental How Do I Get USCIS Forms and Related
disorder itself. This means that the civil surgeon must Information?
determine that there is behavior associated with the disorder
that is harmful either to you, to others, or to property. If you To request USCIS forms, call our toll-free forms line at
have had a history of a physical or a mental disorder, there 1-800-870-3676. You may also obtain USCIS forms and
must be associated harmful behavior that is likely to recur in information about immigration laws and regulations, policy,
order for you to be considered inadmissible. and procedures by calling our National Customer Service
Center at 1-800-375-5283 or visiting the USCIS Internet
The civil surgeon will ask you general questions during the website at www.uscis.gov.
medical exam to determine whether you have such a
condition. Depending on the outcome of the initial exam, the Address Changes. If you change your address, you must fill
civil surgeon may find it necessary to refer you to a specialist out and give us a Form AR-11, Alien's Change of Address
for further testing. Card. Mail the completed form to:

If the civil surgeon finds that you have a physical or mental U.S. Citizenship and Immigration Services
disorder with associated harmful behavior, you may apply for Change of Address
a waiver according to the terms, conditions, and controls P.O. Box 7134
determined necessary by USCIS in consultation with HHS. London, KY 40742-7134
To obtain more information about these waivers, visit the
USCIS website at www.uscis.gov. For commercial overnight or fast freight services only, mail
to:
Drug Addiction/Drug Abuse U.S. Citizenship and Immigration Services
Change of Address
What are the guidelines for determining whether 1084-I South Laurel Road
someone is a drug abuser/drug addict? London, KY 40744
The civil surgeon will review your medical history during the
You may also complete Form AR-11, Alien's Change of
medical exam and ask you questions necessary to determine
Address Card, on the USCIS Internet website at
whether you are currently using or have used in the past any
www.uscis.gov.
drugs or other psychoactive substances. The medical
guidelines for determining drug abuse and drug addiction are Visiting a USCIS Office in Person - InfoPass. To visit a
determined by HHS. USCIS office in person, you must first have an appointment.
InfoPass is an Internet-based system that allows you to make
an appointment to talk to an Immigration Information Officer
in person. To access InfoPass, log onto the Internet website
at www.uscis.gov.

Form I-693 (Rev. 06/05/08)N Page 6


Processing Information Penalties

Initial Processing. Once the application has been accepted, it If you knowingly and willfully falsify or conceal a material
will be checked for completeness, including submission of the fact or submit a false document with this Form I-693, we will
required initial evidence. If you do not completely fill out the deny the Form I-693 and may deny any other immigration
form or file it without the required initial evidence, you will benefit.
not establish a basis for eligibility and we may deny your
application. In addition, you will face severe penalties provided by law
and may be subject to criminal prosecution.
Requests for More Information. We may request more
information or evidence, or we may request that you appear at
a USCIS office for an interview. Unless specifically required Paperwork Reduction Act
that an original document be filed with an application or
petition, an ordinary legible photocopy (standard 8 1/2 x 11
An agency may not conduct or sponsor an information
letter size) may be submitted. Original documents submitted
collection and a person is not required to respond to a
when not required will remain a part of the record.
collection of information unless it displays a currently valid
Decision. The decision on the Form I-693 involves a OMB control number. The public reporting burden for this
determination of whether you have established eligibility for collection of information is estimated at 2 hours, 30 minutes
the requested benefit. You will be notified of the decision in per response, including the time for reviewing instructions,
writing. completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
Privacy Act Notice this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Management Division, 111 Massachusetts
We ask for the information on this form, and associated Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529,
evidence, to determine if you have established eligibility for OMB No. 1615-0033. Do not mail your application to this
the immigration benefit for which you are filing. Our legal address.
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies.
Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of
your Form I-693.

Form I-693 (Rev. 06/05/08)N Page 7


OMB No. 1615-0033; Expires 08/31/09

Department of Homeland Security


I-693, Report of Medical
U.S. Citizenship and Immigration Services Examination and Vaccination Record
START HERE - Please type or print in CAPITAL letters (Use black ink)

Part 1. Information about you (The person requesting a medical examination or vaccinations must complete this part)
Family Name (Last Name) Given Name (First Name) Full Middle Name

Home Address: Street Number and Name Apt. Number Gender:


Male Female
City State Zip Code Phone # ( Include Area Code) no dashes or ()

Date of Birth (mm/dd/yyyy) Place of Birth (City/Town/Village) Country of Birth A-number (if any) U.S. Social Security # (if any)

Applicant's Certification
I certify under penalty of perjury under United States law that I am the person who is identified in Part 1 of this Form I-693, Report of Medical
Examination and Vaccination Record, and that the information in Part 1 of this form is true to the best of my knowledge. I understand the purpose of
this medical exam, and I authorize the required tests and procedures to be completed. If it is determined that I willfully misrepresented a material fact
or provided false/altered information or documents with regard to my medical exam, I understand that any immigration benefit I derived from this
medical exam may be revoked, that I may be removed from the United States, and that I may be subject to civil or criminal penalties.
Signature - Do not sign or date this form until instructed to do so by the civil surgeon Date (mm/dd/yyyy)

Part 2. Medical examination (The civil surgeon completes this part)


1. Examination
Date of First Date(s) of Follow-up Examination(s) if Required:
Examination Date of Exam Date of Exam Date of Exam

Summary of Overall Findings:


No Class A or Class B Condition Class A Conditions (see 2 through 5 below) Class B Conditions (see 2 through 6 below)

2. Communicable Diseases of Public Health Significance


A. Tuberculosis (TB)
Tuberculin Skin Test (TST) (Required for applicants 2 years of age and older: for children under 2 years of age, see pp. 11-12 of
Technical Instructions at http://www.cdc.gov/ncidod/dq/civil.htm.)
Date TST Applied Date TST Read Size of Reaction (mm)

Chest X-Ray - Required ONLY for TST reactions of > 5mm or if specific TST exception criteria met, or for an applicant with TB
symptoms or immunosuppression (e.g., HIV). Attach copy of X-Ray Report.
Date Chest X-Ray Date Chest X-Ray Results
Taken Read Normal
Abnormal (Describe results in remarks.)
Findings:
No Class A or Class B TB Class B1 Pulmonary TB Class B2 Pulmonary TB Class B, Other Chest
Class A Pulmonary TB Disease Class B1 Extra Pulmonary TB Class B, Latent TB Infection Condition (non-TB)

Remarks: (Include any signs or symptoms of TB, additional tests, and therapy given, with stop and start dates and any changes.)

Form I-693 (Rev. 06/05/08)N


Part 2. Medical Examination (Continued)
B. Syphilis
Serologic Test for Syphilis (Required for applicants 15 years and older)
Date Screening Run
Screening Nonreactive
Screening Reactive, Titer 1:
If Reactive, Date Confirmation Run
Confirmation Nonreactive
Confirmation Reactive
Findings:
No Class A or Class B Syphilis, Class A Syphilis, Class B (with residual
Syphilis (untreated) deficit, treated in the past year)

Remarks: (Include any therapy given with doses and dates.)

C. HIV/AIDS
Serologic Test for HIV Antibody (Required for applicants 15 years and older)
Date Screening Run Screening Negative If Positive or Indeterminate, Confirmation Negative
Date Confirmation Run Confirmation Positive
Screening Positive
Screening Indeterminate
Findings:
No Class A HIV HIV, Class A

Remarks: (Include any signs or symptoms of HIV infection, therapy given, and any counseling, or referrals.)

D. Other Class A/Class B Conditions for Communicable Diseases of Public Health Significance
Findings:
Chancroid, Class A Gonorrhea, Class A Hansen's Disease (Leprosy, Infectious), Class A
Granuloma Inguinale, Class A Lymphogranuloma Venereum, Class A Hansen's Disease (Leprosy, Noninfectious), Class B

Remarks: (Include any therapy given and any counseling, or referrals.)

3. Physical or Mental Disorders With Associated Harmful Behavior


Physical/Mental Disorder, With Associated Harmful Behavior, Class A
Physical/Mental Disorder, Without Associated Harmful Behavior, Class B
Remarks: (Include diagnosis, with likelihood of harmful behavior to recur, therapy given, and any counseling, or referrals.)

4. Drug Abuse/Drug Addiction


Substance (Drug) Use, Listed in Section 202 of Controlled Substance Act, Class A
Substance (Drug) Use, Not Listed in Section 202 of Controlled Substance Act, But With Associated Harmful Behavior, Class A
Prior Substance (Drug) Use in Remission, Class B
Remarks: (Include any therapy given, rehabilitation, counseling, or referrals.)

Form I-693 (Rev. 06/05/08)N Page 2


Part 2. Medical examination (Continued)

5. Vaccinations (See Technical Instructions at http://www.cdc.gov/ncidod/dq/civil.htm for list of required vaccines.)


Vaccine History Transferred From a Written Record Waiver(s) to Be Requested From USCIS
Vaccine Given Completed Series
Mark an X if Blanket
Date Given completed; write
Date Date Date by Civil date of lab test if Not Medically Appropriate
Vaccine Received Received Received Surgeon immune or "VH" Not Age Contra- Insufficient Not Flu
mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy if varicella history Appropriate indication Time Interval Season

Specify DT
Vaccine:
DTP

DTaP

Specify Td
Vaccine:
Tdap

Specify OPV
Vaccine:
IPV

MMR (Measles
Mumps-Rubella) or if
monovalent or other
combination of the
vaccines are given,
specify vaccine(s):

Hib

Hepatitis B

Varicella

Pneumococcal

Influenza

Rotavirus

Hepatitis A

Meningococcal

Human Papillomavirus

Zoster

Give Copy to Applicant A-number (if any)


Results: Applicant may be eligible for blanket waiver(s) as indicated above.
Applicant will request an individual waiver based on religious or moral convictions.
Vaccine history complete for each vaccine, all requirements met. Name (Type or print your name)

Applicant does not meet immunization requirements.

Form I-693 (Rev. 06/05/08)N Page 3


Part 2. Medical examination (Continued)
6. List other medical conditions, Class B other (e.g. hypertension, diabetes)

Part 3. Referral to health department or other doctor/facility (To be completed by Civil Surgeon, if referral was made)
Type or Print Name of Doctor or Health Department Date of Referral (mm/dd/yyyy)

Address: (Street Number and Name, City, State and Zip Code) Daytime Phone # (Include Area Code) no dashes or ( )

Remarks: (Include name of medical condition and reasons for referral.)

Part 4. To Be Completed by Physician or Health Department Performing Referral Evaluation


The applicant identified on this form was referred to me by the civil surgeon named in Part 5 of this form. I have provided appropriate
evaluation/treatment.

Type or Print Full Name of Evaluating Physician or Health Department Signature

Address: (Street Number and Name, City, State and Zip Code) Date (mm/dd/yyyy)

Name of Medical Practice or Health Department Daytime Phone # (Include Area Code) no dashes or ( )

Remarks: (Attach a separate sheet of paper, if needed.)

Form I-693 (Rev. 06/05/08)N Page 4


Part 5. Civil Surgeon's Certification (Do not sign form or have the applicant sign in Part 1 until all health follow-up
requirements have been met.)
I certify under penalty of perjury under United States law that: I am a civil surgeon in current status designated to examine applicants
seeking certain immigration benefits in the United States; I have a currently valid and unrestricted license to practice medicine in the
state where I am performing medical examinations; I performed this examination of the person identified in Part 1 of this Form
I-693, after having made every reasonable effort to verify that person whom I examined is the person identified in Part 1; that I
performed the examination in accordance with the Centers for Disease Control and Prevention's Technical Instructions, and all
supplemental information or updates provided to me; and that all information provided by me on this form is true and correct to the
best of my information, knowledge, and belief.

Type or Print Full Name (First, Middle, Last) Signature

Address (Street Number and Name, City, State and Zip Code) Date (mm/dd/yyyy)

Name of Medical Practice or Health Department

Daytime Phone # (Include Area Code) no dashes or ( ) E-Mail Address

Part 6. Health department identifying information. (If completed by State or local health department on behalf of a
refugee, place a stamp or seal where indicated.)

Type or Print Name (Place State or local health


department stamp/seal below.)

Signature

Date (mm/dd/yyyy) Daytime Phone # (Include Area Code) no dashes or ( )

Form I-693 (Rev. 06/05/08)N Page 5


OMB No. 1615-0038; Expires 10/31/09

Department of Homeland Security Instructions for I-751, Petition to


U.S. Citizenship and Immigration Services Remove Conditions on Residence
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

What Is the Purpose of This Form? You will then become removable from the United States.
If your failure to file was through no fault of your own,
This form is for a conditional resident who obtained such you may file your petition late with a written explanation
status through marriage to petition to U.S. Citizenship and and request that USCIS excuse the late filing. Failure to
Immigration Services (USCIS) to remove the conditions on file before the expiration date may be excused if you
his or her residence. demonstrate when you submit the application that the
delay was due to extraordinary circumstances beyond your
Who May File Form I-751? control and that the length of the delay was reasonable.

If you were granted conditional resident status through


marriage to a U.S. citizen or permanent resident, use this form General Instructions
to petition for the removal of those conditions.
Step 1. Fill Out Form I-751
If you are still married, the petition should be filed jointly by 1. Type or print legibly in black ink.
you and the spouse through whom you obtained conditional
status. However, you may apply for a waiver of this joint 2. If extra space is needed to complete any item, attach a
filing requirement if: continuation sheet, indicate the item number, and date and
sign each sheet.
1. You entered the marriage in good faith, but your
spouse subsequently died; 3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
2. You entered the marriage in good faith, but the
write "NONE."
marriage was later terminated due to divorce or
annulment; Translations. Any document containing a foreign language
3. You entered the marriage in good faith and have submitted to the Service shall be accompanied by a full
remained married, but have been battered or subjected English language translation which the translator has certified
to extreme cruelty by your U.S. citizen or permanent as complete and accurate, and by the translator's certification
resident spouse; or that he or she is competent to translate from the foreign
language into English.
4. The termination of your status and removal would
result in extreme hardship. Copies. Unless specifically required that an original
document be filed with an application or petition, an ordinary
Conditional Resident Children legible photocopy may be submitted. Original documents
In Part 5 of the form, please make sure to include any submitted when not required will remain a part of the record,
conditional resident children applying with you in order to even if the submission was not required.
have their conditional basis removed, or they may file
What Initial Evidence Is Required?
separately. Please remember to provide their A-number.
Permanent Resident Card
When Should I File Form I-751? You must file your petition with a copy of your Permanent
Resident Card or Alien Registration Card, and a copy of the
1. Filing jointly. If you are filing this petition jointly with Permanent Resident or Alien Registration cards of any of
your spouse, you must file it during the 90 days your conditional resident children you are including in your
immediately before the second anniversary of the date you petition. Submit copies of both front and back sides of the
were accorded conditional resident status. This is the date card.
your conditional residence expires.
Exception
2. Filing with a request that the joint filing requirement Those who reside overseas pursuant to military or
be waived. You may file this petition at any time after government orders, including conditional resident dependents
you are granted conditional resident status and before you residing overseas and listed under Part 5 of the form, must
are removed. submit the following items with Form I-751:
3. Effect of not filing. If this petition is not filed, you will
automatically lose your permanent resident status as of the 1. Two passport-style photos for applicants and dependents,
second anniversary of the date on which you were granted
regardless of age.
conditional status.
Form I-751 Instructions (Rev. 08/25/08) N
2. Two completed fingerprint cards (Form FD-258) for If you are filing to waive the joint filing requirement
applicants and dependents between the ages of 14 because your marriage has been terminated, also submit a
and 79. You must indicate your Alien Registration copy of the divorce decree or other document terminating or
Number (A#) on the fingerprint card and ensure that the annulling the marriage with your petition.
completed cards are not bent, folded, or creased. The If you are filing to waive the joint filing requirement
fingerprint cards must be prepared by a U.S. Embassy because you and/or your conditional resident child were
or U.S. consulate, USCIS Office, or U.S. Military battered or subjected to extreme cruelty, also file your
installation. petition with the following:

In order for USCIS to identify filings based on military or A. Evidence of the physical abuse, such as copies of reports
government orders, applicants are required to indicate on top or official records issued by police, judges, medical
of Form I-751, "ACTIVE MILITARY" or personnel, school officials and representatives of social
"GOVERNMENT ORDERS" and submit a copy of their service agencies, and original affidavits as described
current military or government orders. under Evidence of the Relationship; or
Evidence of the Relationship B. Evidence of the abuse, such as copies of reports or
Submit copies of documents indicating that the marriage official records issued by police, courts, medical
upon which you were granted conditional status was entered personnel, school officials, clergy, social workers and
in ''good faith'' and was not for the purpose of circumventing other social service agency personnel. You may also
immigration laws. Submit copies of as many documents as submit any legal documents relating to an order of
you wish to establish this fact and to demonstrate the protection against the abuser or relating to any legal
circumstances of the relationship from the date of the steps you may have taken to end the abuse. You may
marriage to the present date, and to demonstrate any also submit evidence that you sought safe haven in a
circumstances surrounding the end of the relationship, if it battered women's shelter or similar refuge, as well as
has ended. The documents should cover, but not limited to, photographs evidencing your injuries.
the following examples:
C. A copy of your divorce decree, if your marriage was
1. Birth certificate(s) of child(ren) born to the marriage. terminated by divorce on grounds of physical abuse or
extreme cruelty.
2. Lease or mortgage contracts showing joint occupancy
and/or ownership of your communal residence. If you are filing for a waiver of the joint filing requirement
because the termination of your status and removal would
result in ''extreme hardship," you must submit with your
3. Financial records showing joint ownership of assets and petition evidence that your removal would result in hardship
joint responsibility for liabilities, such as joint savings and significantly greater than the hardship encountered by other
checking accounts, joint federal and state tax returns, aliens who are removed from this country after extended
insurance policies that show the other spouse as the stays. The evidence must relate only to those factors that
beneficiary, joint utility bills, joint installments or other arose since you became a conditional resident.
loans.
4. Other documents you consider relevant to establish that If you are a child filing separately from your parent, also
your marriage was not entered into in order to evade the submit your petition with a full explanation as to why you are
U.S. immigration laws. filing separately, along with copies of any supporting
documentation.
5. Affidavits sworn to or affirmed by at least two people who
have known both of you since your conditional residence Criminal History
was granted and have personal knowledge of your
If you have ever been arrested or detained by any law
marriage and relationship. (Such persons may be required
to testify before an immigration officer as to the enforcement officer for any reason, and no charges were
information contained in the affidavit.) The original filed, submit:
affidavit must be submitted and also contain the following
information regarding the person making the affidavit: 1. An original official statement by the arresting agency
his or her full name and address; date and place of birth; or applicable court order confirming that no charges
relationship to you or your spouse, if any; and full were filed.
information and complete details explaining how the If you have ever been arrested or detained by any law
person acquired his or her knowledge. Affidavits must be
enforcement officer for any reason, and charges were filed, or
supported by other types of evidence listed above.
if charges were filed against you without an arrest, submit:
If you are filing to waive the joint filing requirement due to 2. An original or court-certified copy of the complete
the death of your spouse, also submit a copy of the death arrest record and/or disposition for each incident, (e.
certificate with your petition. g. dismissal order, conviction record, or acquittal
order).

Form I-751 Instructions (Rev. 08/25/08) N Page 2


NOTE: If you or your spouse are currently serving with or
If you have ever been convicted or placed in an alternative employed by the U.S. Government, either in a civilian or
sentencing program or rehabilitative program (such as a drug military capacity and assigned outside the United States, mail
treatment or community service program), submit: your petition to the USCIS Service Center having jurisdiction
over your residence of record in the United States. Include a
1. An original or court-certified copy of your sentencing copy of the U.S. Government orders assigning you and your
record for each incident, and evidence that you completed spouse abroad.
your sentence, specifically;
A. An original or certified copy of your What Is the Filing Fee?
probation or parole record, or The filing fee for a Form is $465.
B. Evidence that you completed an alternative An additional biometric fee of $80 is required when filing
sentencing program, or rehabilitative program Form I-751. After you submit Form I-751, USCIS will
set aside, sealed, expunged, or otherwise notify you about when and where to go for biometric
removed from your record, submit: services.
2. An original or court-certified copy of the court order You may submit one check or money order for both the
vacating, setting aside, sealing, expunging, or otherwise application and biometric fees, for a total of $545.00.
removing the arrest or conviction, or
NOTE: Each conditional resident dependent, eligible to be
3. An original statement from the court that no record exists included on the principal applicant's Form I-751 and listed
of your arrest or conviction. under Part 5 of Form I-751, is required to submit an
additional biometric services fee of $80.00, including
NOTE: Unless a traffic incident was alcohol or drug related,
you do not need to submit documentation for traffic fines and dependents residing overseas pursuant to military or
incidents that did not involve an actual arrest if the only government orders, regardless of age.
penalty was a fine of less than $500.00 and or points on your Use the following guidelines when you prepare your check or
driver's license. money order for the Form I-751 and the biometric service fee:
1. The check or money order must be drawn on a bank or
Where to File?
other financial institution located in the United States
and must be payable in U.S. currency; and
If you live in Alaska, American Samoa, Arizona, California,
Colorado, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, 2. Make the check or money order payable to U.S.
Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, Department of Homeland Security, unless:
Nevada, North Dakota, Ohio, Oregon, South Dakota, Utah,
Washington, Wisconsin, or Wyoming, mail your petition to A. If you live in Guam, make it payable to
the California Service Center:
Treasurer, Guam.

USCIS California Service Center B. If you live in the U.S. Virgin Islands, make it
P.O. Box 10751 payable to Commissioner of Finance of the
Laguna Niguel, CA 92607-1075 Virgin Islands.
C. If you live outside the United States, Guam, or the
If you live in Alabama, Arkansas, Connecticut, Delaware, U.S. Virgin Islands, contact the nearest U.S.
Washington, D.C., Florida, Georgia, Kentucky, Louisiana, Embassy or consulate for instructions on the
Maine, Maryland, Massachusetts, Mississippi, New method of payment.
Hampshire, New Jersey, New Mexico, New York, North
Carolina, Oklahoma, Pennsylvania, Puerto Rico, Rhode NOTE: Please spell out U.S. Department of Homeland
Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Security; do not use the initials "USDHS" or "DHS."
U.S. Virgin Islands, or West Virginia, mail your petition to the
Vermont Service Center: How to Check If the Fees Are Correct?
The form and biometric fees on this form are current as of the
USCIS Vermont Service Center edition date appearing in the lower right corner of this page.
75 Lower Welden St. However, because USCIS fees change periodically, you can
P.O. Box 200 verify if the fees are correct by following one of the steps
St. Albans, VT 05479-0001 below:
1. Visit our website at www.uscis.gov, select
"Immigration Forms" and check the appropriate fee;

2. Review the Fee Schedule included in your form


package, if you called us to request the form; or

Form I-751 Instructions (Rev. 08/25/08) N Page 3


3. Telephone our National Customer Service Center at USCIS Forms and Information
1-800-375-5283 and ask for the fee information.
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and
NOTE: If your Form I-751 requires payment of a biometric information on immigration laws, regulations, and procedures
service fee for USCIS to take your fingerprints, photograph or by telephoning our National Customer Service Center at
signature, you can use the same procedure to obtain the correct 1-800-375-5283 or visiting our internet website at www.uscis.
biometric fee. gov.

As an altenative to waiting in line for assistance at your local


Address Changes USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
If you change your address and you have an application or visit our website. Use the InfoPass appointment scheduler and
petition pending with USCIS, you may change your address follow the screen prompts to set up your appointment.
on-line at www.uscis.gov, click on "Change your address with InfoPass generates an electronic appointment notice that
USCIS" and follow the prompts or by completing and mailing appears on the screen.
Form AR-11, Alien's Change of Address Card, to:
Penalties
U.S. Citizenship and Immigration Services
Change of Address If you knowingly and willfully falsify or conceal a material
P.O. Box 7134 fact or submit a false document with your Form I-751, we will
London, KY 40742-7134 deny your Form I-751 and may deny any other immigration
For commercial overnight or fast freight services only, mail to: benefit.
In addition, you will face severe penalties provided by law and
U.S. Citizenship and Immigration Services may be subject to criminal prosecution.
Change of Address
1084-I South Laurel Road Privacy Act Notice
London, KY 40744
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
Processing Information the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Acceptance. Any application that is not signed or Immigration and Nationality Act, as amended. We may
accompanied by the correct fee will be rejected with a notice provide this information to other government agencies. Failure
that the application is deficient. You may correct the to provide this information, and any requested evidence, may
deficiency and resubmit the application. However, an delay a final decision or result in denial of your Form I-751.
application is not considered properly filed until accepted by
USCIS. Paperwork Reduction Act
Initial Processing. Once the application has been accepted, it An agency may not conduct or sponsor an information
will be checked for completeness, including submission of collection and a person is not required to respond to a
the required initial evidence. If you do not completely fill out collection of information unless it displays a currently valid
the form or file it without the required initial evidence, you OMB control number. The public reporting burden for this
will not establish a basis for eligibility and we may deny your collection of information is estimated at 3 hours and 20
application. minutes per response, including the time for reviewing
instructions, and completing and submitting the form. Send
Requests for More Information. We may request more comments regarding this burden estimate or any other aspect
information or evidence, or we may request that you appear of this collection of information, including suggestions for
at a USCIS office for an interview. We may also request that reducing this burden, to: U.S. Citizenship and Immigration
you submit the originals of any copy. We will return these Services, Regulatory Management Division, 111
originals when they are no longer needed. Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
Washington, DC 20529. OMB No. 1615-0038. Do not mail
Decision. The decision on Form I-751 involves a your application to this address.
determination of whether you have established eligibility for
the requested benefit. You will be notified of the decision in
writing.

Form I-751 Instructions (Rev. 08/25/08) N Page 4


OMB No. 1615-0038; Expires 10/31/09
Department of Homeland Security I-751, Petition to Remove
U.S. Citizenship and Immigration Services Conditions on Residence
START HERE - Please type or print in black ink. For USCIS Use Only
Part 1. Information About You Returned Receipt
Family Name (Last Name) Given Name (First Name) Full Middle Name Date

Date
Address: (Street number and name) Apt. #
Resubmitted

C/O: (In care of) Date

Date
City State/Province Reloc Sent

Date
Country Zip/Postal Code
Date
Mailing Address, if different than above (Street number and name): Apt. #
Reloc Rec'd

Date
C/O: (In care of)
Date

City State/Province Petitioner


Interviewed
on
Country Zip/Postal Code
Remarks

Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship

Alien Registration Number (#A) Social Security # (If any)

Conditional Residence Expires on (mm/dd/yyyy) Daytime Phone # (Area/Country codes)

Part 2. Basis for Petition (Check one)


a. My conditional residence is based on my marriage to a U.S. citizen or permanent resident, Action Block
and we are filing this petition together.
b. I am a child who entered as a conditional permanent resident and I am unable to be included
in a joint Petition to Remove the Conditions on Residence (Form 1-751) filed by my parent(s).

OR
My conditional residence is based on my marriage to a U.S. citizen or permanent resident, but I am
unable to file a joint petition and I request a waiver because: (Check one)
c. My spouse is deceased.
d. I entered into the marriage in good faith but the marriage was terminated through divorce or
annulment.
To Be Completed by
e. I am a conditional resident spouse who entered a marriage in good faith, and during the
Attorney or Representative, if any.
marriage I was battered by or was the subject of extreme cruelty by my U.S. citizen or
permanent resident spouse or parent. Fill in box if G-28 is attached
f. I am a conditional resident child who was battered by or subjected to extreme cruelty by my to represent the applicant.
U.S. citizen or conditional resident parent(s).
ATTY State License #
g. The termination of my status and removal from the United States would result in an extreme
hardship.
Form I-751 (Rev. 08/25/08)N
Part 3. Additional Information About You
1. Other Names Used (including maiden name):

2. Date of Marriage (mm/dd/yyyy) 3. Place of Marriage 4. If your spouse is deceased, give the date of death (mm/dd/yyyy)

5. Are you in removal, deportation, or rescission proceedings? Yes No


6. Was a fee paid to anyone other than an attorney in connection with this petition? Yes No
7. Have you ever been arrested, detained, charged, indicted, fined, or imprisoned for breaking or violating any
law or ordianance (excluding traffic regulations), or committed any crime which you were not arrested in
the United States or abroad? Yes No
8. If you are married, is this a different marriage than the one through which conditional residence status was
obtained? Yes No
9. Have you resided at any other address since you became a permanent resident? (If yes, attach a list of all
addresses and dates.) Yes No
10. Is your spouse currently serving with or employed by the U.S. government and serving outside the United States? Yes No
If you answered "Yes" to any of the above, provide a detailed explanation on a separate sheet(s) of paper and refer to "What Initial Evidence Is Required?" to determine
what criminal history documentation to include with your petition. Place your name and Alien Registration Number (A#) at the top of each sheet and give the number of
the item that refers to your response.

Part 4. Information About the Spouse or Parent Through Whom You Gained Your Conditional Residence
Family Name First Name Middle Name

Address

Date of Birth (mm/dd/yyyy) Social Security # (if any) A# (if any)

Part 5. Information About Your Children-List all your children (Attach other sheet(s) if necessary)
Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) A # (If any) If in U.S., give address/immigration status Living with you?

Yes No
Yes No

Yes No

Yes No

Yes No
Read the information on penalties in the instructions before completing this section. If you checked block
Part 6. Signature. "a" in Part 2, your spouse must also sign below.
I certify, under penalty of perjury of the laws of the United States of America, that this petition and the evidence submitted with it is all true and
correct. If conditional residence was based on a marriage, I further certify that the marriage was entered in accordance with the laws of the place
where the marriage took place and was not for the purpose of procuring an immigration benefit. I also authorize the release of any information from
my records that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit sought.
Signature Print Name Date (mm/dd/yyyy)

Signature of Spouse Print Name Date (mm/dd/yyyy)

NOTE: If you do not completely fill out this form or fail to submit any required documents listed in the instructions, you may not be found eligible
for the requested benefit and this petition may be denied.
Part 7. Signature of Person Preparing Form, If Other than Above
I declare that I prepared this petition at the request of the above person and it is based on all information of which I have knowledge.
Signature Print Name Date (mm/dd/yyyy)

Firm Name and Address Daytime Phone Number


(Area/Country codes)

E-Mail Address
(If any)

Form I-751 (Rev.08/25/08) N Page 2


OMB No. 1615-0040; Expires 08/31/08

Department of Homeland Security


Instructions for I-765, Application
U.S. Citizenship and Immigration Services for Employment Authorization

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.
The filing addresses provided on this form reflect the most current information as of the date this form was last printed. If you are
filing Form I-765 more than 30 days after the latest edition date shown in the lower right-hand corner, please visit our website at
www.uscis.gov before you file, and check the Forms and Fees page to confirm the correct filing address and version currently in use.
Check the edition date located in the lower right-hand corner of the form. If the edition date on your Form I-765 matches the edition
date listed for Form I-765 on the online Forms and Fees page, your version is current and will be accepted by USCIS. If the edition
date on the online version is later, download a copy and use the online version. If you do not have Internet access, call the National
Customer Service Center at 1-800-375-5283 to verify the current filing address and edition date. Improperly filed forms will be
rejected and the fee returned, with instructions to resubmit the entire filing using the current form instructions.

Index Renewal EAD: An EAD issued to an eligible applicant at or


after the expiration of a previous EAD issued under the same
Page No. category.
What Is the Purpose of This Form 1
Who May File This Form I-765 1 Replacement EAD: An EAD issued to an eligible
Required Documentation 6 applicant when the previously issued EAD has been lost,
stolen, mutilated, or contains erroneous information, such as a
What Is the Filing Fee 7 misspelled name.
Where to File 8
Interim EAD: An EAD issued to an eligible applicant when
Processing Information 12
USCIS has failed to adjudicate an application within 90 days
of receipt of a properly filed EAD application or within 30
days of a properly filed initial EAD application based on an
asylum application filed on or after January 4, 1995. The
What Is the Purpose of This Form? interim EAD will be granted for a period not to exceed 240
days and is subject to the conditions noted on the document.
Certain aliens who are temporarily in the United States may
file a Form I-765, Application for Employment Authorization,
to request an Employment Authorization Document (EAD). Who May File This Form I-765?
Other aliens who are authorized to work in the United States
without restrictions should also use this form to apply to USCIS adjudicates a request for employment authorization by
USCIS for a document evidencing such authorization. Please determining whether an applicant has submitted the required
review Eligibility Categories to determine whether you information and documentation, and whether the applicant is
should use this form. eligible. In order to determine your eligibility, you must
identify the category in which you are eligible and fill in that
If you are a Lawful Permanent Resident, a Conditional
category in Question 16 on the Form I-765. Enter only one of
Resident, or a nonimmigrant authorized to be employed with a
the following category numbers on the application form. For
specific employer under 8 CFR 274a.12(b), please do not use
example, if you are a refugee applying for an EAD, you
this form.
should write "(a)(3)" at Question 16.

