US – N-600, Application for Certificate of Citizenship

US – N-600, Application for Certificate of Citizenship

 

https://www.uscis.gov/n-600

You have two options for filing your Form N-600 with USCIS:

  • Online, using an electronic application form; or
  • By mail, using a paper application form.

1. Filing your Form N-600 online

If you are applying from outside the U.S., are applying for a fee waiver, or are a member or veteran of any branch of the U.S. military filing on your own behalf, you cannot currently file your Form N-600 online. Please see section 2 below for how to file your form by mail.

You must create an online account to file your Form N-600 online. Through your online account, you can:

  • Pay your filing fee;
  • Submit passport-style photos;
  • Check the status of your case;
  • Receive notifications and case updates;
  • Respond to requests for evidence; and
  • Manage your contact information, including updating your address.

Attorneys and accredited representatives can also create an online account, which will allow them to manage all of their clients’ applications in one place.

2.  Filing your Form N-600 by mail

If you file on paper, are a member or veteran of any branch of the U.S. military filing on your own behalf, or are applying for a fee waiver, you must mail your application to USCIS using one of the listed mailing addresses:

For U.S. Postal Service (USPS):

USCIS
P.O. Box 20100
Phoenix, AZ 85036

For FedEx, UPS, and DHL deliveries:

USCIS
Attn: Form N-600
1820 E. Skyharbor Circle S
Suite 100
Phoenix, AZ 85034

Filing Tips for Form N-600, Application for Certificate of Citizenship

Complete all sections of the form. We will reject the form if these fields are missing:

  • Part 1 – Information About Your Eligibility
    • Check only ONE box in Part 1. If you check multiple boxes in Part 1, USCIS will reject your Form N-600 and return it to you for correction and re-filing.
    • Your signature as the applicant.
  • If you are a parent or legal guardian completing Form N-600 for a child younger than 14 years of age, you must sign in Part 8.
  • If you are completing Form N-600 for an applicant, you must complete and sign the designated section in Part 10, Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant.

If you submit Form N-600 on paper, you will receive a USCIS Account Acceptance Notice in the mail with instructions on how to create an online account to track and manage your case. We will process your application even if you do not create an online account, but we encourage you to create and access your online account. We will continue to mail you copies of notifications about your case.

Filing Tips: Go to our Form Filing Tips page for information on how to help ensure that we will accept your application.

Don’t forget to sign your form! We will reject any unsigned form.

Filing Fee
$1,170.

(This fee applies even if you are filing as an adopted child or as a child of a veteran or member of the U.S. armed forces.)

You may pay the fee with a money order, personal check, or cashier’s check.  When filing at a USCIS Lockbox facility, you may also pay by credit card using Form G-1450, Authorization for Credit Card Transactions. If you pay by check, you must make your check payable to the U.S. Department of Homeland Security. Please note that service centers are not able to process credit card payments.

When you send a payment, you agree to pay for a government service. Filing and biometric service fees are final and non-refundable, regardless of any action we take on your application, petition, or request, or if you withdraw your request. Use our Fee Calculator to help determine your fee.

Note:  There is no fee if you are a member or veteran of the U.S. armed forces, but you must submit proof of service.

Read our Paying Immigration Fees page for information on how to pay the fee.

Instructions for Application for

Certificate of Citizenship

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form N-600

OMB No. 1615-0057

Expires 12/31/2018

 

 

Form N-600, Application for Certificate of Citizenship, is an application for a Certificate of Citizenship.

 

 

You should file this application if:

  1. You are requesting a Certificate of Citizenship because you were born outside the United States to a U.S. citizen

parent; or

  1. You are requesting a Certificate of Citizenship because you automatically became a citizen of the United States after birth, but before you turned 18 years of age. (A parent or legal guardian can also file Form N-600 on behalf of a minor child.)

 

Citizenship law has changed over the years and different laws apply to determine whether you automatically became a U.S. citizen at birth, or after birth but before you turned 18 years of age. If you are claiming U.S. citizenship based on your birth abroad to U.S. citizen parents, the law in effect on the date of your birth applies. For purposes of these provisions, you must be the biological child of your U.S. citizen parent, and different provisions apply depending on whether you were born in wedlock or out-of-wedlock.

If you are claiming U.S. citizenship after birth, but before you reached 18 years of age, the law in effect when the last qualifying condition was met is the law that applies to you. Generally, the conditions are listed below.

These conditions must be met before you turn 18 years of age:

  1. Your parent must be a U.S. citizen;
  2. You must be the biological child of that U.S. citizen parent;
  3. You must be lawfully admitted to the United States for lawful permanent residence; and
  4. You must be living in the United States in the legal and physical custody of your U.S. citizen parent.

 

You can file Form N-600 at any time if you became a U.S. citizen at birth or after birth, but before you turned 18 years of age. Filing this application is NOT a request to become a U.S. citizen. Filing this application is ONLY a request to obtain a Certificate of Citizenship which recognizes that you became a citizen on a particular date.

 

Adopted Child

An adopted child may also acquire U.S. citizenship through his or her adoptive U.S. citizen parent depending on the law being applied. Currently, an adopted child can acquire U.S. citizenship through his or her U.S. citizen parent. However, step children CANNOT acquire U.S. citizenship under this provision.

 

NOTE: If you are now 18 years of age, but all of the above conditions apply to you before your 18th birthday and you were under 18 years of age on February 27, 2001 (the date the law took affect), you may file this application to obtain

a Certificate of Citizenship. However, if you were under 18 years of age on February 27, 2001, BUT not all of the conditions noted above were met prior to your 18th birthday, you must qualify for U.S. citizenship in your own right.

 

You may file this application if:

  1. You claim to have acquired U.S. citizenship through a U.S. citizen parent and are now over 18 years of age; or
  2. You are the U.S. citizen parent or legal guardian who has legal and physical custody of an adopted or biological child (under 18 years of age).

 

Law in Effect at the Time of Your Birth

To determine if you were born a U.S. citizen, U.S. Citizenship and Immigration Services (USCIS) must look at the law that was in effect at the time of your birth. The current law was enacted on November 14, 1986 and was last amended on February 27, 2001 (Child Citizenship Act). If you were born before November 14, 1986, and believe you may be a

U.S. citizen, you should contact USCIS by visiting the USCIS website at www.uscis.gov or calling the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

You should not file this application if:

  1. You do not have at least one biological or adoptive U.S. citizen parent;
  2. You are the child of U.S. citizen parents who regularly resides outside the United States. Refer to Form N-600K, Application for Citizenship and Issuance of Certificate Under Section 322;
  3. You were born out-of-wedlock, you were not legitimated prior to your 16th birthday, and your U.S. citizen parent is your father;

NOTE: This does not affect you if you were born abroad to an eligible U.S. citizen mother. You may also be eligible for citizenship through the naturalization of your mother.

  1. You are seeking to replace a lost or stolen certificate. Refer to Form N-565, Application for Replacement Naturalization/Citizenship Document, for information to replace a lost or stolen certificate; or

5.                         You already filed Form N-600 and received a decision from USCIS on that previously filed Form N-600. USCIS will reject (not accept) any subsequently filed Form N-600. Review your Form N-600 denial notice for more information.

 

USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may sign the application on your behalf. A legal guardian may also sign for a mentally incompetent person.

 

Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section

of these Instructions.)

 

Biometric Services Fee. If you file this application with USCIS, you do not need to include a biometric services fee at the time you submit your application. If you are later notified that you must submit biometrics, you will receive a biometric services appointment notice with instructions on how to submit the additional biometric services fee. If you

file this application with an agency other than USCIS, please check with that agency to determine if and when you must submit a biometric services fee.

 

Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the What Evidence Must You Submit sections of these Instructions.

 

Biometric Services Appointment. USCIS may require that you appear for an interview or provide fingerprints, photograph, and/or signature at any time to verify your identity, obtain additional information, and conduct background and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation (FBI), before making a decision on your application, petition, or request. After USCIS receives your application and ensures it is complete, we will inform you in writing, if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support Center (ASC) and the date and time of your appointment or, if you are currently overseas, instruct you to contact a U.S. Embassy, U.S. Consulate, or USCIS office outside the United States to set up an appointment.

If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:

  1. You provided or authorized all information in the application;
  2. You reviewed and understood all of the information contained in, and submitted with, your application; and
  3. All of this information was complete, true, and correct at the time of

If you fail to attend your biometric services appointment, USCIS may deny your application.

 

Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you must submit an original document. USCIS may request an original document at the time of filing or at any time during processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original.

NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be immediately destroyed upon receipt.

 

Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English. The certification should also include the date, the translator’s signature and printed name, and may contain the translator’s contact information.

 

How To Fill Out Form N-600

  1. Type or print legibly in black
  2. If you need extra space to complete any item within this application, use the space provided in Part 11. Additional Information or attach a separate sheet of paper; type or print your name and Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each
  3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None,” unless otherwise directed.

 

  1. Provide your A-Number (if any) on the top right corner of each page. Your A-Number is located on your Permanent Resident Card (formerly known as the Alien Registration or “Green” Card). The A-Number on your card consists of seven to nine numbers, depending on when your record was created. If the A-Number on your card has fewer than nine numbers, place enough zeros before the first number to make a total of nine numbers on Form N-600. For example, type or print number A1234567 as A001234567 or type or print number A12345678 as

 

This application is divided into Parts 1. – 13.

 

Part 1.  Information About Your Eligibility

Item Number 1. Select only one box that indicates why you are eligible for a Certificate of Citizenship. Select “Other” if the basis for your eligibility is not described in any of the previous categories and type or print the basis for your application on the lines provided. USICS will reject your Form N-600 if you select more than one box.

 

Part 2. Information About You

You must provide complete information about yourself if you are the person seeking a Certificate of Citizenship. If you are the U.S. citizen parent applying for a Certificate of Citizenship on behalf of your minor biological or adopted child, submit information relating to your minor child.

Item Number 1. Current Legal Name. Provide your legal name. This should be the name on your birth certificate unless it has been changed after birth by legal action such as marriage, adoption, or court order. Do not provide a nickname.

Item Number 2. Your Name Exactly As It Appears On Your Permanent Resident Card (if different from above). Type or print your name exactly as it appears on the card, even if it is misspelled. Type or print “N/A” if you do not have a permanent resident card.

Item Number 3. Other Names You Have Used Since Birth. Type or print any other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this item number, use the space provided in Part 11. Additional Information.

Item Number 4. U.S. Social Security Number. Type or print your U.S. Social Security Number. Type or print “N/A” if you do not have one.

Item Number 5. USCIS Online Account Number (if any). If you have previously filed an application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions, or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not the same as an A-Number.

Item Number 6. Date of Birth. Provide your date of birth in mm/dd/yyyy format.

Item Number 7. Country of Birth. Provide the name of the country where you were born. Type or print the name of the country where you were born even if the country’s name has since changed or the country no longer exists.

Item Number 8.  Country of Prior Citizenship or Nationality.  Provide the name of the country of your citizenship or nationality before you became a U.S. citizen. If the country no longer exists or you are stateless, provide the name of the foreign country where you were last a citizen or national. If you are a citizen or national of more than one country, provide the name of the foreign country that issued your latest passport.

