Professional Documents
Culture Documents
Publishers
eBook Division
GREEN CARD
APPLICATION
GUIDE
TH
18 EDITION
Electronic Version (e-book)
www.usimmigrationsupport.org
Disclaimer
“U.S. Publishers, Inc.”, the publisher of this information manual, is an independent non-
governmental organization. “U.S. Publishers, Inc.” is not affiliated with the United States
government.
Copyright Warning
This publication is copyrighted by “U.S. Publishers, Inc.” No part of this publication may be
reproduced, transmitted, transcribed, stored in a retrieval system or translated into any language,
in any form or by any means, including electronic, mechanical, optical, chemical, manual or
otherwise, without prior written permission of “U.S. Publishers, Inc.” All violations will be
prosecuted to the fullest extent of the law. Official government forms (if any) included with this
publication are copyrighted by the U.S. government, not by “U.S. Publishers, Inc.”
Table of Contents
GREEN CARD APPLICATION GUIDE
⎪ Page 2 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
⎪ Page 3 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
APPENDIX 8 .............................................................................................................................................. 69
ADOBE ACROBAT HELP ............................................................................................................................ 69
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.
⎪ Page 4 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
DISCLAIMER
U.S. Publishers, Inc. -- the publisher of this information guide -- is not affiliated with the United
States government.
U.S. Publishers, Inc. has made every attempt to provide the most current information available on
United States immigration laws and application procedures. The user should be aware that while
we try to keep the information timely and accurate, there may be a delay between the passage of
new laws and regulations and their inclusions in our immigration guides or on our website.
The information provided in this immigration package and in other documents, forms, website,
comments, e-mails, articles, newsletters, and other communications should not be considered
legal advice for any individual case or situation. No attorney/client relationship is created by the
usage of this immigration guide, its contents, any immigration materials purchased or
downloaded, or any information provided by our website. By using this immigration guide, you
agree that its proprietors, producers, and administrators have no responsibility, directly or
indirectly, for any problems that may arise from the use or misuse of this product and its content.
The responses and information contained herein are intended to be general and should not be
relied on for a specific situation. For specific legal advice, contact an attorney who specializes in
United States immigration law. We have designed this immigration guide at a very low cost to
help you fill out your application without assistance. Therefore, we will not be answering any
questions pertaining to immigration issues. If you have a question regarding immigration, please
contact an immigration attorney.
The text information in this publication is the property of U.S. Publishers, Inc. and is protected by
copyright laws. Copyright is not claimed on material extracted from public resources.
FBI Warning: “The unauthorized reproduction or distribution of this copyrighted work is illegal.
Criminal copyright infringement, including infringement without monetary gain, is investigated by
the FBI and is punishable by up to 5 years in federal prison and a fine of $250,000." – Source:
www.fbi.gov/ipr
All United States immigration forms included with this information guide are provided to our
clients free of charge. We do not charge for any immigration forms. You may download all
immigration forms for free directly from the USCIS (formerly INS) website or you may contact us
for additional forms.
Refunds or exchanges will only be given if the product is returned within 30 days of the date of
purchase.
The maximum liability for any circumstance will not exceed the purchase price of this immigration
manual. The acceptance of these terms begins with the use of this product.
Website: www.usimmigrationsupport.org
Email: info@usimmigrationsupport.org
⎪ Page 5 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
For more information about how to remove conditions on a Green Card, visit:
http://www.usimmigrationsupport.org/remove_conditions.html
⎪ Page 6 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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
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.
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
⎪ Page 7 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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
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 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.
⎪ Page 8 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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).
⎪ Page 9 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
⎪ Page 10 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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.
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.
⎪ Page 11 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
For the applicant to meet managerial or supervisory classifications, he/she must meet all of the
following requirements:
Manager
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.
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.
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.
⎪ Page 12 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
3.6 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.
⎪ Page 13 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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.
3.9 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.
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.
⎪ Page 14 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
For more information about how to obtain a Green Card through employment visit
http://www.usimmigrationsupport.org/greencard_employment.html
⎪ Page 15 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
• You and you accompanying relatives may travel in and out of the U.S. as you wish
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.
For more information about how to obtain a Green Card through investment visit
http://www.usimmigrationsupport.org/greencard_investment.html
⎪ Page 17 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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.
⎪ Page 18 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
For more information about how to obtain to remove conditions on a Green Card visit
http://www.usimmigrationsupport.org/remove_conditions.html
For more information about how to obtain a Green Card through marriage visit
http://www.usimmigrationsupport.org/greencard_marriage.html
⎪ Page 19 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
6.2 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.
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.
⎪ Page 20 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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.
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
⎪ Page 21 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
The court has determined that it is on your best interest to remain in the United States.
For more information about how to obtain a Green Card as a special immigrant visit
http://www.usimmigrationsupport.org/greencard_specialimmigrant.html
⎪ Page 22 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
⎪ Page 23 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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:
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
⎪ Page 24 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
For more information about how to obtain a Green Card through a relative visit
http://www.usimmigrationsupport.org/greencard_relatives.html
⎪ Page 26 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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:
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.