Definitions For easier reference, the categories are subdivided as follows:


Page No.
Employment Authorization Document (EAD): Form
I-688, Form I-688A, Form I-688B, Form I-766, or any Asylee/Refugee and their Spouses and children 2
successor document issued by USCIS as evidence that the Nationality Categories 2
holder is authorized to work in the United States. Foreign Students 3

Form I-765 Instructions (Rev. 05/27/08) N


Eligible Dependents of Employees of Diplomatic D. Temporary Treatment Benefits--(c)(19). For an
Missions, International Organization, or NATO 3 EAD based on 8 CFR 244.5. Include evidence of
Employment-Based Nonimmigrants 3 nationality and identity as required by the Form I-821
instructions.
Family-Based Nonimmigrants 4
Adjustment-of-Status Categories 4 1. Extension of TPS status: Include a copy (front and
back) of your last available TPS document: EAD,
Other Categories 5 Form I-94 or approval notice.
1. Asylee/Refugee Categories 2. Registration for TPS only without employment
authorization: File Form I-765, Form I-821, and a
A. Refugee--(a)(3). File your EAD application with letter indicating that this form is for registration
either a copy of your Form I-590, Registration for purposes only. No fee is required for the Form I-765
Classification as Refugee, approval letter or a copy of filed as part of TPS registration. (Form I-821 has
a Form I-730, Refugee/Asylee Relative Petition, separate fee requirements.)
approval notice.
E. NACARA Section 203 Applicants Who Are
B. Paroled as a Refugee--(a)(4). File your EAD
application with a copy of your Form I-94, Arrival and Eligible to Apply for NACARA Relief With
Departure Record. USCIS--(c)(10). See the instructions to Form I-881,
Application for Suspension of Deportation or Special
C. Asylee (Granted Asylum)--(a)(5). File your EAD Rule Cancellation of Removal, to determine if you are
application with a copy of the USCIS letter, or judge's eligible to apply for NACARA 203 relief with USCIS.
decision, granting you asylum. It is not necessary to If you are eligible, follow the instructions below and
apply for an EAD as an asylee until 90 days before the submit your Form I-765 at the same time you file your
expiration of your current EAD. Form I-881 application with USCIS:
D. Asylum Applicant (With a Pending Asylum 1. If you are filing a Form I-881 with USCIS, file your
Application)Who Filed for Asylum on or EAD application at the same time and at the same
After January 4, 1995--(c)(8). (For specific filing location. Your response to Question 16 on the
instructions for applicants with pending asylum Form I-765 should be "(c)(10)."
claims, see Page 5).
2. If you have already filed your I-881 application at
2. Nationality Categories the Service Center specified on Form I-881, and
now wish to apply for employment authorization,
A. Citizen of Micronesia, the Marshall Islands or your response to Question 16 on Form I-765 should
Palau--(a)(8). File your EAD application if you were be "(c)(10)." You should file your EAD
admitted to the United States as a citizen of the application at the Service Center designated in
Federated States of Micronesia (CFA/FSM), the "Where to File" of these instructions.
Marshall Islands (CFA/MIS), or Palau, pursuant to
agreements between the United States and the former 3. If you are a NACARA Section 203 applicant who
trust territories. previously filed a Form I-881 with USCIS, and the
application is still pending, you may renew your
B. Deferred Enforced Departure (DED) / EAD. Your response to Question 16 on Form I-765
Extended Voluntary Departure--(a)(11). File should be "(c)(10)." Submit the required fee and
your EAD application with evidence of your identity the EAD application to the Service Center
and nationality. designated in "Where to File" of these instructions.

C. Temporary Protected Status (TPS)--(a)(12). F. Dependent of TECRO E-1 Nonimmigrant--(c).


File your EAD application with Form I-821, File your EAD application with the required
Application for Temporary Protected Status. If you certification from the American Institute in Taiwan if
are filing for an initial EAD based on your TPS status, you are the spouse or unmarried dependent son or
include evidence of identity and nationality as required daughter of an E-1 employee of the Taipei Economic
by the Form I-821 instructions. and Cultural Representative Office.

Form I-765 Instructions (Rev. 05/27/08) N Page 2


3. Foreign Students E. M-1 Student Seeking Practical Training After
Completing Studies--(c)(6). File your EAD
A. F-1 Student Seeking Optional Practical application with a completed Form I-539, Application
Training in an Occupation Directly Related to to Change/Extend Nonimmigrant Status. Form I-20 M-
Studies: (c)(3)(A) - Pre-completion Optional N, Certificate of Eligibility for Nonimmigrant (M-1)
Practical Training; (c)(3)(B) - Post-completion Student Status -- For Vocational Students endorsed by
Optional Practical Training; (c)(3)(C) - the Designated School Official within the past 30 days.
17-month extension for STEM Students (Students 4. Eligible Dependents of Employees of Diplomatic
with a degree in Science, Technology, Missions, International Organizations, or NATO
Engineering, or Mathematics); File your EAD
application with a Certificate of Eligibility of A. Dependent of A-1 or A-2 Foreign Government
Nonimmigrant (F-1) Student Status (Form I-20 A-B Officials--(c)(1). Submit your EAD application with
/I-20 ID) endorsed by a Designated School Official Form I-566, Inter-Agency Record of Individual
within the past 30 days. If you are a STEM student Requesting Change/Adjustment to or from A or G
requesting a 17-month extension under the eligibility Status; or Requesting A, G, or NATO Dependent
code (c)(3)(C), you must also submit a copy of your Employment Authorization, through your diplomatic
degree, the employer name as listed in E-Verify, along mission to the Department of State (DOS). The DOS
with the E-Verify Company Identification Number, will forward all favorably endorsed applications directly
or a valid E-Verify Client Company Identification to the Nebraska Service Center for adjudication.
Number, for the employer with whom you are seeking B. Dependent of G-1, G-3 or G-4 Nonimmigrant--
the 17-month OPT extension. This information must (c)(4). Submit your EAD application with a Form
be provided in Item #17 of the application form. I-566, Inter-Agency Record of Individual Requesting
Change/Adjustment to or from A or G Status; or
B. F-1 Student Offered Off-Campus Employment
Requesting A, G, or NATO Dependent Employment
Under the Sponsorship of a Qualifying Authorization, through your international organization
International Organization--(c)(3)(ii). File your to the Department of State (DOS). [In New York City,
EAD application with the international organization's the United Nations (UN) and UN missions should
letter of certification that the proposed employment is submit such applications to the United States Mission
within the scope of its sponsorship, and a Certificate of to the UN (USUN).] The DOS or USUN will forward
Eligibility of Nonimmigrant (F-1) Student Status -- For all favorably endorsed applications directly to the
Academic and Language Students (Form I-20 A-B/ -20 Nebraska Service Center for adjudication.
ID) endorsed by the Designated School Official within
the past 30 days. C. Dependent of NATO-1 Through NATO-6--(c)
(7). Submit your EAD application with Form I-566,
C. F-1 Student Seeking Off-Campus Inter-Agency Record of Individual Requesting
Employment Due to Severe Economic Change/ Adjustment to or from A or G Status; or
Hardship--(c)(3)(iii). File your EAD application Requesting A, G, or NATO Dependent Employment
with Form I-20 A-B/I-20 ID, Certificate of Eligibility Authorization, to NATO SACLANT, 7857 Blandy
of Nonimmigrant (F-1) Student Status -- For Road, C-027, Suite 100, Norfolk, VA 23551-2490.
Academic and Language Students, and any evidence NATO/SACLANT will forward all favorably endorsed
you wish to submit, such as affidavits, that detail the applications directly to the Nebraska Service Center
unforeseen economic circumstances that cause your for adjudication.
request, and evidence you have tried to find off- 5. Employment-Based Nonimmigrant Categories
campus employment with an employer who has filed
a labor and wage attestation. A. B-1 Nonimmigrant Who Is the Personal or
Domestic Servant of a Nonimmigrant
D. J-2 Spouse or Minor Child of an Exchange Employer--(c)(17)(i). File the EAD application
Visitor--(c)(5). File your EAD application with a with:
copy of your J-1's (principal alien's) Certificate of
1. Evidence from your employer that he or she is a B,
Eligibility for Exchange Visitor (J-1) Status (Form
E, F, H, I, J, L, M, O, P, R, or TN nonimmigrant and
IAP-66). You must submit a written statement with
you were employed for at least one year by the
any supporting evidence showing that your
employer before the employer entered the United
employment is not necessary to support the J-1 but is
States or your employer regularly employs personal
for other purposes.
and domestic servants and has done so for a period
of years before coming to the United States; and

Form I-765 Instructions (Rev. 05/27/08) N Page 3


2. Evidence that you have either worked for this 6. Family-Based Nonimmigrant Categories
employer as a personal or domestic servant for at
least one year, or evidence that you have at least one A. K-1 Nonimmigrant Fiance(e) of U.S. Citizen or
year's experience as a personal or domestic servant; K-2 Dependent--(a)(6). File your EAD application
and if you are filing within 90 days from the date of entry.
This EAD cannot be renewed. Any EAD application
3. Evidence establishing that you have a residence other than for a replacement must be based on your
abroad which you have no intention of abandoning. pending application for adjustment under (c)(9).

B. B-1 Nonimmigrant Domestic Servant of a B. K-3 Nonimmigrant Spouse of U.S. Citizen or


U.S. Citizen--(c)(17)ii). File your EAD application K-4 Dependent--(a)(9). File your EAD application
with: along with evidence of your admission such as copies
of your Form I-94, passport, and K visa.
1. Evidence from your employer that he or she is a
U.S. citizen; and C. Family Unity Program--(a)(13). If you are filing
2. Evidence that your employer has a permanent home for initial or extension Family Unity benefits complete
abroad or is stationed outside the United States and and submit Form I-817, Application for Voluntary
is temporarily visiting the United States or the Departure Under the Family Unity Program. An
citizen's current assignment in the United States will Employment Authorization Document (EAD) will be
not be longer than four years; and issued if your I-817 is approved; no I-765 application
is necessary.
3. Evidence that he or she has employed you as a
domestic servant abroad for at least six months prior If your non-expired Family Unity EAD is lost or
to your admission to the United States. stolen, file an I-765 application with proper fee(s),
along with a copy of your approval notice for Family
C. B-1 Nonimmigrant Employed by a Foreign Unity benefits, to request a replacement.
Airline--(c)(17)(iii). File your EAD application
D. LIFE Family Unity--(a)(14). If you are applying
with a letter from the airline fully describing your
for initial employment authorization under Family
duties and indicating that your position would entitle
Unity provisions of section 1504 of the LIFE Act
you to E nonimmigrant status except for the fact that
Amendments, or an extension of such authorization,
you are not a national of the same country as the
you should not be using this form. Please obtain and
airline or because there is no treaty of commerce and
complete a Form I-817, Application for Family Unity
navigation in effect between the United States and
Benefits. If you are applying for a replacement EAD
that country.
that was issued under LIFE Act Amendments Family
Unity provisions, file your EAD application with the
D. Spouse of an E-1/E-2 Treaty Trader or required evidence listed in the "Required Document"
Investor--(a)(17). File your EAD application section of these instructions.
with evidence of your lawful status and evidence
you are a spouse of a principal E-1/E-2, such as your E. V-1, V-2, or V-3 Nonimmigrant--(a)(15). If you
Form I-94. (Other relatives or dependents of E-1/E-2 have been inspected and admitted to the United States
aliens who are in E status are not eligible for with a valid V visa, file this application along with
employment authorization and may not file under evidence of your admission, such as copies of your
this category.) Form I-94, passport, and K visa. If you have been
granted V status while in the United States, file this
E. Spouse of an L-1 Intracompany Transferee-- application along with evidence of your V status, such
(a)(18). File your EAD application with evidence of as an approval notice. If you are in the United States
your lawful status and evidence you are a spouse of a but you have not yet filed an application for V status,
principal L-1, such as your I-94. (Other relatives or you may file this application at the same time as you
dependents of L-1 aliens who are in L status are not file your application for V status. USCIS will
eligible for employment authorization and may not adjudicate this application after adjudicating your
file under this category.) application for V status.

Form I-765 Instructions (Rev. 05/27/08) N Page 4


7. EAD Applicants Who Have Filed for Adjustment D. Paroled in the Public Interest--(c)(11). File your
of Status EAD application if you were paroled into the United
States for emergent reasons or reasons strictly in the
A. Adjustment Applicant--(c)(9). File your EAD public interest.
application with a copy of the receipt notice or other
evidence that your Form I-485, Application for E. Deferred Action--(c)(14). File your EAD
Permanent Residence or Adjust Status, is pending. application with a copy of the order, notice, or
You may file Form I-765 together with your Form document placing you in deferred action and evidence
I-485. establishing economic necessity for an EAD.
B. Adjustment Applicant Based on Continuous
Residence Since January 1, 1972--(c)(16). File F. Final Order of Deportation--(c)(18). File your
your EAD application with your Form I-485, EAD application with a copy of the order of
Application for Permanent Residence; a copy of your supervision and a request for employment
receipt notice; or other evidence that the Form I-485 is authorization which may be based on, but not limited
pending. to the following:
1. Existence of a dependent spouse and/or children in
C. Renewal EAD for National Interest Waiver the United States who rely on you for support; and
Physicians: If you are filing for a renewal EAD based
on your pending adjustment status and an approved 2. Existence of economic necessity to be employed;
National Interest Waiver Physician petition, you must 3. Anticipated length of time before you can be
also include evidence of your meaningful progress removed from the United States.
toward completing the national interest waiver
obligation. Such evidence includes documentation of
employment in any period during the previous 12
G. LIFE Legalization Applicant--(c)(24). We
months (e.g., copies of W-2 forms). If you did not encourage you to file your EAD application together
work as a national interest waiver physician during any with your Form I-485, Application to Register
period of the previous 12 months, you must explain Permanent Residence or Adjust Status, to facilitate
and provide a statement of future intent to work in the processing. However, you may file Form I-765 at a
national interest waiver employment. later date with evidence that you were a CSS, LULAC,
or Zambrano class member applicant before October
8. Other Categories 1, 2000, and with a copy of the receipt notice or other
evidence that your Form I-485 is pending.
A. N-8 or N-9 Nonimmigrant--(a)(7). File your EAD
application with the required evidence listed in the H. T-1 Nonimmigrant--(a)(16). If you are applying
"Required Document" section of these instructions. for initial employment authorization as a T-1
nonimmigrant, file this form only if you did not
B. Granted Withholding of Deportation or request an employment authorization document when
Removal (a)(10). File your EAD application with a you applied for T nonimmigrant status. If you have
copy of the Immigration Judge's order. It is not been granted T status and this is a request for a
necessary to apply for a new EAD until 90 days before renewal or replacement of an employment
the expiration of your current EAD. authorization document, file this application along
with evidence of your T status, such as an approval
C. Applicant for Suspension of Deportation--(c)
notice.
(10). File your EAD application with evidence that
your Form I-881, Application for Suspension of
Deportation, or EOIR-40, is pending. I. T-2, T-3, or T-4 Nonimmigrant--(c)(25). File this
form with a copy of your T-1's (principal alien's)
approval notice and proof of your relationship to the
T-1 principal.

Form I-765 Instructions (Rev. 05/27/08) N Page 5


Special Filing Instructions for Those With
Required Documentation Pending Asylum Applications ((c)(8))
All applications must be filed with the documents required Asylum Applicant (with a pending asylum application)
below, in addition to the particular evidence required for the who filed for asylum on or after January 4, 1995. You must
category listed in "Who May File This Form I-765" with fee, wait at least 150 days following the filing of your asylum
if required. claim before you are eligible to apply for an EAD. If you file
your EAD application early, it will be denied. File your EAD
If you are required to show economic necessity for your
application with:
category, submit a list of your assets, income, and expenses.
1. A copy of the USCIS acknowledgement mailer which was
Please assemble the documents in the following order: mailed to you; or
2. Other evidence that your Form I-589 was filed with
1. Your application with the filing fee. See "What Is the
USCIS; or
Filing Fee" for details.
3. Evidence that your Form I-589 was filed with an
2. If you are mailing your application to USCIS, you must Immigration Judge at the Executive Office for Immigration
also submit: Review (EOIR); or
A. A copy of Form I-94 Departure Record (front and 4. Evidence that your asylum application remains under
back), if available. If you are filing an I-765 under the administrative or judicial review.
(c) (9) category, an I-94 record need not submitted.
Asylum applicant (with a pending asylum application) who
B. A copy of your last EAD (front and back). If no prior filed for asylum and for withholding of deportation prior
EAD has been issued, you must submit a copy of a to January 4, 1995, and is NOT in exclusion or deportation
Federal Government issued identity document, such as a proceedings.
passport showing your picture, name, and date of birth; a You may file your EAD application at any time; however, it
birth certificate with photo ID; a visa issued by a foreign will only be granted if USCIS finds that your asylum
consulate; or a national ID document with photo and/or application is not frivolous. File your EAD application with:
fingerprint. The identity document photocopy must
clearly show the facial features of the applicant and the 1. A complete copy of your previously filed Form I-589; AND
biographical information.
2. A copy of your USCIS receipt notice; or
3. A copy of the USCIS acknowledgement mailer; or
C. You must submit two identical color photographs of
yourself taken within 30 days of the filing of this 4. Evidence that your Form I-589 was filed with EOIR; or
application. The photos must have a white to off-white
background, be printed on thin paper with a glossy 5. Evidence that your asylum application remains under
finish, and be unmounted and unretouched. administrative or judicial review; or
6. A copy of the USCIS acknowledgement mailer.
The passport-style photos must be 2” by 2”. The
photos must be in color with full face, frontal view on a Asylum applicant (with a pending asylum application) who
white to off-white background. Head height should filed an initial request for asylum prior to January 4, 1995,
measure 1” to 1 3/8” from top to bottom of chin, and and IS IN exclusion or deportation proceedings. If you
eye height is between 1 1/8” to 1 3/8” from bottom of filed your Request for Asylum and Withholding of
photo. Your head must be bare unless you are wearing Deportation (Form I-589) prior to January 4, 1995, and you
a headdress as required by a religious order of which ARE IN exclusion or deportation proceedings, file your EAD
you are a member. Using pencil or felt pen, lightly application with:
print your name and Alien Receipt Number on the back 1. A date-stamped copy of your previously filed Form I-589; or
of the photo.

Form I-765 Instructions (Rev. 05/27/08) N Page 6


2. A copy of Form I-221, Order to Show Cause and Notice
1. (a)(3) Refugee;
of Hearing, or Form I-122, Notice to Applicant for
Admission Detained for Hearing Before Immigration 2. (a)(4) Paroled as Refugee;
Judge; or 3. (a)(5) Asylee;
3. A copy of EOIR-26, Notice of Appeal, date stamped by
4. (a)(7) N-8 or N-9 nonimmigrant;
the Office of the Immigration Judge; or
4. A date-stamped copy of a petition for judicial review or 5. (a)(8) Citizen of Micronesia, Marshall Islands, or Palau;
for habeas corpus issued to the asylum applicant; or 6. (a)(10) Granted Withholding of Deportation;
5. Other evidence that you filed an asylum application 7. (a)(11) Deferred Enforced Departure;
with EOIR.
8. (a)(16) Victim of Severe Form of Trafficking (T-1);
Asylum application under the ABC Settlement
Agreement--(c)(8). If you are a Salvadoran or Guatemalan 9. (c)(1), (c)(4), or (c)(7) Dependent of certain foreign
national eligible for benefits under the ABC settlement government, international organization, or NATO
agreement, American Baptist Churches v. Thornburgh , 760 personnel; or
F. Supp. 976 (N.D. Cal. 1991), please follow the instructions
10. (c)(8) Applicant for asylum (an applicant filing under the
contained in this section when filing your Form I-765.
special ABC procedures must pay the fee).
You must have an asylum application (Form I-589) on file
Renewal EAD: If this is a renewal application and you are
either with USCIS or with an Immigration Judge in order to
applying under one of the following categories, a filing fee is
receive work authorization. Therefore, please submit
not required:
evidence that you have previously filed an asylum application
when you submit your EAD application. You are not 1. (a)(8) Citizen of Micronesia, Marshall Islands, or Palau;
required to submit this evidence when you apply, but it will
2. (a)(10) Granted Withholding of Deportation;
help USCIS process your request efficiently.
3. (a)(11) Deferred Enforced Departure; or
If you are renewing or replacing your EAD, you must pay the
filing fee. 4. (c)(l), (c)(4), or (c)(7) Dependent of certain foreign
government, international organization, or NATO
Mark your application as follows: personnel;
1. Write "ABC" in the top right corner of your EAD 5. (c)(9) or (c)(16) adjustment applicant who filed for adjustment
application. You must identify yourself as an ABC class under the fee structure implemented July 30, 2007.
member if you are applying for an EAD under the ABC
settlement agreement. Replacement EAD: If this is your replacement application
and you are applying under one of the following categories, a
2. Write "(c)(8)" in Section 16 of the application.
filing fee is not required:
You are entitled to an EAD without regard to the merits of
your asylum claim. Your application for an EAD will be 1. (c)(l), (c)(4), or (c)(7) Dependent of certain foreign
decided within 60 days if: (1) you pay the filing fee, (2) you government, international organization, or NATO
have a complete pending asylum application on file, and (3) personnel.
write "ABC" in the top right corner of your EAD application.
NOTE: If you are requesting a replacement EAD under the
If you do not pay the filing fee for an initial EAD request,
(c)(9) or (c)(16) Applicant for Adjustment of Status filed
your request may be denied if USCIS finds that your asylum
under the fee structure implemented July 30, 2007, then the
application is frivolous. However, if you cannot pay the filing
full filing fee will be required; however, no biometrics fee is
fee for an EAD, you may qualify for a fee waiver under 8 CFR
required.
103.7(c).
Incorrect Card: No fee is required if you are filing only
What is the Filing Fee? because the card issued to you was incorrect due to a USCIS
administrative error. However, if the error was not caused by
The filing fee for Form I-765 is $340. USCIS, both application and biometrics fees are required.
Exceptions:
You may be eligible for a fee waiver under 8 CFR 103.7(c).
Initial EAD: If this is your initial application and you are
applying under one of the following categories, a filing fee is
not required:

Form I-765 Instructions (Rev. 05/27/08) N Page 7


You will not receive your original check back. We will
USCIS will use the Poverty Guidelines published annually by
destroy your original check, but we will keep a copy of it. If
the U.S. Department of Health and Human Services as the
the EFT cannot be processed for technical reasons, you
basic criteria in determining the applicant's eligibility when
authorize us to process the copy in place of your original
economic necessity is identified as a factor.
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times.
The Poverty Guidelines will be used as a guide, but not as a
conclusive standard, in adjudicating fee waiver requests for
How to Check If the Fees Are Correct
employment authorization applications requiring a fee.
The form fee on this form is current as of the edition date
Use the following guidelines when you prepare your check or appearing in the lower right corner of this page. However,
money order for the Form I-765 fee: because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below:
1. The check or money order must be drawn on a bank or
other financial institution located in the United States 1. Visit our website at www.uscis.gov, select "Immigration
and must be payable in U.S. currency; and Forms," and check the appropriate fee;
2. Review the Fee Schedule included in your form package, if
2. Make the check or money order payable to U.S. you called us to request the form; or
Department of Homeland Security, unless:
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.
A. If you live in Guam and are filing your petition
there, make it payable to Treasurer, Guam.
Where to File?
B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to
Commissioner of Finance of the Virgin Islands. E-Filing Form I-765: Certain Form I-765 filings may be
electronically filed (e-filed) with USCIS. Please view our
website at www.uscis.gov for a list of who is eligible to e-file
NOTE: If you filed a Form I-485, Application to Register this form and instructions.
Permanent Residence or Adjust Status, as of July 30, 2007, no
fee is required to also file a request for employment If your response to Question 16 is (a)(3), admitted as a
authorization on Form I-765. You may file the I-765 refugee, (a)(4), paroled as a refugee, (a)(5), asylum granted,
concurrently with your I-485, or you may submit the I-765 at a (a)(7), N-8 or N-9 nonimmigrant, or (a)(8), admitted as citizen
later date. If you file Form I-765 separately, you must also of the Federated States of Micronesia or of the Marshall
submit a copy of your Form I-797C, Notice of Action, receipt Islands mail your application to:
as evidence of the filing of an I-485 as of July 30, 2007.
USCIS
Nebraska Service Center
P.O. Box 87765
NOTE: Please spell out U.S. Department of Homeland Lincoln, NE 68501-7765
Security; do not use the initials "USDHS" or "DHS."
For courier/express deliveries:
Notice to Those Making Payment by Check. If you send us USCIS
a check, it will be converted into an electronic funds transfer Nebraska Service Center
(EFT). This means we will copy your check and use the 850 S. Street
account information on it to electronically debit your account Lincoln, NE 68508-1225
for the amount of the check. The debit from your account will
usually take 24 hours and will be shown on your regular
If your response to Question 16 is:
account statement.
1. (a)(10), an alien granted withholding of deportation or
removal;
2. (c)(11), an alien paroled into the United States temporarily
for emergency reasons, or reasons deemed strictly in the
public interest;

Form I-765 Instructions (Rev. 05/27/08) N Page 8


3. (c)(14), an alien who has been granted deferred action, If you need to replace a valid lost, stolen, or mutilated
(Exception: If the grant of deferred action was based on an Temporary Protected Status EAD, send your application to
approved Form I-360 petition filed for a battered or abused (this address may be used for both U.S. Postal Service and
spouse or child, file your Form I-765 with the Vermont private courier deliveries):
Service Center at the address below.);
USCIS
4. (c)(16), an alien who has filed an application for creation of Vermont Service Center
record of lawful admission for permanent residence; or Attn: TPS
75 Lower Welden St.
5. (c)(18), an alien against whom a final order of deportation St. Albans, VT 05479-0001
or removal exists and who is released on an order of
supervision, mail your application to the following If your response to Question 16 is (c)(1), alien spouse or
address: unmarried dependent child, son or daughter of a foreign
government official, or (c)(4), eligible dependent of a G-1,
USCIS
G-3 or G-4 non-immigrant, or (c)(7), dependent of a NATO 1
P.O. Box 805887
through NATO 7, submit your application through your
Chicago, IL 60680-4120
principal's sponsoring organization. Your application will be
If your response to Question 16 is (c)(14), an alien who has reviewed and forwarded by DOS, USUN, or NATO/
been granted deferred action based on an approved Form I-360 SACLANT to the Nebraska Service Center following
petition filed for a battered or abused spouse or child, (a)(16), certification of your eligibility for an EAD.
victim of trafficking, or (c)(25), immediate family member of If your response to Question 16 is (c)(8) under the special
a T-1 victim of severe form of trafficking in persons, send ABC filing instructions, and you are filing your Form I-589
your application to (this address may be used for both U.S. Application for Asylum and this application together, mail
Postal Service and private courier deliveries): your applications to the office where you will file your asylum
USCIS application. Otherwise, for all other (c)(8) filings, see
Vermont Service Center additional instructions below.
Attn: I-765
If your response to Question 16 is (c)(9) and you filed your
75 Lower Welden St.
I-485 application with the USCIS Chicago Lockbox Facility,
St. Albans, VT 05479-0001
file your Form I-765 with the following address (if you filed
If your response to Question 16 is (a)(14), an alien granted your Form I-485 with a USCIS Service Center, see
family unity benefits under Section 1504 of the LIFE Act, or instructions below):
(c)(24), an alien who has filed for adjustment under section USCIS Lockbox Addresses:
1104 of the LIFE Act, mail your application to:
For U. S. Postal Service (USPS) deliveries:
USCIS
P.O. Box 7219 USCIS
Chicago, IL 60680-7219 P.O. Box 805887
Chicago, IL 60680-4120
If your response to Question 16 is (a)(15), any alien in V
nonimmigrant status, mail your application to: For courier/express deliveries:

USCIS USCIS
P.O. Box 7216 Attn: FBAS
Chicago, IL 60680-7216 131 South Dearborn - 3rd Floor
Chicago, IL 60603-5517
If your response to Question 16 is (a)(12), alien granted
Temporary Protected Status, or (c)(19), alien who has a Otherwise, if you filed your I-485 adjustment application with
pending application for TPS, mail your application according a USCIS Service Center, you must file Form I-765 at the
to the instructions in the Federal Register notice for your Nebraska Service Center or the Texas Service Center,
particular country's TPS designation. depending on where you live (see the following addresses).

Form I-765 Instructions (Rev. 05/27/08) N Page 9


Nebraska Service Center Filings If your response to Question 16 is:
File Form I-765 alone or concurrently with Form I-485 with
the Nebraska Service Center if you live in: 1. (a)(6), alien admitted as a nonimmigrant fiancé(e) pursuant
Alaska, Arizona, California, Colorado, Guam, Hawaii, to section 101(a)(15) (K)(i);
Idaho, Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Missouri, Montana, Nebraska, Nevada, North 2. (a)(11), alien granted extended voluntary departure by the
Dakota, Ohio, Oregon, South Dakota, Utah, Washington, Secretary as a member of a nationality group pursuant to a
Wisconsin, or Wyoming. request by the Secretary of State;
If you are filing Form I-765 alone, mail your Form I-765
package to: 3. (a)(13), alien granted voluntary departure under the Family
Unity Program;
USCIS
Nebraska Service Center
4. (a)(17), spouse of a treaty trader, investor;
P.O. Box 87765
Lincoln, NE 68501-7765
5. (a)(18), spouse of an intracompany transferee;
If you are filing Form I-765 concurrently with Form I-485,
mail to:
6. (c)(2), alien spouse or unmarried dependent son or
USCIS daughter of an employee of the Coordination Council for
Nebraska Service Center North American Affairs;
P.O. Box 87485
Lincoln, NE 68501-7485 7. (c)(3)(A), (c)(3)(B), or (c)(3)(C), F-1 student seeking
For private courier (non-USPS) deliveries: optional practical training;
USCIS
Nebraska Service Center 8. (c)(3)(ii), F-1 student offered employment under the
850 S. Street sponsorship of an international organization;
Lincoln, NE 68508-1225
Texas Service Center Filings 9. (c)(3)(iii), F-1 student seeking employment because of
File Form I-765 with the Texas Service Center if you live in: severe economic hardship;
Alabama, Arkansas, Connecticut, Florida, Georgia,
10. (c)(5), spouse or minor child of an exchange visitor (J-2);
Kentucky, Louisiana, Maine, Maryland, Massachusetts,
Mississippi, New Hampshire, New Jersey, New Mexico,
New York, North Carolina, South Carolina, Oklahoma, 11. (c)(6), M-1 student seeking employment for practical
Pennsylvania, Puerto Rico, Rhode Island, Tennessee, training;
Texas, Vermont, Virginia, U.S. Virgin Islands, West
Virginia, or Washington, DC. 12. (c)(8), an alien who has filed an application for asylum or
If you are filing Form I-765 concurrently with Form I-485, withholding of deportation or removal;
mail your Form I-765 to the address you will use to file
Form I-485. 13. (c)(17)(i), a visitor for business (B-1) who is the personal
or domestic servant who is accompanying or following to
If you are filing Form I-765 alone, mail your Form I-765
join an employer;
package to:
USCIS 14. (c)(17)(ii), a domestic servant of a U.S. citizen
Texas Service Center accompanying or following to join his or her U.S. citizen
P.O. Box 851041 employer who has a permanent home or is stationed in a
Mesquite, TX 75185-1041 foreign country; or
For private courier (non-USPS) deliveries:
15. (c)(17)(iii), an employee of a foreign airline engaged in
USCIS international transportation of passengers freight:
Texas Service Center mail your application to the appropriate Service Center
4141 North St. Augustine Road depending on where you live (see chart on the following
Dallas, TX 75227 page).