 

Item Number 9. Gender. Indicate whether you are male or female.

Item Number 10. Mailing Address. Provide your mailing address even if it is the same as your physical address. Provide “In Care Of Name” information, if any. You must type or print something in every box, except an apartment, suite, or floor number or “In Care Of Name” if you do not have one, within “Mailing Address.”

NOTE: USCIS may not be able to contact you if you do not provide a complete and valid address. If USCIS rejects your application, USCIS may not be able to return the filing fee for Form N-600 to you if you do not provide a complete and valid address. If USCIS cannot return the filing fee, USCIS will cash your check.

Item Number 11. Physical Address (Do not provide a PO Box in this space unless it is your ONLY address). Provide the address where you now reside.

Item Number 12. Current Marital Status. Select the marital status you have on the date you file this application. Select “Other” if your marriage was legally terminated and explain the circumstances.

Item Number 13. U.S. Armed Forces. Indicate if you are a member or veteran of any branch of the U.S. Armed Forces.

Item Number 14. Information About Your Admission Into the United States and Current Immigration Status.

Item A. Provide information about where you entered the United States and what name you used when you entered.

Item B. Provide information about what documents you presented to enter the United States. Provide your passport or travel document number and date of issuance, if known.

Item C. Provide information about your current immigration status in the United States. Select the box to indicate if you are a lawful permanent resident, a nonimmigrant, a refugee asylee, or other.

Item D. Provide information if you adjusted to lawful permanent resident status while in the United States including the date, USCIS office, and location where USCIS granted your status or location where you were admitted as a lawful permanent resident.

Item Number 15. Previous Application for Certificate of Citizenship or U.S. Passport. If you previously applied for a Certificate of Citizenship or a U.S. Passport (or you are a U.S. citizen parent who previously applied for a Certificate of Citizenship or U.S. Passport for your minor child), explain in the space provided what happened with that application and whether the Certificate of Citizenship or U.S. Passport was or was not issued. If you need extra space to complete this item number, use the space provided in Part 11. Additional Information.

Item Number 16. Permanent Resident Status Abandonment. Indicate if you have ever abandoned or lost your lawful permanent resident status.

Item Number 17. Information on Adoption. If you were adopted, select the appropriate box and if you answer “Yes,” provide information as to the date and place of the adoption and the dates that legal and physical custody began in

Items A. – D.

Item Number 18. Re-Adoption in the United States. Indicate if you have been re-adopted in the United States. (See the What Evidence Must You Submit section of these Instructions for more information.)

Item Number 19. Marital Status of Your Parents At Time of Birth (or Adoption)Indicate whether your parents were married to each other at the time of your birth. If you were born out-of-wedlock, indicate “No” even if your parents

subsequently married. If you were adopted, indicate whether your adoptive parents were married to each other at the time of your adoption.

NOTE: If you are a U.S. citizen parent applying on behalf of a minor biological or adopted child, indicate whether you were married to his or her parent at the time of your minor child’s birth (or adoption). If your minor child was born out- of-wedlock, indicate “No” even if you subsequently married your child’s biological parent.

Item Number 20. Marital Status of Your Parents After Birth. Indicate whether your parents married after your birth.

 

Item Number 21. Legal and Physical Custody. Indicate whether you are in the physical and legal custody of your U.S. citizen parent.

Item Number 22. Absences from the United States. Provide the requested information for every trip abroad that you have taken since you first arrived in the United States. Begin with the most recent trip. This information is needed only for persons born before October 10, 1952, who are claiming U.S. citizenship at the time of birth.

 

Part 3. Biographic Information

Provide the biographic information requested in Part 3., Item Numbers 1. – 6.  Providing this information as part of your application may reduce the time you spend at your USCIS ASC appointment as described in the Biometric Services Appointment section of these Instructions.

Item Numbers 1. – 2. Ethnicity and Race. Select the boxes that best describe your ethnicity and race.

Categories and Definitions for Ethnicity and Race

  1. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. (NOTE: This category is only included under Ethnicity in Part 3., Item Number )
  2. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
  3. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  4. Black or African American. A person having origins in any of the black racial groups of
  5. American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community
  6. Native Hawaiian or Other Pacific A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Item Number 3. Height. Select the values that best match your height in feet and inches. For example, if you are five feet and nine inches, select “5” for feet and “09” for inches. Do not enter your height in meters or centimeters.

Item Number 4. Weight. Enter your weight in pounds. If you do not know your weight, or need to enter a weight under 30 pounds or over 699 pounds, enter “000.” Do not enter your weight in kilograms.

Item Number 5.  Eye Color.  Select the box that best describes the color of your eyes.

Item Number 6.  Hair Color.  Select the box that best describes the color of your hair.

 

Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father)

Item Numbers 1. – 9. If you are claiming citizenship through a U.S. citizen biological father (or adoptive father), provide the full legal name, date of birth, country of birth, country of citizenship or nationality, information on U.S. citizenship, marital history, and physical address of your U.S. citizen father in the spaces provided. Complete Part 5. if you are claiming citizenship solely through a U.S. citizen biological mother (or adoptive mother).

Provide information about yourself if you are a U.S. citizen biological father (or adoptive father) applying for a Certificate of Citizenship on behalf of your minor child where information is requested about the U.S. citizen father.

 

Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother)

Item Numbers 1. – 9. If you are claiming citizenship through a U.S. citizen biological mother (or adoptive mother), provide the full legal name, date of birth, country of birth, country of citizenship or nationality, information on U.S. citizenship, marital history, and physical address of your U.S. citizen mother in the spaces provided. Complete Part 4. if you are claiming citizenship solely through a U.S. citizen biological father (or adoptive father).

 

Provide information about yourself if you are a U.S. citizen biological mother (or adoptive mother) applying for a Certificate of Citizenship on behalf of your minor child where information is requested about the U.S. citizen mother.

 

Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600

Item Numbers 1. – 2. Physical Presence. If you were born outside the United States and claim to have been born a U.S. citizen, you are required to provide all the dates when your U.S. citizen biological father or U.S. citizen biological mother resided in the United States. Include all dates from your birth until the date you file your Form N-600.

Children of Members of the U.S. Armed Forces or U.S. Government Employees temporarily stationed abroad are generally considered to be “residing in the United States” for purposes of acquisition of citizenship at birth.

 

Part 7. Information About Military Service of U.S. Citizen Parents (Applicable only for applications filed under the Immigration and Naturalization Act (INA) section 301(g).)

Item Numbers 1. – 4. Provide the requested information if either U.S. citizen parent served in the U.S. Armed Forces. Also indicate whether he or she was honorably discharged from service.

 

Part 8. Applicant’s Statement, Contact Information, Certification, and Signature

Item Numbers 1. – 6. Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

 

Part 9. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1. – 7. If you used anyone as an interpreter to read the Instructions and questions on this application to you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date the application.

 

Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant

Item Numbers 1. – 8. This section must contain the signature of the person who completed your application, if other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both Part 9. and Part 10.  If the person who completed this application is associated with a business or organization, that person should complete the business or organization name and address information. Anyone who helped you complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited representative whose representation extends beyond preparation of this application, he or she may be obliged to also submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your application.

 

Part 11. Additional Information

Item Numbers 1. – 6. If you need extra space to provide any additional information within this application, use the space provided in Part 11. Additional Information. If you need more space than what is provided in Part 11., you may make copies of Part 11. to complete and file with your application, or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers, and sign and date each sheet.

 

 

 

Part 12. Affidavit (At the time of Interview)

Do NOT complete this part unless instructed to do so AT THE INTERVIEW.

 

Part 13. Officer’s Report and Recommendation On Application for Certificate of Citizenship

For USCIS use ONLY.

 

You must submit all evidence requested in these Instructions with your application. If you fail to submit required evidence, USCIS may reject or deny your application for failure to submit requested evidence or supporting documents in accordance with 8 CFR 103.2(b)(1) and these Instructions.

Unless specifically noted otherwise, you must submit each of the documents listed below for you and your U.S. citizen parent through whom you are claiming U.S. citizenship at the time of filing to avoid delays in processing your Form N-600. USCIS may require verification for any or all information provided with Form N-600.

Additionally, if you are scheduled for an interview with USCIS, you must bring in documentation if information has been updated or has changed after filing.

 

NOTE: “You” and “your” in this section refers to the individual for whom a Certificate of Citizenship is sought. It is NOT the applicant’s parent or legal guardian who may apply on the minor child’s behalf.

  1. You must submit two identical color passport-style photographs of yourself taken within 30 days of filing this application. The photos must have a white to off-white background, be printed on thin paper with a glossy finish, and be unmounted and unretouched.

The two identical color passport-style photos must be 2 by 2 inches. The photos must be in color with full face, frontal view on a white to off-white background. Head height should measure 1 to 1 3/8 inches from top of hair to bottom of chin, and eye height is between 1 1/8 to 1 3/8 inches from bottom of photo. Your head must be bare unless you are wearing headwear as required by a religious denomination of which you are a member. Using a pencil or felt pen, lightly print your name and A-Number (if any) on the back of the photo.

  1. Your Birth Certificate. You must submit a birth certificate or record issued and certified by a civil authority in the country of birth.
  2. Birth Certificate or Record of Your S. Citizen Parent. You must submit a birth certificate or record of your U.S. citizen parent issued and certified by a civil authority in the country of birth.

If your U.S. citizen parent applies, your U.S. citizen parent must submit his or her birth certificate or record issued and certified by a civil authority in the country of birth.

  1. Marriage Certificates of Your S. Citizen Parent. You must submit a marriage certificate issued and certified by a civil authority in the state or country of marriage.

 

  1. Documents Showing the Marriage Termination (if applicable). You must submit a certified divorce decree, death certificate, or annulment
  2. Proof of U.S. Citizenship. Examples of this are birth certificates showing birth in the United States; a Form N-550, Certificate of Naturalization; a Form N-560, Certificate of Citizenship; a Form FS-240, Report of Birth Abroad of United States Citizen; or a valid unexpired U.S.
  3. Proof of Status as U.S. National (only required if you are claiming U.S. citizenship through a U.S. national, such as a person born in American Samoa or Swains Island).

If you were born outside the United States or its outlying possessions, you are born a U.S. citizen if your parents met the following conditions:

  1. Your S. citizen parent was physically present in the United States or one of its outlying possessions for a continuous period of one year prior to your birth; and
  2. Your other parent was a national, but not a U.S.

NOTE: If you have a U.S. citizen parent and a noncitizen parent who is an alien but not a national, your U.S. citizen parent must have met the physical presence requirements prior to your birth.

  1. Proof of Legitimation (only required if you who were born out-of-wedlock and your father is your U.S. Citizen parent).

For information regarding legitimation see the USCIS Policy Manual at www.uscis.gov/policymanual/HTML/PolicyManual-Volume12-PartH.html.

Provide legitimation documentation from the country or state in which you legitimated. Legitimation can also be established according to the laws of your father’s residence or your residence.