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).
⎪ Page 27 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 28 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
For more information about how to apply for the Green Card Lottery visit
http://www.usimmigrationsupport.org/greencardlottery.html
⎪ Page 29 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
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
⎪ Page 30 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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
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.
• 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.
⎪ Page 31 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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.
• 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.
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.
⎪ Page 32 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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?
⎪ Page 33 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 34 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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.
• 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.
• 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.
⎪ Page 35 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
• 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
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.
⎪ Page 36 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 37 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
APPENDIX 2
USCIS Application Support Centers (ASC)
National Toll Free Telephone Number: 1-800-375-5283
Alabama
Alaska
Arizona
Arkansas
⎪ Page 38 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
California
Colorado
Connecticut
⎪ Page 39 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
⎪ Page 40 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Illinois
Indiana
Iowa
Kansas
Kentucky
⎪ Page 41 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
⎪ Page 42 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
⎪ Page 43 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
⎪ Page 44 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
⎪ Page 45 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Utah
Vermont
Virgin Islands
Virginia
Washington
⎪ Page 46 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
West Virginia
Wisconsin
Wyoming
⎪ Page 47 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
APPENDIX 3
USCIS Field Offices
National Toll Free Telephone Number: 1-800-375-5283
Alabama
Alaska
Arizona
Arkansas
California
⎪ Page 48 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Colorado
Connecticut
Delaware
Distric of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
⎪ Page 49 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
⎪ Page 50 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
⎪ Page 52 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
⎪ Page 53 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
Virginia
Washington
West Virginia
Wisconsin
Wyoming
⎪ Page 54 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
Reschedule of an appointment?
⎪ Page 55 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
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:
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
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:
Include the name as spelled in the application
The A-number
Your previous and new address
The letter must be marked: “ATTN: CHANGE OF ADDRESS”
Write the address like this:
USCIS ________ District Office
(for example, Boston District Office)
123 Main Street, City, State, Zip
ATTN: Change of Address
⎪ Page 57 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
⎪ Page 58 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 59 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 61 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 63 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 64 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
⎪ Page 65 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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.
⎪ Page 66 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
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
⎪ Page 67 ⎪
⎪ www.usimmigrationsupport.org
Green Card Application Guide
⎪ Page 68 ⎪
⎪ www.usimmigrationsupport.org
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.
“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.
⎪ Page 69 ⎪
⎪ www.usimmigrationsupport.org
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.
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
⎪ Page 70 ⎪
⎪ www.usimmigrationsupport.org
United States Immigration
Do-It-Yourself Immigration Guides
Save up to 90% in legal fees
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
2. Other Names Used or Aliases (If married woman, give maiden name)
4. Date of Birth (mm-dd-yyyy) 5. Age 6. Place of Birth (City or town) (Province) (Country)
14. Name of Spouse (Maiden or 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
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)
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.
27. Other Names Used or Aliases (If married woman, give maiden name)
28. Full Name in Native Alphabet (If Roman letters not used)
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.
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)
Signature of Applicant
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)
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.
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.
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.
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.
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.
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).
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.
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.
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.
6. Enter the city, state or province, country and postal code 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.
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-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.
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.
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.
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.
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).
22. Enter the dates advertised with radio or TV stations (if applicable).
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.
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.
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.
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.
3. Enter the city, state or province, country and postal code for the business address.
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.
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.
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.
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:
2. Address 1
Address 2
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
5. E-mail address
2. Firm name
5. Address 1
Address 2
7. E-mail address
Address 2
3. Job title
5. Is training required in the job opportunity? 5-A. If Yes, number of months of training required:
Yes No
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
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.
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.
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:
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:
11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed:
Newspaper Journal
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:
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).
2. Current address 1
Address 2
Address 2
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
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
b. Job 2
1. Employer name
2. Address 1
Address 2
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
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
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
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
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.
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.
2. Title
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.
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
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.
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.
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)
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)
Type of Case:
Date:
(2)Rec. Br. See Instructions on Page 3 Form G-325 (Rev. 07/14/06)Y Page 2
Instructions
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.
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.
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.
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)
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)
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
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.
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.
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.
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.
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
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?
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
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
14. If you are a lawful permanent resident alien, complete the following: 15. Name and address of present employer (if any)
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:
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
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.
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.)
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.
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.
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.
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.
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.
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:
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
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:
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)
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.
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.
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.
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
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.
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.) $
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.
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
at . My commission expires on
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.
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;
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;
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
IRS Tax # U.S. Social Security # (if any) E-Mail Address (if any) Date
Reloc Rec'd
Daytime Phone # (with area/country codes) Date of Birth (mm/dd/yyyy) Action Block
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.
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
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
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)
Daytime Phone Number (Area/Country Codes) Fax Number (Area/Country Codes) E-Mail Address
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.
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.
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
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
Part 4. Signature of Person Filing the Appeal/Motion or His or Her Authorized Representative
Signature Signer's Printed Name Date (mm/dd/yyyy)
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
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
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.
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.