Form I-765 Instructions (Rev. 05/27/08) N Page 10


If you live in: Mail your application to: If your response to Question 16 is:

Connecticut Delaware For both U.S. Postal 1. (a)(9), admitted as a K-3 spouse or K-4 dependant; or
D.C. Maine Service and private
courier deliveries: 2. (c)(10), and you are a NACARA 203 applicant eligible to
Maryland Massachusetts
New Hampshire New Jersey apply for relief with USCIS, or if your I-881 application is
USCIS
New York Pennsylvania still pending with USCIS and you wish to renew your
Vermont Service Center
Puerto Rico Rhode Island ATTN: I-765 EAD:
Vermont Virginia 75 Lower Welden Street Mail your EAD application with the required fee to the
West Virginia U.S.V.I. St. Albans, VT appropriate USCIS service center below:
05479-0001
U.S. Postal Service If you live in Alabama, Arkansas, Colorado, Connecticut,
Arizona California deliveries: Delaware, the District of Columbia, Florida, Georgia,
Guam Hawaii Louisiana, Maine, Maryland, Massachusetts, Mississippi,
Nevada USCIS New Hampshire, New Jersey, New Mexico, New York,
California Service Center
P.O. Box 10765 North Carolina, Oklahoma, Pennsylvania, Puerto Rico,
Laguna Niguel, CA Rhode Island, South Carolina, Tennessee, Texas, Utah, the
92607-1076 U.S. Virgin Islands, Vermont, Virginia, West Virginia, or
Wyoming, send your application to (this address may be
For courier/express used for both U.S. Postal Service and private courier
deliveries:
deliveries):
USCIS
California Service Center USCIS
24000 Avila Road Vermont Service Center
2nd Floor, Room 2312 Attn: I-765
Laguna Niguel, CA 92677 75 Lower Welden St.
St. Albans, VT 05479-0001
Alabama Arkansas U.S. Postal Service
Florida Georgia deliveries: If you live in Alaska, Arizona, California, the
Kentucky Louisiana USCIS Service Center Commonwealth of Guam, Hawaii, Idaho, Illinois, Indiana,
Mississippi New Mexico Texas Service Center Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri,
North Carolina Oklahoma P.O. Box 851041 Montana, Nebraska, Nevada, North Dakota, Oregon, Ohio,
South Carolina Tennessee Mesquite, TX 75185-1041 South Dakota, Washington, or Wisconsin, mail your
Texas application to:
For courier/express
deliveries: USCIS
California Service Center
USCIS P.O. Box 10765
Texas Service Center
4141 N St. Augustine Rd Laguna Niguel, CA 92607-1076
Dallas, TX 75227 For courier/express deliveries:
Alaska Colorado US Postal Service USCIS
Idaho Illinois deliveries: California Service Center
Indiana Iowa USCIS Service Center 24000 Avila Road
Kansas Michigan Nebraska Service Center 2nd Floor, Room 2312
Minnesota Missouri P.O. Box 87765 Laguna Niguel, CA 92677
Montana Nebraska Lincoln, NE 68501-7765
North Dakota Ohio
Oregon South Dakota For courier/express NOTE: You should submit the fee for the EAD
Utah Washington deliveries: application on a separate check or money order. Do not
Wisconsin Wyoming combine your check or money order with the fee for Form
USCIS
Nebraska Service Center I-881.
850 S. Street
Lincoln, NE 68508-1225

Form I-765 Instructions (Rev. 05/27/08) N Page 11


If your response to Question 16 is (c)(10) and you are not
eligible to apply for NACARA 203 relief with USCIS, but you Penalties
are eligible for other deportation or removal relief, mail your If you knowingly and willfully falsify or conceal a material fact
application to the following address: or submit a false document with this Form I-765, we will deny
USCIS the Form I-765 and may deny any other immigration benefit.
P.O. Box 805887 In addition, you will face severe penalties provided by law and
Chicago, IL 60680-4120 may be subject to criminal prosecution.

Questions Regarding Form I-765 USCIS Forms and Information


For additional information about Form I-765, including how to To order USCIS forms, call our toll-free number at 1-800-
file your application or filing locations not mentioned, call the 870-3676. You can also get USCIS forms and information on
USCIS National Customer Service Center at 1-800-375-5283 immigration laws, regulations, and procedures by telephoning
or visit our website at www.uscis.gov. our National Customer Service Center at 1-800-375-5283 or
visiting our Internet website at www.uscis.gov.
As an altenative to waiting in line for assistance at your local
Processing Information USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system,
Any Form I-765 that is not signed or accompanied by the visit our website. Use the InfoPass appointment scheduler and
correct fee will be rejected with a notice that the Form follow the screen prompts to set up your appointment.
I-765 is deficient. You may correct the deficiency and InfoPass generates an electronic appointment notice that
resubmit the Form I-765. An application or petition is not appears on the screen.
considered properly filed until accepted by USCIS.

Initial processing. Once a Form I-765 has been accepted, it Paperwork Reduction Act
will be checked for completeness, including submission of the Authority for Collecting This Information. The
required initial evidence. If you do not completely fill out the authority to require you to file Form I-765, Application for
form, or file it without required initial evidence, you will not Employment Authorization, when applying for employment
establish a basis for eligibility, and we may deny your Form authorization is found at sections 103(a) and 274A(h)(3) of the
I-765. Immigration and Nationality Act. Information you provide on
your Form I-765 is used to determine whether you are eligible
Requests for more information or interview. We may for employment authorization and for the preparation of your
request more information or evidence, or we may request that Employment Authorization Document if you are found
you appear at a USCIS office for an interview. We may also eligible. Failure to provide all information as requested may
request that you submit the originals of any copy. We will result in the denial or rejection of this application. The
return these originals when they are no longer required. information you provide may also be disclosed to other
Federal, State, local, and foreign law enforcement and
Interim EAD. If you have not received a decision within regulatory agencies during the course of the USCIS
90 days of receipt by USCIS of a properly filed EAD investigations.
application or within 30 days of a properly filed initial EAD
application based on an asylum application filed on or after An agency may not conduct or sponsor an information
January 4, 1995, you may obtain interim work authorization collection and a person is not required to respond to a collection
by appearing in person at your local USCIS District Office. of information unless it displays a currently valid OMB control
You must bring proof of identity and any notices that you have number. The public reporting burden for this collection of
received from USCIS in connection with your application for information is estimated at 3 hours and 25 minutes per
employment authorization. response, including the time for reviewing instructions and
completing and submitting the form. Send comments regarding
Approval. If approved, your EAD will either be mailed to this burden estimate or any other aspect of this collection of
you or you may be required to appear at your local USCIS information, including suggestions for reducing this burden, to:
office to pick it up. U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W., 3rd
Denial. If your application cannot be granted, you will Floor, Suite 3008, Washington, DC 20529. OMB No.
receive a written notice explaining the basis of your denial. 1615-0040. Do not mail your application to this address.

Form I-765 Instructions (Rev. 05/27/08) N Page 12


OMB No. 1615-0040; Expires 08/31/08

Department of Homeland Security


I-765, Application For
U.S. Citizenship and Immigration Services Employment Authorization
Do not write in this block.
Remarks Action Block Fee Stamp

A#

Applicant is filing under §274a.12


Application Approved. Employment Authorized / Extended (Circle One) until (Date).
(Date).
Subject to the following conditions:
Application Denied.
Failed to establish eligibility under 8 CFR 274a.12 (a) or (c).
Failed to establish economic necessity as required in 8 CFR 274a.12(c)(14), (18) and 8 CFR 214.2(f)
I am applying for: Permission to accept employment.
Replacement (of lost employment authorization document)
Renewal of my permission to accept employment (attach previous employment authorization document).
1. Name (Family Name in CAPS) (First) (Middle) Which USCIS Office? Date(s)

2. Other Names Used (Include Maiden Name) Results (Granted or Denied - attach all documentation)

3. Address in the United States (Number and Street) (Apt. Number) 12. Date of Last Entry into the U.S. (mm/dd/yyyy)

(Town or City) (State/Country) (ZIP Code) 13. Place of Last Entry into the U.S.

4. Country of Citizenship/Nationality 14. Manner of Last Entry (Visitor, Student, etc.)

5. Place of Birth (Town or City) (State/Province) (Country) 15. Current Immigration Status (Visitor, Student, etc.)

6. Date of Birth (mm/dd/yyyy) 7. Gender 16. Go to Part 2 of the Instructions, Eligibility Categories. In the space below,
place the letter and number of the category you selected from the instructions
Male Female (For example, (a)(8), (c)(17)(iii), etc.).
8. Marital Status Married Single Eligibility under 8 CFR 274a.12 ( ) ( ) ( )
Widowed Divorced
9. Social Security Number (Include all numbers you have ever used) (if any) 17. If you entered the Eligibility Category, (c)(3)(C), in item 16 above, list your
degree, your employer's name as listed in E-Verfy, and your employer's E-
Verify Company Identification Number or a valid E-Verify
10. Alien Registration Number (A-Number) or I-94 Number (if any) Client Company Identification Number in the space below.
Degree:
11. Have you ever before applied for employment authorization from USCIS? Employer's Name as listed in E-Verify:
Yes (If yes, complete below) No Employer's E-Verify Company Identification Number or a valid E-Verify
Client Company Identification Number

Certification
Your Certification: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and
correct. Furthermore, I authorize the release of any information that U.S. Citizenship and Immigration Services needs to determine
eligibility for the benefit I am seeking. I have read the Instructions in Part 2 and have identified the appropriate eligibility category in
Block 16.
Signature Telephone Number Date

Signature of person preparing form, if other than above: I declare that this document was prepared by me at the
request of the applicant and is based on all information of which I have any knowledge.
Print Name Address Signature Date

Initial Receipt Resubmitted Relocated Completed


Remarks
Rec'd Sent Approved Denied Returned

Form I-765 (Rev. 05/27/08) N


OMB No. 1615-0044; Expires 08/31/09

Department of Homeland Security


Instructions for Form I-824, Application for
U.S. Citizenship and Immigration Services Action on an Approved Application or Petition

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

A request for replacement of employment


What Is the Purpose of This Form? authorization card may be filed on Form I-765. A
request for replacement of Form I-94 may be filed on
Use Form I-824 to request further action on an approved Form I-102. A request for replacement of permanent
petition or application. resident card may be filed on Form I-90. Refer to the
respective form instructions for further information.

When Must I Use Form I-824? B. USCIS to notify a new U.S. Consulate through the U.S.
Department of State's National Visa Center (NVC) or
You must use Form I-824 to request U.S. Citizenship and Kentucky Consular Center (KCC) concerning the
Immigration Services (USCIS) to provide further action on a approval of a nonimmigrant visa petition or to notify a
previously approved petition or application. new Port-of-Entry concerning the approval of a waiver
application, Check Box B. If approved, USCIS will
NOTE: USCIS will not process Form I-824 if your petition or send information regarding the approval of your
application has been denied or has not yet been approved. nonimmigrant visa petition to a new U.S. Consulate
This form must not be used to verify the status of a pending through the NVC or the KCC, or the approval of your
petition or application. waiver application to a new Port-of-Entry different
from that originally requested.

General Instructions NOTE: This notification is not available for E or R


visa approval notification.

You may file this form at any time while the application or C. USCIS to notify a U.S. Consulate through the U.S.
petition is valid. Department of State's National Visa Center that your
status has been adjusted to permanent resident based on
A separate Form I-824 must be filed for each action being
an approved Form I-485 application, Check Box C.
requested. Follow the steps below to complete your
This is to request USCIS to notify a U.S. Consulate
application:
through the NVC that your status has been adjusted to
Step 1 - Reason for Filing Form I-824 that of a lawful permanent resident based on an
approved Form I-485 application, so that your spouse
Step 2 - Fill Out Form I-824 and/or child(ren) may apply for an immigrant visa.

Step 1. Reason for Filing Form I-824 NOTE: This notification is not available if you have
The reasons why you may request further action are listed in been issued an immigrant visa at a U.S. Embassy or
the next column. Check the box in Part 2 of Form I-824 that consulate and have been admitted to the United States
applies to your request. as a lawful permanent resident. You may contact the
NVC for information on how to request following-to-
1. If you are requesting: join benefits for your dependent(s). You may direct
your inquiry by sending an e-mail to
A. A duplicate approval notice, Check Box A. NVCInquiry@state.gov or by writing to the National
Visa Center, ATTN: WC, 32 Rochester Avenue,
NOTE: The duplicate approval notice will contain
Portsmouth, NH 03801-2909. This notification is also
only the information listed on the original Form I-797,
not available if you have been admitted to the United
Notice of Action. A replacement employment
States as a refugee or were granted status in the
authorization card, Form I-94, permanent resident card,
United States as an asylee. Please refer to the
or any other USCIS authorization document will not
instructions on Form I-730, Refugee/Asylee Relative
accompany the duplicate approval notice.
Petition, for specific information on following-to-join
benefits for your spouse or unmarried child(ren) under
21 years of age.
Form I-824 Instructions (Rev. 08/25/08) Y
D. USCIS to send your approved immigrant visa petition Part 1. Information About You (Person filing this
to the U.S. Department of State's National Visa Center application)
(NVC), Check Box D. This is to request USCIS to
A. If you are requesting category A or B in Part 2, the
send your approved immigrant visa petition to the U.S.
application must be completed and signed by the
Department of State through the NVC.
petitioner or the applicant of the underlying petition or the
E. USCIS to notify the U.S. Department of State of your application.
U.S. citizenship status, Check Box E. This is to
B. If you are requesting category C in Part 2, the application
request USCIS to notify the U.S. Department of State
must be completed and signed by the principal applicant
that you have become a U.S. citizen through
who filed Form I-485.
naturalization.
NOTE: You may also notify the U.S. Department of C. If you are requesting category D or E in Part 2, the
State of your status as a U.S. citizen by submitting a application must be completed and signed by the
copy of your naturalization certificate, without fee, to petitioner of the underlying immigrant visa petition.
the National Visa Center, ATTN: WC, 32 Rochester
Avenue, Portsmouth, NH 03801-2909.
1. Family Name (Last name) - Give your legal name. If you
2. You may not file this form to request: have two last names, include both and use a hyphen (-)
A. A duplicate approval notice for an application or between the names, if appropriate.
petition that is pending or has been denied;
2. Company or Organization Name - Give the entity's
B. A duplicate approval notice naming a spouse or complete name if the petitioner or applicant is a company
children accompanying or following-to-join the or organization.
principal beneficiary on an approved immigrant
3. Home or Business Address - Give your physical street
petition;
address. This must include a street number and name or a
C. USCIS to send information to the U.S. Department of rural route number. Do not put a post office box (P.O. Box
State regarding the approval of your expired number here).
nonimmigrant application or petition;
4. Mailing Address - Give your mailing address, if different
D. USCIS to send information to the U.S. Department of from your home or business address.
State regarding an employment based application or
petition if your employment for the original petitioner 5. Daytime Telephone Number - Give a complete number
has ended; or with area/country codes where you can be reached during
the day.
E. USCIS to notify the U.S. Department of State of the
approval of Form I-600A, Application for Advanced 6. Country of Birth - Give the name of the country where
Processing of Orphan Petition, and/or Form I-600, you were born.
Petition to Classify Orphan as an Immediate Relative,
7. Country of Citizenship - Give the name of the country of
as well as the approval of Form I-800, Petition to
which you are a citizen.
Classify Convention Adoptee as an Immediate
Relative, and/or Form I-800A, Application for 8. Date of Birth - Use eight numbers to show your date of
Determination of Suitability to Adopt a Child from a birth (example: May 1, 1979, should be written
Convention Country. 05/01/1979).
Step 2. Fill Out Form I-824 9. IRS Tax # - If you are filing this application on behalf of a
1. Type or print legibly in black ink. business or organization, give the Internal Revenue Service
2. If extra space is needed to complete any item, attach a Tax Number of the business or organization.
continuation sheet, indicate the item number, and date and
sign each sheet. 10. A # - This is your Alien Registration Number
(immigration file number). If you do not have an A
3. Answer all questions fully and accurately. State that an
number or do not know it, leave this blank.
item is not applicable with "N/A." If the answer is none,
write "None." 11. U.S. Social Security # - If you do not have a U.S. Social
This form is divided into Parts 1 through 5. The following Security number, leave this blank.
information should help you fill out the form.
Form I-824 Instructions (Rev. 08/25/08) Y Page 2
Part 2 - Reason for Request
What Is the Filing Fee?
Check one box that applies to your particular request.

Part 3 - Additional Information The filing fee for Form I-824 is $340.
Provide the requested information regarding the original Use the following guidelines when you prepare your check or
application or petition. money order for the Form I-824 fee:
Part 4 - Signature 1. The check or money order must be drawn on a bank or
As the applicant, you must sign and date your Form I-824. If other financial institution located in the United States and
you do not sign the form, the application will be returned as must be payable in U.S. currency; and
incomplete. 2. Make the check or money order payable to U.S.
Part 5 - Signature of Person Preparing Form, Department of Homeland Security, unless:
if Other than Applicant A. If you live in Guam and are filing your petition
If you, the applicant, did not fill out Form I-824, the preparer there, make it payable to Treasurer, Guam.
must also sign, date, and give his or her address. B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to
Step 3. General Requirements Commissioner of Finance of the Virgin Islands.
Attach copies, showing the front and back of the following
documents, if available. NOTE: Please spell out U.S. Department of Homeland
Security; do not use the initials "USDHS" or "DHS."
1. A copy of the original petition or application.
2. A copy of Form I-797, Notice of Action, for the original Notice to Those Making Payment by Check
petition or application. If you send us a check, it will be converted into an electronic
funds transfer (EFT). This means we will copy your check
3. A copy of Form N-550, Certificate of Naturalization. and use the account information on it to electronically debit
Copies your account for the amount of the check. The debit from
Unless specifically required that an original document be filed your account will usually take 24 hours, and will be shown on
with an application or petition, an ordinary legible photocopy your regular account statement.
may be submitted. Original documents submitted when not
You will not receive your original check back. We will
required will remain a part of the record, even if the
destroy your original check, but we will keep a copy of it. If
submission was not required.
the EFT cannot be processed for technical reasons, you
authorize us to process the copy in place of your original
Translations
check. If the EFT cannot be completed because of insufficient
Any document containing a foreign language submitted to
funds, we may try to make the transfer up to two times.
USCIS shall be accompanied by a full English language
translation which the translator has certified as complete and
How to Check If the Fees Are Correct
accurate, and by the translator's certification that he or she is
competent to translate from the foreign language into English. The fee on this form is current as the edition date appearing in
the lower right corner of this page. However, because USCIS
fees change periodically, you can verify if the fees are correct
Where to File? by following one of the steps below:

You should submit this form and any related evidence to the 1. Visit our website at www.uscis.gov, select
USCIS office that approved the original petition or "Immigration Forms" check the appropriate fee;
application. This could be either a USCIS Service Center or 2. Review the Fee Schedule included in your form
local USCIS office. package, if you called us to request the form; or
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.

Form I-824 Instructions (Rev. 08/25/08) Y Page 3


Address Changes USCIS Forms and Information

If you change your address and you have an application or To order USCIS forms, call our toll-free number at
petition pending with USCIS, you may change your address 1-800-870-3676. You can also get USCIS forms and
on-line at www.uscis.gov, click on "Change your address with information on immigration laws, regulations, and procedures
USCIS" and follow the prompts or by completing and mailing by telephoning our National Customer Service Center at
Form AR-11, Alien's Change of Address Card, to: 1-800-375-5283 or visiting our Internet website at www.uscis.
gov.
U.S. Citizenship and Immigration Services
As an alternative to waiting in line for assistance at your local
Change of Address
USCIS office, you can now schedule an appointment through
P.O. Box 7134
our internet-based system, InfoPass. To access the system,
London, KY 40742-7134
visit our website. Use the InfoPass appointment scheduler and
For commercial overnight or fast freight services only, mail to: follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
U.S. Citizenship and Immigration Services
appears on the screen.
Change of Address
1084-I South Laurel Road
London, KY 40744 Penalties

Processing Information If you knowingly and willfully falsify or conceal a material


fact or submit a false document with your Form I-824, we will
Any Form I-824 that is not signed or accompanied by the deny your Form I-824 and may deny any other immigration
correct fee, will be rejected with a notice that Form I-824 benefit.
is deficient. You may correct the deficiency and resubmit In addition, you will face severe penalties provided by law and
Form I-824. An application or petition is not considered may be subject to criminal prosecution.
properly filed until accepted by USCIS.
Privacy Act Notice
Initial Processing
Once Form I-824 has been accepted, it will be checked for We ask for the information on this form, and associated
completeness, including submission of the required initial evidence, to determine if you have established eligibility for
evidence. If you do not completely fill out the form, or file it the immigration benefit for which you are filing. Our legal
without required initial evidence, you will not establish a basis right to ask for this information can be found in the
for eligibility and we may deny your Form I-824. Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
Requests for More Information or Interview
to provide this information, and any requested evidence, may
We may request more information or evidence, or we may
delay a final decision or result in denial of your Form I-824.
request that you appear at a USCIS office for an interview.
We may also request that you submit the originals of any
copy. We will return these originals when they are no longer Paperwork Reduction Act
required.
An agency may not conduct or sponsor an information
Decision collection and a person is not required to respond to a
The decision on Form I-824 involves a determination of collection of information unless it displays a currently valid
whether you have established eligibility for the requested OMB control number. The public reporting burden for this
benefit. You will be notified of the decision in writing. collection of information is estimated at 25 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 Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
OMB No. 1615-0044. Do not mail your application to this
address.
Form I-824 Instructions (Rev. 08/25/08) Y Page 4
OMB No. 1615-0044: Expires 08/31/09

Department of Homeland Security I-824, Application for Action on an


U.S. Citizenship and Immigration Services Approved Application or Petition
START HERE - Please type or print in black ink For USCIS Use Only
Returned Receipt
Part 1. Information About You (Person filing this application)
Family Name (Last name) Given Name (First name) Middle Name Date

Company or Organization Name Date


Resubmitted

Home or Business Address - Street Number and Name Apt./Suite # Date

Date
City State or Province Reloc Sent

Date
Zip/Postal Code Country
Date
Mailing Address - Street Number and Name Apt./Suite # Reloc Rec'd

Date
C/O (In care of):
Date

City State or Province Remarks

Zip/Postal Code Country

Daytime Phone # (Area/country codes)

Country of Birth Country of Citizenship

Date of Birth (mm/dd/yyyy) IRS Tax # (If any)

Action Block
A # (If any) U.S. Social Security # (If any)

Part 2. Reason for Request


I am requesting (Check one box):
A. A duplicate approval notice
B. USCIS to notify a new U.S. Consulate, different from that originally requested, through the
U.S. Department of State's National Visa Center or Kentucky Consular Center about the
approval of a nonimmigrant visa petition or to notify a new Port-of-Entry, different from that
originally requested, about the approval of a waiver application. Please notify the U.S.
Consulate or Port-of-Entry at: To Be Completed by
Attorney or Representative, if any.
Fill in box if G-28 is attached to
C. USCIS to notify a U.S. Consulate through the National Visa Center that my status has been represent the applicant.
adjusted to permanent resident based on an approved I-485 application. Please notify the U.S.
Consulate at: ATTY State License #

D. USCIS to send my approved immigrant visa petition to the National Visa Center (NVC)
E. USCIS to notify the U.S. Department of State of my U.S. Citizenship status
Form I-824 (Rev. 08/25/08) Y
Part 3. Additional Information
1. Give the following information about the original petition or application.
Type of Petition or Application (Form number) Receipt Number (On Form I-797, Notice of Action)

Filing Date of Petition or Application (mm/dd/yyyy) Approval Date (mm/dd/yyyy)

2. Give the following information about the petitioner or applicant for the original petition or application.
Current/Most Recent Immigration Status Naturalization/Citizenship Certificate Number

3. Give the following information about the principal beneficiary of the original petition or application.
Family Name (Last name) Given Name (First name) Middle Name

Date of Birth (mm/dd/yyyy) Country of Birth A # (If any)

Home Address - Street Number and Name Apt. #

City State or Province Zip/Postal Code Country

Mailing Address - (If different from home address)


Street Number and Name/P.O. Box Number C/O (In care of)

City State or Province Zip/Postal Code Country

Daytime Phone (Area/country code and number)

4. If you have checked box C in Part 2, give the following information about the dependents(s) for whom you are requesting
following-to-join. If you need additional space, attach a separate sheet(s) of paper.
Family Name (Last name) Given Name (First name) Middle Name

Relationship to the Principal Alien Foreign Address Foreign Telephone Number

Form I-824 (Rev. 08/25/08) Y Page 2


Part 4. Signature (Read the information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that this information and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
Signature Daytime Phone Number (With area code) Date (mm/dd/yyyy)

NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested benefit and this application may be denied.

Part 5. Signature of Person Preparing Form, if Other than Above (Sign below)
I declare that I prepared this at the request of the applicant and it is based on all information of which I have knowledge.
Signature Print or Type Your Name

Firm Name and Address

Date (mm/dd/yyyy) E-Mail Address (If any) Daytime Phone Number (With area code)

Form I-824 (Rev. 08/25/08) Y Page 3


OMB No. 1615-0045; Expires 05/31/09

Department of Homeland Security


Instructions for I-829, Petition by
U.S. Citizenship and Immigration Services Entrepreneur to Remove Conditions

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.

If you obtained conditional permanent resident status through


What Is the Purpose of This Form? your entrepreneur spouse or parent and your spouse or parent
has died, you may use this form for removal of the conditions.
This form is for a conditional permanent resident who You may use this form to petition for removal of the
obtained such status through entrepreneurship to petition to conditions.
the U.S. Citizenship and Immigration Services (USCIS) to
remove the conditions on his or her residence.
General Instructions.
When Should I Use Form I-829?
Step 1. Fill Out the Form I-829
You must file this petition during the 90 days 1. Type or print legibly in black ink.
immediately before the second anniversary of the date
that you obtained conditional permanent resident status. 2. If extra space is needed to complete any item, attach a
This is the date your conditional permanent residence continuation sheet, indicate the item number, and date and
expires. sign each sheet.
3. Answer all questions fully and accurately. State that an
Effect of Filing. item is not applicable with "N/A." If the answer is none,
write "none."
Filing this petition extends your conditional permanent
residence for six months. You will receive a filing receipt that
you should carry with your Permanent Resident Card. If you Step 2. General requirements
travel outside the United States during this period, you may You must file your petition with:
present your Permanent Resident Card and the filing receipt
in order to be readmitted. 1. Permanent Resident Card (Form I-551).

Effect of Not Filing. A. A copy of your Permanent Resident Card and, if


applicable;
If this petition is not filed, you will automatically lose your
permanent resident status as of the second anniversary of the B. A copy of the Permenent Resident Card of your
date that you were granted conditional status. As a result, you conditional permanent resident spouse and each of your
will become removable from the United States. If your failure conditional permanent resident children included in
to file was for good cause and due to extenuating your petition.
circumstances, you may file your petition late with a written
explanation and request that USCIS excuse the late filing. 2. Evidence of the Commercial Enterprise. Submit the
following types of evidence with your petition: (Please
label each type of evidence.)
Who May File This I-829?
A. Evidence that you established a commercial enterprise.
Such evidence includes, but is not limited to, federal
If you were granted conditional permanent resident status tax returns;
through entrepreneurship, use this form to petition for the
removal of those conditions. You may include your B. Evidence that you invested or were actively in the
conditional permanent resident spouse and children in your process of investing the amount of capital required for
petition, or they may file separately subsequent to your the location of your enterprise. Such evidence
petition. If filing subsequently, attach a copy of the Form includes, but is not limited to, an audited financial
I-797, Notice of Action, relating to the principal's petition. statement; and

Form I-829 Instructions (Rev. 07/30/07) Y


C. Evidence that you sustained your enterprise and your A. An original official statement by the arresting agency
investment in that business throughout your period of or applicable court order confirming that no charges
conditional permanent residence. Examples of such were filed.
evidence include:
If you have ever been arrested or detained by any law
1. Invoices and receipts; enforcement officer for any reason, and charges were
2. Bank statements; filed, or if charges were filed against you without an
arrest, submit:
3. Contracts;
A. An original or court-certified copy of the complete
4. Business licenses; and arrest record, and/or disposition for each incident (e.g.,
dismissal order, conviction record or acquittal order.)
5. Federal or state income tax returns or quarterly tax
statements.
If you have ever been convicted or placed in an alternative
sentencing program or rehabilitative program (such as a
D. Evidence of the number of full-time employees at the
drug treatment or community service program), submit:
beginning of the investment and at present. Such
evidence includes but is not limited to: A. An original or court-certified copy of the sentencing
1. Payroll records; record for each incident, and
B. Evidence that you completed your sentence,
2. Relevant tax documents; and
specifically:
3. Forms I-9. 1. An original or certified copy of your probation or
parole record, or
3. If you are filing as a spouse or child whose entrepreneur
spouse or parent has died, submit the following with your 2. Evidence that you completed an alternative
petition: sentencing program, or rehabilitative program.
A. Your spouse's permanent resident card;
If you have ever had any arrest or conviction vacated, set
B. Your spouse's death certificate; and aside, sealed, expunged or otherwise removed from your
record, submit:
C. Evidence that the conditions set forth above in
"Evidence of the Commercial Enterprise" have been A. An original or court-certified copy of the court order
met. vacating, setting aside, sealing, expunging or otherwise
removing the arrest or conviction, or
4. Biometric Services.
B. An original statement from the court that no record
Applicants will have their photograph, fingerprint, and exists of your arrest or conviction.
signature taken by USCIS. When you file Form I-829,
USCIS will notify you in writing of the date, time, and NOTE: Unless a traffic incident was alcohol or drug
location where you must go for the required biometric related, you do not need to submit documentation for
services. Failure to appear for the biometric services may traffic fines and incidents that did not involve an
result in a denial of your application. actual arrest if the only penalty was a fine of less than
$500.00 and or points on your drivers license.
NOTE: Because USCIS is now taking photographs of
applicants, you no longer need to submit two passport-
style photos.

5. Criminal History.
If you have ever been arrested or detained by any law
enforcement officer for any reason, and no charges were
filed, submit:

Form I-829 Instructions (Rev. 07/30/07) Y Page 2


2. Make the check or money order payable to U.S.
Where To File? Department of Homeland Security, unless:
If the new commercial enterprise is located or will be doing
A. If you live in Guam and are filing your petition
business principally in Alabama, Arkansas, Connecticut,
there, make it payable to Treasurer, Guam.
Delaware, District of Columbia, Florida, Georgia, Kentucky,
Louisiana, Mississippi, Maine, Maryland, Massachusetts, B. If you live in the U.S. Virgin Islands and are
New Hampshire, New Jersey, New Mexico, New York, North filing your petition there, make it payable to
Carolina, South Carolina, Oklahoma, Pennsylvania, Puerto Commissioner of Finance of the Virgin
Rico, Rhode Island, Tennessee, Texas, Vermont, U.S. Virgin Islands.
Islands, Virginia or West Virginia, mail the petition to:
NOTE: Please spell out U.S. Department of Homeland
USCIS Texas Service Center Security; do not use the initials "USDHS" or "DHS."
P.O. Box 852135
Mesquite, TX 75185-2135 Notice to Those Making Payment by Check. If you send us
a check, it will be converted into an electronic funds transfer
If the new commercial enterprise is located or will be doing (EFT). This means we will copy your check and use the
business principally in Alaska, Arizona, California, Colorado, account information on it to electronically debit your account
Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, for the amount of the check. The debit from your account will
Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, usually take 24 hours, and will be shown on your regular
North Dakota, Ohio, Oregon, South Dakota, Utah, account statement.
Washington, Wisconsin or Wyoming, mail the petition to:
You will not receive your original check back. We will
destroy your original check, but we will keep a copy of it. If
USCIS California Service Center
the EFT cannot be processed for technical reasons, you
P.O. Box 10526
authorize us to process the copy in place of your original
Laguna Niguel, CA 92607-0526
check. If the EFT cannot be completed because of
insufficient funds, we may try to make the transfer up to two
What Is the Filing Fee? times.

How to Check If the Fees Are Correct.


The filing fee for a Form I-829 is $2,850.00
The form fee on this form is current as the the edition date
The fee for biometric services is $80.00 appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if the
You may submit one check or money order for both the fees are correct by following one of the steps below:
petition and biometric services, for a total of $2,930.00.
1. Visit our website at www.uscis.gov, select "Immigration
NOTE: Each conditional resident dependent, eligible to be Forms" check the appropriate fee;
included on the principal applicant's Form I-829 and listed
under Part 3 or Part 4 of Form I-829, is required to submit 2. Review the Fee Schedule included in your form package, if
an additional biometric services fee of $80.00. you called us to request the form or

The fees must be submitted in the exact amount. It cannot be 3. Telephone our National Customer Service Center at
refunded. Do not mail cash. 1-800-375-5283 and ask for the fee information.

Use the following guidelines when you prepare your check or


money order for the Form I-829 fee:

1. The check or money order must be drawn on a bank or


other financial institution located in the United States and
must be payable in U.S. currency; and

Form I-829 Instructions (Rev. 07/30/07) YPage 3


Address Changes. USCIS Forms and Information.

If you change your address and you have an application or To order USCIS forms, call our toll-free number at 1-800-
petition pending with USCIS, you may change your address 870-3676. You can also get USCIS forms and information on
on-line at www.uscis.gov, click on "Change your address with immigration laws, regulations and procedures by telephoning
USCIS" and follow the prompts or by completing and mailing our National Customer Service Center at 1-800-375-5283 or
Form AR-11, Alien's Change of Address Card, to: visiting our internet website at www.uscis.gov.
As an altenative to waiting in line for assistance at your local
U.S. Citizenship and Immigration Services USCIS office, you can now schedule an appointment through
Change of Address our internet-based system, InfoPass. To access the system,
P.O. Box 7134 visit our website. Use the InfoPass appointment scheduler and
London, KY 40742-7134 follow the screen prompts to set up your appointment.
For commercial overnight or fast freight services only, mail InfoPass generates an electronic appointment notice that
to: appears on the screen.