  1. Proof of Legal and Physical Custody (only required for applicants whose U.S. citizen parents divorced and/or separated and for applicants who are adopted or legitimated).
  2. Copy of Permanent Resident Card or Other Evidence of Permanent Resident Status (only required if you are claiming U.S. citizenship after birth through a U.S. citizen parent).
  3. Proof of Required Residence or Physical Presence In the United States. Any document that proves the U.S citizen parent’s residence or physical presence in the United States. This proof may include, but is not limited to the following:
    1. School, employment, or military records;
    2. Deeds, mortgages, or leases showing residence;
    3. Attestations by churches, unions, or other organizations;
    4. S. Social Security quarterly reports; and
    5. Affidavits of third parties having knowledge of the residence and physical
  4. Copy of Full, Final Adoption Decree (only required for adopted applicants).
  5. Re-adoption in the United States. If you had to be re-adopted in the United States, submit evidence of a full and final foreign adoption if the appropriate authority in the applicant’s current location of residence recognizes its validity.
  6. Evidence of All Legal Name Changes. If you legally changed your name, submit evidence of an issued and certified document by the court that authorized the legal name changes.

 

What If a Document Is Unavalaible?

You must provide a typed or printed explanation of the reasons a required document is unavailable and submit secondary evidence to establish eligibility. Secondary evidence must overcome the unavailability of the required documents. USCIS may request an original typed or printed statement from the appropriate government or other legal authority to support your claim that the documents are unavailable.

The following types of secondary evidence may be submitted to establish eligibility.

  1. Baptismal Certificate. Certificate under the church seal where your baptism occurred showing your:
    1. Place of birth;
    2. Date of birth;
    3. Baptism date;
    4. Parents’ names; and
    5. Godparents’ names, if
  2. School Record. An official letter from school authorities for the school attended (preferably the first school) showing your:
    1. Date of admission to the school;
    2. Place of birth;
    3. Date of birth or age at that time; and
    4. The names and residences of your birth parents, if shown in the school
  3. Census Records. State or Federal census records showing your:
    1. Name;
    2. Place of birth; and
    3. Date of birth or
  4. Affidavits (if other types of secondary evidence are not available).

Typed or printed statements sworn to (or affirmed) by two people who have personal knowledge of the claimed event. Affidavits must overcome the unavailability of both required documents and secondary evidence. Examples of events you may submit an affidavit for include the following:

  1. Your place and date of birth;
  2. Marriage; or

The people making these statements are not required to be U.S. citizens and may be relatives. Each affidavit must contain the following information about the person making the affidavit:

  1. Full legal name;
  2. Address;
  3. Place of birth;
  4. Date of birth;
  5. Relationship to you; and
  6. Detailed information about the event to include how they came to know about its

 

 

The fee for filing Form N-600 is $1,170.

 

NOTE: There is no filing fee for Form N-600 if you are a member or veteran of any branch of the U.S. Armed Forces filing on your own behalf. You must attach proof of U.S. military service; otherwise USCIS will charge a fee to file the Form N-600. Children of members or veterans of the Armed Forces are required to pay the filing fee for Form N-600.

NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this application. DO NOT MAIL CASH. You must submit all fees in the exact amounts.

 

Use the following guidelines when you prepare your check or money order for the Form N-600 filing 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 S. Department of Homeland Security.

NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”

  1. If you live outside the United States, contact the nearest U.S. Embassy or U.S. Consulate for instructions on the method of payment.

If USCIS rejects your Form N-600 for any of the reasons above, the application and any filing fees will be returned to you if you provided a complete and valid mailing address.

 

Notice To Those Making Payment by Check.

If you send us a check, USCIS will convert it 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 your bank will show it on your regular account statement.

You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If your check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the check is returned as unpayable a second time, we will reject your application and charge you a returned check fee.

 

How to Check If the Fees Are Correct

Form N-600’s filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS fees change periodically, you can verify that the fees are correct by following one of the steps below.

  1. Visit the USCIS website at uscis.gov, select “FORMS,” and check the appropriate fee; or
  2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

Fee Waiver Request

You may be eligible for a fee waiver under 8 CFR 103.7(c). If you believe you are eligible for a fee waiver, complete Form I-912, Request for Fee Waiver (or a written request) and submit it and any required evidence of your inability to pay the filing fee with this application. You can review the fee waiver guidance at www.uscis.gov/feewaiver.

 

Please see our website at www.uscis.gov/n-600 or call our National Customer Service Center at 1-800-375-5283 for the most current information about where to file this application. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address, go to the USCIS website at www.uscis.gov/ addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because the Lockbox does not process change of address requests.

 

 

Initial Processing. Once USCIS accepts your application we will check it for completeness. If you do not completely fill out this application, you will not establish a basis for your eligibility and USCIS may reject or deny your application.

 

Requests for More Information. We may request that you provide more information or evidence to support your application. We may also request that you provide the originals of any copies you submit. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original.

 

Requests for Interview. We may request that you appear at a USCIS office for an interview based on your application. At the time of any interview or other appearance at a USCIS office, we may require that you provide your fingerprints, photograph, and/or signature to verify your identity and/or update background and security checks.

 

Decision. The decision on Form N-600 involves a determination of whether you have established eligibility for the immigration benefit you are seeking. USCIS will notify you of the decision in writing.

 

NOTE: Any Form N-600 that is not signed or accompanied by the correct fee, except those accompanied by a fee waiver request (Form I-912, Request for Fee Waiver), will be rejected. A Form N-600 that is not completed according to these Instructions, is missing pages, or otherwise not executed in its entirety, or is not accompanied

by the required initial evidence may be rejected or delayed. You will be notified why the application is considered deficient. You may correct the deficiency and refile Form N-600. An application is not considered properly filed until accepted by USCIS.

 

To ensure use of the latest version of this application, visit the USCIS website at www.uscis.gov where the latest USCIS forms and immigration-related information are available. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at www.uscis.gov. Select “Schedule an appointment online” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.

 

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form N-600, we will deny your Form N-600 and may deny any other immigration benefit. In addition, the applicant will face severe penalties provided by law and may be subject to criminal prosecution.

 

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the Immigration and Nationality Act, section 101.

 

PURPOSE: The primary purpose for providing the requested information on this application is to determine if you have established eligibility for the immigration benefit for which you are filing. Department of Homeland Security (DHS) will use the information you provide to grant or deny the immigration benefit you are seeking.

 

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay a final decision in your case or result in denial of your application.

 

ROUTINE USES: DHS may share the information you provide on this application with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records notices [DHS/USCIS-007 – Benefits Information System and DHS/USCIS-001

– Alien File, Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law enforcement purposes or in the interest of national security.

 

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 Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 1 hour and 35 minutes per response, including the time for reviewing instructions, gathering the required documentation and information, completing the application, preparing statements, attaching necessary documentation, and submitting the application. The collection of biometrics is estimated to require 1 hour and 10 minutes. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No. 1615-0057. Do not mail your completed Form N-600 to this address.

US – I-824, Application for Action on an Approved Application or Petition

https://www.uscis.gov/i-824

For applicants filing with USCIS:

  • File this form with the correct USCIS Lockbox facility. You can find a complete list of filing addresses on our website. Exception: If you are filing Form I-824 with another USCIS form, mail your Form I-824 according to the filing instructions of the other form.
  • Read important filing tips, and additional information on our Lockbox Filing Tips webpage.
  • We will not process Form I-824 if your petition or application is still pending or has been denied.
  • Do not use this form to verify the status of a pending petition or application.

For applicants filing with CBP:

  • File this form at a designated CBP land border port of entry, a CBP preclearance office listed at cbp.gov, or it mail to U.S. Customs and Border Protection, Admissibility Review Office, at the address specified on the CBP website.

Filing Tips for Form I-824, Application for Action on an Approved Application or Petition

Complete all sections of the form. We will reject the form if these fields are missing:

  • Part 3 – Other Information
    • Receipt Number (on Form I-797, Notice of Action)

Don’t forget to sign your form! We will reject any unsigned form.

Filing Fee
$465.

You may pay the fee with a money order, personal check, or cashier’s check.  When filing at a USCIS Lockbox facility, you may also pay by credit card using Form G-1450, Authorization for Credit Card Transactions. If you pay by check, you must make your check payable to the U.S. Department of Homeland Security. Please note that service centers are not able to process credit card payments.

When you send a payment, you agree to pay for a government service. Filing and biometric service fees are final and non-refundable, regardless of any action we take on your application, petition, or request, or if you withdraw your request. Use our Fee Calculator to help determine your fee.

Instructions for Application for

Action on an Approved Application or Petition

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-824

OMB No. 1615-0044

Expires 11/30/2021

 

 

Use Form I-824, Application for Action on an Approved Application or Petition, to request further action on a previously approved application or petition.

 

You must use Form I-824 to request U.S. Citizenship and Immigration Services (USCIS) or U.S. Customs and Border Protection (CBP) action on a previously approved application or petition.

NOTE: USCIS or CBP will not approve Form I-824 if your previous approval is expired or was revoked.

You cannot use Form I-824 to verify the status of a pending application or petition. However, in accordance with 8 CFR

section 103.9, this application may be filed with the original application or petition.

 

For applications previously approved by CBP

You must use Form I-824 to request that CBP issue a duplicate of your Form I-192, Application for Advance Permission to Enter as Non-Immigrant, or Form I-212, Application for Permission to Reapply for Admission into the United States After Deportation or Removal, approval notice if the original was lost, stolen, or mutilated.

You may also obtain a duplicate of an indefinite waiver that was issued prior to April 1, 1998. An indefinite waiver

may be on Form I-185, Canadian Border Crossing Card (BCC) or on Form I-194 which shows the validity period as “indefinite.” You may obtain a duplicate of a previously issued indefinite waiver as long as your waiver was not revoked or voided.

 

Do not file Form I-824 with USCIS if you are requesting follow-to-join benefits for your spouse and/or children, and you are in one of the following classifications:

  1. You were issued an immigrant visa at a U.S. Embassy or U.S. Consulate via consular processing and were admitted to the United States as a lawful permanent resident (LPR) on an immigrant visa;
  2. You were granted refugee status after you were admitted to the United States;
  3. You were granted status in the United States as an asylee; or
  4. You have gained your LPR status through a T or U

Do not file Form I-824 with USCIS, if you are requesting:

  1. Further action on an application or petition that was denied, revoked, terminated or withdrawn;
  2. A correction of an error on your previously approved application or petition;
  3. A copy of the approved Form I-485, Application to Register Permanent Residence or Adjust Status, or Form N-400, Application for Naturalization, for your personal records;
  4. A duplicate approval notice of an approved immigrant visa petition naming the spouse or children who are accompanying or following to join you;

 

 

  1. USCIS to send information to the U.S. Department of State (DOS) regarding the approval of your expired nonimmigrant application or petition;
  2. USCIS to send information to DOS regarding an employment-based application or petition if your employment for the original petitioner has ended;
  3. USCIS to notify DOS of the approval of Form I-600A, Application for Advanced Processing of Orphan Petition, and/or Form I-600, Petition to Classify Orphan as an Immediate Relative, as well as the approval of Form I-800A, Application for Determination of Suitability to Adopt a Child from a Convention Country;
  4. An action on an approved application that was filed with CBP; or
  5. A replacement of the following documents: Employment Authorization Document (EAD), Form I-94 Arrival-

Departure Record, Form I-551, Permanent Resident Card, or Form I-512/I-512L, travel document.