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
Company or Organization
Name Reloc Sent
Address - C/O
Address - C/O
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
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
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):
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
U.S. citizen born in the United States. U.S. lawful permanent resident (Show 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
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
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
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.
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.
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
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;
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
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.
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.
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.)
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
Country of Citizenship/Nationality:
Reloc Rec'd
U.S. Social Security # A # (if any)
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 #
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.)
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)
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?
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
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.
( )
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
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
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
2. In addition, you must fall within one of the categories noted below:
A. Alien crewmen;
D. Aliens who fail to continuously maintain a lawful status since entry into the United States;
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.
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.
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:
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
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.
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:
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.
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:
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.
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.
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.
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.
Address: In Care Of
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.
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)
( )
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.
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,
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.
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
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 #
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
Total value of all property transferred from abroad to the new enterprise........................... $
Total $
Income:
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?
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
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
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
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.
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:
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.
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
Penalties
Reloc Sent
Country of Birth Country of Citizenship
If the petition or application is pending with USCIS, also give the following data: Action Block
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:
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.
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.
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.
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.
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.
Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)
Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)
Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)
Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)
Country of Birth Country of Citizenship U.S. Social Security # (if any) A # (if any)
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.
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.
Penalties.
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)
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.)
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.
Place of adoption
Executed on (Date)
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 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.
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.
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.
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.
Penalties.
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)
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.)
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)
Executed on (Date)
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
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;
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.
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
Address Date
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 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.
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
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.
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.
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
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)
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.)
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
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
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 ( )
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 ( )
Address (Street Number and Name, City, State and Zip Code) Date (mm/dd/yyyy)
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.)
Signature
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.
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).
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;
Date
Address: (Street number and name) Apt. #
Resubmitted
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
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)
Part 4. Information About the Spouse or Parent Through Whom You Gained Your Conditional Residence
Family Name First Name Middle Name
Address
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)
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)
E-Mail Address
(If any)
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.
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).
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
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.
A#
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.
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
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.
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.
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.
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
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
Action Block
A # (If any) U.S. Social Security # (If any)
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)
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
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
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
Date (mm/dd/yyyy) E-Mail Address (If any) Daytime Phone Number (With area code)
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.
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:
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.
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.
Number of full-time employees in enterprise in United States (excluding you, your spouse, sons and daughters):
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.
Firm Name and Address (Include Telephone Number with Area Code and E-Mail Address.)
-- 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.
Do I Have to Report My
Change of Address If I Move?
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:
-- 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.
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.
Reporting Burden.
___ 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.
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
12. Mailing Address Street Number and Name (Include Apartment Number)
13. Place of Residence Street Number and Name (Include Apartment Number)
(if different from
mailing address)
City State or Province
14. Telephone Number (Include Area Code or Country and City Codes)
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.
h. Add together lines and enter the number here. Household Size:
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 .
d. Unemployed since .
(Date)
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:
$
$
$
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.
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.
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: $
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
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.
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.
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.
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:
31.
(Sponsor's Signature) (Date-- mm/dd/yyyy)
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 :
For the 48 Contiguous States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam:
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.
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
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.
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.
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
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.
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 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)
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)
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.
M-603 (07/04)
Applications and Petitions That Require Photos, and the Number Required
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.
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:
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.
Part 1. Information about you. (Person filing this application) Returned Receipt
Date
A # (if any) U.S. Social Security # (if any)
Resubmitted
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
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.
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
Daytime Phone Number (with area code) E-Mail Address (if any) Fax Number (if any)
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.
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.
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
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:
2. Mailing Address - Street Number and Name (If different from home address) Apartment Number
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
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:
C. I entered as:
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)
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)
5. Home Address - Street Number and Name (If deceased, so state and enter date of death.) Apartment Number
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)
C. Is your U.S. citizen father's current spouse also your mother? No Yes
5. Home Address - Street Number and Name (If deceased, so state and enter date of death) Apartment Number
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)
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)
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)
( )
Preparer's Address - Street Number and Name
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.
Subscribed and sworn or affirmed before me upon examination of the applicant (parent, guardian) on at
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
and that (s)he has has not been expatriated since that time. I recommend that this application be granted denied and that
District Adjudication Officer's Name and Title District Adjudication Officer's Signature
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.
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
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.
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.
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.
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.
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)
Action
D. U.S. Social Security # (If Applicable) E. Date of Birth (mm/dd/yyyy)
H. Gender I. Height
Male Female
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
B. Mailing Address - Street Number and Name (If Different From Home Address) Apartment Number
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
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
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)
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?
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.
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)
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
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?
Family Name (Last Name) Given Name (First Name) Full Middle Name (If applicable)
Naturalization
Date of Naturalization (mm/dd/yyyy) Place of Naturalization (Name of Court & City/State or USCIS or former INS Office Location)
G. Name of Authority that Granted Legal Guardianship H. Address of Authority that Granted Legal Guardianship
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.
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.
Name of Business/Organization (If Applicable) Preparer's Daytime Phone Number Date (mm/dd/yyyy)
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.
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
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
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
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