U.S. Citizenship and Immigration Services Penalties.


Change of Address
1084-I South Laurel Road If you knowingly and willfully falsify or conceal a material
London, KY 40744 fact or submit a false document with this Form I-829, we will
deny the Form I-829 and may deny any other immigration
benefit.
Processing Information.
In addition, you will face severe penalties provided by law and
Any Form I-829 that is not signed or accompanied by the may be subject to criminal prosecution.
correct fee, will be rejected with a notice that the Form
I-829 is deficient. You may correct the deficiency and Privacy Act Notice.
resubmit the Form I-829. An application or petition is not
considered properly filed until accepted by USCIS. We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
Initial processing. Once a Form I-829 has been accepted, it the immigration benefit for which you are filing. Our legal
will be checked for completness, including submission of the right to ask for this information can be found in the
required initial evidence. If you do not completely fill out the Immigration and Nationality Act, as amended. We may
form, or file it without required initial evidence, you will not provide this information to other government agencies.
establish a basis for eligibility and we may deny your Form Failure to provide this information, and any requested
I-829. evidence, may delay a final decision or result in denial of
your Form I-829.
Requests for more information or interview. We may
request more information or evidence, or we may request that
Paperwork Reduction Act.
you appear at a USCIS office for an interview. We may also
request that you submit the originals of any copy. We will An agency may not conduct or sponsor an information
return these originals when they are no longer required. collection and a person is not required to respond to a collection
of information unless it displays a currently valid OMB control
Decision. The decision on a Form I-829 involves a number. The public reporting burden for this collection of
determination of whether you have established eligiblity for information is estimated at 1 hour, 5 minutes per response,
the requested benefit. You will be notified of the decision in including the time for reviewing instructions, completing and
writing. 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 Management
Division, 111 Massachusetts Avenue, N.W., 3rd Floor, Suite
3008, Washington, DC 20529. OMB No. 1615-0045. Do not
mail your application to this address.

Form I-829 Instructions (Rev. 07/30/07) Y Page 4


OMB No. 1615-0045; Expires 05/31/09
Department of Homeland Security I-829, Petition by Entrepreneur
U.S. Citizenship and Immigration Services to Remove Conditions
Do not write in this block - For USCIS use only (Except G-28 Block Below)
Applicant Interviewed Action Block Fee Receipt

To be completed by Attorney or Representative, if any


G-28 is attached
Attorney's State License No.
Remarks:
START HERE - Type or print in black ink.
Part 1. Information about you.
A # (if any) Form I-526 Receipt Number
Family Given Middle
Name Name Name
Address:
In care of
Number and
Street Apt. #
State or
City Province
Zip/Postal Daytime
Country Code Phone #
Date of Birth Country U.S. Social Security #
(mm/dd/yyyy) of Birth (if any)
Since becoming a conditional permanent resident, have you ever been arrested, cited, charged, indicted, convicted, fined or imprisoned
for breaking or violating any law or ordinance (excluding traffic regulations), or committed any crime for which you were not arrested?
Yes No (If yes, explain on separate sheet(s) of paper, including disposition, if any.)
Part 2. Basis for petition. (Check one)
a. My conditional permanent residence is based on an investment in a commercial enterprise.
b. Reserved.
c. Reserved.
d. I am a conditional permanent resident spouse or child of an entrepreneur, and I am unable to be included in a Petition by
Entrepreneur to Remove Conditions (Form I-829) filed by my conditional resident spouse or parent.
e. I am a conditional permanent resident spouse or child of an entrepreneur who is deceased.
Part 3. Information about your husband or wife.
Family Given Middle
Name Name Name
Male Date of Birth Date of Marriage
Gender
Female (mm/dd/yyyy) (mm/dd/yyyy)

Other names used (including maiden name or aliases)


A# Current Is your current immigration status based Yes
(If any) Immigration Status on the petitioner's current status? No
RECEIVED: ________________ RESUBMITTED:__________________________ RELOCATED: SENT _____________________REC'D ____________________

Form I-829 (Rev. 07/30/07)Y


Part 4. Children. (List all your children. Attach another sheet(s) of paper, if necessary.)
Family Given Middle
Name Name Name
Yes
A# Current Immigration Date of Birth Living with
(if any) Status (mm/dd/yyyy) you? No

Family Given Middle


Name Name Name
Yes
A# Current Date of Birth Living with
(if any) Immigration Status (mm/dd/yyyy) you? No

Family Given Middle


Name Name Name
Yes
A# Current Date of Birth Living with
(if any) Immigration Status (mm/dd/yyyy) you? No

Family Given Middle


Name Name Name
Yes
A# Current Date of Birth Living with
(if any) Immigration Status (mm/dd/yyyy) you? No

Family Given Middle


Name Name Name
Yes
A# Current Date of Birth Living with
(if any) Immigration Status (mm/dd/yyyy) you? No

Family Given Middle


Name Name Name
Yes
A# Current Date of Birth Living with
(if any) Immigration Status (mm/dd/yyyy) you? No
Part 5. Information about your commercial enterprise.
Type of Enterprise (Check one):
New commercial enterprise resulting from the creation of a new business.

New commercial enterprise resulting from the reorganization of an existing business.

New commercial enterprise resulting from a capital investment in an existing business.

Kind of Business (Be as specific as possible):


Amount of
Date Business Established (mm/dd/yyyy) Initial Investment

Date of Initial Investment (mm/dd/yyyy) % of Enterprise You Own

Number of full-time employees in enterprise in United States (excluding you, your spouse, sons and daughters):

At the time of your initial investment: Presently: Difference:

How many of these new jobs were created by your investment?

Form I-829 (Rev. 07/30/07)Y Page 2


Part 5. Information about your commercial enterprise . (Continued.)
Subsequent Investment in the Enterprise:
Date of Investment Amount of Investment Type of Investment

Provide the gross and net incomes generated annually by the commercial enterprise since your initial investment. Include all income
generated up to date during the present year.
Year Gross Income Net Income

Has your commercial enterprise filed for bankruptcy, ceased business operations, or have any changes in its business organization
or ownership occurred since the date of your initial investment? Yes (Explain on separate sheet) No
Has your commercial enterprise sold any corporate assets, shares, property, or had any capital withdrawn since the date of your initial
investment? Yes (Explain on separate sheet) No

Part 6. Signature. (Read the information on penalties in the instructions before completing this section.)
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is
all true and correct. I further certify that the investment was made in accordance with the laws of the United States and was not for the
purpose of evading United States immigration laws. I also authorize the release of any information from my records that the U.S.
Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Signature of Applicant Print Name Date

NOTE: If you do not completely fill out this form or fail to submit any required documents listed in the instructions, you may
not be found eligible for the requested benefit and this petition may be denied.

Part 7. Signature of person preparing form, if other than above.


I declare that I prepared this petition at the request of the above person and it is based on all information of which I have knowledge.
Signature Print Name Date

Firm Name and Address (Include Telephone Number with Area Code and E-Mail Address.)

Form I-829 (Rev. 07/30/07)Y Page 3


OMB No. 1615-0075; Expires 10/31/10

Department of Homeland Security I-864, Affidavit of Support


U.S. Citizenship and Immigration Services Under Section 213A of the Act
Instructions
How Should I Complete This Form? Not all benefits are considered to be means-tested public
benefits. See Form I-864P, Poverty Guidelines, for more
Print clearly or type your answers using CAPITAL letters. information on which benefits may be covered by this
definition, or the contract on Page 6 of this form for a list of
Use black or blue ink. benefits explicitly not considered means-tested public
If you need extra space to answer any item: benefits.

-- Attach a separate sheet of paper (or more sheets if Who Needs This Form?
necessary); The following immigrants are required by law to submit Form
I-864 completed by the petitioner to obtain an immigrant visa
-- Write your name, U.S. Social Security number and the overseas or to adjust status to that of a lawful permanent
words "Form I-864" on the top right corner of the sheet; resident in the United States:
and
All immediate relatives of U.S. citizens (spouses, unmarried
-- Write the number and subject of each question for which
children under age 21, and parents of U.S. citizens age 21
you are providing additional information. and older);
What Is the Purpose of This Form? All family-based preference immigrants (unmarried sons
and daughters of U.S. citizens, spouses and unmarried sons
This form is required for most family-based immigrants and
and daughters of permanent resident aliens, married sons
some employment-based immigrants to show that they have
and daughters of U.S. citizens, and brothers and sisters of
adequate means of financial support and that they are not
U.S. citizens age 21 and older); and
likely to become a public charge. For more information about
Form I-864, or to obtain related forms please contact: Employment-based preference immigrants in cases only
when a U.S. citizen or lawful permanent resident relative
The USCIS website (www.uscis.gov); filed the immigrant visa petition or such relative has a
significant ownership interest (five percent or more) in the
The National Customer Service Center (NCSC) telephone
entity that filed the petition.
line at 1-800-375-5283 TTY: (1-800-767-1833); or
Are There Exceptions to
Your local USCIS office by using Infopass. Who Needs This Form?
How Is This Form Used? The following types of intending immigrants do not need to
This form is a contract between a sponsor and the U.S. file this form:
Government. Completing and signing this form makes you
Any intending immigrant who has earned or can be credited
the sponsor. You must show on this form that you have
with 40 qualifying quarters (credits) of work in the United
enough income and/or assets to maintain the intending
States. In addition to their own work, intending immigrants
immigrant(s) and the rest of your household at 125 percent of
may be able to secure credit for work performed by a
the Federal Poverty Guidelines. By signing Form I-864, you
spouse during marriage and by their parent(s) while the
are agreeing to use your resources to support the intending
immigrants were under 18 years of age. The Social Security
immigrant(s) named in this form, if it becomes necessary.
Administration (SSA) can provide information on how to
The submission of this form may make the sponsored count quarters of work earned or credited and how to
immigrant ineligible for certain Federal, State, or local means- provide evidence of such. See the SSA website at
tested public benefits, because an agency that provides means- www.ssa.gov/mystatement/credits for more information;
tested public benefits will consider your resources and assets Any intending immigrant who will, upon admission, acquire
as available to the sponsored immigrant in determining his or U.S. citizenship under section 320 of the Immigration and
her eligibility for the program. Nationality Act, as amended by the Child Citizenship Act of
If the immigrant sponsored in this affidavit does receive one 2000 (CCA);
of the designated Federal, State or local means-tested public
Self-petitioning widow/ers who have an approved Petition
benefits, the agency providing the benefit may request that
for Amerasian, Widow(er), or Special Immigrant, Form
you repay the cost of those benefits. That agency can sue you
I-360; and
if the cost of the benefits provided is not repaid.

Form I-864 Instructions (Rev. 10/18/07)Y


Self-petitioning battered spouses and children who have an What If I Cannot Meet
approved Petition for Amerasian, Widow(er), or Special the Income Requirements?
Immigrant, Form I-360. If your income alone is not sufficient to meet the requirement
for your household size, the intending immigrant will be
NOTE: If you qualify for one of the exemptions listed above,
ineligible for an immigrant visa or adjustment of status, unless
submit Form I-864W, Intending Immigrant's I-864 Exemption,
the requirement can be met using any combination of the
instead of Form I-864.
following:
Who Completes and Signs Form I-864? Income from any relatives or dependents living in your
A sponsor completes and signs Form I-864. A sponsor is household or dependents listed on your most recent Federal
required to be at least 18 years old and domiciled in the tax return who signed a Form I-864A;
United States, or its territories or possessions (see Step-by-
step Instructions for more information on domicile). The Income from the intending immigrant, if that income will
petitioning sponsor must sign and complete Form I-864, even continue from the same source after immigration, and if the
if a joint sponsor also submits an I-864 to meet the income intending immigrant is currently living in your residence. If
requirement. The list below identifies who must become the intending immigrant is your spouse, his or her income
sponsors by completing and signing a Form I-864. can be counted regardless of current residence, but it must
continue from the same source after he or she becomes a
The U.S. citizen or lawful permanent resident who filed a lawful permanent resident.
Form I-130 for a family member, Form I-129F for a
fiance(e), or Form I-600 or I-600A for an orphan. The value of your assets, the assets of any household
member who has signed a Form I-864A, or the assets of the
The U.S. citizen or permanent resident alien who filed an
intending immigrant;
employment-based immigrant visa petition (Form I-140) for
a spouse, parent, son, daughter, or sibling who: (1) has a A joint sponsor whose income and/or assets equal at least
significant ownership interest (five percent or more) in the 125 percent of the Poverty Guidelines. See question below
business which filed the employment-based immigrant visa for more information on joint sponsors.
petition; or (2) is related to the intending immigrant as a
spouse, parent, son, daughter, or sibling. How Can My Relatives and Dependents
What Are the Income Requirements? Help Me Meet the Income Requirements?
To qualify as a sponsor, you must demonstrate that your You may use the income of your spouse and/or any other
income is at least 125 percent of the current Federal poverty relatives living in your residence if they are willing to be
guideline for your household size. The Federal poverty line, jointly responsible with you for the intending immigrant(s)
for purposes of this form, is updated annually and can be you are sponsoring. If you have any unrelated dependents
found on Form I-864P, Poverty Guidelines. listed on your income tax return you may include their income
regardless of where they reside.
If you are on active duty in the U.S. Armed Forces, including
The income of such household members and dependents can
the Army, Navy, Air Force, Marines or Coast Guard, and you
be used to help you meet the income requirements if they
are sponsoring your spouse or minor child, you only need to
complete and sign Form I-864A, Contract Between Sponsor
have an income of 100 percent of the Federal poverty line for
and Household Member, and if they are at least 18 years of
your household size. This provision does not apply to joint or
age when they sign the form.
substitute sponsors.
Can the Intending Immigrant Help
How Do I Count Household Size?
Me Meet the Income Requirements?
Your household size includes yourself and the following If certain conditions are met, the intending immigrant's
individuals, no matter where they live: any spouse, any income can help you meet the income requirement. If the
dependent children under the age of 21, any other dependents intending immigrant is your spouse, his or her income can be
listed on your most recent Federal income tax return, all included if it will continue from the same source after he or
persons being sponsored in this affidavit of support, and any she obtains lawful permanent resident status. If the intending
immigrants previously sponsored with a Form I-864 or Form immigrant is another relative, there are two requirements.
I-864 EZ affidavit of support whom you are still obligated to
support. If necessary to meet the income requirements to be a First, the income must be continuing from the same source
sponsor, you may include additional relatives (adult children, after he or she obtains lawful permanent resident status, and
parents, or siblings) as part of your household size as long as second, the intending immigrant must currently live with you
they have the same principle residence as you and promise to in your residence. Evidence must be provided to support both
use their income and resources in support of the intending requirements.
immigrant(s).
Form I-864 Instructions (Rev. 10/18/07)Y Page 2
However, an intending immigrant whose income is being used What Is a Substitute Sponsor?
to meet the income requirement does not need to complete
Form I-864A, Contract Between Sponsor and Household A substitute sponsor is a sponsor who is completing a
Member, unless the intending immigrant has a spouse and/or Form I-864 on behalf of an intending immigrant whose
children immigrating with him or her. In this instance, the original I-130 petitioner has died after the Form I-130 was
contract relates to support for the spouse and/or children. approved, but before the intending immigrant obtained
permanent residence.
Does Receipt of Means-Tested Public Benefits
Disqualify me From being a Sponsor? The substitute sponsor must be related to the intending
immigrant in one of the following ways: spouse, parent,
No. Receipt of means-tested public benefits does not mother-in-law, father-in-law, sibling, child (at least 18 years of
disqualify anyone from being a sponsor. However, means- age), son, daughter, son-in-law, daughter-in-law, brother-in-
tested public benefits cannot be accepted as income for the law, sister-in-law, grandparent, grandchild or legal guardian.
purposes of meeting the income requirement. The substitute sponsor must also be a U.S. citizen or lawful
permanent resident.
How Can I Use Assets to Qualify?
If you are a substitute sponsor, you must indicate that that you
Assets may supplement income if the consular or immigration are related to the intending immigrant in one of the ways
officer is convinced that the monetary value of the asset could listed above and include evidence proving that relationship.
reasonably be made available to support the sponsored The beneficiary must also file this form along with a written
immigrant and converted to cash within one year without statement explaining the reasons why the Form I-130 visa
undue harm to the sponsor or his or her family members. You petition should be reinstated, having been revoked following
may not include an automobile unless you show that you own the petitioner's death. The beneficiary must also include a
at least one working automobile that you have not included. copy of the Form I-130 approval notice.

What Is a Joint Sponsor? How Long Does My Obligation


as a Sponsor Continue?
If the person who is seeking the immigration of one or more Your obligation to support the immigrant(s) you are
of his or her relatives cannot meet the income requirements, a sponsoring in this affidavit of support will continue until the
"joint sponsor" who can meet the requirements may submit a sponsored immigrant becomes a U.S. citizen, or can be
Form I-864 to sponsor all or some of the family members. credited with 40 qualifying quarters of work in the United
States.
A joint sponsor can be any U.S. citizen, U.S. national, or
lawful permanent resident who is at least 18 years old, Although 40 qualifying quarters of work (credits) generally
domiciled in the United States, or its territories or possessions, equate to ten years of work, in certain cases the work of a
and willing to be held jointly liable with the petitioner for the spouse or parent adds qualifying quarters. The Social Security
support of the intending immigrant. A joint sponsor does not Administration can provide information on how to count
have to be related to the petitioning sponsor or the intending qualifying quarters (credits) of work.
immigrant.
The obligation also ends if you or the sponsored immigrant
dies or if the sponsored immigrant ceases to be a lawful
If the first joint sponsor completes Form I-864 for some rather permanent resident and departs the United States. Divorce
than all the family members, a second qualifying joint sponsor does not end the sponsorship obligation.
will be required to sponsor the remaining family members.
There may be no more than two joint sponsors. A joint Do I Need to Submit a Separate
sponsor must be able to meet the income requirements for all Affidavit for Each Family Member?
the persons he or she is sponsoring without combining
resources with the petitioning sponsor or a second joint You must submit a Form I-864 affidavit of support for each
sponsor. Any dependents applying for an immigrant visa or intending immigrant you are sponsoring. You may submit
adjustment of status more than six months after immigration of photocopies if you are sponsoring more than one intending
the intending immigrants must be sponsored by the petitioner immigrant listed on the same affidavit of support.
but may be sponsored by an original joint sponsor or a different
joint sponsor. Separate affidavits of support are required for intending
immigrants for whom different Form I-130 family-based
Even if one or more I-864s are submitted for an intending petitions were filed. For instance, if you are sponsoring both
immigrant, the petitioning sponsor remains legally parents, each will need an original affidavit of support and
accountable for the financial support of the sponsored alien accompanying documentation since you were required to
along with the joint sponsor(s). submit separate Form I-130 visa petitions for each parent.

Form I-864 Instructions (Rev. 10/18/07)Y Page 3


Often a spouse or minor children obtain visas or adjust status You should complete and submit Form I-865 to USCIS only
as dependents of a relative, based on the same visa petition. If when the address you indicated on the original I-864 Affidavit
you are sponsoring such dependents, you only need to provide of Support has changed. Please see Form I-865 for further
a photocopy of the original Form I-864, as long as these directions on filing the Sponsor's Change of Address. This
dependents are immigrating at the same time as the principal requirement does not relieve a sponsor who is a lawful
immigrant or within six months of the time he or she permanent resident from submitting Form AR-11 within ten
immigrates to the United States. You do not need to provide days of a change of address.
copies of the supporting documents for each of the
photocopied Forms I-864.

When Do I Complete Form I-864


and Where Do I Send It?
If the intending immigrant will apply for an immigrant
visa at a U.S. Embassy or Consulate overseas:

Complete Form I-864 when it is mailed to you from the


National Visa Center (NVC). Different instructions apply to
some cases so follow the instructions provided by the National
Visa Center for your particular case. The instructions on when
and where to submit Form I-864 are included in the
information packet that is mailed to you with Form I-864.
Form I-864 and all accompanying documentation must be
submitted to the government within one year of when you sign
Form I-864.

If the intending immigrant will adjust status in the United


States:

Complete Form I-864 when the intending immigrant is ready


to submit his or her Form Application to Register Permanent
Residence or Adjust Status. Then give the completed Form
I-864 along with any Forms I-864A and all supporting
documentation to the intending immigrant to submit with his
or her application for adjustment of status. To be valid, Form
I-864 and all supporting documentation must be submitted
within one year of when you sign Form I-864. For privacy,
you may enclose these documents in a sealed envelope
marked "Form I-864: To Be Opened Only by a U.S.
Government Official." You may be requested to submit
updated information if there is a significant delay in
processing.

Do I Have to Report My
Change of Address If I Move?

Federal law requires that every sponsor report every change of


address to the USCIS within 30 days of the change. To do
this, send a completed Form I-865, Sponsor's Change of
Address, to the Service Center having jurisdiction over your
new address.

Do not complete Form I-865 at the same time that you


complete the I-864.

Form I-864 Instructions (Rev. 10/18/07)YPage 4


Step-by-Step Instructions
Form I-864 is divided into nine parts. The information below will help you fill out the form.

Part 1. Basis for Filing Affidavit of Support. Part 2. Information on the Principal Immigrant.
The principal immigrant is the intending immigrant who
is the primary beneficiary of the visa petition.
Check box "a" if you are the petitioner who is filing or who
has already filed Form I-130, Petition for Alien Relative;
6. Alien Registration Number. An "A-number" is an Alien
Form I-600, Petition to Classify Orphan as an Immediate
Registration Number assigned by the former Immigration and
Relative; or Form I-600A, Application for Advance
Naturalization Service (INS) or U.S. Citizenship and
Processing of Orphan Petition. If you are the petitioner, you
Immigration Services (USCIS). If the intending immigrants
must sponsor each intending immigrant.
you are sponsoring have not previously been in the United
Check box "b" if you are filing or have filed Form I-140, States or have only been in the United States as tourists, they
Immigrant Petition for Alien Worker, for your husband, wife, probably do not have A-numbers. Persons with A-numbers
father, mother, child, adult son or daughter, brother, or sister. can locate the number on their INS or USCIS-issued
documentation.
Check box "c" if you have an ownership interest of at least
8. Indicate whether you are sponsoring the principal
five percent in a business, corporation or other entity that filed
immigrant listed in item 2 in this Form I-864. This only
or is filing a Form I-140 for your husband, wife, father,
applies to cases with two joint sponsors. Check "No" only if
mother, child, adult son or daughter, brother, or sister.
you are sponsoring only intended immigrants listed in 9 (a
through e) and not the principal immigrant listed in item 2.
Check box "d" if you are the only joint sponsor or box "e" if
you are either of two joint sponsors. A joint sponsor must be a
person, and may not be a corporation, organization, or other
Part 3. Information on Immigrants
entity. A joint sponsor does not have to be related to the You Are Sponsoring.
intending immigrant. Indicate whether you are the only joint 9. Accompanying Family Members You are Sponsoring.
sponsor or one of two joint sponsors. Check with the The immigrant you are sponsoring may be bringing a spouse
petitioning sponsor or the intending immigrant if you are not and/or children to the United States. If the spouse and/or
certain. children will be traveling with the immigrant, or within six
months of the immigrant's entry to the United States and you
Check box "f" if you are the substitute sponsor. A substitute are sponsoring them, you should list the names and other
sponsor is a sponsor who is completing a Form I-864 on requested information on the lines provided. If any
behalf of an intending immigrant whose original Form I-130 dependents are not immigrating, will be immigrating more
petitioner has died after the Form I-130 was approved, but than 6 months after the sponsored alien arrives in the United
before the intending immigrant obtained permanent States, or you are not sponsoring them, do not list their names
residence. The substitute sponsor must be related to the here. A separate Form I-864 will be required for them when
intending immigrant in one of the following ways: spouse, they apply for their immigrant visas.
parent, mother-in-law, father-in-law, sibling, child (at least 18
years of age), son, daughter, son-in-law, daughter-in-law, Part 4. Information on the Sponsor.
brother-in-law, sister-in-law, grandparent, grandchild or legal
guardian. The substitute sponsor must also be a U.S. citizen 15. Country of Domicile. This question is asking you to
or lawful permanent resident. If you are a substitute sponsor, indicate the country where you maintain your principal
you must sponsor each intending immigrant. residence and where you plan to reside for the foreseeable
future. If your mailing address and/or place of residence is
not in the United States, but your country of domicile is the
United States, you must attach a written explanation and
documentary evidence indicating how you meet the domicile
requirement. If you are not currently living in the United
States, you may meet the domicile requirement if you can
submit evidence to establish that any of the following
conditions apply:

Form I-864 Instructions (Rev. 10/18/07)Y Page 5


A. You are employed by a certain organization. 18. U.S. Social Security Number.
Some individuals employed overseas are automatically Every sponsor's Social Security number is required by law. If
considered to be domiciled in the United States because of the you do not currently have a Social Security number you must
nature of their employment. The qualifying types of obtain one before submitting this Form I-864.
employment include employment by:

-- The U.S. government; 19. Citizenship/Residency.

-- An American institution of research recognized by the Proof of U.S. citizen, national, or permanent resident status is
Secretary of Homeland Security (The list of required for joint and substitute sponsors and for relatives of
qualifying institutions may be found at 8 CFR 316.20); employment-based immigrants who file this form. Petitioning
relatives who have already filed proof of their citizenship or
-- A U.S. firm or corporation engaged in whole or in part in immigration status with Forms I-130, Form I-129F, I-600 and
the development of foreign trade and commerce with the I-600A do not need to submit proof of their status with this
United States, or a subsidiary of such a firm or corporation; form.
Proof of U.S. citizen or national status includes a copy of your
-- A public international organization in which the United birth certificate, certificate of naturalization, certificate of
States participates by treaty or statute; citizenship, consular report of birth abroad to citizen parents,
or a copy of the biographic data page of your U.S. passport.
-- A religious denomination having a bona fide organization in
the United States, if the employment abroad involves the Proof of permanent resident status includes a photocopy of
person's performance of priestly or ministerial functions on both sides of the "green card," Form I-551, Alien Registration
behalf of the denomination; or Receipt Card/Permanent Resident Card; or a photocopy of an
unexpired temporary I-551 stamp in either a foreign passport
-- A religious denomination or interdenominational
or a DHS Form I-94, Arrival/Departure Document.
missionary organization having a bona fide organization in
the United States, if the person is engaged solely as a
missionary. 20. Military Service.
B. You are living abroad temporarily. Check "yes" if you are the petitioning sponsor and on active
duty in the U.S. Army, Navy, Air Force, Marines,or Coast
If you are not currently living in the United States, you must Guard, other than for training. If you provide evidence that
show that your trip abroad is temporary and that you have you are currently on active duty in the military and you are
maintained your domicile in the United States. You can show petitioning for your spouse or minor child, you will need to
this by providing proof of your voting record in the United demonstrate income at only 100 percent of the poverty level
States, proof of paying U.S. State or local taxes, proof of for your household size, instead of at 125 percent of the
having property in the United States, proof of maintaining poverty level. (See Form I-864P for information on the
bank or investment accounts in the United States, or proof of poverty levels.) Check "no" if you are not on active duty in
having a permanent mailing address in the United States. the U.S. military. This provision does not apply to joint and
Other proof could be evidence that you are a student studying substitute sponsors.
abroad or that a foreign government has authorized a
temporary stay.
Part 5. Sponsor's Household Size.
C. You intend in good faith to reestablish your domicile in This section asks you to add together the number of persons
the United States no later than the date of the intending for whom you are financially responsible. Some of these
immigrant's admission or adjustment of status. persons may not be residing with you. Make sure you do not
count any individual more than once, since in some cases the
You must submit proof that you have taken concrete steps to same person could fit into two categories. For example, your
establish you will be domiciled in the United States at a time spouse (whom you would enter on line 21c) might also be a
no later than the date of the intending immigrant's admission lawful permanent resident whom you have already sponsored
or adjustment of status. Concrete steps might include using Form I-864 (line 21f). If you included your spouse on
accepting a job in the United States, signing a lease or line 21c, do not include him or her again on line 21f.
purchasing a residence in the United States, or registering
children in U.S. schools. Please attach proof of the steps you
have taken to establish domicile as described above.

Form I-864 Instructions (Rev. 10/18/07)YPage 6


21d - Enter the number of unmarried children you have who You may include evidence supporting your claim about your
are under age 21, even if you do not have legal custody of expected income for the current year if you believe that
these children. You may exclude any unmarried children submitting this evidence will help you establish ability to
under 21, if these children have reached majority under the maintain sufficient income. You are not required to submit
law of their place of domicile and you do not claim them as this evidence, however, unless specifically instructed to do
dependents on your income tax returns. so by a Government official. For example, you may include
a recent letter from your employer, showing your employer's
21e - Enter the number of any other dependents. You must address and telephone number, and indicating your annual
include each and every person whom you have claimed as a salary. You may also provide pay stub(s) showing your
dependent on your most recent Federal income tax return, income for the previous six months. If your claimed income
even if that person is not related to you. Even if you are not includes alimony, child support, dividend or interest income,
legally obligated to support that person, you must include the or income from any other source, you may also include
person if in fact you did support that person and claimed the evidence of that income.
person as a dependent.

21f - Enter the number of lawful permanent residents whom 24. Annual Household Income.
you are currently obligated to support based on your previous
submission of Form I-864 as a petitioning, substitute, or joint This section is used to determine the sponsor's household
sponsor, or of Form I-864EZ as a petitioning sponsor. Include income. Take your annual individual income from line 23 and
only those persons who have already immigrated to the United enter it on line 24a. If this amount is greater than 125 percent
States. Do not include anyone for whom your obligation to (or 100 percent if you are on active duty in the U.S. military
support has ended through the sponsored immigrant's and sponsoring your spouse or child) of the Federal Poverty
acquisition of U.S. citizenship, death, abandonment of lawful Guidelines for your household size from line 21h, you do not
permanent residence in the United States, acquisition of 40 need to include any household member's income. See Form
quarters of earned or credited work in the United States, or I-864P for reference on the Poverty Guidelines.
obtaining a new grant of adjustment of status while in removal To determine the filing requirements for your relatives
proceedings based on a new affidavit of support, if one is included in item 24b, follow these instructions:
required.

21g - This question gives you the option of including certain If you included the income of your spouse listed in 21c, or
other non-dependent relatives who are living in your residence any child listed in 21d, or any dependent listed in 21e, or
as part of your household size. Such relatives may include any other relative listed in 21g, each one of these
your mother, father, sister, brother or adult children, if they are individuals must be over 18 years of age and must complete
living in your residence. However, the only reason to include Form I-864A.
these family members in your household size is if you need to If you included the income of the intending immigrant who
include their income when you calculate your household is your spouse (he or she would be counted on line 21a),
income for purposes of meeting the income requirement for evidence that his/her income will continue from the current
this form. To be considered, any relative indicated in this source after obtaining lawful permanent resident status must
category must sign and submit Form I-864A. be provided. He/she does not need to complete Form
I-864A unless he/she has accompanying children.
Part 6. Sponsor's Income and Employment. If you included the income of the intending immigrant who
is not your spouse, (he or she would be counted on line
22. Job Classification. 21a), evidence that his or her income will continue from the
Check the box (a through d) that applies to you. current source after obtaining lawful permanent resident
status must be provided and the intending immigrant
must provide evidence that he/she is living in your
23. Current Individual Annual Income.
residence. He or she does not need to complete
Enter your current individual earned or retirement annual Form I-864A, Contract Between Sponsor and Household
income that you are using to meet the requirements of this Member, unless he or she has an accompanying spouse or
form and indicate the total on this line. children.

Form I-864 Instructions (Rev. 10/18/07)Y Page 7


25. Federal Income Tax Information. residents from filing a U.S. Federal income tax return. See
"Filing Requirements" in the IRS Form 1040 Filing
You must provide either an IRS transcript or a photocopy Instructions to determine whether you were required to file.
from your own records of your Federal individual income tax
return for the most recent tax year. If you believe additional For purposes of this affidavit, the line for gross (total) income
returns may help you to establish your ability to maintain on IRS Forms 1040 and 1040A will be considered when
sufficient income, you may submit transcripts or photocopies determining income. For persons filing IRS Form 1040 EZ,
of your Federal individual income tax returns for the three the line for adjusted gross income will be considered.
most recent years.
Obtaining Tax Transcripts. You may use Internal Revenue
You are not required to have the IRS certify the transcript or Service (IRS) Form 4506-T to request tax transcripts from the
photocopy unless specifically instructed to do so by a IRS. Complete IRS Form 4506-T with the ending date for
Government official; a plain transcript or photocopy is each of your three most recent tax years listed on line 9.
acceptable. Telefile tax records are not acceptable proof of Follow all instructions for completing and filing Form 4506-T
filing. with the IRS.