To request replacement of:

  1. An EAD, you must file Form I-765, Application for Employment Authorization;
  2. Form I-94 Arrival-Departure Record, you must file Form I-102, Application for Replacement/Initial

Nonimmigrant Arrival-Departure Document;

  1. Form I-551, Permanent Resident Card, you must file Form I-90, Application to Replace Permanent Resident Card;
  2. Form I-512 or I-512L, travel document, you must file Form I-131, Application for Travel Document.

These forms can be found on the USCIS website at www.uscis.gov. Select the “FORMS” tab.

Do not file Form I-824 with CBP if you are requesting:

  1. A duplicate approval notice that is expired or was revoked;
  2. A correction of an error on your approval notice (visit cbp.gov for instructions on how to request a correction to your approval notice); or
  3. Action on an approved application or petition that was filed with

 

USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have Internet access, you may call the USCIS Contact Center at 1-800-375-5283 and ask that we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may sign the application on your behalf. A legal guardian may also sign for a mentally incompetent person.

 

Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section of these Instructions.)

 

For individuals filing this application with CBP: Please refer to CBP’s website at www.cbp.gov (go to the search box

and type “Form I-824,” “I-824,” or “824”) for further instructions.

 

Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific

Instructions and/or What Evidence Must You Submit sections of these Instructions.

 

 

Biometric Services Appointment. USCIS may require that you appear for an interview or provide fingerprints, photograph, and/or signature at any time to verify your identity, obtain additional information, and conduct background and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation (FBI), before making a decision on your application, petition, or request. After USCIS receives your application and ensures it is complete, we will inform you in writing if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support Center (ASC) and the date and time of your appointment or, if you are currently overseas, instruct you to contact a U.S. Embassy, U.S. Consulate, or USCIS office outside the United States to set up an appointment.

If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:

  1. You provided or authorized all information in the application;
  2. You reviewed and understood all of the information contained in, and submitted with, your application; and
  3. All of this information was complete, true, and correct at the time of

If you fail to attend your biometric services appointment, USCIS may deny your application.

 

Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you must submit an original document. USCIS may request an original document at the time of filing or at any time during processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original.

NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be

immediately destroyed upon receipt.

 

Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English. The certification must include the translator’s signature. DHS recommends the certification contain the translator’s printed name and the date and the translator’s contact information.

NOTE: You may file this application at any time while the previously approved application or petition is valid or

pending.

NOTE: A separate Form I-824 must be filed for each action being requested.

 

How To Fill Out Form I-824

  1. Type or print legibly in black
  2. If you need extra space to complete any item within this application, use the space provided in Part 7. Additional Information or attach a separate sheet of paper; type or print your name and Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each
  3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None,” unless otherwise directed.

 

 

This application is divided into Parts 1. – 7. The following information will help you fill out the application.

If you are the applicant or the petitioner of the previously approved application or petition, and you are now requesting action in Part 2., Item Number 1.a. or Item Number 1.b. of this application, you must complete and sign this application.

If you are the principal applicant who filed Form I-485 and you are now requesting action in Part 2., Item Number 1.c.

of this application, you must complete and sign this application.

Only the petitioner of the previously approved immigrant visa petition may file Form I-824, if action in Part 2., Item Number 1.d. or Item Number 1.e. is requested. You must provide the A-Number (in Part 1., Item Number 6. of the application) or the Receipt Number of the previously approved petition (in Part 3., Item Number 1.b. of this application), and complete and sign this application.

 

Part 1. Information About You (Person filing this Application)

Item Number 1. If you are the applicant or petitioner of the previously approved application or petition, select the appropriate box, and provide all the requested information.

NOTE: If the petitioner is a company or organization, provide the entity’s information in Part 1. of the application, if applicable.

 

Item Numbers 2.a. 2.c. Your Full Legal Name. Provide your full legal family name (last name), given name (first name), and middle name. If you have two last names, include both names. If a company or organization is the petitioner on the previously approved petition, leave these spaces blank.

 

Item Number 3. Company or Organization Name (if any). If the petitioner on the previously approved petition is a company or organization, provide the entity’s complete name.

Item Number 4. Current/Recent Immigration Status. Provide your current or most recent immigration status. If you

are a U.S. citizen, type or print “N/A.”

Item Number 5. Certificate of Naturalization or Citizenship Number (if any). If you are a naturalized U. S. citizen and select Part 2., Item Number 1.a., Item Number 1.b., Item Number 1.d., or Item Number 1.e., provide your Certificate of Naturalization or Citizenship Number.

 

Item Number 6. Alien Registration Number (A-Number) (if any). This is your Alien Registration Number

(immigration file number). If you do not have an A-Number or do not know it, leave this space blank.

 

Item Number 7. Date of Birth. Provide your date of birth in mm/dd/yyyy format (for example, May 1, 1979, should be typed or printed as 05/01/1979).

 

Item Number 8. Country of Birth. Provide the name of the country where you were born.

 

Item Number 9. Country of Citizenship or Nationality. Provide the country of citizenship or nationality of the principal applicant or petitioner.

 

Item Number 10. IRS Tax Number (if any). If you are filing this application on behalf of a business or organization,

provide the Internal Revenue Service (IRS) Tax Number of the business or organization.

 

Item Number 11. U. S. Social Security Number. If you are filing as an individual, provide your U.S. Social Security

Number in the spaces provided. If you do not have a U.S. Social Security Number, leave the spaces blank.

 

 

Item Number 12. USCIS Online Account Number (if any). If you have previously filed an application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions, or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not the same as an A-Number.

 

Item Numbers 13.a. – 13.i. Mailing Address. Provide your mailing address, if different from your physical address.

 

Item Numbers 14.a. – 14.h. Physical Address. Provide your physical street address. This must include a street number

and name or a rural route number. Do not provide a post office box (PO Box).

 

Part 2. Reason for Request

For individuals filing this application with CBP: Select Item Number 1.a. to request a duplicate of your Form I-192, Application for Advance Permission to Enter as Nonimmigrant, approval notice or your Form I-121, Application for Permission to Reapply for Admission into the United States After Deportation or Removal, approval notice if the original notice was lost, stolen, or mutilated, or a duplicate of an indefinite waiver was previously issued in conjunction with Form I-185, Nonresident Alien Canadian Border Crossing Card (BCC).

NOTE: If your Form I-192 approval notice expires in less than six months, please consider submitting a new Form I-192.

 

For individuals filing this application with USCIS. The reasons for requesting further action are listed below. Select the box that applies to your particular request (Select only one box).

  1. If you are requesting a duplicate approval notice of the application or petition, select Item Number a.

NOTE: The duplicate approval notice contains only the information regarding the approval as listed on the original Form I-797, Notice of Action. The duplicate approval notice does not include a copy of the previously approved application or petition; it only includes Form I-797.

NOTE: A replacement Employment Authorization Document (EAD) card, Permanent Resident Card, travel document or any other USCIS authorization document will not accompany the duplicate approval notice.

  1. If you are requesting USCIS to notify a new U.S. Consulate (different from that originally requested) through the U.S. Department of State’s National Visa Center (NVC) or Kentucky Consular Center (KCC) concerning the approval of a nonimmigrant visa petition or to notify a new Port-of-Entry (different from that originally requested) concerning the approval of a waiver application, select Item Number 1.b. If approved, USCIS will send information regarding the approval of your nonimmigrant visa petition to a new U.S. Consulate through the NVC or the KCC, or the approval of your waiver application to a new Port-of-Entry different from that originally
  2. If you are requesting USCIS to notify a U.S. Consulate through the NVC that your status was adjusted to that of a lawful permanent resident based on an approved Form I-485, select Item Number 1.c. This will permit your spouse and/or children to apply for an immigrant visa and follow-to-join you in the United

This notification is available if:

  1. An Immigration Judge or USCIS approved your lawful permanent resident status; and
  2. You wish to have your spouse or children follow-to-join you in the U.S. based on a previously approved Form

I-485 that was based upon:

  • A family preference visa petition (Form I-130);
  • An employment-based visa petition (Form I-140);

 

 

  • A religious worker or VAWA (Form I-360) petition; or
  • A diversity case

This notification is not available if:

  1. You were issued an immigrant visa at a U.S. Embassy or U.S. Consulate and were admitted to the United States as a lawful permanent resident. You may contact the NVC for information on how to request follow-to-join benefits for your dependents. You may direct your inquiry to our Public Inquiry Form (https://travel.state.gov/content/travel/en/us-visas/visa-information-resources/ask-nvc. html?wcmmode=disabled) or by writing to the National Visa Center, at:
  1. You were admitted to the United States as a refugee or were granted status in the United States as an asylee. Please refer to Form I-730, Refugee/Asylee Relative Petitions, for specific information on follow-to-join benefits for your spouse or unmarried children under 21 years of

NOTE: The approval of Form I-824 does not guarantee a visa will be granted by the U.S. Consulate overseas.

  1. If you are requesting USCIS to send your approved immigrant visa petition to the NVC, select Item Number 1.d. NOTE: If the beneficiary has already gained lawful permanent resident status through the approval of Form I-485,

this option is no longer available.

  1. If you are requesting USCIS to notify DOS that you have become a U.S. citizen through naturalization, select Item Number e.

NOTE: If you want to notify DOS that you have become a U.S. citizen through naturalization, you may do so by attaching your naturalization certificate to the Public Inquiry Form, https://travel.state.gov/content/travel/en/us- visas/visa-information-resources/ask-nvc.html?wcmmode=disabled, or sending your request along with a copy of your naturalization certificate directly to the National Visa Center at:

 

Part 3. Other Information

Provide the information about the previously approved application or petition in Item Numbers 1.a. – 1.d.

If you select Part 2., Item Number 1.a., Item Number 1.b., Item Number 1.d., or Item Number 1.e., provide the information in Part 3., Item Numbers 2.a. – 4.i., if applicable.

If you select Part 2., Item Number 1.c., provide the requested information in Part 3., Item Numbers 5.a. – 34., for each

family member for whom you are requesting follow-to-join benefits.

 

Part 4. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature

Item Numbers 1.a. – 6.b.  Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

 

 

Part 5. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1.a. – 7.b. If you used anyone as an interpreter to read the Instructions and questions on this application to you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date the application.

 

Part 6. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than

the Applicant

Item Numbers 1.a. – 8.b. This section must contain the signature of the person who completed your application, if other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both Part 5. and Part 6. If the person who completed this application is associated with a business or organization,

that person should complete the business or organization name and address information. Anyone who helped you complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited representative, he or she may be obliged to also submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited

Representative, or Form G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines

of the United States, along with your application.