Do not submit copies of your State income tax returns. Do


not submit any tax returns that you filed with any foreign Part 7. Use of Assets to Supplement Income.
government unless you claim that you were not required to
file a Federal tax return with the United States government Only complete this Part if you need to use the value of assets
and you wish to rely on the foreign return solely to establish to meet the income requirements. If your Total Household
the amount of your income that is not subject to tax in the Income (indicated on Line 24c) is equal to or more than
United States. needed to meet the income requirement as shown by the
current Poverty Guidelines (Form I-864P) for your household
If you provide a photocopy of your tax return(s), you must size (indicated on Line 21h), you do not need to complete this
include a copy of each and every FormW-2 and Form 1099 Part. If your total household income does not meet the
that relates to your return(s). Do not include copies of these requirement, you may submit evidence of the value of your
Forms if you provide an IRS transcript of your return(s) rather assets, the sponsored immigrant's assets, and/or assets of a
than a photocopy. household member that can be used, if necessary, for the
support of the intending immigrant(s). The value of assets of
If you checked box 22(b) (self-employed), you should have all of these persons may be combined in order to meet the
completed one of the following forms with your Federal necessary requirement.
income tax return: Schedule C (Profit or Loss from Business),
Schedule D (Capital Gains), Schedule E (Supplemental Only assets that can be converted into cash within one year
Income or Loss) or Schedule F (Profit or Loss from Farming). and without considerable hardship or financial loss to the
You must include each and every Form 1040 Schedule, if any, owner may be included. The owner of the asset must include
that you filed with your Federal tax return. a description of the asset, proof of ownership, and the basis
for the owner's claim of its net cash value.
If you were required to file a Federal income tax return during
any of the previous three tax years but did not do so, you must You may include the net value of your home as an asset. The
file any and all late returns with IRS and attach an IRS- net value of the home is the appraised value of the home,
generated tax return transcript documenting your late filing minus the sum of any and all loans secured by a mortgage,
before submitting the I-864 Affidavit of Support. If you were trust deed, or other lien on the home. If you wish to include
not required to file a Federal income tax return under U.S. tax the net value of your home, this, you must include
law because your income was too low, attach a written documentation demonstrating that you own it, a recent
explanation. If you were not required to file a Federal income appraisal by a licensed appraiser, and evidence of the amount
tax return under U.S. tax law for any other reason, attach a of any and all loans secured by a mortgage, trust deed, or
written explanation including evidence of the exemption and other lien on the home. You may not include the net value an
how you are subject to it. Residence outside of the United automobile unless you show that you have more than one
States does not exempt U.S. citizens or lawful permanent automobile, and at least one automobile is not included as an
asset.

Form I-864 Instructions (Rev. 10/18/07)Y Page 8


26. Assets. Part 8. Sponsor's Contact.
To use your own assets, you must complete lines 26a through Read the contract carefully, print your name, and then sign
26d and submit corresponding evidence with this form. and date the form. If you do not print your name on line 30
Supporting evidence must be attached to establish location, and sign and date the form on line 31, the intending
ownership, date of acquisition, and value of any real estate immigrant you are sponsoring cannot be issued a visa or
holding. be granted adjustment of status.
27. Household Member's Assets.
Other Information.
To use the assets of a relative (spouse, adult son or daughter,
parent or sibling), the relative must reside with you and have Penalties.
completed a Form I-864A, Contract Between Sponsor and
Household Member, with accompanying evidence of assets. The Government may pursue verification of any information
The Form I-864A and accompanying evidence of assets is provided on or in support of this form, including employment,
submitted with Form I-864. You may use the assets of more income, or assets with the employer, financial or other
than one relative who resides with you so long as you submit a institutions, the Internal Revenue Service, or the Social Security
complete Form I-864A with evidence of assets for each such Administration. If you include in this affidavit of support any
relative. information that you know to be false, you may be liable for
criminal prosecution under the laws of the United States.
28. Assets of the Intending Immigrant.
If you fail to give notice of your change of address, as
You may use the assets of the intending immigrant regardless required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be
of where he or she resides. The intending immigrant must liable for the civil penalty established by 8 U.S.C. 1183a(d)
provide evidence of such assets with this form. Form I-864A (2). The amount of the civil penalty will depend on whether
is not required to document the intending immigrant's assets. you failed to give this notice because you were aware that the
29. Total Value of Assets. immigrant(s) you sponsored had received Federal, State, or
local means-tested public benefits.
In order to qualify based on the value of your assets, the total
value of your assets must equal at least five times the If the failure to report your change of address occurs with
difference between your total household income and the knowledge that the sponsored immigrant received means-
current poverty guidelines for your household size. However, tested public benefits (other than benefits described in section
if you are a U.S. citizen and you are sponsoring your spouse 401(b), 403(c)(2), or 4ll(b) of the Personal Responsibility and
or minor child, the total value of your assets must only be Work Opportunity Reconciliation Act of 1996, which are
equal to at least three times the difference. If the intending summarized in the contract in Part 8) such failure may result
immigrant is an alien orphan who will be adopted in the in a fine of not less than $2,000 or more than $5,000.
United States after the alien orphan acquires permanent Otherwise, the failure to report your change of address may
residence, and who will, as a result, acquire citizenship under result in a fine not less than $250 or more than $2,000.
section 320 of the Act, the total value of your assets need only
equal the difference. Privacy Act Notice.
Example of How to Use Assets: If you are petitioning for a Authority for the collection of the information requested on
parent and the poverty line for your household size is $22,062 this form is contained in 8 U.S.C. 1182a(4), 1183a, 1184(a),
and your current income is $18,062, the difference between and 1258. The information will be used principally by an
your current income and the poverty line is $4,000. In order immigration judge, USCIS or a Consular Officer to support an
for assets to help you qualify, the combination of your assets, alien's application for benefits under the Immigration and
plus the assets of any household member who is signing Form Nationality Act and specifically the assertion that he or she has
I-864A, plus any available assets of the sponsored immigant, adequate means of financial support and will not become a
would have to equal five times this difference (5 x $4,000). In public charge. Submission of the information is voluntary.
this case, you would meet the income requirements if the net Failure to provide the information will result in denial of the
value of the assets equaled at least $20,000. application for an immigrant visa or adjustment of status.

Form I-864 Instructions (Rev. 10/18/07)Y Page 9


The information may also, as a matter of routine use, be
disclosed to other Federal, State and local agencies providing
means-tested public benefits for use in civil action against the
sponsor for breach of contract. Social Security numbers may
be verified with the Social Security Administration consistant
with the consent signed as part of the contract in Part 8 of the
Form I-864. It may also be disclosed as a matter of routine use
to other Federal, State, local, and foreign law enforcement and
regulatory agencies to enable these entities to carry out their
law enforcement responsibilities.

USCIS Forms and Information.


To order USCIS forms, call our toll-free forms line at
1-800-870-3676. You can also obtain 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.

Reporting Burden.

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 which impose the least 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 form is as


follows: (1) 75 minutes to learn about the law and form; (2) 90
minutes to complete the form; and (3) 3 hour and 15 minutes to
assemble and file the form; for a total estimated average of 6
hours per form.

If you have comments regarding the accuracy of this estimate,


or suggestions for making this form simpler, write to U.S.
Citizenship and Immigration Services, Regulatory Management
Division, Attn: OMB No. 1615-0075, 111 Massachusetts
Avenue N.W., Washington, D.C. 20529. Do not mail your
completed affidavit of support to this address.

Form I-864 Instructions (Rev. 10/18/07)Y Page 10


Check List
The following items must be submitted with Form I-864:
For ALL sponsors:
___ A copy of your individual Federal income tax return, including W-2s for the most recent tax year, or a statement
and/or evidence describing why you were not required to file. Also include a copy of each and every Form 1099,
Schedule, and any other evidence of reported income. You may submit this information for the most recent three tax
years , pay stub(s) from the most recent six months, and/or a letter from your employer if you believe any of these
items will help you qualify.
For SOME sponsors:
___ If you are currently self-employed, a copy of your Schedule C, D, E or F from your most recent Federal Tax Return
which establishes your income from your business.

___ If you are sponsoring more than one intending immigrant listed on the same affidavit of support, photocopies of the
original affidavit of support may be submitted for any additional intending immigrants listed. Copies of supporting
documentation are not required for these family members.

___ If you are the petitioning sponsor and on active duty in the U.S. Armed Forces and are sponsoring your spouse or
child using 100 percent of governing poverty guideline, proof of your active military status.

___ If you are using the income of persons in your household or dependents to qualify,

___ A separate Form I-864A for each person whose income you will use. However, an intending immigrant
whose income is being used needs to complete Form I-864A only if his or her spouse and/or children are
immigrating with him or her.

___ Proof of their residency in your household and relationship to you if they are not the intending immigrants
or are not listed as dependents on your Federal income tax return for the most recent tax year.

___ Proof that the intending immigrant's current employment will continue from the same source if his or her
income is being used.
___ A copy of their individual Federal income tax return, including W-2s and 1099s, for the most recent tax
year, or evidence that they were not required to file. You may submit this information for the most recent
three years if you believe it will help you qualify.
___ If you use your assets or the assets of a household member to qualify,
___ Documentation of assets establishing location, ownership, date of acquisition and value. Evidence of any
liens or liabilities against these assets.
___ A separate Form I-864A for each household member using assets other than for the intending immigrant.

___ If you are a joint sponsor, substitute sponsor, or the relative of an employment-based immigrant requiring an affidavit
of support, proof of your citizenship status, U.S. national status or lawful permanent resident status.
___ For U.S. citizens or nationals, a copy of your birth certificate, passport, or certificate of naturalization or
citizenship.
___ For lawful permanent residents, a copy of both sides of your Form I-551, Permanent Resident Card.

Form I-864 Instructions (Rev. 10/18/07)Y Page 11


OMB No. 1615-0075; Expires 10/31/10

Department of Homeland Security


I-864, Affidavit of Support
U.S. Citizenship and Immigration Services Under Section 213A of the Act
Part 1. Basis for filing Affidavit of Support.
1. I, , For Government
Use Only
am the sponsor submitting this affidavit of support because (Check only one box):
This I-864 is from:
a. I am the petitioner. I filed or am filing for the immigration of my relative.
the Petitioner
b. I filed an alien worker petition on behalf of the intending immigrant, who is related to me as
my a Joint Sponsor #
______________
c. I have an ownership interest of at least 5 percent in ,
which filed an alien worker petition on behalf of the intending immigrant, who is related to the Substitute
me as my Sponsor

I am the only joint sponsor. 5% Owner


d.
e. I am the first second of two joint sponsors. (Check appropriate box.) This I-864:
f. The original petitioner is deceased. I am the substitute sponsor. I am the intending does not meet the
immigrant's requirements of
.
section 213A.
Part 2. Information on the principal immigrant. meets the
requirements of
2. Last Name
section 213A.
First Name Middle Name
Reviewer

3. Mailing Address Street Number and Name (Include Apartment Number)


Location

City State/Province Zip/Postal Code Country Date (mm/dd/yyyy)

Number of Affidavits of
4. Country of Citizenship 5. Date of Birth (mm/dd/yyyy) Support in file:

6. Alien Registration Number (if any) 7. U.S. Social Security Number (if any) 1 2
A-
Part 3. Information on the immigrant(s) you are sponsoring.
8. I am sponsoring the principal immigrant named in Part 2 above.
Yes No (Applicable only in cases with two joint sponsors)
9. I am sponsoring the following family members immigrating at the same time or within six months of the principal
immigrant named in Part 2 above. Do not include any relative listed on a separate visa petition.
Relationship to Date of Birth U.S.Social Security
Name Sponsored Immigrant (mm/dd/yyyy) A-Number (if any) Number (if any)

a.

b.

c.

d.

e.

10. Enter the total number of immigrants you are sponsoring on this form from Part 3, Items 8 and 9.
Form I-864 (Rev. 10/18/07)Y
Part 4. Information on the Sponsor.
11. Name Last Name For Government
Use Only

First Name Middle Name

12. Mailing Address Street Number and Name (Include Apartment Number)

City State or Province

Country Zip/Postal Code

13. Place of Residence Street Number and Name (Include Apartment Number)
(if different from
mailing address)
City State or Province

Country Zip/Postal Code

14. Telephone Number (Include Area Code or Country and City Codes)

15. Country of Domicile

16. Date of Birth (mm/dd/yyyy)

17. Place of Birth (City) State or Province Country

18. U.S. Social Security Number (Required)

19. Citizenship/Residency
I am a U.S. citizen.
I am a U.S. national (for joint sponsors only).
I am a lawful permanent resident. My alien registration number is A-
If you checked box (b), (c), (d), (e) or (f) in line 1 on Page 1, you must include proof of your
citizen, national, or permanent resident status.

20. Military Service (To be completed by petitioner sponsors only.)

I am currently on active duty in the U.S. armed services. Yes No

Form I-864 (Rev. 10/18/07)Y Page 2


Part 5. Sponsor's household size.
For Government
21. Your Household Size - DO NOT COUNT ANYONE TWICE Use Only

Persons you are sponsoring in this affidavit:


a. Enter the number you entered on line 10.

Persons NOT sponsored in this affidavit:


b. Yourself. 1

c. If you are currently married, enter "1" for your spouse.

d. If you have dependent children, enter the number here.

e. If you have any other dependents, enter the number here.

f. If you have sponsored any other persons on an I-864 or I-864 EZ


who are now lawful permanent residents, enter the number here.

g. OPTIONAL: If you have siblings, parents, or adult children with


the same principal residence who are combining their income
with yours by submitting Form I-864A, enter the number here.

h. Add together lines and enter the number here. Household Size:

Part 6. Sponsor's income and employment.

22. I am currently:

a. Employed as a/an .
Name of Employer #1 (if applicable) .
Name of Employer #2 (if applicable) .

b. Self-employed as a/an .

c. Retired from since .


(Company Name) (Date)

d. Unemployed since .
(Date)

23. My current individual annual income is: $


(See Step-by-Step Instructions)

Form I-864 (Rev. 10/18/07)Y Page 3


24. My current annual household income: For Government
Use Only
$
a. List your income from line 23 of this form.

Household Size =
b. Income you are using from any other person who was counted in your household
size, including, in certain conditions, the intending immigrant. (See step-by-step
instructions.) Please indicate name, relationship and income.
Name Relationship Current Income Poverty line for year

$ _______________ is:
$
$
$

c. Total Household Income: $


(Total all lines from 24a and 24b. Will be Compared to Poverty Guidelines -- See Form I-864P.)

d. The persons listed above have completed Form I-864A. I am filing along with this
form all necessary Forms I-864A completed by these persons.

e. The person listed above, does not need to


(Name)
complete Form I-864A because he/she is the intending immigrant and has no
accompanying dependents.

25. Federal income tax return information.

I have filed a Federal tax return for each of the three most recent tax years. I have
attached the required photocopy or transcript of my Federal tax return for only the
most recent tax year.

My total income (adjusted gross income on IRS Form 1040EZ) as reported on my


Federal tax returns for the most recent three years was:
Tax Year Total Income
(most recent) $

(2nd most recent) $

(3rd most recent) $

(Optional) I have attached photocopies or transcripts of my Federal tax returns for my


second and third most recent tax years.

Form I-864 (Rev. 10/18/07)Y Page 4


Part 7. Use of assets to supplement income. (Optional) For Government Use
Only
If your income, or the total income for you and your household, from line 24c exceeds the
Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to
complete this Part. Skip to Part 8. Household Size =

26. Your assets (Optional)

a. Enter the balance of all savings and checking accounts. $


Poverty line for year

b. Enter the net cash value of real-estate holdings. (Net means _______________ is:
current assessed value minus mortgage debt.)
$
$
c. Enter the net cash value of all stocks, bonds, certificates of
deposit, and any other assets not already included in lines 26 $
(a) or (b).
d. Add together lines 26 a, b and c and enter the
number here. TOTAL: $

27. Your household member's assets from Form I-864A. (Optional)


Assets from Form I-864A, line 12d for
$
(Name of Relative)

28. Assets of the principal sponsored immigrant. (Optional)


The principal sponsored immigrant is the person listed in line 2.
a. Enter the balance of the sponsored immigrant's savings and
checking accounts. $

b. Enter the net cash value of all the sponsored immigrant's real
estate holdings. (Net means investment value minus $
mortgage debt.)
c. Enter the current cash value of the sponsored immigrant's
stocks, bonds, certificates of deposit, and other assets not
included on line a or b. $
The total value of all
d. Add together lines 28a, b, and c, and enter the number assests, line 29, must equal

here. $ 5 times (3 times for


spouses and children of
USCs, or 1 time for
orphans to be formally
29. Total value of assets. adopted in the U.S.) the
difference between the
Add together lines 26d, 27 and 28d and enter the poverty guidelines and the
number here. TOTAL: $
sponsor's household
income, line 24c.

Form I-864 (Rev. 10/18/07)Y Page 5


Part 8. Sponsor's Contract.
Please note that, by signing this Form I-864, you agree to assume certain specific obligations under the Immigration and
Nationality Act and other Federal laws. The following paragraphs describe those obligations. Please read the following
information carefully before you sign the Form I-864. If you do not understand the obligations, you may wish to consult
an attorney or accredited representative.

What is the Legal Effect of My Signing a Form I-864?

If you sign a Form I-864 on behalf of any person (called the "intending immigrant") who is applying for an immigrant
visa or for adjustment of status to a permanent resident, and that intending immigrant submits the Form I-864 to the U.S.
Government with his or her application for an immigrant visa or adjustment of status, under section 213A of the
Immigration and Nationality Act these actions create a contract between you and the U. S. Government. The intending
immigrant's becoming a permanent resident is the "consideration" for the contract.
Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not
inadmissible to the United States as an alien likely to become a public charge, the U.S. Government can consider your
income and assets to be available for the support of the intending immigrant.

What If I choose Not to Sign a Form I-864?

You cannot be made to sign a Form 1-864 if you do not want to do so. But if you do not sign the Form I-864, the
intending immigrant may not be able to become a permanent resident in the United States.

What Does Signing the Form I-864 Require Me to do?

If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed,
then, until your obligations under the Form I-864 terminate, you must:
-- Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent
of the Federal Poverty Guidelines for his or her household size (100 percent if you are the petitioning sponsor and are
on active duty in the U.S. Armed Forces and the person is your husband, wife, unmarried child under 21 years old.)
-- Notify USCIS of any change in your address, within 30 days of the change, by filing Form I-865.

What Other Consequences Are There?


If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed,
then until your obligations under the Form I-864 terminate, your income and assets may be considered ("deemed") to be
available to that person, in determining whether he or she is eligible for certain Federal means-tested public benefits and
also for State or local means-tested public benefits, if the State or local government's rules provide for consideration
("deeming”) of your income and assets as available to the person.
This provision does not apply to public benefits specified in section 403(c) of the Welfare Reform Act such as, but not
limited to, emergency Medicaid, short-term, non-cash emergency relief; services provided under the National School
Lunch and Child Nutrition Acts; immunizations and testing and treatment for communicable diseases; and means-tested
programs under the Elementary and Secondary Education Act.

Contract continued on following page.

Form I-864 (Rev. 10/18/07)Y Page 6


What If I Do Not Fulfill My Obligations?

If you do not provide sufficient support to the person who becomes a permanent resident based on the Form I-864 that you
signed, that person may sue you for this support.
If a Federal, State or local agency, or a private agency provides any covered means-tested public benefit to the person who
becomes a permanent resident based on the Form I-864 that you signed, the agency may ask you to reimburse them for the
amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that
the agency believes you owe.
If you are sued, and the court enters a judgment against you, the person or agency that sued you may use any legally
permitted procedures for enforcing or collecting the judgment. You may also be required to pay the costs of collection,
including attorney fees.
If you do not file a properly completed Form I-865 within 30 days of any change of address, USCIS may impose a civil
fine for your failing to do so.
When Will These Obligations End?

Your obligations under a Form I-864 will end if the person who becomes a permanent resident based on a Form I-864 that
you signed:
Becomes a U.S. citizen;
Has worked, or can be credited with, 40 quarters of coverage under the Social Security Act;
No longer has lawful permanent resident status, and has departed the United States;
Becomes subject to removal, but applies for and obtains in removal proceedings a new grant of adjustment of status,
based on a new affidavit of support, if one is required; or
Dies.
Note that divorce does not terminate your obligations under this Form I-864.

Your obligations under a Form I-864 also end if you die. Therefore, if you die, your Estate will not be required to take
responsibility for the person's support after your death. Your Estate may, however, be responsible for any support that
you owed before you died.

30. I, ,
(Print Sponsor's Name)
certify under penalty of perjury under the laws of the United States that:

a. I know the contents of this affidavit of support that I signed.


b. All the factual statements in this affidavit of support are true and correct.
c. I have read and I understand each of the obligations described in Part 8, and I agree, freely and without any
mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the
immigrants indicated in Part 3 to become permanent residents of the United States;
d. I agree to submit to the personal jurisdiction of any Federal or State court that has subject matter jurisdiction of a
lawsuit against me to enforce my obligations under this Form I-864;
e. Each of the Federal income tax returns submitted in support of this affidavit are true copies, or are unaltered tax
transcripts, of the tax returns I filed with the U.S. Internal Revenue Service; and
Sign on following page.
Form I-864 (Rev. 10/18/07)Y Page 7
f. I authorize the Social Security Administration to release information about me in its records to the Department of
State and U.S. Citizenship and Immigration Services.
g. Any and all other evidence submitted is true and correct.

31.
(Sponsor's Signature) (Date-- mm/dd/yyyy)

Part 9. Information on Preparer, if prepared by someone other than the sponsor.

I certify under penalty of perjury under the laws of the United States that I prepared this affidavit of support at
the sponsor's request and that this affidavit of support is based on all information of which I have knowledge.

Signature: Date:
(mm/dd/yyyy)
Printed Name:

Firm Name:

Address:

Telephone Number:

E-Mail Address :

Business State ID # (if any)

Form I-864 (Rev. 10/18/07)Y Page 8


Department of Homeland Security
U.S.Citizenship and Immigration Services I-864P, Poverty Guidelines
2008 Poverty Guidelines*
Minimum Income Requirement for Use in Completing Form I-864.

For the 48 Contiguous States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam:

Sponsor's 100% of Poverty Guidelines* 125% of Poverty Line


Household Size For all other sponsors
For sponsors on active duty in the U.S.
Armed Forces who are petitioning for
their spouse or child.

2 $14,000 $17,500
3 17,600 22,000
4 21,200 26,500
5 24,800 31,000
6 28,400 35,500
7 32,000 40,000
8 35,600 44,500
Add $3,600 for each Add $4,500 for each
additional person. additional person.

For Alaska: For Hawaii:


Sponsor's 100% of Poverty Line 125% of Poverty Line 100% of Poverty Line 125% of Poverty Line
Household Size For sponsors on active duty For all other sponsors For sponsors on active duty For all other sponsors
in the U.S. Armed Forces in the U.S. Armed Forces
who are petitioning for their who are petitioning for their
spouse or child spouse or child
2 $17,500 $21,875 $16,100 $20,125
3 22,000 27,500 20,240 25,300
4 26,500 33,125 24,380 30,475
5 31,000 38,750 28,520 35,650
6 35,500 44,375 32,660 40,825
7 40,000 50,000 36,800 46,000
8 44,500 55,625 40,940 51,175
Add $4,500 for each additional Add $5,625for each Add $4,140 for each Add $5,175 for each
person for sponsor on active additional person. additional person. additional person.
duty in Armed Forces.

Means -Tested Public Benefits.

Federal Means-Tested Public Benefits. To date, Federal agencies administering benefit programs have determined that Federal
means-tested public benefits include Food Stamps, Medicaid, Supplemental Security Income (SSI), Temporary Assistance for
Needy Families (TANF) and the State Child Health Insurance Program (SCHIP).
State Means-Tested Public Benefits. Each State will determine which, if any, of its public benefits are means-tested. If a State
determines that it has programs which meet this definition, it is encouraged to provide notice to the public on which programs are
included. Check with the State public assistance office to determine which, if any, State assistance programs have been
determined to be State means-tested public benefits.
Programs Not Included: The following Federal and State programs are not included as means-tested benefits: emergency
Medicaid; short-term, non-cash emergency relief; services provided under the National School Lunch and Child Nutrition Acts;
immunizations and testing and treatment for communicable diseases; student assistance under the Higher Education Act and the
Public Health Service Act; certain forms of foster-care or adoption assistance under the Social Security Act; Head Start
Programs; means-tested programs under the Elementary and Secondary Education Act; and Job Training Partnership Act
programs.
* These poverty guidelines remain in effect for use with Form I-864, Affidavit of Support, from March 1, 2008 until new poverty guidelines go
into effect in the spring of 2009.
Form I-864P (Rev. 03/01/08)N
OMB No. 1615-0048 ; Expires 07/31/09

Department of Homeland Security Instructions for I-907, Request for


U.S. Citizenship and Immigration Services Premium Processing Service
NOTE: You may file Form I-907 electronically. Go to our internet website at www.uscis.gov and follow the detailed instructions on e-filing.

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

What Is the Purpose of This Form? General Instructions.


How Do I File Form I-907?
Use Form I-907 to request Premium Processing Service on
certain petitions or applications designated as eligible for You must fill out a separate Form I-907 for each petition or
this service. application submitted. Follow the steps below to complete
your request process:
When Should I Use Form I-907? Step 1 - Fill Out the Form I-907
You should use Form I-907 to request Premium Processing Step 2 - Submit Your Request
Service for certain petitions or applications designated as NOTE: USCIS wants to make sure that you receive the
eligible for Premium Processing Service. Visit our web site at requested immigration benefit. To do this, we may ask for
www.uscis.gov for details about which petitions or more evidence, interview you, and/or conduct an
applications are eligible for this service. investigation.
You may file your request for Premium Processing Service
with the eligible petition or application. You may also file the Step 1. Fill Out the Form I-907.
request for Premium Processing Service after you file the Use black ink only. Type or print clearly using CAPITAL
eligible petition or application, as long as the eligible petition letters. If an item does not apply to you, write "N/A." If the
or application is still pending. answer is none, write "NONE."
Only the petitioner or applicant who filed the corresponding This form is divided into Parts 1 through 4. The following
petition or application (e.g. Form I-129), or the attorney or information should help you fill out the form.
accredited representative of the petitioner or applicant, may
request Premium Processing Service. If the attorney or Part 1 - Information about you.
accredited representative makes the request, a properly Company or Business Name - Give the full name of the
completed Notice of Appearance (Form G-28) must company or business.
accompany the request, even if the attorney or accredited
representative has already filed a Form G-28 in the case. Part 2 - Information about request.
Give the requested information about the related petition
Premium Processing Service guarantees 15 calendar day
or application for which you are requesting Premium
processing of certain employment-based petitions or
Processing Service. USCIS must have this information in
applications. U.S. Citizenship and Immigration Services
order to match the Form I-907 with the underlying form
(USCIS) will refund the Premium Processing Service fee but
for which you are requesting Premium Processing Service.
continue to process the case unless within 15 calendar days of
If you are requesting an upgrade of the pending
receipt of a properly filed Form I-907, USCIS issues an
underlying form to Premium Processing Service, you must
approval notice or, where appropriate, issues a notice of intent
complete all blocks (1 through 5) in Part 2 of the Form
to deny, a request for evidence or opens an investigation for
I-907 or your Form I-907 will be rejected and the filing
suspected fraud or misrepresentation on the related petition or
fee returned. If you are concurrently filing the Form I-907
application.
with the underlying form for which you are requesting
Premium Processing Service, you must complete blocks 1,
If an intent to deny or request for evidence is issued within
3, 4 and 5 in Part 2 or your Form I-907 will be rejected
15 calendar days of receipt or if the case is referred for
and the fee returned. (You don't have to complete block 2
investigation of suspected fraud or misrepresentation, the
because if you are concurrently filing Form I-907 with the
processing time has been met. Once a response is received to
underlying form, you will not know the receipt number of
the notice of intent to deny or request for evidence, USCIS
the underlying form at the time you file).
will guarantee 15 calendar day processing from the date the
response was received.

Form I-907 Instructions (Rev. 07/30/07) Y


Part 3 - Original signature. The filing address for the Form I-907 depends on whether
you are requesting Premium Processing Service for Form
The petitioner, applicant, attorney, or accredited I-129 or for Form I-140.
representative must sign and date the request. If the Form
I-907 does not contain an original signature (stamped
signatures or photocopies are not acceptable) the request
Premium Processing Service for Form I-129 -
for Premium Processing Service (along with the $1,000 Initial Filings
Premium Processing Service fee) will be returned to the
If you are requesting Premium Processing Services on Form
requester.
I-129, Petition for Nonimmigrant Worker, you must also file
NOTE: Only the petitioner (including the self- Form I-907, request for Premium Processing Services. Send
petitioner) or the applicant of the relating petition may the entire Forms I-129/I-907 package to the address listed in
sign the Form I-907 to seek Premium Processing Service the I-129 filing instructions.
on the related petition or application.
NOTE: Before you file the Forms I-129/I-907 package, check
Part 4 - Original signature of attorney or accredited the Premium Processing website to make sure the requested
representative who submitted Form G-28. classification is Premium Processing Service eligible.
(Premium Processing website link: http://www.uscis.gov)
1. If a Form G-28, Notice of Entry of Appearance as
Attorney or Representative, is attached to this request, the
attorney or accredited representative listed on the Form Premium Processing Service for Form I-129 -
G-28 must sign, date and give his or her address and Upgrades for Pending Cases
daytime phone number.
If you have already filed Form I-129, and you wish to request
2. If the preparer is a business or organization, its name Premium Processing Service, file Form I-907 with the Service
must be included on the form. Center where Form I-129 is pending. Include a copy of Form
I-797, Notice of Action, or a copy of the transfer notice, if
Step 2. Submit Your Request. applicable, showing the location of the relating petition. To
You must include the following items with your request. ensure that Form I-907 is matched up with the pending Form
I-129, you must completely answer Questions 1 through 5 in
1. Your signed and completed Form I-907.
Part 2 of Form I-907. If this information is not provided, the
2. Your signed and completed petition or application - Form I-907 will be rejected. The Premium Processing
unless the petition or application was previously filed and addresses for each service center that handles Form I-129 is
is still pending. If this is the case, you must submit a copy listed in the Form I-129 filing chart.
of the filing receipt or a copy of the transfer notice, if
applicable.
NOTE: Form I-129 filing chart internet address:
http://www.uscis.gov)
Where To File?

Submit the request. The Form I-907 may be filed at the same Premium Processing Service for Form I-140 -
time as the relating petition or application, or it may be filed at Initial Filings
a later date. If you plan to file the Form I-907 electronically,
refer to the USCIS website at www.uscis.gov and click on All Forms I-140 are filed either at the Nebraska Service
"Immigration Forms." Centeror the Texas Service Center, depending on the
location of the beneficiary's permanent employment. If
The filing location for the Form I-907 depends on the filing
you are requesting Premium Processing Service on Form
location of the underlying petition or application for which
I-140 for a preference category that is Premium Processing
you are requesting Premium Processing Service as described
eligible, you must include Form I-907, and send the entire
later in this form.
Form I-907/I-140 package to the correct filing location
listed below. Before you file, note the different filing
If you have already filed the underlying form (i.e., Form I-129 addresses. Failure to follow these instructions may result
or Form I-140) and wish to request Premium Processing in your application or petition being rejected, delayed, or
Service, submit the Form I-907 to the Service Center where denied.
the underlying form is pending. Include a copy of the filing
receipt or a copy of the transfer notice, if applicable.