 

Part 7. Additional Information

Item Numbers 1.a – 7.d. If you need extra space to provide any additional information within this application, use the space provided in Part 7. Additional Information. If you need more space than what is provided in Part 7., you may make copies of Part 7. to complete and file with your application, or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

 

 

You must submit all evidence requested in these Instructions with your application. If you fail to submit required evidence, USCIS may reject or deny your application for failure to submit requested evidence or supporting documents in accordance with 8 CFR 103.2(b)(1) and these Instructions.

Attach copies, showing the front and back of the following documents, if applicable:

  1. If you select Part 2., Item Numbers 1.a., b., 1.c., or 1.d., provide a copy of Form I-797 for the previously approved

application or petition; or

  1. If you select Part 2., Item Number 1.e., provide a copy of Form N-550, Certificate of

 

The filing fee for Form I-824 is $465.

NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this application. DO NOT MAIL CASH. You must submit all fees in the exact amounts.

 

 

Use the following guidelines when you prepare your check or money order for the Form I-824 filing 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

  1. Make the check or money order payable to S. Department of Homeland Security.

NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”

  1. When applying with CBP, you must make your check or money order payable to U.S. Customs and Border Protection. 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. Certain CBP-designated Ports-of-Entry and certain CBP-designated preclearance offices may accept payment in the form of cash or credit cards.
  2. If you live outside the United States, contact the nearest U.S. Embassy or U.S. Consulate for instructions on the method of payment.

We recommend that you contact the CBP-designated Port-of-Entry or CBP preclearance office where you intend to be processed for payment instructions. Please visit www.cbp.gov (go to the search box and type “Form I-824,” or “I-824” or “824”).

 

Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it 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 your bank will show it on your regular account statement.

You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If your check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the check is returned as unpayable a second time, we will reject your application and charge you a returned check fee.

 

How To Check If the Fees Are Correct

Form I-824’s filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS fees

change periodically, you can verify that the fees are correct by following one of the steps below.

  1. Visit the USCIS website at uscis.gov, select “FORMS,” and check the appropriate fee; or
  2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or

hard of hearing) call: 1-800-767-1833.

 

For applicants filing with USCIS:

Please see our website at www.uscis.gov/I-824 or call our USCIS Contact Center at 1-800-375-5283 for the most current

information about where to file this application. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

For applicants filing with CBP:

Please file this application request at a designated CBP land border Port-of-Entry or a CBP preclearance office listed on www.cbp.gov or mail to U.S. Customs and Border Protection, Admissibility Review Office at the address specified on www.cbp.gov.

 

 

If you filed this application with USCIS:

An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address go to the USCIS website at www.uscis.gov/ addresschange or contact the USCIS Contact Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800- 767-1833.

NOTE: Do not submit a change of address request to USCIS Lockbox facilities because the Lockbox does not process change of address requests.

 

If your application is pending with CBP:

You may change your address by writing via regular mail or via email to the Admissibility Review Office/U.S. Customs

and Border Protection.

 

Mailing address: Please refer to www.cbp.gov for the most updated mailing address of the Admissibility Review Office.

 

Email address: Inquiry.waiver.aro@cbp.dhs.gov.

 

Do not send a Change of Address Request to USCIS or a USCIS Lockbox facility.

 

Initial Processing. Once USCIS accepts your application we will check it for completeness. If you do not completely fill

out this application, you will not establish a basis for your eligibility and USCIS may reject or deny your application.

 

Requests for More Information. We may request that you provide more information or evidence to support your application. We may also request that you provide the originals of any copies you submit. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original.

 

Requests for Interview. We may request that you appear at a USCIS office for an interview based on your application. At the time of any interview or other appearance at a USCIS office, we may require that you provide your fingerprints, photograph, and/or signature to verify your identity and/or update background and security checks.

 

Decision. The decision on Form I-824 involves a determination of whether you have established eligibility for the

immigration benefit you are seeking. USCIS will notify you of the decision in writing.

 

To ensure you are using the latest version of this application, visit the USCIS website at www.uscis.gov where you can obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at www.uscis.gov. Select “Schedule an Appointment” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.

 

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-824, we will deny your Form I-824 and may deny any other immigration benefit. In addition, you will face severe penalties provided by law and may be subject to criminal prosecution.

 

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under 8 CFR 103.5b.

 

PURPOSE: The primary purpose for providing the requested information on this application is to request further action on a previously approved application or petition. DHS uses the information you provide to grant or deny the immigration benefit you are seeking.

 

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in the denial of your application..

 

ROUTINE USES: The Department of Homeland Security (DHS) may share the information you provide on this application, and any additional requested evidence, with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index, and National File Tracking System of Records, DHS/ USCIS-007 Benefits Information System, DHS/USCIS-018 Immigration Biometric and Background Check, DHS/CBP- 006 Automated Targeting System, and DHS/CBP-011 U.S. Customs and Border Protection TECS] and the published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System and Associated Systems, DHS/CBP/PIA-009 TECS System: CBP Primary and Secondary Processing, and DHS/CBP/ PIA-006(b) Automated Targeting System], which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.

 

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 Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 25 minutes per response, including the time for reviewing instructions, gathering the required documentation and information, completing the application, preparing statements, attaching necessary documentation, and submitting the application. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S.

Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts

Ave NW, Washington, DC 20529-2140; OMB No. 1615-0044. Do not mail your completed Form I-824 to this address.

US – Change My Nonimmigrant Status – I-539, Application To Extend/Change Nonimmigrant Status

https://www.uscis.gov/visit-the-united-states/change-my-nonimmigrant-status

If you want to change the purpose of your visit while in the United States, you (or in some cases your employer) must file a request with USCIS on the appropriate form before your authorized stay expires. For instance, if you arrived here as a tourist but want to become a student, you must submit an application to change your status. We recommend that you apply as soon as you determine that you need to change to a different nonimmigrant category.

Until you receive approval from USCIS, do not assume the status has been approved, and do not change your activity in the United States.  For example, if you are currently a nonimmigrant tourist, do not begin attending school as a student until you have received authorization from USCIS to change your status. If you fail to maintain your nonimmigrant status, you may be barred from returning to and/or removed (deported) from the United States. Your authorized status and the date your status expires can be found in the lower right-hand corner of your Form I-94, Arrival-Departure Record.

In general, you may apply to change your nonimmigrant status if you were lawfully admitted to the United States with a nonimmigrant visa, your nonimmigrant status remains valid, you have not violated the conditions of your status, and you have not committed any crimes that would make you ineligible.

You do not need to apply to change your nonimmigrant status if you were admitted into the United States for business reasons (B-1 visa category ) and you wish to remain in the United States for pleasure before your authorized stay expires.

You do not need to apply to change your nonimmigrant status if you wish to attend school in the United States, and you are the spouse or child of someone who is lawfully admitted to the United States in any of the following nonimmigrant visa categories:

  • Diplomatic and other government officials, and employees (A visa category)
  • International trade and investors (E visa )
  • Representatives to international organizations and their employees (G visa )
  • Temporary workers (H visa)
  • Representatives of foreign media (I visa)
  • Exchange visitors (J visa)
  • Intracompany transferees (L visa)
  • Academic (F visa) or vocational (M visa) students (you may attend elementary, middle or high school only: if you want to attend post-secondary school full-time you must apply for a change of status).

You may not apply to change your nonimmigrant status if you were admitted to the United States in the following categories:

  • Visa Waiver Program
  • Crew member (D nonimmigrant visa)
  • In transit through the United States (C nonimmigrant visa)
  • In transit through the United States without a visa (TWOV)
  • Fiancé of a U.S. citizen or dependent of a fiancé (K nonimmigrant visa)
  • Informant (and accompanying family) on terrorism or organized crime (S nonimmigrant visa)

If you are a vocational student (M-1), you may not apply to change your status to a(n):

  • Academic student (F-1)
  • Any H status (Temporary worker), if the training you received as a vocational student in the United States provided the qualifications for the temporary worker position you seek.

If you are an international exchange visitor (J-1), you may not change your nonimmigrant status if:

  • You were admitted to the United States to receive graduate medical training, unless you receive a special waiver.
  • You are an exchange visitor and are required to meet the foreign residence requirement, unless you receive a waiver.
    • If you do not receive a waiver, you may only apply to change to a diplomatic and other government officials (A visa) or representatives to international organizations (G visa)

For information on how to apply, see the How Do I Apply page.

Related Links

More Information

Last Reviewed/Updated:

Instructions for Application to Extend/Change Nonimmigrant Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-539

OMB No. 1615-0003

Expires 10/31/2021

 

 

You should use this application if you are one of the nonimmigrants listed below and wish to apply to U.S. Citizenship and Immigration Services (USCIS) for an extension of stay or a change to another nonimmigrant status.

In certain situations, you may use this application to apply for an initial nonimmigrant status.

You may also use this application if you are a nonimmigrant F-1 or M-1 student applying for reinstatement.

 

 

You must submit an application for extension of stay or change of status before your current authorized stay expires.

Even if you are approved for another status in the future, you will be required to file a Form I-539 to “bridge” any gap that might arise between the expiration of your current status and validity of your future status. Therefore, we suggest you file at least 45 days before your stay expires or as soon as you determine your need to change or extend status. Failure to file before the expiration date may be excused if you demonstrate when you file the application that:

  1. The delay was due to extraordinary circumstances beyond your control;
  2. The length of the delay was reasonable;
  3. You have not otherwise violated your status;
  4. You are still a bona fide nonimmigrant; and
  5. You are not in removal

 

 

Extension of Stay or Change of Status

Nonimmigrants in the United States may apply for an extension of stay or a change of status on this application, except as noted in the Who May Not File Form I-539 section of these Instructions.

 

Multiple Applicants

You may include your spouse and your unmarried children under 21 years of age as co-applicants in your application for the same extension or change of status, but only if you are all now in the same status or they are all in derivative status. You must complete Form I-539A for each person that you want to include on your application. If you need additional space, you may print additional copies of the Form I-539A to complete for additional co-applicants.

NOTE: Extensions granted to members of a family group must be for the same period of time. The shortest period granted to any member of the family shall be granted to all members of the family.

 

Part 5. Public Benefits

In general, as a condition on the approval of this application, you must demonstrate that you have not received since obtaining the nonimmigrant status you seek to extend or from which you seek to change, one or more public benefits set forth in 8 CFR 212.21(b) (and listed below) for more than 12 months within any 36 month period (such that, for instance, receipt of two benefits in one month counts as two months).

You must provide information about all public benefits you have received since obtaining the nonimmigrant status you seek to extend or from which you seek to change. You do not need to provide information on your receipt of public benefits if you are filing under one of these categories: A1, A2, G1, G2, G3, G4, NATO1, NATO2, NATO3, NATO4, NATO5, NATO6, NATO7, T1, T2, T3, T4, T5, T6, U1, U2, U3, U4, U5).

Receipt means when a benefit-granting agency provides a public benefit to you whether in the form of cash, voucher, services, or insurance coverage. Only the amount received by or attributable to you will be considered.

In the space provided, please provide all requested information about each public benefit received, regardless of how long you received the public benefit. USCIS will calculate the duration you received public benefits, as described below, for purposes of determining your eligibility for an extension of stay or change of status. If you received public benefits intermittently throughout the year, provide each instance separately. For example, if you received SNAP from January to February and from June to December, list the information separately.

Indicate whether, since obtaining the nonimmigrant status you seek to extend or from which you seek to change, or have been certified to receive, any of the following public benefits (You need to respond even if you fall within one of the categories of individuals for whom receipt of public benefits will not be considered – see table below for evidence that must be provided to document that you qualify for the exclusion):

  1. Any Federal, state, local, or tribal cash assistance for income maintenance;
  2. Supplemental Security Income (SSI);
  3. Temporary Assistance for Needy Families (TANF);
  4. Federal, state, or local cash benefit programs for income maintenance (often called “General Assistance” in the state

context, but which may exist under other names);

  1. Supplemental Nutrition Assistance Program (SNAP, formerly called “Food Stamps”);
  2. Section 8 Housing Assistance under the Housing Choice Voucher Program;
  3. Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation);
  4. Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.; and
  5. Federally-funded

NOTE: You only need to report public benefits received on or after October 15, 2019 but not any received before October 15, 2019.

If you have not received any public benefits, please select that option.

If you are not certified to receive any of the above listed public benefits, please select that option.

If you have received or are certified to receive the public benefits but requested disenrollment, please provide, in addition to providing the information about any exclusions below, evidence of your request to disenroll if the public benefit- granting agency has not processed your request.

Unless you qualify for certain exclusions listed in the table below, you are ineligible for extension of stay and change of status if you have received, since obtaining the nonimmigrant status that you seek to extend or from which you seek to change, the benefits listed above for more than 12 months in the aggregate within any 36-month period (such that, for instance, receipt of two public benefits in one month counts as two months).

 

The following is a list of exclusions from the public benefit considerations listed above. If you belong to one of the

following categories, submit the evidence listed for the applicable categories.

 

Exclusion Description Evidence you must submit to qualify for exclusions (as applicable)
U.S. Armed Forces Service Members At the time the public benefit was received or at the time you file your Form I-539, or at time of adjudication of your Form I-539, the applicant is:

•       An alien enlisted in the U.S. Armed Forces, or serving in active duty or in the Ready Reserve component of the

U.S. Armed Forces;

•       The spouse or child of the service member (listed in Item Number 1., above); or

•       The spouse or child of an individual enlisted in the U.S. Armed Forces, or serving in active duty or in the Ready Reserve component of the

U.S. Armed Forces.

•               Service Members: Certified evidence of alien’s enlistment/service issued by the authorizing official of the executive department in which service member is serving.

•               Spouses and Children of Service

Members:

•              Copy of Form DD-1173, United States Uniformed Services Identification and Privilege Card (Dependent).

Federally-funded Medicaid •          Receipt by an alien under 21 years of age;

•          The recipient of Medicaid payment(s) for an “emergency medical condition;

•          The receipt of Medicaid for services provided under the Individuals with Disabilities Education Act (IDEA);

•          The receipt of Medicaid for school-based benefits for children who are of an age eligible for secondary education as determined under state or local law; or

•          Receipt during pregnancy and during the 60-day period after the last day of the pregnancy.

•          A statement with information regarding the “emergency medical condition” determination (if applicable);

•          Documentation of these payments under the IDEA or school-based service; or

•          Pregnancy verification letter from medical professional including estimated duration of pregnancy.

 

Exclusion Description Evidence you must submit to qualify for exclusions (as applicable)
Children Who Will Naturalize Under INA 322 •                             Child currently residing abroad who entered the United States with a nonimmigrant visa to attend N-600K, Application for Citizenship and Issuance of Certificate Under INA Section 322 interview. •          A copy of the N-600K interview notice.
Public Benefits While in an Immigration Category Exempt from Public Charge •              Received public benefits while in a category that is exempt from public charge inadmissibility; or

•              Received public benefits while in a category for which you had received a waiver for public charge inadmissibility.

•               Information that evidences your status or that you received a waiver for the public charge ground of inadmissibility, such as

•       Approval notice (Form I-797,

Notice of Action); or

•       Form I-94, Arrival/Departure Record.

 

Documentation

If you have received any of the public benefits listed above, submit evidence in the form of a letter, notice, certification, or other agency documents that contain the following:

  1. Your name;
  2. Name and contact information for the public benefit granting agency;
  3. Type of benefit;
  4. Date you started receiving the benefit or if certified, date you will start receiving the benefit; and
  5. Date benefit or coverage ended or expires (mm/dd/yyyy) (if applicable).

If you have received public benefits as listed above, please indicate whether an exclusion applies to you in Item Number 3. and provide the evidence listed in the chart above to demonstrate why the benefit should not be considered.

 

Nonimmigrant Categories

This application may be submitted by the following nonimmigrants listed in alphabetical order.

1.  A, Ambassador, Public Minister, or Career Diplomatic or Consular Officer and Their Immediate Family

Members

You must submit a copy, front and back, of Form I-94 Arrival-Departure Record Number, for each person included  in the application and Form I-566, Interagency Record of Request – A, G, or NATO Dependent Employment Authorization or Change/Adjustment to/from A, G, or NATO Status, certified by the U.S. Department of State (DOS) to indicate your accredited status.

  1. A-3, Attendant or Servant of an A Nonimmigrant and the A-3’s Immediate Family Members You must submit a copy, front and back, of Form I-94 for each person included in the application. The apllication must be filed with:
    1. A copy of your employer’s Form I-94 or approval notice demonstrating A status;

 

  1. An original letter from your employer stating:
    • Your duties;
    • That the employer intends to personally employ you for the entirely of your contract; and
    • Arrangements you have made to depart from the United States; and
  2. An original Form I-566, certified by DOS, indicating your employer’s continuing accredited

NOTE: There is no fee required for any A-1, A-2, or A-3 applicant with Form I-539.

3.  B-1, Visitor for Business, or B-2, Visitor for Pleasure

If you are filing for an extension/change, you must file your application with the original Form I-94 for each person included in your application. In addition, you must submit a typed or written statement explaining in detail:

  1. The reasons for your request;
  2. The reasons why your extended stay would be temporary, including what arrangements you have made to depart from the United States; and
  3. Any effect the extended stay may have on your foreign employment or

If you are applying for a change of B-1, visitor for business status, you must designate your desired status using the

following classification in Part 2., Item Number 3.c. of Form I-539:

  1. B-1A, nonimmigrant who is the personal or domestic servant of a nonimmigrant employer;
  2. B-1B, nonimmigrant domestic servant of a U.S. citizen;
  3. B-1C, nonimmigrant who is employed by a foreign airline;
  4. B-1D, nonimmigrant who is a missionary; and
  5. B-1, all other visa classifications not designated

4.  Dependents (CW-2) of a CW-1 Transitional Worker

If you are filing for an extension/change of status as the dependent of an employee who is a CW-1 transitional worker, this application must be submitted with:

  1. Evidence of lawful presence in the Commonwealth of the Northern Mariana Islands (CNMI) as defined in 8 CFR

214.2(w)(1)(v); and

  1. Evidence of each applicant’s relationship to the CW-1 transitional worker, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  2. One of the following:
    • Form I-129CW, Petition for a Nonimmigrant Worker in the CNMI, filed on behalf of the CW-1 transitional

worker;

  • A copy of the I-797 Receipt Notice related to the transitional worker’s already pending petition;
  • A copy of the front and back of the transitional worker’s most recent Form I-94; or
  • A copy of the I-797 Approval Notice showing the transitional worker has already been granted status for the

period requested on your application.

NOTE: Dependents of CW-1 transitional workers must apply for extension/change of status to CW-2 on this application. An employer must file Form I-129CW to obtain CW-1 status on behalf of an employee or prospective employee.

 

5.  Dependents of a Principal E Nonimmigrant

The principal E nonimmigrant classifications include: E-1 Treaty Traders and their E-1 employees, E-2 Treaty Investors and their E-2 employees, E-2 CNMI Investors, and E-3 Australian Specialty Occupation Professionals.

The principal E nonimmigrant classifications include: E-1 Treaty Traders and their E-1 employees, E-2 Treaty Investors and their E-2 employees, E-2 CNMI Investors, and E-3 Australian Specialty Occupation Professionals.

Dependents of E nonimmigrants receive the same classification as the principal.

If you are filing for an extension/change of status as the dependent of a principal E nonimmigrant, you must submit the following with your application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the principal E nonimmigrant, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the principal E nonimmigrant;
    • A copy of the I-797 Receipt Notice related to the principal E nonimmigrant’s already pending Form I-129

petition;

  • A copy of the front and back of the principal E nonimmigrant’s most recent Form I-94; or
  • A copy of the I-797 Approval Notice showing the principal E nonimmigrant has already been granted status

for the period requested on your application.

NOTE: Dependents of principal E nonimmigrants must apply on this form for extension/change of status to the same E classification as the principal. An employer must file Form I-129 on behalf of a principal E nonimmigrant who is currently in the United States. If the principal E nonimmigrant is not currently in the United States, he or she must contact a U.S. Embassy or U.S. Consulate abroad to apply for E classification.

Dependent spouses of principal E nonimmigrants may not work upon approval of this application. To request work authorization, the dependent spouse must file Form I-765, Application for Employment Authorization. Dependent children of principal E nonimmigrants are not authorized for employment.

6.  F-1, Academic Student

To request a change to F-1 status or to apply for reinstatement as an F-1 student, you must submit your Form I-94, as well as the Form I-94 for each person included in the application.

Your application must also include a copy of your Form I-20, Certificate of Eligibility for Nonimmigrant Student, issued by the school where you will study and you must submit documentation that demonstrates your ability to pay for your studies and support yourself, and any accompanying dependent family members, while you are in the United States.

NOTE: A change of status may be granted for a period up to 30 days before the report date or start date of the course of study listed on Form I-20. You must maintain your current, or other, nonimmigrant status up to 30 days before

the report date or start date of the course of study listed on Form I-20 or your requested change of status may not be granted.

F-1 Reinstatement

In addition to the above documents, you must also submit evidence that your violation of status resulted from circumstances beyond your control or that your violation relates to a reduction in your course load that would have been within a Designated School Official’s (DSO’s) power to authorize, and that failure to approve reinstatement would result in extreme hardship to you.

 

If you have been out of status for more than 5 months at the time of filing your request for reinstatement, you must also provide evidence that your failure to file within the 5 month period was the result of exceptional circumstances and that you filed your request for reinstatement as promptly as possible under these exceptional circumstances.

F-1 Extensions

Only use this form to request an extension if you were admitted for a limited duration as a student entering to study at a public secondary school. All other students seeking information concerning extensions should contact their DSO.

7.  G, Designated Principal Resident Representative of a Foreign Government and His or Her Immediate Family Members

You must submit a copy, front and back, of Form I-94 for each person included in the application, and Form I-566,

certified by Department of State (DOS) to indicate your accredited status.

8.  G-5, Attendant or Servant of a G Nonimmigrant and the G-5’s Immediate Family Members

The application must also be filed with:

  1. A copy of your employer’s Form I-94 or approval notice demonstrating G status;
  2. An original letter from your employer describing your duties stating that he or she intends to personally employ you and arrangements you have made to depart from the United States; and
  3. An original Form I-566, certified by the DOS, indicating your employer’s continuing accredited

NOTE: There is no fee required for any G-1, G-2, G-3, G-4, or G-5 applicant with Form I-539.