Form I-907 Instructions (Rev. 07/30/07) Y Page 2


The mailing address you should use is:
Nebraska Service Center Filings
Form I-140 Premium Processing Mailing Address:

File Form I-907/I-140 package with the Nebraska Premium Processing


Service Center if the beneficiary will be employed USCIS Texas Service Center
permanently in: P.O. Box 279030
Dallas, TX 75227-9030
Alaska, Arizona, California, Colorado, Guam,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Form I-140 Premium Processing Courier Address:
Michigan, Minnesota, Missouri, Montana,
Nebraska, Nevada, North Dakota, Ohio, Oregon, Premium Processing
South Dakota, Utah, Washington, Wisconsin or USCIS Texas Service Center
Wyoming. 4141 North St. Augustine Road
Dallas, TX 75227
The mailing address you should use is:
Form I-140 Premium Processing E-mail Address:
Form I-140 Premium Processing Mailing Address:
TSC-Premium.140@dhs.gov
Premium Processing
USCIS Nebraska Service Center Premium Processing Service for Form I-140 - Upgrades
P.O. Box 87103 for Pending Cases
Lincoln, NE 68501-7103
If you have already filed Form I-140, and you wish to
request Premium Processing Service, file Form I-907 with
Form I-140 Premium Processing Courier Address: theServiceCenterwhere Form I-140 is pending. Include a
copy of Form I-797, Notice of Action, or a copy of the
Premium Processing transfer notice, if applicable, showing the location of the
USCIS Nebraska Service Center relating petition. To ensure that Form I-907 is matched up
850 S St. with the pending Form I-140, you must completely answer
Lincoln, NE 68508 Questions 1 through 5 in Part 2 of Form I-907. If this
information is not provided, the Form I-907 will be rejected.
Form I-140 Premium Processing E-mail Address:
If your Form I-140 is pending with the Nebraska Service
NSC-Premium.140@dhs.gov Center or the Texas Service Center, send Form I-907 to
that center at the previously noted address. If your Form
Texas Service Center Filings I-140 is pending at either the California or Vermont
Service Centeryou may use the corresponding address listed
File Form I-907/I-140 package with the Texas Service Center below to file an I-907.
if the beneficiary will be employed permanently in:

Alabama, Arkansas, Connecticut, Delaware, the California Service Center


District of Columbia, Florida, Georgia, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Form I-140 Mailing Address:
Mississippi, New Hampshire, New Jersey, New
Mexico, New York, North Carolina, South I-140 Premium Processing
Carolina, Oklahoma, Pennsylvania, Puerto Rico, USCIS California Service Center
Rhode Island, Tennessee, Texas, Vermont, P.O. Box 10140
Virginia, U.S. Virgin Islands, or West Virginia. Laguna Niguel,CA 92607-0140

Form I-907 Instructions (Rev. 07/30/07) Y Page 3


Use the following guidelines when you prepare your
Form I-140 Courier Address:
check or money order:
Premium Processing 1. The check or money order must be drawn on a bank
USCIS California Service Center or other financial institution located in the United
24000 Avila Road States and must be payable in U.S. currency. Do
2nd Floor, Room 2312 not mail cash.
Laguna Niguel,CA 92677 2. Make the check or money order payable to the
Department of Homeland Security. Please spell
Form I-140 E-mail Address: out U.S. Department of Homeland Security. Do not
CSC-Premium.140@dhs.gov use the initials "USDHS" or "DHS."

Vermont Service Center Your check or money order must be honored by the bank
or financial institution. If it is not, we will charge you a
Form I-140 Courier and Mailing Address: fee for a returned/bounced check and your request for
Premium Processing Service will be terminated.
Premium Processing
USCIS Vermont Service Center How to Check If the Fees Are Correct?
63 Lower Welden Street The form and biometric fees on this form are current as of the
St. Albans, VT 05479-8001 edition date appearing in the lower right corner of this page.
However, because USCIS fees change periodically, you can
Form I-140 E-mail Address: verify if the fees are correct by following one of the steps
VSC-Premium.140@dhs.gov below:
1. Visit our website at www.uscis.gov, select
Service Processing Information. "Immigration Forms" and check the appropriate fee;

Our goal at USCIS is to process all petitions and applications 2. Review the Fee Schedule included in your form
fairly. The processing time will vary, depending on the package, if you called us to request the form; or
specific circumstances of each case. We may reject an
incomplete request. We may deny your request if you do not 3. Telephone our National Customer Service Center at
give us the requested information or do not go to a scheduled 1-800-375-5283 and ask for the fee information.
interview.
NOTE: If your Form I-907 requires payment of a biometric
To request USCIS forms, call our toll-free forms line at service fee for USCIS to take your fingerprints, photograph or
1-800-870-3676. You may also get USCIS forms and signature, you can use the same procedure to obtain the correct
information about immigration laws and regulations by calling biometric fee.
our National Customer Service Center at 1-800-375-5283 or
visting the USCIS internet website at www.uscis.gov.
If you change your address, you must complete Form AR-11,
Address Changes.
Alien's Change of Address Card, according to the instructions If you change your address and you have an application or
on the form. petition pending with USCIS, you may change your address
on-line at www.uscis.gov, click on "Change your address with
What Is the Filing Fee?
USCIS" and follow the prompts or by completing and mailing
The filing fee for the Form I-907 is $1,000. Form AR-11, Alien's Change of Address Card, to:

The $1,000 Premium Processing fee is in addition to all other U.S. Citizenship and Immigration Services
applicable filing fees. The petitioner, attorney or beneficiary Change of Address
may pay the $1,000 fee but the beneficiary cannot sign the P.O. Box 7134
Form I-907. You must pay for Premium Processing Service London, KY 40742-7134
with a separate check or money order. (Example: One For commercial overnight or fast freight services only, mail
check or money order attached to the relating petition or to:
application, and one check or money order attached to the U.S. Citizenship and Immigration Services
Form I-907). Change of Address
1084-I South Laurel Road
London, KY 40744

Form I-907 Instructions (Rev. 07/30/07) Y Page 4


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.

As an altenative 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. 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.

Penalties.
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this Form I-907, we will
deny the Form I-907 and may deny any other immigration
benefit.

In addition, you will face severe penalties provided by law and


may be subject to criminal prosecution.

Privacy Act Notice.


We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-907.

Paperwork Reduction Act.

An agency may not conduct or sponsor an information


collection and a person is not required to respond to a Form I-907 Check List.
collection of information unless it displays a currently valid
Did you completely fill out and sign the form?
OMB control number. The public reporting burden for this
collection of information is estimated at 30 minutes per Did you attach a check or money order for $1,000 plus a
response, including the time for reviewing instructions, check for the relating petition or application if applicable?
completing and submitting the form. Send comments (See Step 2 of these instructions for fee information.)
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing NOTE: If you wish to have the notice mailed to you rather
this burden, to: U.S. Citizenship and Immigration Services, than wait for the batch-printed notice, submit a pre-paid
Regulatory Management Division, 111 Massachusetts express mail label and envelope for mailing.
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
For your records, you should keep copies of your request
OMB No. 1615-0048. Do not mail your application to this
packet.
address.

Form I-907 Instructions (Rev. 07/30/07) Y Page 5


OMB No. 1615-0048; Expires 07/31/09

Department of Homeland Security I-907, Request for


U.S. Citizenship and Immigration Services Premium Processing Service
START HERE - Please Type or Print (Use black ink.) For USCIS Use Only
Part 1. Information about you. (Person filing this petition.) Request Physically Receipt
Received by USCIS
Individual Named in the Related Case:
Family Name (Last Name) Given Name (First Name) Full Middle Name
Date
If filed on behalf of a company: Company or Business Named in the Related Case
Date
Returned
Mailing Address - Street Number and Name / P.O. Box Number
Date
Company Contact Information:
Name of Company Contact Title/Position
Date
Resubmitted
City State/Province Zip/Postal Code
Date
IRS Tax # (if any)
Date

You (the person submitting this request): To Be Completed by


Are the petitioner who is filing or has filed a petition eligible for Premium Processing. Attorney or Representative, if any.

Are the attorney/accredited representative for the petitioner who is filing or has filed a Fill in box if G-28 is attached to
petition eligible for Premium Processing. (Complete and submit Form G-28.) represent the applicant.
Are the applicant who is filing or has filed an application eligible for Premium Processing. ATTY State License #
Are the attorney/accredited representative for the applicant who is filing or has filed an
application eligible for Premium Processing. (Complete and submit Form G-28.)
Phone Number (Area/Country Code) Fax Number (Area/Country Code) E-Mail Address (If Any)

Part 2. Information about request.


1. Form number of related petition/application. 2. Receipt number of related petition/application. 3. Classification/Eligibility Requested.

4. Petitioner/Applicant in the relating case. 5. Beneficiary in the relating case.

Part 3. Original signature. (This is the same person authorized to sign the petition or application.)
It is understood that if U.S. Citizenship and Immigration Services (USCIS) does not issue an approval notice, request for evidence, notice of intent to
deny, or refer for investigation of suspected fraud or misrepresentation within 15-calendar days after this request has been physically received at the
appropriate USCIS office, a refund of the Premium Processing fee will be given to the addressee shown in Part 1 of this request.
I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this request is all true and
correct. I authorize the release of any information from my records that USCIS needs to determine eligibility for the benefit being sought.
Signature Title (if applicable)

Print Your Name Date (mm/dd/yyyy)

Part 4. Original signature of attorney or accredited representative. (Note if attorney is signing above in Part 3.)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Same individual as signing above in Part 3. (If this box is checked, provide all the requested information below and a submit a Form G-28.)
Signature Print Your Name Date (mm/dd/yyyy)

Firm Name and Address Daytime Phone Number (Area Code and Number)

Form I-907 (Rev. 07/30/07) Y


USCIS Is Making
Photos Simpler
Washington, DC — In accordance with language specified in the Border
Security Act of 2003, U.S. Citizenship and Immigration Services (USCIS)
announced a change in the photo requirements for all applicants from
a three-quarter face position to a standard, full-frontal face position to take
effect August 2, 2004.
Old Three-Quarter
USCIS will accept both three-quarter and full-frontal color photographs until
Style Photo
September 1, 2004, after which only full-frontal color will be accepted.

The application process of customers who have already submitted materials


that include color photos with the three-quarter standard will not be affected
by this change.

All photos must be of just the person. Where more than one photo is


required, all photos of the person must be identical. All photos must meet
the specifications for full-frontal/passport photos.

For more information on photo standards, visit the Department of State


New Passport website at http://www.travel.state.gov/passport/pptphotos/index.html,
Style Photo or contact the USCIS National Customer Service Center at 1 800 375 5283.

Photos Must Be in Color

List of forms that require photos is on the back

M-603 (07/04)
Applications and Petitions That Require Photos, and the Number Required

2 photos are required for the following forms:


I-90 – Renew or replace your Permanent Resident Card (green card)
I-131 – Re-entry permit, refugee travel document, or advance parole
I-485 – Adjust status and become a permanent resident while in the U.S.
I-765 – Employment Authorization/Employment Authorization
Document (EAD)
I-777 – Replace Northern Mariana Card
I-821 – Temporary Protected Status (TPS) Program
N-300 – Declaration of Intent (to apply for U.S. citizenship)
N-400 – Naturalization (to become a U.S. citizen)
N-565 – Replace Naturalization/Citizenship Certificate
3 photos are required for the following forms:
I-698 – Temporary Resident’s application under the 1987 Legalization Program
for permanent resident status — file 1 photo for your application, and bring the
other 2 with you to your interview
N-600K – To apply for U.S. citizenship for foreign-born child residing abroad
with U.S. citizen parent
4 photos are required for the following forms:
I-817 – To apply for Family Unity Benefits
I-881 – NACARA — suspension of deportation or special rule cancellation
File the following with your photos and of others as shown below:
I-129F – Fiancé(e) Petition — file with 1 photo of you + 1 photo of fiancé(e)
I-130 – Relative petition — if filing for your husband or wife, file with 1 photo
of you + 1 photo of your husband or wife
I-589 – Asylum — file with 1 photo of you + 1 photo of each family member
listed in Part A. II that you are including in your application
I-730 – Relative petition filed by a person granted Asylum or Refugee status —
file with 1 photo of the family member for whom you are filing the I-730
I-914 – ‘T’ nonimmigrant status — file with 3 photos of you + 3 photos of
each immediate family member for which you file an I-914A supplement
All photos must be of just the person. Where more than one photo is required, all photos of the
person must be identical. All photos must meet the specifications for full-frontal/passport photos.
For more information, visit our website at www.uscis.gov, or call our
customer service at 1 800 375 5283.
OMB No. 1615-0056; Expires 10/31/09
Department of Homeland Security Instructions for N-470, Application to Preserve
U.S. Citizenship and Immigration Services Residence for Naturalization Purposes
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

What Is the Purpose of This Form? U.S. corporation or as a member of the U.S. military. For
additional information, call our National Customer Service
Use Form N-470 to preserve your lawful permanent resident Center at 1-800-375-5283 or visit our internet website at
status for naturalization purposes. www.uscis.gov.

In certain limited situations, a person may be able to preserve When Should I Use Form N-470?
residency, previously accumulated for naturalization
purposes, even though he or she may be residing outside the Generally, applicants for naturalization must reside in the
United States for longer than one year. Thus the time spent United States for five years (three years if qualifying under
abroad may be counted toward the residency requirement. the citizen-spouse exemption) immediately preceding the date
of filing an application for naturalization. Additionally,
These cases involve persons employed in specific jobs in the
naturalization applicants are required to have been physically
United States government and private sector as well as
present in the United States for at least 30 months of those
religious organizations.
five years (18 months if eligible under the citizen-spouse
exemption).
To obtain approval to preserve residency, such permanent
residents must file a Form N-470 application before departing
Permanent residents who remain outside the United States for
from the United States.
more than one uninterrupted year will disrupt their
naturalization residence requirement, unless they are the
The regulations are different for religious workers proceeding
beneficiaries of an approved Form N-470.
abroad to perform religious duties. Religious workers may
apply before or after departure, or after return to the United
States. They are not required to have lived in the United You should use Form N-470 if you are a lawful permanent
States for a specific period of time prior to filing Form N-470. resident (permanent resident) who will be absent from the
United States for more than one year due to qualifying
Filing a Form N-470 does not relieve a permanent resident employment and you want to preserve your residence for
from obtaining a reentry permit, in advance of trips outside naturalization purposes.
the United States for a year or more, nor does it relieve the
applicant from the naturalization law's physical presence Please note that in most cases you must have been physically
requirement. present and residing in the United States for an uninterrupted
period, without any absences whatsoever, for at least one
An applicant qualifying for the residency preservation may year after your admission as a lawful permanent resident
extend the benefit to his or her spouse and dependent children before you can file a Form N-470.
who are all members of the same household and have lived
with the principal applicant while abroad. In addition, you must submit the Form N-470 to USCIS
before you have been absent from the United States for a
Another exception to the residency requirement is made for continuous period of one year. However, if your absence
alien members of the U.S. armed forces. A permanent from the United States is, was or will be solely as a clergyman
resident employee of the U.S. government abroad who has or clergywoman, missionary, brother, nun or sister of a
filed a Form N-470 is considered physically present in the religious denomination or interdenominational mission
United States during such employment abroad. He or she organization having a bona fide organization within the
does not need to obtain a reentry permit. United States, you may file this application before or after an
absence of one year or more.
NOTE: As a naturalization applicant, you may be eligible for
expeditious processing if your U.S. citizen spouse is For additional information regarding qualifying employment
employed outside the United States as a missionary, or by a and eligibility, see Step 1 of these instructions.

Form N-470 (Rev. 07/30/07) Y


Step 2. Fill Out the Form N-470.
General Instructions.
Use black ink. Type or print clearly using capital letters. If
How Do I File Form N-470? an item does not apply to you, write "N/A." If the answer is
none, write "NONE."
You do not have to be in the United States to file Form N-470, This form is divided into Parts 1 through 5. The following
but you must file it before you have been absent for a information should help you fill out the form.
continuous period of one year. However, members of a
qualifying religious or interdenominational mission Part 1. Information about you.
organization may file Form N-470 before or after an absence 1. Family Name (Last name) - Give your legal name. If you
of one year or more. have two last names, include both and use a hyphen (-)
You may include in your application a qualifying spouse and between the names, if appropriate.
dependent unmarried children, sons and daughters. These 2. Home Address - Give your physical street address. This
family members must be permanent residents and are or will must include a street number and name or a rural route
be residing outside of the United States as members of your number. Do not put a post office box (P.O. Box) number
household. here.
Follow the steps below to complete your application: 3. Mailing Address - Give your mailing address, if different
Step 1 - Reason for Filing Form N-470 from your address.
Step 2 - Fill Out the Form N-470 4. Daytime Telephone Number - Give a telephone number
Step 3 - Submit Your Application with area code where you can be reached during the day.
5. Country of Birth - Give the name of the country where
Step 1. Reason for Filing Form N-470. you were born.
Check the box in Part 2 of Form N-470 that applies to your 6. Country of Citizenship - Give the name of the country of
request. which you are a citizen.
My absence from the United States is: 7. Date of Birth - Use eight numbers to show your date of
birth (example: May 1, 1979, should be written 05/01/1979).
1. On behalf of the U. S. Government - Check Box A if you
are, or will be employed by, or are under contract with the 8. A # - This is your Alien Registration File Number. It can
U.S. Government. This includes members of the U.S. be found on your Form I-551, Permanent Resident Card.
Armed Services. 9. U.S. Social Security # - If you do not have a U.S. Social
2. For the purpose of carrying on scientific research on Security number, leave this blank.
behalf of an American institution of research - Check
Box B if you are employed by a qualifying organization. Part 2 - Reason for request.
3. For the purpose of engaging in the development of 1. Check one box that applies to your particular request.
foreign trade and commerce of the United States on Note that your absence from the United States is:
behalf of an American firm or corporation or a
subsidiary thereof - Check Box C if you are employed by a On behalf of the U. S. Government.
qualifying firm or corporation. A For the purpose of carrying on scientific research on
4. Necessary to the protection of property rights outside the behalf of an American institution of research.
United States of an American firm or corporation B. For the purpose of engaging in the development of foreign
engaged in the development of foreign trade and
trade and commerce of the United States on behalf of an
commerce of the United States - Check Box D if you are
American firm or corporation or a subsidiary thereof.
employed to perform such services.
5. On behalf of a public international organization of which C. Necessary for the protection of property rights outside the
the United States is a member- Check Box E if you are United States of an American firm or corporation engaged
employed by a qualifying organization. in the development of foreign trade and commerce of the
United States.
NOTE: Your employment cannot have started until after
D. On behalf of a public international organization of which
your admission as a permanent resident.
the United States is a member.
6. Solely because of my capacity as a clergyman or
clergywoman, missionary, nun, or sister of a F. Soley because of your capacity as a clergyman or
denomination or mission having a bona fide organization clergywoman, missionary, brother, nun or sister of a
in the United States - Check Box F if you are to serve in denomination or mission, having a bona fide organization
such capacity for a qualifying mission or organization. in the United States.

Form N-470 (Rev. 07/30/07) Y Page 2


Part 3 - Additional information. C. Your check or money order must be honored by the
bank or financial institution on which it is drawn. If it
1. Number 1 - Give the date you entered the United States as is not, we will charge you a fee and your application
a lawful permanent resident or the date you adjusted status and any document issued to you will not be valid.
to that of a lawful permanent resident.
NOTE: Please spell out Department of Homeland
2. Number 2 - Mark the appropriate box. Security. Do not use the initials "USDHS" or "DHS."
3. Number 3 - When furnishing information regarding How to Check If the Fees Are Correct.
absences, you must show each departure from and return
to the United States, including absences in foreign The form fee on this form is current as the the edition date
contiguous countries (i.e., Canada, Mexico), no matter appearing in the lower right corner of this page. However,
how short. because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below:
4. Numbers 4 through 7 - Give all the requested information.
1. Visit our website at www.uscis.gov, select
Part 4 - Signature. "Immigration Forms" check the appropriate fee;

As the applicant, you must sign and date the Form N-470. If 2. Review the Fee Schedule included in your form
you do not sign the form, the application will be returned as package, if you called us to request the form; or
incomplete. 3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.
Part 5 - Signature of person preparing form,
if other than the applicant.
Address Changes.
If you, the applicant, did not fill out Form N-470, the preparer If you change your address and you have an application or
must also sign, date and give his or her address. petition pending with USCIS, you may change your address
on-line at www.uscis.gov, click on "Change your address with
USCIS" and follow the prompts or by completing and mailing
Where to File? Form AR-11, Alien's Change of Address Card, to:

You should submit your application at the USCIS office U.S. Citizenship and Immigration Services
having jurisdiction over your place of residence in the United Change of Address
States. P.O. Box 7134
London, KY 40742-7134
What is the Filing Fee?
For commercial overnight or fast freight services only, mail
The filing fee for Form N-470 is $305.00. to:
U.S. Citizenship and Immigration Services
Use the following guidelines when you prepare your check or Change of Address
money order for the application fee. 1084-I South Laurel Road
London, KY 40744
1. The check or money order must be drawn on a bank or
other financial institution located in the United States
Evidence.
and must be payable in U.S. currency; and
Attach copies, showing the front and back of the following
2. Make the check or money order payable to the documents, if available. Do not send original documents
Department of Homeland Security, unless: unless instructed to do so.
As evidence of your eligibility, submit letters or affidavits
A. If you live in Guam and are filing your application
from the appropriate officer or the department or agency of
there, make it payable to the Treasurer, Guam.
the U.S. Government, American research institution,
B. If you live in the U.S. Virgin Islands and are filing American firm or corporation, public international
organization, or religious denomination or interdenomination
your application there, make it payable to the
mission organization. Depending on the circumstances why
Commissioner of Finance of the Virgin Islands.
you are applying to preserve your residence, the letters or
affidavits should include the following documentation:

Form N-470 (Rev. 07/30/07) Y Page 3


1. An official communication from the appropriate office of Whether you will be engaged in the development of
the department or agency of the U.S. Government, or the foreign trade and commerce of the United States; or
public international organization; or
8. Your absence from the United States was or will be
2. Affidavit or affidavits executed by the appropriate necessary for the protection of the property rights
administrative official of the American institution or abroad of the employing firm or corporation or
religious denomination or interdenominational mission subsidiary during the period or periods of absence to be
for whom you are, were or will be employed or with considered; or
whom you entered into a contract; or by the appropriate
administrative official of the American firm or 9. Solely in the capacity of a regularly ordained
corporation, or subsidiary thereof by whom you are or clergyman or clergywoman, missionary, brother, nun
will be employed. or sister; and
10. In the case where employment is for a public
When an affidavit is made with respect to employment by
international organization, the date when and place
such firm, corporation or subsidiary, it should state:
where you were first employed.
1. The title of the official making the affidavit, the name
of the firm or corporation in which he or she holds In addition, you must submit the following evidence.
office and whether he or she has access to records of
the same. 1. Attach a copy showing the front and back of your I-551,
Permanent Resident Card.
2. Whether the employing organization is an American
firm or corporation engaged in the development of 2. Copies of legal evidence of a name change or date of birth
foreign trade and commerce of the United States, or (See Part 3 of the form).
subsidiary thereof. 3. A complete copy of all passports in your possession,
expired or unexpired, issued to you since your admission
3. The nature of the business conducted by the employing
as a permanent resident to the United States.
organization, church, religious denomination or
interdenominational mission organization.
Copies. Unless specifically required that an original
4. If it is a corporation, the name of the State under laws document be filed with an application or petition, an ordinary
legible photocopy may be submitted. Original documents
of which it was organized, the date of incorporation
submitted when not required will remain a part of the record,
and that it is existent.
even if the submission was not required.
5. If it is a subsidiary (whether American or foreign) of an
American firm or corporation engaged in the Translations. Any document containing foreign language
development of foreign trade and commerce of the submitted to the Service shall be accompanied by a full
United States, the affidavit should be: English language translation which the translator has certified
as complete and accurate, and by the translator's certification
A. Executed by an appropriate administrative that he or she is competent to translate from the foreign
official of the parent organization, and language into English.

B. Should state the facts of ownership and/or What is the effect of claiming
control of the subsidiary, and nonresident alien status?
C. Should state the exact percentage of stock After having been admitted to the United States as a
owned by the parent organization. permanent resident, if you claim or claimed nonresident alien
status under the income tax laws, you may be regarded as
having abandoned your residence in the United States and as
6. The facts of your employment, including the nature of having lost permanent resident status under the immigration
the services performed by you during the period or and nationality laws. Consequently, you may be or become
periods of absence to be considered. ineligible for naturalization or for preservation of residence.
If you have claimed nonresident alien status, submit a full
7. Whether you will be engaged in the development of explanation. This should be written on a separate sheet(s) of
foreign trade and commerce of the United States; or paper.

Form N-470 (Rev. 07/30/07) Y Page 4


What is the effect on employment changes Penalties.
or on a valid document for reentry?
If you knowingly and willfully falsify or conceal a material
Approval of this application will be only for the employment
fact or submit a false document with this Form N-470, we will
and conditions stated. Any changes of employment must be
deny the FormN-470 and may deny any other immigration
approved by a new application.
benefit.
Approval of this application will not relieve you of the In addition, you will face severe penalties provided by law and
requirement to present a valid document for reentry into the may be subject to criminal prosecution.
United States.

Privacy Act Notice.


Processing Information.
We ask for the information on this form, and associated
Acceptance. Any application that is not signed or evidence, to determine if you have established eligibility for
accompanied by the correct fee will be rejected with a the immigration benefit for which you are filing. Our legal
notice that the application is deficient. You may correct right to ask for this information can be found in the
the deficiency and resubmit the application. However, an Immigration and Nationality Act, as amended. We may
application is not considered properly filed until accepted provide this information to other government agencies. Failure
by USCIS. to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form N-470.
Initial Processing. Once the application has been
accepted, it will be checked for completeness, including
submission of the required initial evidence. If you do not Paperwork Reduction Act.
completely fill out the form or file it without the required An agency may not conduct or sponsor an information
initial evidence, you will not establish a basis for collection and a person is not required to respond to a
eligibility and we may deny your application. collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
Requests for More Information. We may request more
collection of information is estimated at 35 minutes per
information or evidence, or we may request that you
response, including the time for reviewing instructions,
appear at a USCIS office for an interview. We may also
completing and submitting the form. Send comments
request that you submit the originals of any copy. We will
return these originals when they are no longer needed. regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
Decision. The decision on the Form N-300 involves a this burden, to: U.S. Citizenship and Immigration Services,
determination of whether you have established eligibility Regulatory Management Division, 111 Massachusetts
for the requested benefit. You will be notified of the Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
decision in writing. OMB No. 1615-0056. Do not mail your application to this
address.
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.

As an altenative to waiting in line for assistance at your local Check List


USCIS office, you can now schedule an appointment through
Did you completely fill out and sign the form?
our internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler and Did you attach all required evidence?
follow the screen prompts to set up your appointment. Did you attach a check or money order for the
InfoPass generates an electronic appointment notice that application fee?
appears on the screen. You should keep copies of your application and documents
for your records.

Form N-470 (Rev. 07/30/07) Y Page 5


OMB No. 1615-0056; Expires 10/31/09

Department of Homeland Security N-470, Application to Preserve


U.S. Citizenship and Immigration Services Residence for Naturalization Purposes
START HERE - Please type or print in black ink. For USCIS Use Only

Part 1. Information about you. (Person filing this application) Returned Receipt

Family Name Given Name Middle Name Date

Date
A # (if any) U.S. Social Security # (if any)
Resubmitted

Home Address - Street Number and Name Apt. # Date

Date
City State/Province Reloc Sent

Date
Zip/Postal Code Country
Date
Reloc Rec'd
Mailing Address - Street Number and Name Apt. #
Date
C/O (in care of):
Date
Remarks
City State/Province

Zip/Postal Code Country

Daytime Phone # (Area/Country Code) Date of Birth (mm/dd/yyyy)

Country of Birth Country of Citizenship

Part 2. Reason for request.


My absence from the United States is: (Check one box.) Action Block
A. On behalf of the U.S. Government.

B. For the purpose of carrying on scientific research on behalf of an American


institution of research.
C. For the purpose of engaging in the development of foreign trade and commerce
of the United States on behalf of an American firm or corporation or a
subsidiary thereof.
D. Necessary for the protection of property rights outside the United States of an
American firm or corporation engaged in the development of foreign trade and
commerce of the United States.
To Be Completed by
E. On behalf of a public international organization of which the United States is a Attorney or Representative, if any.
member.
Fill in box if G-28 is attached
F. Solely because of my capacity as a clergyman or clergywoman, missionary, to represent the applicant.
brother, nun or sister of a denomination or mission having a bona fide ATTY State License #
organization in the United States.

Form N-470 (Rev. 07/30/07) Y


Part 3. Additional information.

1. Give the date that you obtained lawful permanent resident status.
Enter date (mm/dd/yyyy)
2. Since lawfully entry as a permanent resident, have you resided in and been physically present in the United States for an
uninterrupted period of at least one year? Yes No
3. List all you absences from the United States since your admission as a lawful permanent resident. Begin with your most recent trip.

Date of Departure Date of Return Port of Entry Into Purpose of Trip


(mm/dd/yyyy) (mm/dd/yyyy) the United States

4. Explain the position of employment that requires your absence from the United States and the intended length of employment.

5. Is the name you provided in Part 1 different from the name that appears on your Form I-551, Permanent
Resident Card? Yes No
If "Yes," note the information that is different. You must provide evidence showing the legal basis for the difference.

6. Since becoming a lawful permanent resident, have you ever filed an income tax return as a nonresident
or otherwise claimed or received benefits as a nonresident alien under U.S. federal, state or local
income tax laws? Yes No
7. Are other family members who are lawful permanent residents intending to reside outside the United States
with you? Yes No
Give the following information about other family members who will reside outside the United States with you.
Name (Last/First/Middle) Date of Birth Relationship A # (if applicable)
(mm/dd/yyyy)

Part 4. Signature. Read the information on penalties in the instructions before completing this part.
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
Signature Daytime Phone Number (with area code) E-Mail Address (if any) Date (mm/dd/yyyy)

NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible
for the requested document and this application may be denied.
Part 5. Signature of person preparing form, if other than above. (Sign below)
I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge.
Signature Print or Type Your Name

Firm Name and Address Date (mm/dd/yyyy)

Daytime Phone Number (with area code) E-Mail Address (if any) Fax Number (if any)

Form N-470 (Rev. 07/30/07) Y Page 2


OMB No. 1615-0057; Expires 10/31/08

Department of Homeland Security


Instructions for N-600, Application
U.S. Citizenship and Immigration Services for Certificate of Citizenship
Instructions

4. You may also file for a certificate of citizenship if all of


What Is the Purpose of This Form? the following actions occurred before your 18th birthday
and prior to February 27, 2001:
Form N-600 is an application for a Certificate of Citizenship.
A. You regularly resided in the United States after
admission as a lawful permanent resident, and
Who Should Use Form N-600? B. Both of your parents, the parent having legal and
physical custody of you, or your sole surviving parent
1. You may use this form if you claim U.S. citizenship either naturalized as a U.S. citizen.
by action of law while residing in the United States or by
having been born outside the United States to U.S. citizen 5. If you are the biological child of a U.S. citizen, you were
parent(s). born outside the United States and you are claiming
citizenship by having been born to U.S. citizen parent(s),
2. If you are the biological or adopted child of a U.S. you automatically become a U.S. citizen at birth if:
citizen, you were born outside the United States, and you
are claiming citizenship by action of law, you A. You were born to two U.S. citizen parents and at
automatically become a U.S. citizen if: least one of your parents had a residence in the United
States or one if its outlying possessions. This
A. You have at least one parent who is a U.S. citizen, residence had to have taken place prior to your birth;
whether by birth or naturalization; and or
B. You regularly reside in the United States in the legal B. You were born to parents, one of whom is an alien and
and physical custody of your U.S. citizen parent; and the other a U.S. citizen who, prior to your birth, had
been physically present in the United States or one of
C. You have been lawfully admitted for permanent
its outlying possessions for a period or periods totaling
residence (NOTE: If you entered the United States
not less than five years, at least two of which were
as an adopted child, you must have been admitted as
after the age of 14 years.
an IR-3 (child adopted outside the United States). If
you entered as an IR-4 (child coming to the United NOTE: To determine if you were born a U.S. citizen, USCIS
States to be adopted), a final adoption must take must look at the law that was in effect at the time of your
place for this section of law to apply to you; and birth. The current law was enacted on November 14, 1986,
and was last amended on February 27, 2001. If you were born
D. You have not yet reached your 18th birthday; and before November 14, 1986, and believe you may be a U.S.
E. You are a biological child, you were legitimate, or citizen, you should contact USCIS by calling our National
you were legitimated while in the legal custody of Customer Service Center 1-800-375-5283 or visiting our
your legitimating parent(s) prior to reaching your internet website at http://www.uscis.gov.
16th birthday; or
F. You are a biological child born out of wedlock and Who May File This Form?
you have not been legitimated and your mother
naturalizes as a U.S. citizen. 1. Form N-600 may be filed by any person claiming to have
acquired (at birth) or derived (after birth) U.S. citizenship
NOTE: If you are now over the age of 18 years but all of the through a U.S. citizen parent.
above conditions applied to you before your 18th birthday and
you were under the age of 18 on February 27, 2001 (the date 2. Any person who was born a U.S. citizen outside the
the law took effect), you may file this form to obtain a United States or who fulfilled the requirements for
certificate of citizenship. becoming a U.S. citizen prior to their 18th birthday may
file this form at any time during his or her lifetime.
3. If you were under the age of 18 on February 27, 2001, but
not all of the conditions noted above were met prior to
your 18th birthday, you must qualify for U.S. citizenship
in your own right.