9.  Dependents (H-4) of an H, Temporary Worker

If you are filing for an extension/change of status as the dependent of an employee who is an H temporary worker, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the H temporary worker, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the H temporary worker;
    • A copy of the Form I-797 Receipt Notice related to the H temporary worker’s already pending Form I-129

petition;

  • A copy of the front and back of the H temporary worker’s most recent Form I-94; or
  • A copy of the Form I-797 Approval Notice showing the H temporary worker has already been granted status

for the period requested on your application.

NOTE: Dependents of H temporary workers must apply for extension/change of status to H-4 on this form. An

employer must file Form I-129 on behalf of the H temporary worker.

10.  I, Representatives of Foreign Media and Dependents

Nonimmigrants granted I classification may be admitted for the duration of employment. You do not need to file for

an extension of stay as long as you work for the same employer in the same information medium.

However, you must file this form to request a change of employer or a change in the information medium in which you work. To do this, select Item Number 1. in Part 2. of Form I-539 and annotate “change of employer” or “change of information medium” next to that selection.

If you are requesting a change of status to I nonimmigrant status, select Item Number 2.a. in Part 2. of Form I-539

and indicate “I-Foreign Press” in the space provided.

 

To change your status to I, or to extend your stay in I nonimmigrant status due to a change of employer or information

medium, you must submit the following with your application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. A letter from the employing foreign media organization that verifies the employment, establishes that you are a

representative of that media organization, and describes the remuneration and work to be performed; and

  1. If applicable, evidence of each dependent’s relationship to the principal, such as a birth certificate or marriage certificate and proof of termination of any prior marriages. (NOTE: Dependents of I nonimmigrants receive the same classification as the )

11.  J-1, Exchange Visitor

If you are requesting a change of status to J-1 nonimmigrant classification, your application must be filed with a

DS-2019, Certificate of Eligibility for Exchange Visitor Status. You must also submit your Form I-94, as well as the

Form I-94 for each person included in the application.

NOTE: A change of status may be granted for a period up to 30 days before the report date or start date of the approved program listed on Form DS-2019. You must maintain your current, or other, nonimmigrant status up to

30 days before the report date or start date of the approved program listed on Form DS-2019 or your requested change of status may not be granted.

J-1 Extensions

If you are a J-1 exchange visitor seeking an extension of nonimmigrant status, contact the responsible officer of your

program for information about this procedure.

J-1 Reinstatement

If you are a J-1 exchange visitor seeking reinstatement, contact the responsible officer at your sponsoring program for

information about the reinstatement procedure.

Notice to J Nonimmigrants

A J-1 exchange visitor whose status is to receive graduate medical education or training, and who has not received the appropriate waiver, is ineligible for change of status except to a nonimmigrant T or U visa. In addition, a J-1 exchange visitor who is subject to the foreign residence requirement, and who has not received a waiver of that requirement, is only eligible for a change of status to a nonimmigrant A, G, T, or U visa.

If a J-1 exchange visitor is subject to the foreign residence requirement, the J-2 dependent is also subject as a derivative to this requirement. If the J-1 exchange visitor obtains a waiver of the foreign residence requirement, the J-2 dependent is also exempt from the requirement. Under certain limited circumstances, a J-2 dependent may be independently eligible for a waiver of the foreign residence requirement.

A former J nonimmigrant (either a J-1 principal or a J-2 dependent) subject to the foreign residence requirement, who is currently maintaining another nonimmigrant visa status, continues to be subject to the foreign residence

requirement. As noted above, the former J nonimmigrant is ineligible for a change of status until he or she fulfills the

foreign residence requirement or obtains the appropriate waiver.

If you are a current or former J nonimmigrant, you must provide information about this status, including the dates you maintained status as a J-1 exchange visitor or a J-2 dependent. Willful failure to disclose this information (or other relevant information) can result in your application being denied. Provide proof of this status along with your application, 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.

12.  Dependents (L-2) of an L, Intracompany Transferee

If you are filing for an extension/change of status as the dependent of an employee who is an L intracompany transferee, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;

 

  1. Evidence of each applicant’s relationship to the L intracompany transferee, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  2. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the L intracompany transferee;
    • A copy of the I-797 Receipt Notice related to the L intracompany transferee’s already pending Form I-129

petition;

  • A copy of the front and back of the L intracompany transferee’s most recent Form I-94; or
  • A copy of the I-797 Approval Notice showing the L intracompany transferee has already been granted status

for the period requested on your application.

NOTE: Dependents of L intracompany transferees must apply for extension/change of status to L-2 on this form. An employer must file Form I-129 on behalf of the L intracompany transferee.

Dependent spouses of L intracompany transferees may not work upon approval of this application. To request work authorization, the dependent spouse must file Form I-765, Application for Employment Authorization. Dependent children of L intracompany transferees are not authorized for employment.

13.  M-1, Vocational or Non-Academic Student

To request a change to or extension of M-1 status, or apply for reinstatement to M-1 status, you must submit your Form I-94, as well as Form I-94 for each person included in the application.

Your application must also include a copy of your Form I-20, Certificate of Eligibility for Nonimmigrant Student, issued by the school where you will study and you must submit documentation that demonstrates your ability to pay for your studies and support yourself, and any accompanying dependent family members, while you are in the United States.

NOTE: A change of status may be granted for a period up to 30 days before the report date or start date of the course of study listed on Form I-20. You must maintain your current, or other, nonimmigrant status up to 30 days before

the report date or start date of the course of study listed on Form I-20 or your requested change of status may not be granted.

M-1 Reinstatement

In addition to the above documents you must also submit evidence that your violation of status resulted from circumstances beyond your control or that your violation relates to a reduction in your course load that would have been within a DSO’s power to authorize, and that failure to approve reinstatement would result in extreme hardship to you.

If you have been out of status for more than 5 months at the time of filing your request for reinstatement you, must also provide evidence that your failure to file within the 5 month period was the result of exceptional circumstances and that you filed your request for reinstatement as promptly as possible under these exceptional circumstances.

M-1 Extension

In addition to submitting the above evidence, you will need to submit evidence supporting your reason for requesting

an extension. You may request an extension of stay for the following reasons:

  1. If compelling educational or medical reasons have resulted in a delay to your course of Delays caused by academic probation or suspension are not acceptable reasons for program extension.
  2. You are transferring to a different

NOTE: If you are transferring schools 6 months, or more, from the date you were first admitted, you will need to submit evidence showing you are unable to remain at the school you were initially admitted to attend due to circumstances beyond your control.

  1. You are applying for post-completion optional practical

 

NOTE: M-1 students may not change their educational objective and should not request an extension for this reason.

No extension can be granted to an M-1 student if the M-1 student is unable to complete the course of study, to

include any requested post-completion OPT, within 3 years of the original program start date.

14.  Dependents (O-3) of an O, Alien of Extraordinary Ability or Achievement

If you are filing for an extension/change of status as the dependent of an employee who is an O nonimmigrant worker, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the O nonimmigrant worker, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the O nonimmigrant worker;
    • A copy of the Form I-797 Receipt Notice related to the O nonimmigrant worker’s already pending Form I-129

petition;

  • A copy of the front and back of the O nonimmigrant worker’s most recent Form I-94; or
  • A copy of the Form I-797 Approval Notice showing the O nonimmigrant worker has already been granted

status for the period requested on your application.

NOTE: Dependents of O nonimmigrant workers must apply for extension/change of status to O-3 on this form. An employer must file Form I-129 on behalf of the O nonimmigrant worker.

15.  Dependents (P-4) of a P, Artist, Athlete, or Entertainer

If you are filing for an extension/change of status as the dependent of an employee who is a P nonimmigrant worker, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the P nonimmigrant worker, such as birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the P nonimmigrant worker;
    • A copy of the Form I-797 Receipt Notice related to the P nonimmigrant worker’s already pending I-129

petition;

  • A copy of the front and back of the P nonimmigrant worker’s most recent Form I-94; or
  • A copy of the Form I-797 Approval Notice showing the P nonimmigrant worker has already been granted

status for the period requested on your application.

NOTE: Dependents of P nonimmigrant workers must apply for extension/change of status to P-4 on this form. An

employer must file Form I-129 on behalf of the P nonimmigrant worker.

16.  Dependents (R-2) of an R, Religious Worker

If you are filing for an extension/change of status as the dependent of an employee who is an R religious worker, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the R religious worker, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:

 

  • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the R religious worker;
  • A copy of the Form I-797 Receipt Notice related to the R religious worker’s already pending Form I-129

petition;

  • A copy of the front and back of the R religious worker’s most recent Form I-94; or
  • A copy of the Form I-797 Approval Notice showing the R religious worker has already been granted status for

the period requested on your application.

NOTE: Dependents of R religious workers must apply for extension/change of status to R-2 nonimmigrant status on

this form. An employer must file Form I-129 on behalf of the R religious worker.

17.  Dependents (TD) of a TN, Canadian or Mexican Professional

If you are filing for an extension/change of status as the dependent of an employee who is a TN professional worker, you must submit the following with this application:

  1. A copy of the front and back of Form I-94 for each person included on this application;
  2. Evidence of each applicant’s relationship to the TN professional worker, such as a birth certificate or marriage certificate and proof of termination of any prior marriages; and
  3. At least one of the following:
    • Form I-129, Petition for a Nonimmigrant Worker, filed on behalf of the TN professional worker;
    • A copy of the Form I-797 Receipt Notice related to the TN professional worker’s already pending Form I-129

petition;

  • A copy of the front and back of the TN professional worker’s most recent Form I-94; or
  • A copy of the Form I-797 Approval Notice showing the TN professional worker has already been granted

status for the period requested on your application.

NOTE: Dependents of TN professional workers must apply for extension/change of status to TD on this form. An employer must file Form I-129 on behalf of a TN professional worker who is currently in the United States. If the principal TN nonimmigrant is not currently in the United States, Mexican citizen professionals must contact a U.S. Embassy or U.S. Consulate in Mexico and Canadian citizen professionals must contact a designated port-of-entry to apply for TN classification.

18.  T Nonimmigrants

If you are filing for an extension of status as a T nonimmigrant based on law enforcement need, this application must be submitted with:

  1. A copy of your Form I-94 or approval notice showing that you have already been granted T status; and
  2. Evidence demonstrating law enforcement need, such as a new Form I-914 Supplement B, Declaration of Law Enforcement Officer for Victims of Trafficking in Persons, or other evidence from law enforcement explaining that your presence is necessary, and any other credible

If you are filing for an extension of status as a T nonimmigrant based on exceptional circumstances, this application must be submitted with:

  1. A copy of your Form I-94 or approval notice showing that you have already been granted T status; and
  2. Evidence demonstrating exceptional circumstances, such as an affirmative statement or any other credible

evidence.

NOTE: Extensions of T nonimmigrant status based on the filing of Form I-485, Application to Register Permanent Residence or Adjust Status, do not require the filing of Form I-539. T nonimmigrant status is automatically extended when the Form I-485 is filed.