Form N-600 Instructions (Rev. 10/15/07)Y


3. In the case of minor adopted or biological children (under 2. Make the check or money order payable to U.S.
18 years) qualifying for citizenship under section 320 of Department of Homeland Security, unless:
the Immigration and Nationality Act (INA), the
application must be filed by the U.S. citizen parent or A. If you live in Guam and are filing your petition there,
legal guardian with legal and physical custody of the make it payable to Treasurer, Guam.
child.
B. If you live in the U.S. Virgin Islands and are filing
4. In the case of an adult applicant with a disability, an your petition there, make it payable to Commissioner
immediate relative or legal guardian may file the of Finance of the Virgin Islands.
application.
C. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S. embassy
Who May Not File This Form? or consulate for instructions on the method of
payment.
1. Persons who do not have a claim to citizenship either at NOTE: Please spell out U.S. Department of Homeland
the time of birth or by action of law. Security; do not use the initials "USDHS" or "DHS."

2. Stepchildren. Notice to Those Making Payment by Check. If you send us


a check, it will be converted into an electronic funds transfer
3. Children who are not legitimate or who were not (EFT). This means we will copy your check and use the
legitimated prior to their 16th birthday. (Except for account information on it to electronically debit your account
children who were born abroad to an eligible U.S. citizen for the amount of the check. The debit from your account will
mother or eligible children who became citizens through usually take 24 hours, and will be shown on your regular
the naturalization of their mother). account statement.
4. U.S. citizen parents of children who regularly reside You will not receive your original check back. We will
outside the United States. They should refer to Form destroy your original check, but we will keep a copy of it. If
N-600K, Application for Citizenship and Issuance of the EFT cannot be processed for technical reasons, you
Certificate Under Section 322. authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times.
Where To File?
How to Check If the Fees Are Correct.
The completed Form N-600 and accompanying
documentation must be filed with the appropriate USCIS The form and biometric fees on this form are current as of the
district or field office in the United States with jurisdiction edition date appearing in the lower right corner of this page.
over your place of residence. However, because USCIS fees change periodically, you can
verify if the fees are correct by following one of the steps
below:
What Is the Filing Fee?
1. Visit our website at www.uscis.gov, select "Immigration
The fee for this Form N-600 is $460.00, except for U.S. Forms," and check the appropriate fee;
citizen parents requesting a Certificate of Citizenship for an
adopted chid. 2. Review the Fee Schedule included in your form package
if you called us to request the form; or
For U.S. citizen parents filing on behalf of an adopted minor
3. Telephone our National Customer Service Center at
child under section 320 of the INA (checking Part 2, Box C
1-800-375-5283 and ask for the fee information.
on the Form), the fee for the Form N-600 is $420.00.
The fee must be paid at the time of filing the application. The
fee is not refundable, even if the application is subsequently General Instructions.
withdrawn.

Use the following guidelines when you prepare your check or


Step 1. Fill Out the Form N-600
money order for the Form N-600. 1. Type or print legibly in black ink.
1. The check or money order must be drawn on a bank or 2. If extra space is needed to complete any item, attach a
other financial institution located in the United States and continuation sheet, indicate the item number, and date and
must be payable in U.S. currency; and sign each sheet.

Form N-600 Instructions (Rev. 10/15/07)Y Page 2


3. Write your name, your ''A" number (if any) and "N-600" A. Translations - Any document in a foreign language
on the top right corner of the sheet. must be accompanied by a translation in English. The
translator must certify that he or she is competent to
4. Answer all questions fully and accurately. State that an
translate and that the translation is true and accurate.
item is not applicable with "N/A." If the answer is none,
For each document needed, you may submit a clear,
write "none."
readable copy or the originals. Do not send an
5. If you are the applicant or you are filing for a child original Certificate of Citizenship or Certificate of
and you or the child have an A-number, write that Naturalization. USCIS may request that you present
A-number in the place indicated on the top right hand original documents at the interview.
corner of the first page. If there is no A-number, leave B. Birth certificate or record - A certified birth
this blank. The A-number can be found on you or the certificate or record issued by a civil authority in the
child's Permanent Resident Card, if applicable, or on DHS country of birth.
issued travel documents or letters.
C. Marriage certificate(s) - Certified marriage
6. If the A-number has fewer than nine numbers, place certificate(s) issued by a civil authority in the state or
enough zeros before the first number to make a total of country of marriage.
nine numbers on the application. For example, A 12 345
678 as A 012 345 678. D. Documents showing the termination of a marriage
Examples include a divorce decree, death certificate,
7. Individuals can become citizens under several very or annulment document.
different sections of law and can use this form to obtain a
certificate of citizenship. You only need to complete F. Proof of U.S. citizenship - Examples of this are birth
those sections of the form that relate to you or the child's certificates showing birth in the United States; an
eligibility. N-550, Certificate of Naturalization; an N-560,
Certificate of Citizenship; an FS-240, Report of Birth
Step 2. General Requirements. Abroad of United States Citizen; or a valid unexpired
U.S. passport.
You do not need to submit documents that were provided in
connection with: G. Proof of status as national of United States - (Only
required for applicants claiming U.S. citizenship
1. An application for an immigrant visa and retained by the through a national of the United States, such as a
U.S. embassy or consulate for inclusion in the immigrant person born in American Samoa or Swains Islands.)
visa package, or A person is born a citizen if born outside of the United
States and its outlying possessions of parents, one of
2. An immigrant petition or application and included in a whom is a citizen of the United States who has been
USCIS administrative file. You should indicate that you physically present in the United States or one of its
want USCIS to rely on such documents and identify the outlying possessions for a continuous period of one
administrative file(s) by name and A-number. USCIS will year prior to the birth of such person, and the other of
only request the required documentation again if whom is a national but not a citizen of the United
necessary. States. If the non-citizen parent is an alien but not a
national, the citizen parent would need to meet the
3. The following is a list of documents that must be
physical presence requirement, depending on the date
submitted with the Form N-600, if the USCIS does not
of birth, prior to the child's birth.
already have the document or if you would rather
resubmit the document than wait for the retrieval of the
H. Proof of legitimation - (Only required for applicants
USCIS file. Unless specifically noted otherwise, you
who were born out of wedlock).
must submit each of the documents listed below for
yourself and/or your child and the U.S. citizen parent(s) Documents must establish legitimation according to
through whom you are claiming U.S. citizenship. the laws of the child's residence or domicile or father's
residence or domicile (if applicable). Legitimation for
INA benefits requires that the child be in the legal
custody of the legitimating parent(s) at the time of
legitimation.

Form N-600 Instructions (Rev. 10/15/07)Y Page 3


I. Proof of legal custody - (Only required for D. Census records - State or federal census records
applicants whose U.S. citizen parent(s) divorced and/ showing the name(s) and place(s) of birth, and the
or separated and for applicants who are adopted or date(s) of birth or age(s) of the person(s) listed.
legitimated).
E. Affidavits - Written statements sworn (or affirmed)
J. Copy of Permanent Resident Card or other to by two persons who have personal knowledge of
evidence of Lawful Permanent Resident status - the claimed event (i.e., the date and place of a birth,
(Only required for applicants claiming U.S. marriage, or death). The persons may be relatives and
citizenship through alien parent(s) who naturalized need not be citizens of the United States. Each
or claiming automatic acquisition of U.S. citizenship affidavit should contain the following information
while under the age of 18 under section 320 of INA.) regarding the person making the affidavit: his or her
full name and address; date and place of birth;
K. Proof of required residence or physical presence in relationship to the applicant, if any; full information
the United States - Any document that proves the concerning the event; and complete details concerning
U.S citizen parent(s)' residence or physical presence how he or she acquired knowledge of the event.
in the United States. This proof may include but is not
limited to the following:
Photographs.
1. School, employment, military records;
(Photographs only required of the person to whom the
2. Deeds, mortgages, leases showing residence; Certificate of Citizenship will be issued).
3. Attestations by churches, unions, or other
You must submit two identical color photographs of yourself
organizations;
taken within 30 days of the filing of this application. The
4. U.S. Social Security quarterly reports; photos must have a white to off-white background, be printed
on thin paper with a glossy finish, and be unmounted and
5. Affidavits of third parties having knowledge of unretouched.
the residence and physical presence.
Passport-style photos must be 2" x 2." The photos must be in
L. Copy of full, final adoption decree - (Only required color with full face, frontal view on a white to off-white
for adopted applicants). background. Head height should measure 1" to 1 3/8" from
M. Evidence of all legal name changes. top of hair to bottom of chin, and eye height is between 1 1/8"
to 1 3/8" from bottom of photo. Your head must be bare
4. If it is not possible to obtain any one of the above- unless you are wearing a headdress as required by a religious
required documents, you must establish why the evidence order of which you are a member.
is not available. You may be required to submit an
The photographs must not be signed. Using a soft lead pencil,
original written statement from the relevant government
print your name (or if a U.S. citizen parent applying on behalf
or other authority explaining the reason for the
of a minor child, the child's name) and Alien Registration
unavailability of the document(s).
Number (if applicable) in the center of the back of each
A. Baptismal certificate - A certificate under the seal of photograph.
the church where the baptism occurred, showing the
date and place of the child's birth, date of baptism, the Step-by-Step Instructions.
names of the godparents, if known.
This form is divided into ten parts. The information below
B. Church records - A certificate under the church seal will help you fill out the form.
issued within two months of birth.
C. School record - A letter from authorities of the Part 1. Information About Your Child.
school attended (preferably the first school), showing
the date of admission to the school, the child's date of The person seeking the Certificate of Citizenship should
birth or age at that time, place of birth, and the names complete information in this section.
and places of birth of parents, if shown in the school
records. NOTE: If you are a U.S. citizen parent applying for a
certificate of citizenship on behalf of your minor biological or
adopted child, provide information relating to your minor
child.

Form N-600 Instructions (Rev.10/15/07)Y Page 4


1. Current legal name - Your current legal name is the Part 3. Additional Information About You.
name on the birth certificate, unless it has been changed
after birth by a legal action such as a marriage, adoption, Complete information must be provided about the person
or court order. seeking a Certificate of Citizenship.
2. Name exactly as it appears on your Permanent NOTE: If you are a U.S. citizen parent applying for a
Resident Card (if different from above) - Write your Certificate of Citizenship on behalf of your minor biological
name exactly as it appears on the card, even if it is or adopted child, submit information relating to your minor
misspelled. child.
3. Other names used since birth - If you have ever used 1. Home address - Give the address where you now live. Do
any other names since birth, write them in this section. If not put post office (P.O.) box numbers here.
you need more space, use a separate sheet of paper.
2. Mailing address - If your mailing address is the same as
4. U.S. Social Security Number - Print your U.S. Social
the home address, write "same." If the mailing address is
Security Number. If the child does not have a U.S. Social
different from your home address, write it in this part.
Security Number, write "N/A" in the space provided.
Provide "Care Of" information if applicable.
5. Date of birth - Use eight numbers to show your date of
birth (example: May 1, 1979, should be written 3. Telephone numbers (optional) - Telephone numbers and
05/01/1979). e-mail addresses allow USCIS to contact you more
quickly about the application. If you are hearing
6. Country of birth - Give the name of the country where impaired and use a TTY telephone connection, please
you were born. Write the name of the country even if it no indicate this by writing "(TTY)" after the telephone
longer exists. If the name of the country has changed, number.
write the name of the country as it was at the time of your
birth. 4. Current marital status - Check the marital status you
have on the date you are filing this application. If you
7. Country of prior nationality - If you were a citizen of a are currently not married but had a prior marriage that
different country before becoming a U.S. citizen, write was annulled (declared by a court to be invalid), check
the name of the country of your prior nationality. "Other" and provide an explanation.

A. If the country no longer exists and/or the child is 5. Information about your child's entry into the United
stateless, write the name of the country where the States and current immigration status-
child was last a citizen or national.
A. Provide information about where you entered the
B. If you were a citizen or national of more than one United States and what name you used when you
country, write the name of the foreign country that entered.
issued your last passport.
B. Provide information about what documents you
8. Gender - Indicate whether male or female.
presented to enter the United States. Provide your
9. Height - Give your height in feet and inches. passport number and date of issuance, if known.

C. Provide information about your immigration status on


Part 2. Information About Your Eligibility. entry into the United States.

Check the box in Section A that best indicates why you are D. If you adjusted to lawful permanent resident status
eligible for a Certificate of Citizenship. while in the United States, provide the date you
became a lawful permanent resident and place where
If you are a U.S. citizen parent applying for a Certificate of such status was granted.
Citizenship on behalf of a minor child, check the box in either
Section B or C, indicating whether you are applying for a 6. Previous application for Certificate of Citizenship or
biological or adopted child. U.S. passport - If you previously applied for a Certificate
of Citizenship or a U.S. passport (or you are a U.S. citizen
If the basis for your eligibility is not described in any of the parent who previously applied for a Certificate of
categories, check Box D "Other" and briefly write the basis Citizenship or U.S. passport for your minor child),
for your application on the lines provided. indicate on a separate piece of paper what happened with
the application and whether a Certificate of Citizenship or
U.S. passport was or was not issued.

Form N-600 Instructions (Rev. 10/15/07)Y Page 5


7. Information on adoption - If you were adopted, provide 2. Date of birth - Use eight numbers to show the U.S.
information as to the place and date of the adoption. citizen father's date of birth (example: May 1, 1969,
should be written 05/01/1969).
8. Re-adoption in the United States - Children who are
admitted to the United States under section 101(b)(1)(F) 3. Country of birth - Give the name of the country where
of the INA as IR-4s (orphans coming to the United States the U.S. citizen father was born. Write the name of the
to be adopted by U.S. citizen parent(s)) do not country even if it no longer exists. If the name of the
automatically acquire citizenship on entry, even though country has changed, write the name of the country as it
admitted as lawful permanent residents. Children was at the time of the U.S. citizen father's birth.
admitted as IR-4s must have been finally adopted in the
United States or had the foreign adoption recognized by 4. Country of nationality - Write the name of the country
the state where the child is permanently residing. If you or where the U.S. citizen father is currently a citizen or
your child had to be re-adopted in the United States, national. If the country no longer exists and/or you are
provide the information requested. If the appropriate stateless, write the name of the country where the U.S.
authority in your current place of residence recognizes the citizen father was last a citizen or national.
validity of a full, final foreign adoption, submit evidence
5. Home address - Give the address where the U.S. citizen
of this.
father now lives. Do not put post office (P.O.) box
numbers here. If deceased, write "deceased" and provide
9. Marital status of parents at time of birth (or adoption)
the date of death.
Indicate whether the child's parents were married to each
other at the time of the child's birth. If the child was born 6. U. S. citizenship - Indicate how the U.S. citizen father
out-of-wedlock, indicate "No," even if the parents became a U.S. citizen. Provide all the requested
subsequently married. If the child was adopted, indicate information.
whether the adoptive parents were married to each other
at the time of the adoption. 7. Loss of U. S. citizenship - Indicate whether the U.S.
citizen father ever lost his U.S. citizenship. Provide this
If you are a U.S. citizen parent applying on behalf of a information even if the U.S. citizen father regained
minor biological or adopted child, indicate whether you citizenship at a later date.
were married to the child's natural (or adoptive mother) at
the time of your minor child's birth (or adoption). If your 8. Residence and/or physical presence- Only applicants
minor child was born out-of-wedlock, indicate "No," even born outside the United States who are claiming to have
if you subsequently married the child's other parent. been born U.S. citizens are required to provide all the
dates when their U.S. citizen father was in the United
10. Absences from the United States - Provide the States. Dates should include all time immediately after
requested information for every trip that you have taken birth as well as after the age of 14 years and older.
since you first arrived in the United States. Begin with the
most recent trip. This information is needed only for 9. Marital history-
persons born before October 10, 1952, who are claiming
U.S. citizenship at the time of birth. A. Write the number of times the U.S. citizen father was
married. Include any annulled marriages. If he was
married more than one time to the same spouse, count
Part 4. Information About the U.S. Citizen Father each time as a separate marriage.
(or Adoptive Father).
B. If now married, provide information about the U.S.
Information in this section should be completed if you are citizen father's current spouse. Check the appropriate
claiming citizenship through a U.S. citizen father (or adoptive box to indicate his immigration status.
father). If you are claiming citizenship solely through a U.S.
C. Indicate whether the U.S. citizen father's current
citizen mother (or adoptive mother), see Part 5 of the form.
spouse is also your parent. If "No," you will be asked
to provide information about your father's previous
NOTE: If you are a U.S. citizen father (or adoptive father)
spouse or spouses.
applying for a Certificate of Citizenship on behalf of your
minor child, where information is requested about the U.S.
citizen, provide information about YOURSELF in the
sections noted.

1. Current legal name - Give the U.S. citizen father's


current legal name. It is the name on the birth certificate
unless it was changed after birth by a legal action
(marriage, adoption, or court order).

Form N-600 Instructions (Rev. 10/15/07)Y Page 6


Part 5. Information About Your U.S. Citizen 9. Marital history-
Mother (or Adoptive Mother). A. Write the number of times the U.S. citizen mother was
married. Include any annulled marriages. If she was
Information in this section should be completed if you are
married more than one time to the same spouse, count
claiming citizenship through a U.S. citizen mother (or
each time as a separate marriage.
adoptive mother). If you are claiming citizenship solely
through a U.S. citizen father (or adoptive father), see Part 4 of B. If now married, provide information about the U.S.
the form. citizen mother's current spouse.Check the appropriate
NOTE: If you are a U.S. citizen mother (or adoptive mother) box to indicate his immigration status.
applying on behalf of your minor child, where information is
C. Indicate whether the U.S. citizen mother's current
requested about "the U.S. citizen mother," provide
spouse is also your parent. If "No," you will be asked
information about YOURSELF in the sections noted.
to provide information about your mother's previous
spouse or spouses.
1. Current legal name - Give current legal name of the U.S.
citizen mother. It is the name on her birth certificate unless
it was changed after birth by a legal action such as a Part 6. Information About Military Service of U.S.
marriage, adoption, or court order. Citizen Parent -- (Applicable only for
applications filed under section 301(g)
2. Date of birth - Use eight numbers to show the U.S.
citizen mother's date of birth (example: May 1, 1969, Provide requested information if either U.S. citizen parent
should be written 05/01/1969). served in the U.S. Armed Forces. Also indicate whether he or
she was honorably discharged from service.
3. Country of birth - Give the name of the country where
the U.S. citizen mother was born. Write the name of the
Part 7. Your Signature.
country even if it no longer exists. If the name of the
country has changed, write the name of the country as it If you are over the age of 18 years and you are filing this
was at the time of the U.S. citizen mother's birth. application for yourself, you must sign and date the
application. If you do not sign the application, USCIS will
4. Country of nationality - Write the name of the country return the application to you.
where the U.S. citizen mother is currently a citizen or
national. If the country no longer exists and/or you are If you are under the age of 18 years and your U.S. citizen
stateless, write the name of the country where the U.S. parent or legal guardian is filing the application on your
citizen mother was last a citizen or national. behalf, your U.S. citizen parent or legal guardian must sign
and date the application. If your U.S. citizen parent or legal
5. Home address - Give the address where the U.S. citizen guardian does not sign the application, the application will be
mother now lives. Do not put post office (P.O.) box returned.
numbers here. If the U.S. citizen mother is deceased,
write "deceased" and provide the date of death.
Part 8. Signature of Person Preparing Form,
6. U. S. citizenship - Indicate how the U.S. citizen mother If Other Than Applicant.
became a U.S. citizen. Provide all the requested
information. If you do not fill out this Form N-600, the preparer must also
sign, date and give his or her address. If the preparer is a
7. Loss of U. S. citizenship - Indicate whether the U.S. business or organization, it is name must be included on the
citizen mother ever lost her U.S. citizenship. Provide this form.
information even if the U.S. citizen mother regained
citizenship at a later date.
Part 9. Affidavit.
8. Residence and/or physical presence - Only applicants Do not complete this part.
who are claiming to have been born U.S. citizens outside
of the United States are required to provide all the dates
when the U.S. citizen mother was in the United States. Part 10. Officer Report and Recommendation.
Dates should include all time immediately after birth as
Do not complete this part.
well as after the age of 14 years and older.

Form N-600 Instructions (Rev.10/15/07)Y Page 7


As an altenative to waiting in line for assistance at your local
Address Changes. USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
If you change your address and you have an application or visit our website. Use the InfoPass appointment scheduler and
petition pending with USCIS, you may change your address follow the screen prompts to set up your appointment.
on-line at www.uscis.gov, click on "Change your address with InfoPass generates an electronic appointment notice that
USCIS," and follow the prompts. Or you may complete and appears on the screen.
mail a Form AR-11, Alien's Change of Address Card, to:

U.S. Citizenship and Immigration Services Penalties.


Change of Address
P.O. Box 7134 If you knowingly and willfully falsify or conceal a material
London, KY 40742-7134 fact or submit a false document with this request, we will
deny the benefit you are filing for, and may deny any other
For commercial overnight or fast freight services only, mail to:
immigration benefit.
In addition, you will face severe penalties provided by law,
U.S. Citizenship and Immigration Services
and may be subject to criminal prosecution.
Change of Address
1084-I South Laurel Road
London, KY 40744 Privacy Act Notice.

We ask for the information on this form, and associated


Processing Information. evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
Any Form N-600 that is not signed or accompanied by the right to ask for this information can be found in the
correct fee will be rejected with a notice that the Form Immigration and Nationality Act, as amended. We may
N-600 is deficient. You may correct the deficiency and provide this information to other government agencies. Failure
resubmit the Form N-600. An application or petition is not to provide this information, and any requested evidence, may
considered properly filed until accepted by USCIS. delay a final decision or result in denial of your Form N-600.
Initial processing. Once a Form N-600 has been accepted,
it will be checked for completness, including submission of
Paperwork Reduction Act.
the required initial evidence. If you do not completely fill out
the form, or file it without required initial evidence, you will
not establish a basis for eligibility, and we may deny your An agency may not conduct or sponsor an information
Form N-600. collection and a person is not required to respond to a
collection of information unless it displays a currently valid
Requests for more information or interview. We may OMB control number. The public reporting burden for this
request more information or evidence, or we may request that collection of information is estimated at 1 hour and 35
you appear at a USCIS office for an interview. We may also minutes per response, including the time for reviewing
request that you submit the originals of any copy. We will instructions, completing and submitting the form. Send
return these originals when they are no longer required. comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for
Decision. The decision on a Form N-600 involves a reducing this burden, to: U.S. Citizenship and Immigration
determination of whether you have established eligiblity for Services, Regulatory Management Division, 111
the requested benefit. You will be notified of the decision in Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
writing. Washington, DC 20529. OMB No. 1615-0057. Do not mail
your application to this address.

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.

Form N-600 Instructions (Rev.10/15/07)Y Page 8


OMB No. 1615-0057, Expires 10/31/08

Department of Homeland Security N-600, Application for


U.S. Citizenship and Immigration Services Certificate of Citizenship

Print clearly or type your answers, using CAPITAL letters in black ink. Failure to print clearly may delay processing of your application.

Part I. Information about you. (Provide information about yourself, if you are If your child has an "A" Number,
a person applying for the Certificate of Citizenship. If you are a U.S. citizen parent write it here:
applying for a Certificate of Citizenship for your minor child, provide information A
about your child).
1. Current legal name For USCIS Use Only
Family Name (Last Name) Returned Receipt

Date
Given Name (First Name) Full Middle Name (If applicable)
Date
Resubmitted
2. Name exactly as it appears on your Permanent Resident Card (If applicable).
Family Name (Last Name) Date

Date
Given Name (First Name) Full Middle Name (If applicable)
Reloc Sent

Date
3. Other names used since birth
Family Name (Last Name) Given Name (First Name) Middle Name (If applicable) Date
Reloc Rec'd

Date

4. U.S. Social Security # (If applicable) 5. Date of Birth (mm/dd/yyyy) Date


Remarks

6. Country of Birth 7. Country of Prior Nationality

8. Gender 9. Height
Male Female

Part 2. Information about your eligibility. (Check only one.) Action Block
A. I am claiming U.S. citizenship through:

A U.S. citizen father or a U.S. citizen mother.

Both U.S. citizen parents.

A U.S. citizen adoptive parent(s).

An alien parent(s) who naturalized.

B. I am a U.S. citizen parent applying for a certificate of citizenship on


behalf of my minor (under 18 years) BIOLOGICAL child. To Be Completed by
C. I am a U.S. citizen parent applying for a certificate of citizenship on Attorney or Representative, if any.
behalf of my minor (less than 18 years) ADOPTED child. Fill in box if G-28 is attached to
represent the applicant.
D. Other (Please explain fully)
ATTY State License #

Form N-600 (Rev. 10/15/07) Y


Part 3. Additional information about you. (Provide additional information about yourself, if you are the person
applying for the Certificate of Citizenship. If you are a U.S. citizen parent applying for a Certificate of
Citizenship for your minor child, provide the additional information about your minor child).
1. Home Address - Street Number and Name (Do not write a P.O. Box in this space) Apartment Number

City County State/Province Country Zip/Postal Code

2. Mailing Address - Street Number and Name (If different from home address) Apartment Number

City County State/Province Country Zip/Postal Code

3. Daytime Phone Number (If any) Evening Phone Number (If any) E-Mail Address (If any)

( ) ( )
4. Marital Status
Single, Never Married Married Divorced Widowed

Marriage Annulled or Other (Explain)

5. Information about entry into the United States and current immigration status
A. I arrived in the following manner:
Port of Entry (City/State) Date of Entry (mm/dd/yyyy) Exact Name Used at Time of Entry:

B. I used the following travel document to enter:


Passport
Passport Number Country Issuing Passport Date Passport Issued (mm/dd/yyyy)

Other (Please Specify Name of Document and Dates of Issuance)

C. I entered as:

An immigrant (lawful permanent resident) using an immigrant visa


A nonimmigrant
A refugee
Other (Explain)

D. I obtained lawful permanent resident status through adjustment of status (If applicable):
Date you became a Permanent Resident (mm/dd/yyyy) USCIS Office where granted adjustment of status

6. Have you previously applied for a certificate of citizenship or U.S. passport? No Yes (Attach explanation)

Form N-600 (Rev. 10/15/07) Y Page 2


Part 3. Additional information about you. (Provide additional information about yourself, if you are the person applying for
the Certificate of Citizenship. If you are a U.S. citizen parent applying for a Certificate of Citizenship for your minor child, provide
the additional information about your minor child). Continued.

7. Were you adopted? No Yes (Please complete the following information):


Date of Adoption (mm/dd/yyyy) Place of Final Adoption (City/State or Country)

Date Legal Custody Began (mm/dd/yyyy) Date Physical Custody Began (mm/dd/yyyy)

8. Did you have to be re-adopted in the United States? No Yes (Please complete the following information):
Date of Final Adoption (mm/dd/yyyy) Place of Final Adoption (City/State)

Date Legal Custody Began (mm/dd/yyyy) Date Physical Custody Began (mm/dd/yyyy)

9. Were your parents married to each other when you were born (or adopted)? No Yes
10. Have you been absent from the United States since you first arrived? (Only for persons born before
October 10, 1952, who are claiming U.S. citizenship at time of birth; otherwise, do not complete this section.) No Yes
If yes, complete the following information about all absences, beginning with your most recent trip. If you need more space, use a separate
sheet of paper.

Date You Left the United States Date You Returned to the United States Place of Entry Upon Return to
(mm/dd/yyyy) (mm/dd/yyyy) the United States

Part 4. Information about U.S. citizen father (or adoptive father). (Complete this section if you are claiming citizenship
through a U.S. citizen father. If you are a U.S. citizen father applying for a Certificate of Citizenship on
behalf of your minor biological or adopted child, provide information about yourself below.)
1. Current legal name of U.S. citizen father.
Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Country of Nationality

5. Home Address - Street Number and Name (If deceased, so state and enter date of death.) Apartment Number

City County State/Province Country Zip/Postal Code

Form N-600 (Rev. 10/15/07) Y Page 3


Part 4. Information about U.S. citizen father (or adoptive father). (Complete this section if you are claiming citizenship
through a U.S. citizen father. If you are a U.S. citizen father applying for a Certificate of Citizenship on
behalf of your minor biological or adopted child, provide information about yourself below.) Continued.
6. U.S. citizen by:
Birth in the United States
Birth abroad to U.S. citizen parent(s)
Acquisition after birth through naturalization of alien parent(s)
Naturalization
Date of Naturalization (mm/dd/yyyy) Place of Naturalization (Name of Court and City/State or USCIS or Former INS Office Location)

Certificate of Naturalization Number Former ''A'' Number (If known)

7. Has your father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
No Yes (Provide full explanation on a separate sheet(s) of paper.)
8. Dates of Residence and/or Physical Presence in the United States (Complete this only if you are an applicant claiming U.S.
citizenship at time of birth abroad)
Provide the dates your U.S. citizen father resided in or was physically present in the United States. If you need more space, use a separate
sheet(s) of paper.
From To
(mm/dd/yyyy) (mm/dd/yyyy)

9. Marital History
A. How many times has your U.S. citizen father been married (including annulled marriages)?
B. Information about U.S. citizen father's current spouse:
Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

Date of Birth (mm/dd/yyyy) Country of Birth Country of Nationality

Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip/Postal Code

Date of Marriage (mm/dd/yyyy) Place of Marriage (City/State or Country)

Spouse's Immigration Status:


U.S. Citizen Lawful Permanent Resident Other (Explain)

C. Is your U.S. citizen father's current spouse also your mother? No Yes

Form N-600 (Rev. 10/15/07) Y Page 4


Part 5. Information about your U.S. citizen mother (or adoptive mother). (Complete this section if you are claiming
citizenship through a U.S. citizen mother (or adoptive mother). If you are a U.S. citizen mother applying for a Certificate of
Citizenship on behalf of your minor biological or adopted child, provide information about yourself below).
1. Current legal name of U.S. citizen mother.
Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Country of Nationality

5. Home Address - Street Number and Name (If deceased, so state and enter date of death) Apartment Number

City County State/Province Country Zip/Postal Code

6. U.S. citizen by:


Birth in the United States
Birth abroad to U.S. citizen parent(s)
Acquisition after birth through naturalization of alien parent(s)
Naturalization
Date of Naturalization (mm/dd/yyyy) Place of Naturalization (Name of Court and City/State or USCIS)

Certificate of Naturalization Number Former ''A'' Number (If known)

7. Has your mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
No Yes (Provide full explanation on a separate sheet(s) of paper.)
8. Dates of Residence and/or Physical Presence in the United States (Complete this only if you are an applicant claiming U.S.
citizenship at time of birth abroad)
Provide the dates your U.S. citizen father resided in or was physically present in the United States. If you need more space, use a separate
sheet(s) of paper.
From To
(mm/dd/yyyy) (mm/dd/yyyy)

9. Marital History
A. How many times has your U.S. citizen mother been married (including annulled marriages)?
B. Information about U.S. citizen mother's current spouse:
Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

Date of Birth (mm/dd/yyyy) Country of Birth Country of Nationality

Form N-600 (Rev. 10/15/07) Y Page 5


Part 5. Information about your U.S. citizen mother (or adoptive mother). (Complete this section if you are claiming
citizenship through a U.S. citizen mother (or adoptive mother). If you are a U.S. citizen mother applying for a Certificate of
Citizenship on behalf of your minor biological or adopted child, provide information about yourself below). Continued.
C. Information about U.S. citizen mother's current spouse: (Continued.)
Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip/Postal Code

Date of Marriage (mm/dd/yyyy) Place of Marriage (City/State or Country)

Spouse's Immigration Status:


U.S. Citizen Lawful Permanent Resident Other (Explain)
D. Is your U.S. citizen mother's current spouse also your father? No Yes

Part 6. Information about military service of U. S. citizen parent(s). (Complete this only if you are an applicant claiming
U.S. citizenship at time of birth abroad.)
1. Has your U. S. citizen parent(s) served in the armed forces? No Yes
2. If "Yes," which parent? U.S. Citizen Father U.S. Citizen Mother
3. Dates of Service. (If time of service fulfills any of required physical presence, submit evidence of service.)
From (mm/dd/yyyy) To (mm/dd/yyyy) From (mm/dd/yyyy) To (mm/dd/yyyy)

4. Type of discharge. Honorable Other than Honorable Dishonorable

Part 7. Signature.
I certify, under penalty of perjury under the laws of the United States, that this application and the evidence submitted with it is all true
and correct. I authorize the release of any information from my records, or my minor child's records, that U.S. Citizenship and
Immigration Services needs to determine eligibility for the benefit I am seeking.
Applicant's Signature Printed Name Date (mm/dd/yyyy)

Part 8. Signature of person preparing this form, if other than applicant.


I declare that I prepared this application at the request of the above person. The answers provided are based on information of which I
have personal knowledge and/or were provided to me by the above-named person in response to the questions contained on this form.
Preparer's Signature Preparer's Printed Name Date (mm/dd/yyyy)

Name of Business/Organization (If applicable) Preparer's Daytime Phone Number

( )
Preparer's Address - Street Number and Name

City County State Zip Code

Form N-600 (Rev. 10/15/07) Y Page 6


NOTE: Do not complete the following parts unless a USCIS officer instructs you to do so at the interview.

Part 9. Affidavit.
I, the (applicant, parent or legal guardian) do swear or affirm, under penalty of perjury laws of the
United States, that I know and understand the contents of this application signed by me, and the attached supplementary pages number ( ) to
( ) inclusive, that the same are true and correct to the best of my knowledge, and that corrections number ( ) to ( ) were made by me or
at my request.

Signature of parent, guardian or applicant Date (mm/dd/yyyy)

Subscribed and sworn or affirmed before me upon examination of the applicant (parent, guardian) on at

Signature of Interviewing Officer Title

Part 10. Officer Report and Recommendation on Application for Certificate of Citizenship.
On the basis of the documents, records and the testimony of persons examined, and the identification upon personal appearance of the underage

beneficiary, I find that all the facts and conclusions set forth under oath in this application are true and correct; that the applicant did

derive or acquire U.S. citizenship on (mm/dd/yyyy), through (mark "X" in appropriate section of law or, if

section of law not reflected, insert applicable section of law in "Other" block): section 301 of the INA section 309 of the INA

section 320 of the INA section 321 of the INA Other

and that (s)he has has not been expatriated since that time. I recommend that this application be granted denied and that

A or AA Certificate of Citizenship be issued in the name of .

District Adjudication Officer's Name and Title District Adjudication Officer's Signature

I do do not concur in recommendation of the application.

District Director or Officer-in-Charge Signature Date (mm/dd/yyyy)

Form N-600 (Rev. 10/15/07) Y Page 7


OMB No. 1615-0087; Expires 09/30/09
Instructions for N-600K, Application for Citizenship
Department of Homeland Security
U.S. Citizenship and Immigration Services and Issuance of Certificate Under Section 322
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

3. Is a biological child who is a legitimate child or is a child


What Is the Purpose of This Form? who was legitimated, while in the legal custody of the
legitimating parent(s), prior to reaching the sixteenth
This form, the N-600K is an application for the naturalization birthday or
of a child who regularly resides outside the United States
and for the issuance of a Certificate of Citizenship to the 4. Is an adopted child who has a full and final adoption and
child. the child either is the beneficiary of an approved I-600 or
fulfilled the two-years legal custody, two-years joint
Who May Use Form N-600K? residence requirements of INA section 101(b)(1)(E).

The following individuals may use this form: Who May Not File Form N-600K?
1. A U.S. citizen parent seeking citizenship on behalf of a
minor adopted or biological child under section 322 of the Therefore this form should not be used for stepchildren,
Immigration and Nationality Act (INA) (providing for children who are not legitimate and children who were not
citizenship through an application process for biological legitimated prior to their 16th birthday. Such children are not
and adopted children who regularly reside outside of the eligible for benefits under section 322 of the INA. Any
United States and meet certain conditions while under the person other than a citizen parent should not use this form
age of 18 years). except in cases in which a U.S. citizen parent has died.

2. If a U.S. citizen parent of a child who otherwise meets the


eligibility requirements of INA 322 has died, a U.S.
What Is the Filing Fee?
citizen parent of the U.S. citizen parent or a U.S. legal
guardian can file this application at any time within five
The fee for Form N-600K is $460.00. Except for a person who
years of the U.S. citizen parent's death.
is requesting a Certificate of Citizenship for an adopted child,
(checking Part 2, Box A or C on the form), all applicants
must pay the fee for filing Form N-600K, under section 322 of
Who May File Form N-600K? the INA .

This form should be filed only if the child: For U.S. citizen parents, or a U.S. citizen grandparent or U.S.
citizen legal guardian filing in lieu of a deceased U.S. citizen
1. In the case of minor adopted or biological children (under parent, filing on behalf of an adopted minor child under
18 years) qualifying for citizenship under section 322 of section 322 of the INA (checking Part 2, Box B on the
the INA, the application must be filed by the U.S. citizen form), the fee for this is $420.00.
parent with legal and physical custody of the child.
Use the following guidelines when you prepare your check or
2. In the case of an application filed by a U.S. citizen parent money order for the Form N-600K.
of a deceased citizen parent or of an application filed by a
U.S. citizen legal guardian, the child does not have to be 1. The check or money order must be drawn on a bank or
residing in the legal and physical custody of the applicant. other financial institution located in the United States and
The application can be filed and approved if the child is must be payable in U.S. currency; and
residing in the legal and physical custody of a person who
2. Make the check or money order payable to U.S.
does not object to the application.
Department of Homeland Security, unless:
3. Will not yet have reached their eighteenth birthday at the A. If you live in Guam and are filing your petition there,
time of fulfilling all of the requirements for citizenship, make it payable to Treasurer, Guam.
including the required interview of U.S. citizen parent and
the child, and

Form N-600K Instructions (Rev. 09/06/07)Y


B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to Commissioner General Instructions.
of Finance of the Virgin Islands.
Step 1. Fill Out Form N-600K.
C. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S. embassy 1. Type or print legibly in black ink.
or consulate for instructions on the method of
payment. 2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
NOTE: Please spell out U.S. Department of Homeland
sign each sheet.
Security; do not use the initials "USDHS" or "DHS."
Notice to Those Making Payment by Check. If you send us 3. Answer all questions fully and accurately. State that an
a check, it will be converted into an electronic funds transfer item is not applicable with "N/A." If the answer is "none,"
(EFT). This means we will copy your check and use the write none.
account information on it to electronically debit your account
for the amount of the check. The debit from your account will 4. If the child has a USCIS "A" number, write the "A"
usually take 24 hours, and will be shown on your regular number in the place indicated on the top right hand
account statement. corner of the first page. Use the ''A" number on the
Permanent Resident Card (formerly known as the Alien
You will not receive your original check back. We will Registration Receipt or ''Green'' Card), if the child has one.
destroy your original check, but we will keep a copy of it. If Otherwise, use the ''A'' number shown on the USCIS or
the EFT cannot be processed for technical reasons, you former INS-issued correspondence about the child.
authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times. Step 2. General Requirements.

How to Check If the Fees Are Correct. Translations. Any document containing foreign language
submitted to USCIS shall be accompanied by a full English
The form and biometric fees on this form are current as of the
language translation which the translator has certified as
edition date appearing in the lower right corner of this page.
complete and accurate, and by the translator's certification that
However, because USCIS fees change periodically, you can
he or she is competent to translate from the foreign language
verify if the fees are correct by following one of the steps
into English.
below:
1. Visit our website at www.uscis.gov, select "Immigration Copies. Unless specifically required that an original
Forms" and check the appropriate fee; document be filed with an application or petition, an ordinary
legible photocopy may be submitted. Original documents
2. Review the Fee Schedule included in your form package, submitted when not required will remain a part of the record,
if you called us to request the form; or even if the submission was not required. Do not send an
original Certificate of Citizenship or Certificate of
3. Telephone our National Customer Service Center at Naturalization. USCIS may request that you present original
1-800-375-5283 and ask for the fee information. documents at the interview.
NOTE: If your Form N-600K requires payment of a
biometric service fee for USCIS to take your fingerprints, What Documents or Evidence
photograph, or signature, you can use the same procedure to Must I Send With the Application?
obtain the correct biometric fee.
The following is a list of documents that must be submitted
with the Form N-600K. Unless specifically noted otherwise,
Where To File. every applicant must submit each of the documents listed
below for himself/herself and the U.S. citizen parent(s) (or
For all applicants seeking a U.S. citizenship and the issuance grandparent(s) if applicable) through whom the applicant
of a Certificate of Citizenship for a minor adopted or is claiming U.S. citizenship.
biological child who resides outside of the United States and
qualifies for citizenship under section 322 of the INA, the
Form N-600K may be filed at any USCIS office or suboffice
in the United States or its outlying possessions (including San
Juan, Puerto Rico; the U.S. Virgin Islands; and Guam). The
address of USCIS offices can be found at: www.uscis.gov.

Form N-600K Instructions (Rev. 09/06/07)Y Page 2


1. Photographs.
7. Proof of Legal Guardianship - Proof of legal
You must submit two identical color photographs of guardianship issued by competent authority in the place
yourself taken within 30 days of the filing of this of residence of the legal guardian must be submitted for
application. The photos must have a white to off-white any application filed by a legal guardian in lieu of a
background, be printed on thin paper with a glossy finish, deceased citizen parent.
and be unmounted and unretouched.
8. Proof of Legal Custody - (Only required for applicants
NOTE: Because of the current USCIS scanning
whose U.S. citizen parent(s) divorced and/or separated
process, if a digital photo is submitted, it needs to be
and for applicants who are adopted or legitimated).
produced from a high resolution camera, which has at
least a 3.5 mega pixel.
9. Evidence of Lawful Admission and Maintenance of
Passport-style photos must be 2" x 2." The photos must Such Lawful Status (e.g. Form I-94, Arrival/Departure
be in color with full face, frontal view on a white to off- Record) - (Required at time of interview for all applicants
white background. Head height should measure 1" to 1 seeking citizenship under section 322 of the INA).
3/8" from top of hair to bottom of chin, and eye height is
between 1 1/8" to 1 3/8" from bottom of photo. Your head 10. Proof of Required Residence or Physical Presence in
must be bare unless you are wearing a headdress as the United States - Any document that proves the U.S
required by a religious order of which you are a member. citizen parent(s)' residence or physical presence in the
Using pencil or felt pen, lightly print your name and Alien United States. This proof may include but is not limited
Receipt Number on the back of the photo. to the following:
2. Birth Certificate or Record of the Child - A certified A. School, employment, military records;
birth certificate or record issued by a civil authority in the
country of birth. B. Deeds, mortgages, leases showing residence;

3. Birth Certificate or Record of the Citizen Parent - A C. Attestations by churches, unions, or other
certified birth certificate or record issued by a civil organizations;
authority in the country of birth is required for
applications filed by a citizen parent of a citizen parent. D. U.S. Social Security quarterly reports;

3. Marriage Certificate(s) - Certified marriage certificate(s) E. Affidavits of third parties having knowledge of the
issued by a civil authority in the state or country of residence and physical presence.
marriage.
11. Proof of U.S. Citizen Grandparent(s)' Required
4. Documents Showing the Termination of a Marriage - Physical Presence in the United States - (Only required
Examples include a divorce decree, death certificate, or for applicants seeking citizenship under section 322 of the
annulment document. Act whose U.S. citizen parent(s) does not meet the
physical presence requirement of five years in the United
5. Proof of U.S. Citizenship - Examples of this are birth States, two years of which were after the age of 14).
certificates showing birth in the United States; an N-550, Documentation establishing that the U.S. citizen
Certificate of Naturalization; an N-560, Certificate of grandparent(s) met the required physical presence
Citizenship; an FS-240, Report of Birth Abroad of United requirements.
States Citizen; or a valid unexpired U.S passport.
12. Current Status of U.S. Citizen Grandparent.
6. Proof of Legitimation - (Only required for applicants
who were born out of wedlock). An application filed by a citizen parent that relies on the
physical presence in the United States of a citizen
Documents must establish legitimation according to the grandparent cannot be approved unless the citizen
laws of the child's residence or domicile or father's grandparent is a U.S. citizen, if living, or if deceased, was
residence or domicile (if applicable). a U.S. citizen at the time of his or her death.
Legitimation for INA benefits requires that the child is in
An application filed by any grandparent or legal guardian
the legal custody of the legitimating parent(s) at the time
in lieu of a deceased citizen parent that relies on the
of legitimation.
physical presence of a citizen grandparent cannot be
approved unless evidence is submitted that the citizen
grandparent was a U.S. citizen and still alive at the time
of the death of the citizen parent.
Form N-600K Instructions (Rev. 09/06/07)Y Page 3
13. Copy of Notice of Approval of a Form I-600, Petition Step-By-Step Instructions.
to Classify Orphan as an Immediate Relative, and
Supporting Documentation for Such Form (Except This form is divided into ten parts. The information below will
Home Study) - (All adopted orphans applying under help you fill out the form.
section 322 of the INA must either have this form or have
complied with the two years legal custody and two years Part 1. Information About Your Child.
of joint residence requirement of INA 101(b)(1)(E)).
NOTE: If you are a U.S. citizen parent, grandparent or legal
14. Copy of Full, Final Adoption Decree - (Only required guardian applying for a certificate of citizenship on behalf of
for adopted applicants). your minor biological, or adopted child, give information for
your minor child.
15. Evidence of All Legal Name Changes.
1. Current Legal Name - The child's current legal name is
What If a Document Is Not Available? the name on the birth certificate unless it has been
changed after birth by a legal action such as a marriage,
If it is not possible to obtain any one of the above-required adoption, or court order.
documents, you must establish why the evidence is not
available. You may be required to submit an original written 2. Name Exactly as It Appears on Your Permanent
statement from the relevant government or other authority Resident Card (if applicable and if different from above).
explaining the reason for the unavailability of the document(s). Write the child's name exactly as it appears on the card,
You may submit the following secondary evidence for even if it is misspelled.
consideration. However, secondary documents that do not
overcome the availability of primary documents may result in 3. Other Names Used Since Birth - If the child has ever
denial of the application: used any other names since birth, write them in this
section. If you need more space, use a separate sheet of
1. Baptismal Certificate: A certificate under the seal of the paper.
church where the baptism occurred, showing the date and
place of the child's birth, date of baptism, the names of 4. U.S. Social Security Number - Print the child's U.S.
the godparents, if known. Social Security number. If the child does not have a Social
Security number, write "N/A" in the space provided.
2. Church Records: A certificate under the church seal
5. Date of Birth - Use eight numbers to show the child's
issued within two months of birth.
date of birth (example: May 1, 1992, should be written
3. School Record: A letter from authorities of the school 05/01/1992).
attended (preferably the first school), showing the date of
6. Country of Birth - Give the name of the country where
admission to the school, the child's date of birth or age at
the child was born. Write the name of the country even if
that time, place of birth, and the names and places of
it no longer exists. If the name of the country has
birth of parents, if shown in the school records.
changed, write the name of the country as it was at the
4. Census Records: State or Federal census records showing time of your birth.
the name(s) and place(s) of birth, and the date(s) of birth
7. Country of Citizenship/Nationality - Write the name of
or age(s) of the person(s) listed.
the country of the child's citizenship/nationality.
5. Affidavits: Written statements sworn to (or affirmed) by A. If the country no longer exists and/or the child is
two persons who have personal knowledge of the claimed stateless, write the name of the country where the
event (i.e., the date and place of a birth, marriage, or child was last a citizen or national.
death). The persons may be relatives and need not be
citizens of the United States. Each affidavit should B. If the child is a citizen or national of more than one
contain the following information regarding the person country, write the name of the foreign country that
making the affidavit: his/her full name and address; date issued the last passport.
and place of birth; relationship to the applicant, if any;
full information concerning the event; and complete 8. Gender - Indicate whether male or female.
details concerning how he/she acquired knowledge of the
event. 9. Height - Give the child's height in feet and inches.

Form N-600K Instructions (Rev. 09/06/07)Y Page 4


Part 2. Information About the Child's Eligibility. 7. Information on Adoption - If the child was adopted,
provide information as to the place and date of adoption.
Check the box that indicates why the child is eligible to
8. Marital Status of Parents at Time of Birth (or
apply for a Certificate of Citizenship.
Adoption) - Indicate whether the child's parents were
If you are a U.S. citizen parent applying for a Certificate of married to each other at the time of the child's birth. If
Citizenship on behalf of a minor biological child, check the the child was born out-of- wedlock, indicate "No," even if
box in Section A. If you are a U.S. citizen parent applying for the parents subsequently married. If the child was
a Certificate of Citizenship on behalf of a minor adopted adopted, indicate whether the adoptive parents were
child, check the box in Section B. If you are the U.S. citizen married to each other at the time of the adoption.
parent of a deceased U.S. citizen parent applying for your
grandchild, check the box in Section C. If you are the U.S. Part 4. Information on Child's U.S. Citizen Father
citizen legal guardian of an eligible child, check the box in or Mother (or Adoptive Father or Mother).
Section C.
NOTE: If you are a U.S. citizen father or mother (or
adoptive father or mother) applying for citizenship and a
Part 3. Additional Information About the Child. certificate of citizenship on behalf of your minor child, where
information is requested about in this section, provide
The information in this section should be about the child who
information about YOURSELF in the sections noted. If you
will be issued the Certificate of Citizenship.
are a U.S. citizen grandparent or legal guardian, provide
NOTE: If you are a U.S. citizen parent, grandparent, or legal information about the child's U.S. citizen PARENT in the
guardian applying for a Certificate of Citizenship on behalf sections noted.
of a minor biological or adopted child, give information for
1. Current Legal Name - Give current legal name, or name
your minor child.
at time of death, of the U.S. citizen father or mother. It is
the name on the birth certificate unless it was changed
1. Home Address - Give the address where the child now after birth by a legal action such as a marriage, adoption,
lives. Do not put post office (P.O.) box numbers here. or court order.
2. Mailing Address - If the mailing address is the same as 2. Date of Birth - Use eight numbers to show the U.S.
the home address, write "same." If the mailing address is citizen father or mother's date of birth (example: May 1,
different from the home address, write it in this part. 1969, should be written 05/01/1969).
Provide "Care Of" information if applicable.
3. Country of Birth - Give the name of the country where
3. Telephone Numbers - Telephone numbers and e-mail the U.S. citizen father or mother was born. Write the
addresses allow USCIS to contact you more quickly name of the country even if it no longer exists. If the
about the application. If you are hearing impaired and name of the country has changed, write the name of the
use a TTY telephone connection, please indicate this by country as it was at the time of your U.S. citizen father or
writing "(TTY)" after the telephone number. mother's birth.
4. Home Address - Give the address where the U.S. citizen
4. Current Marital Status - Check the marital status of the
father or mother now lives. Do not put post office (P.O.)
child on the date you are filing this application.
box numbers here.
5. Information About the Child's Entry Into the U.S. 5. U.S. Citizenship - Indicate how the U.S. citizen father or
and Current Immigration Status - mother became a U.S. citizen. Provide all the requested
Do not complete this section. The USCIS Adjudicator information.
will complete this during the interview. 6. Loss of U.S. Citizenship - Indicate whether the U.S.
citizen father or mother ever lost U.S. citizenship. Provide
6. Previous Application for Certificate of Citizenship or
this information even if the U.S. citizen father or mother
U.S. Passport - If you know of any prior application for
regained citizenship at a later date.
a Certificate of Citizenship or a U.S. passport (or you are
a U.S. citizen parent who previously applied for a 7. Residence and/or Physical Presence - Provide all the
Certificate of Citizenship or U.S. passport for your minor dates when the U.S. citizen father or mother was in
child), indicate on a separate piece of paper what United States. Dates should include all time immediately
happened with the application and whether a Certificate after birth as well as after the age of 14 years and older.
of Citizenship or U.S. passport was or was not issued.

Form N-600K Instructions (Rev. 09/06/07)Y Page 5


8. Marital History. D. Home Address - Give the address where the U.S.
citizen grandfather or grandmother now lives. Do not
A. Write the number of times the U.S. citizen father or put post office (P.O.) box numbers here.
mother was married. Include any annulled marriages.
If there was more than one marriage to the same E. U.S. Citizenship - Indicate how the U.S. citizen
spouse, count each time as a separate marriage. grandfather or grandmother became a U.S. citizen.
Provide all the requested information.
B. If now married, provide information about the U.S.
citizen father or mother's current spouse. Check F. Loss of U.S. Citizenship - Indicate whether the U.S.
appropriate box to indicate immigration status. citizen grandfather or grandmother ever lost U.S.
citizenship. Provide this information even if the U.S.
C. Indicate whether the U.S. citizen father or mother's citizen grandfather or grandmother regained
current spouse is also your parent. If "No," you will citizenship at a later date.
be asked to provide information about your father or
mother's previous spouse or spouses. G. Residence and/or Physical Presence - Provide all
the dates when the U.S. citizen grandfather or
grandmother was in United States. Dates should
Part 5. Information About the U.S. Citizen include all time immediately after birth as well as
Grandfather or Grandmother. after the age of 14 years and older.
Complete This Section Only If:
Part 6. Legal Guardian.
1. You are a U.S. citizen parent, grandparent or legal
guardian applying for citizenship on behalf of a United Complete this part only for applications filed by a legal
States citizen's adopted or biological child who regularly guardian in lieu of a deceased U.S. citizen parent.
resides outside the United States;
Part 7. Your Signature.
2. The U.S. citizen parent, has not been physically present
in the U.S. for five years, two years of which were after Except in cases in which a U.S. citizen parent of the child has
the age of 14 years; and died, only a U.S. citizen parent may file this application on
their child's behalf. In cases in which a U.S. citizen parent has
3. If the eligible application is relying on the physical died, a U.S. citizen grandparent or U.S. citizen legal guardian
presence in the United States of the U.S citizen father or can file the application. The applicant must sign and date the
mother of the United States citizen parent (the child's application. If the applicant does not sign the application, the
grandfather or grandmother) to get citizenship for the application will be returned.
adopted or biological child.

4. The applicant should provide information about the U.S. Part 8. Signature of Person Preparing Form,
citizen parent (the grandparent of the child) of the U.S. If Other Than Applicant.
citizen father or mother in the sections noted. If you do not fill out the Form N-600K yourself, the preparer
must also sign, date, and give his or her address. If the
A. Current Legal Name - Give current legal name of
preparer is a business or organization, its' name must be
the U.S. citizen grandfather or grandmother. It is the
included on the form.
name on his or her birth certificate unless it was
changed after birth by a legal action such as a
marriage, adoption, or court order. Part 9. Affidavit.

B. Date of Birth - Use eight numbers to show the U.S. Do not complete this part. You will be asked to complete
citizen grandfather or grandmother's date of birth this part at the interview.
(example: May 1, 1949, should be written
05/01/1949). Part 10. Officer Report and Recommendation.
C. Country of Birth - Give the name of the country Do not complete this part. This part is for USCIS use only.
where the U.S. citizen grandfather or grandmother
was born. Write the name of the country even if it no
longer exists. If the name of the country has changed,
write the name of the country as it was at the time of
the U.S. citizen grandfather or grandmother's birth.

Form N-600K Instructions (Rev. 09/06/07)Y Page 6


Penalties. Paperwork Reduction Act.

If you knowingly and willfully falsify or conceal a material An agency may not conduct or sponsor an information
fact or submit a false document with this Form N-600K, we collection and a person is not required to respond to a
will deny the Form N-600K and may deny any other collection of information unless it displays a currently valid
immigration benefit. OMB control number. The public reporting burden for this
In addition, you will face severe penalties provided by law and collection of information is estimated at 1 hour and 35 minutes
may be subject to criminal prosecution. per response, including the time for reviewing instructions,
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
Privacy Act Notice. collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Management Division, 111 Massachusetts
USCIS will use the information and evidence requested on Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529.
Form N-600K to determine your eligibility for the requested OMB No. 1615-0087. Do not mail your application to this
immigration benefit. We may provide information from your address.
application to other government agencies. Our legal right to
ask for this information can be found in the Immigration and
Nationality Act, as amended. We may provide this information
to other government agencies. Failure to provide this
information, and any requested evidence, may delay a final
decision or result in denial of your Form N-600K.

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.
As an altenative 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. 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.

Form N-600K Instructions (Rev. 09/06/07)Y Page 7


OMB No. 1615-0087; Expires 09/30/09
Department of Homeland Security N-600K, Application for Citizenship and
U.S. Citizenship and Immigration Services Issuance of Certificate Under Section 322
Print clearly or type your answers in black ink, using CAPITAL letters. Failure to print clearly may delay your application.

Part 1. Information about your child. (Provide information about the child on
If your child has an "A" Number,
whose behalf this application for citizenship and a Certificate of write it here:
Citizenship is being filed.)
A. Current legal name. - -
Family Name (Last Name)

For USCIS Use Only


Given Name (First Name) Full Middle Name (If applicable)
Bar Code Date Stamp

B. Name exactly as it appears on your Permanent Resident Card (If applicable).


Family Name (Last Name)

Given Name (First Name) Full Middle Name (If applicable)


Remarks

C. Other names used since birth.


Family Name (Last Name) Given Name (First Name) Middle Name (If Applicable)

Action
D. U.S. Social Security # (If Applicable) E. Date of Birth (mm/dd/yyyy)

F. Country of Birth G. Country of Citizenship/Nationality

H. Gender I. Height
Male Female

Part 2. Information About the Child's Eligibility. (Check only one.)

This application is being filed on my behalf based on the fact that:

A. I am a BIOLOGICAL child (under 18 years) of a United States citizen parent who is applying for citizenship on my behalf.

B. I am an ADOPTED child (under 18 years) of a United States citizen parent who is applying for citizenship on my behalf.

C. I am a child (under 18 years) of a United States citizen parent who died during the five years preceding the filing of this
application. A United States citizen grandparent or a United States citizen legal guardian is applying for citizenship on my
behalf.

Part 3. Additional Information About the Child. (Provide information about the child on whose behalf this
application for citizenship and a Certificate of Citizenship is being filed.)
A. Home Address - Street Number and Name (Do not write a P.O. Box in this space.) Apartment Number

City County

State or Province Country Zip Code

Form N-600K (Rev. 09/06/07)Y


Part 3. Additional information about the child. (Provide information about the child on whose behalf this
application for citizenship and a Certificate of Citizenship is being filed.) - Continued.

B. Mailing Address - Street Number and Name (If Different From Home Address) Apartment Number

City County State or Province Country Zip Code

C. Daytime Phone Number (If any) Evening Phone Number (If any) E-Mail Address (If any)

D. Marital Status
Single, Never Married Married Divorced Widowed

Marriage Annulled or Other (Explain)

E. Information about entry into the United States and current immigration status.
(Do not complete this section. The Adjudicator will complete it with you during the interview.)
I arrived in the following manner:
Port of Entry (City/State) Date of Entry (mm/dd/yyyy) Current Immigration Status

Exact Name Used at Time of Entry:

F. Do you know of any prior application for a certificate of citizenship or U.S. passport for this child? No Yes

G. Was the child adopted? No Yes (Please complete the following information.)

Date of Adoption (mm/dd/yyyy) Date Legal Custody Began (mm/dd/yyyy) Date Physical Custody Began (mm/dd/yyyy)

H. Were the child's parents married to each other when the child was born (or adopted)? No Yes

Part 4. Information about the child's U.S. citizen father or mother (or adoptive father or mother). (If you
are a United States citizen father or mother applying for citizenship and a Certificate of Citizenship on behalf
of your eligible child, provide information about yourself below). If you are a U.S. citizen grandparent or
legal guardian, provide information about the child's U.S. citizen parent in the sections noted.
A. Current legal name of U.S. citizen father or mother.

Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

B. Date of Birth (mm/dd/yyyy) C. Country of Birth

D. Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip Code

Form N-600K (Rev. 09/06/07)Y Page 2


Part 4. Information about the child's U.S. citizen father or mother (or adoptive father or mother). (If you
are a United States citizen father or mother applying for citizenship and a Certificate of Citizenship on behalf
of your eligible child, provide information about yourself below). If you are a U.S. citizen grandparent or
legal guardian, provide information about the child's U.S. citizen parent in the sections noted.- (Continued.)
E. U.S. citizen by:
Birth in the United States

Naturalization Place of Naturalization


Date of Naturalization (mm/dd/yyyy) (Name of Court and City/State or USCIS (or former INS) Office Location)

Certificate of Naturalization Number Former ''A'' Number (If known)

Through birth abroad to U.S. citizen parent(s)

Acquired after birth through naturalization of alien parent(s)

F. Has the U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause loss of United States
citizenship?

No Yes (Please provide full explanation.)

G. Dates of Residence and/or Physical Presence in the United States.

Provide the dates the U.S. citizen father or mother resided in or was physically present in the United States. If you need more space, use a
separate sheet of paper.

From (Month/Day/Year - mm/dd/yyyy) To (Month/Day/Year - mm/dd/yyyy)

H. Marital History.
1. How many times has the U.S. citizen father or mother been married (including annulled marriages)?
2. Information about the U.S. citizen father or mother's current spouse:

Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship/Nationality

Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip Code

Date of Marriage (mm/dd/yyyy) Place of Marriage (City/State or Country)

Spouse's Immigration Status:

U.S. Citizen Lawful Permanent Resident Other (Explain)

3. Is the U.S. citizen Father or Mother's current spouse listed in Question 2 above also the parent of the
child (biological or adoptive) for whom this application is being submitted? No Yes

Form N-600K (Rev. 09/06/07)Y Page 3


Part 5. Information about the U.S. citizen grandfather or grandmother. (Complete this section only if you
are a U.S. citizen parent (or adoptive parent) grandparent or legal guardian applying for a Certificate of
Citizenship for your biological or adopted child and the citizen parent has not been physically
present in the United States for five years, two years of which were after the age of 14. The information
provided here should describe, the U.S. citizen grandfather or U.S. grandmother of the minor child.)

A. Current legal name of U.S. citizen grandfather or grandmother.


Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

B. Date of Birth (mm/dd/yyyy) C. Country of Birth

D. Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip Code

E. U.S. citizen by:


Birth in the United States
Naturalization
Place of Naturalization
Date of Naturalization (mm/dd/yyyy) (Name of Court and City/State or (USCIS or former INS) Office Location)

Certificate of Naturalization Number Former "A" Number (If known)

Through birth abroad to U.S. citizen parent(s)

Acquired after birth through naturalization of alien parent(s)

F. Has your father or mother (your child's grandfather or grandmother) ever lost U.S. citizenship or taken any action that
would cause loss of U.S. citizenship?

No Yes (Please provide full explanation.)

G. Dates of Residence and/or Physical Presence in the United States


Provide the dates that your U.S. citizen father or mother (your child's grandfather or grandmother) lived in the United States. If you need
more space, use a separate sheet of paper.

From (Month/Day/Year - mm/dd/yyyy) To (Month/Day/Year - mm/dd/yyyy)

Form N-600K (Rev. 09/06/07)Y Page 4


Part 6. Legal guardian. (Complete this part only for applications filed by a legal guardian in lieu of a deceased
U.S. citizen parent.)

A. Current legal name of U.S. citizen Legal Guardian.

Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)

B. Date of Birth (mm/dd/yyyy) C. Country of Birth

D. Home Address - Street Number and Name Apartment Number

City County State or Province Country Zip Code

E. U.S. citizen by:

Birth in the United States

Naturalization

Date of Naturalization (mm/dd/yyyy) Place of Naturalization (Name of Court & City/State or USCIS or former INS Office Location)

Certificate of Naturalization Number Former "A" Number (If known)

Through birth abroad to United States citizen parent(s)

Acquired after birth through naturalization of alien parent(s)

F. Date of Legal Guardianship

G. Name of Authority that Granted Legal Guardianship H. Address of Authority that Granted Legal Guardianship

Part 7. Your Signature.

I certify, under penalty of perjury under the laws of the United States, that this application, and the evidence submitted with it, is all true and
correct. I authorize the release of any information from my records that U.S. Citizen and Immigration Services needs to determine eligibility
for the benefit I am seeking.

Applicant's Signature Print Name Date (mm/dd/yyyy)

Form N-600K (Rev. 09/06/07)Y Page 5


Part 8. Signature of person preparing this form, if other than above.

I declare that I prepared this application at the request of the above person. The answers provided are based on information of which I have personal
knowledge and/or were provided to me by the above-named person in response to the questions contained on this form.

Preparer's Printed Name Preparer's Signature

Name of Business/Organization (If Applicable) Preparer's Daytime Phone Number Date (mm/dd/yyyy)

Preparer's Address - Street Number and Name

City County State Zip Code

NOTE: Do not complete the following parts below unless the USCIS officer instructs you to do so at the interview.

Part 9. Affidavit.

I, the parent/grandparent/legal guardian, do swear or affirm, under penalty of perjury laws of the

United States, that I know and understand the contents of this application signed by me, and the attached supplementary pages number ( ) to

( ) inclusive, that the same are true and correct to the best of my knowledge, and that corrections number ( ) to ( ) were made by

me or at my request.

Signature of U.S. citizen parent/grandparent/legal guardian Date (mm/dd/yyyy)

Subscribed and sworn or affirmed before me upon examination of the applicant and U.S. citizen parent/grandparent/legal guardian on

at .
Signature of Interviewing Officer Title

Form N-600K (Rev. 09/06/07)Y Page 6


Part 10. Officer Report and Recommendation.

On the basis of the documents, records, and the testimony of persons examined, and the identification upon personal appearance of the underage

beneficiary, I find that all the facts and conclusions set forth under oath in this application are true and correct; that the applicant is eligible

to be naturalized on (month/day/year), through section 322 of the INA ; section 322 of the INA (grandparent

residence) section 322 of the INA (grandparent or legal guardian application) .

and I recommend that this application be (granted or denied) and that a Certificate of Citizenship be issued in the name of
.
District Adjudications Officer's Name and Title District Adjudications Officer's Signature

I do concur in recommendation of the application. Date:


(mm/dd/yyyy)

District Director or Officer-in-Charge Signature:

Form N-600K (Rev. 09/06/07)Y Page 7


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