 

19.  T Derivative Nonimmigrants

A T derivative nonimmigrant may file for an extension of status independently if the T-1 principal remains in valid T nonimmigrant status, or the T-1 principal nonimmigrant may file for an extension of T-1 status and request that this extension be applied to the derivative family members.

If the T-1 principal nonimmigrant wants the extension of status request described above to be applied to derivative family members with T-2, T-3, T-4, T-5, or T-6 nonimmigrant status that are currently in the United States, indicate that request in writing and list each derivative separately on Supplement A of the Form I-539. Each Supplement A of the Form I-539 must be submitted with a copy of the derivative’s Form I-94 or approval notice showing that the derivative was already granted T-2, T-3, T-4, T-5, or T-6 status.

If the T-2, T-3, T-4, T-5, or T-6 nonimmigrant is filing independently for an extension of status, this application must be submitted with:

  1. Justification for your extension request (statement of need and reasons);
  2. A copy of your Form I-94, approval notice or your passport with your T nonimmigrant visa showing that you have already been granted T nonimmigrant status; and
  3. Evidence of relationship to the T-1 nonimmigrant principal, such as a birth certificate or marriage certificate and

proof of termination of any prior marriages.

NOTE: Extensions cannot be granted to derivative family members who are still outside the United States and have never entered the United States in T nonimmigrant status.  A statement should be included with the application if there are family members outside the United States who have not consular processed. Therefore, if the T-1 principal’s status is extended, an amended approval notice will be issued for derivative family members outside the United States to facilitate the consular processing.

20.  U Nonimmigrants

If you are filing for an extension of status as a U nonimmigrant based on law enforcement need, this application must be submitted with:

  1. A copy of your Form I-94 or approval notice showing that you have already been granted U status; and
  2. Evidence demonstrating law enforcement need, such as a new Form I-918 Supplement B, U Nonimmigrant Status Certification, or other evidence from law enforcement explaining that your presence is necessary, and any other credible evidence.

If you are filing for an extension of status as a U nonimmigrant based on exceptional circumstances, this application must be submitted with:

  1. A copy of your Form I-94 or approval notice showing that you have already been granted U status; and
  2. Evidence demonstrating exceptional circumstances, such as an affirmative statement or any other credible

evidence.

NOTE: Extensions of U nonimmigrant status based on the filing of Form I-485, Application to Register Permanent Residence or Adjust Status, do not require the filing of Form I-539. U nonimmigrant status is automatically extended when the Form I-485 is filed.

21.  U Derivative Nonimmigrants

A U derivative nonimmigrant may file for an extension of status independently, or the U-1 principal nonimmigrant may file for an extension of U-1 status and request that this extension be applied to the derivative family members.

If the U-1 nonimmigrant principal wants the extension of status request based on law enforcement need or exceptional circumstances described above to be applied to derivative family members with U-2, U-3, U-4, or U-5 nonimmigrant status that are currently in the United States, indicate that request in writing and list each derivative separately on Supplement A of the Form I-539. Each Supplement A of the Form I-539 must be submitted with a copy of the derivative’s Form I-94 or approval notice showing that the derivative was already granted U-2, U-3, U-4, or U-5status.

 

If the U-2, U-3, U-4, or U-5 nonimmigrant is filing independently for an extension of status, for example, based on consular delays or to ensure 3 years of physical presence, this application must be submitted with:

  1. Justification for your extension request (statement of need and reasons);
  2. A copy of your Form I-94, approval notice or your passport with your U nonimmigrant visa showing that you have already been granted U nonimmigrant status; and
  3. Evidence of relationship to the U-1 nonimmigrant principal, such as a birth certificate or marriage certificate and

proof of termination of any prior marriages.

NOTE: Extensions cannot be granted to derivative family members who are still outside the United States and have never entered the United States in U nonimmigrant status.  A statement should be included with the application if there are family members outside the United States who have not consular processed. Therefore, if the U-1 principal’s status is extended, an amended approval notice will be issued for derivative family members outside the United States to facilitate the consular processing.

NOTE: If you never entered the United States in U-2, U-3, U-4, or U-5 derivative status and the principal U-1 nonimmigrant has an approved Form I-485, Applicant to Register Permanent Residence or Adjust Status, you are not eligible for an extension of status. The U-1 principal nonimmigrant may consider filing Form I-929, Petition for Qualifying Family Member of a U-1 Nonimmigrant.

22.  V, Spouse or Child of a Lawful Permanent Resident

Use Form I-539 if you are physically present in the United States and wish to request initial status or change status to a V nonimmigrant, or to request an extension of your current V nonimmigrant status.

Applicants must follow these form instructions and the form instructions for Supplement A to Form I-539 (Filing Instructions for V Nonimmigrants). The supplement contains additional information and the location where V applicants must file their applications.

NOTE: In addition to the $370 application fee required to file Form I-539, V applicants are required to pay an $85

biometrics services fee for USCIS to take their fingerprints.

If necessary, USCIS may also take the V applicant’s photograph and signature as part of the biometrics services.

Notice to V Nonimmigrants

The Legal Immigration Family Equity Act (LIFE), signed into law on December 21, 2000, created a new V visa. This nonimmigrant status allows certain persons to reside legally in the United States and to travel to and from the United States while they wait to obtain lawful permanent residence.

In order to be eligible for a V visa, all of the following conditions must be met:

  1. You must be the spouse or the unmarried child of a lawful permanent resident;
  2. Form I-130, Petition for Alien Relative, must have been filed for you by your permanent resident spouse on or

before December 21, 2000; and

  1. You must have been waiting for at least 3 years after Form I-130 was filed for you; or
  2. You must be the unmarried child (under 21 years of age) of a person who meets the three requirements listed

above. If you are 21 years of age or older, to qualify for an extension of V status, you must:

  • Have previously been granted V status;
  • Be the unmarried son or daughter of a person who meets the requirements listed above; and
  • Be the beneficiary of a Form I-130 filed on your

V visa holders will be eligible to adjust to lawful permanent resident status once an immigrant visa becomes available to them. While they are waiting, V visa holders may be authorized to work following their submission and USCIS approval of their Form I-765, Application for Employment Authorization.

 

WARNING: V nonimmigrants who have been in the United States illegally for more than 180 days may trigger the grounds of inadmissibility regarding unlawful presence (for the applicable 3-year or 10-year bar to admission) if they leave the United States. Their departure may prevent them from adjusting status as a permanent resident.

 

You may not be granted an extension or change of status if you were admitted under the Visa Waiver Program or if your

current status is:

  1. An alien in transit (C) or in transit without a visa (TWOV);
  2. A crewman (D); or
  3. A fiancé(e) or dependent of a fiancé(e) (K-1 or K-2).

A spouse (K-3) of a U.S. citizen and his or her children (K-4), accorded such status pursuant to the LIFE Act, may not

change to another nonimmigrant status.

EXCEPTION: A K-3 and K-4 are eligible to apply for an extension of status. They should file for an extension during the processing of Form I-130 filed on their behalf and up to completion of their adjustment-of-status application.

NOTE: Any nonimmigrant (A to V) may not change his or her status to K-3 or K-4.

 

USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have Internet access, you may call the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section of these instructions.) Each application must be properly signed and filed. A photocopy of a signed application or a typewritten name in place of a signature is not acceptable.

If you are under 14 years of age, your parent or legal guardian may sign the application on your behalf.

Evidence. You must submit all required initial evidence and supporting documentation with your application at the time of filing. If you are electronically filing this application, you must follow the instructions provided on the USCIS website, www.uscis.gov/e-filing. You may be required to submit additional evidence as noted in these instructions.

You may be required to submit additional evidence as noted in these instructions.

Biometrics Services Appointment. After USCIS receives your application and ensures it is complete, the agency will inform you in writing when to go to your local USCIS Application Support Center (ASC) for your biometrics services appointment. Failure to attend the biometrics services appointment may result in denial of your application.

Copies. You may submit a legible photocopy of documents requested, unless the instructions specifically state that you must submit an original document. Original documents submitted when not required may remain a part of the record, and will not be automatically returned to you.

Translations. Any document you submit to USCIS with information in a foreign language must be accompanied by a full English translation. The translator must certify that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English.

Online Submission. When authorized by USCIS, you may submit this form online. Please check the USCIS website for the latest information on whether electronic submission of this form is possible.

 

How to Fill Out Form I-539

  1. Type or print legibly in black
  2. If you need extra space to complete any item within this application, attach a sheet of paper, and type or print your name and A-Number (if any) at the top of each sheet of paper; indicate the Page Number, Part Number, and Item Number to which your answer refers; and date and sign each
  3. Answer all questions fully and accurately. If an item is not applicable or the answer is “none,” type or print “N/A,”

unless otherwise directed.

  1. USCIS Online Account Number (if any). If you have previously filed an application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions, or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account If you received such a notice, your USCIS Online Account Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not the same as an A-Number.
  2. If you are currently in F or J status and granted Duration of Status (D/S), check the box in Part 1., Item Number

12.c. of the form.

  1. Part 2., Item Number 3.a. of the form, select the date you want your change of status to occur on. If approved, your change of status will occur on the date your current nonimmigrant status ends, the date of approval, or the requested date, whichever occurs
  2. If you were granted D/S as an F or J nonimmigrant and are seeking reinstatement or are requesting a change of status to an F or J nonimmigrant then you should check the box in Part 3., Item Number 1.b. of the form to indicate a duration of D/S.

NOTE: An F-1 nonimmigrant student who is admitted to attend a public high school is restricted to an aggregate of 12 months of study at any public high school(s) and is not eligible for D/S. Please indicate a specific date for the duration of your requested status.

  1. Part 6. Statement, Contact Information, Declaration, Certification, and Signature. Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not
  2. Part 7. Contact Information, Certification, and Signature. If you used an interpreter to read the instructions and complete the questions on this form, the interpreter must fill out this section, provide the name of his or her business/ organization, the business/organization’s address, his or her daytime telephone number, and his or her e-mail The interpreter must also sign and date the form.

 

  1. Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, If Other Than the Applicant. This section must contain the signature of the person who completed your application, if other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both Part 7. and Part 8. If the person who completed this application is associated with a business or organization, that person should complete the business or organization name and address information. Anyone who helped you complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited

representative, he or she may also need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney

or Accredited Representative, along with your application.

 

 

Required Documentation – Form I-94, Nonimmigrant Arrival-Departure Record. You are required to submit with your Form I-539 the original or a copy, front and back, of Form I-94 for each person included in your application.  If the original Form I-94 or required copy cannot be submitted with this application, complete Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Document, and submit it with the required fee, with Form I-539.

Form I-94 Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or USCIS issued you a Form I-94, Arrival-Departure Record, provide your I-94 admission number and date that your authorized period of stay expires or expired (as shown on Form I-94). The I-94 admission number also is known as the Departure Number on some versions of Form I-94.

NOTE: If you were admitted to the United States by CBP at an airport or seaport after April 30, 2013, you may have been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. You may visit the CBP website at www.cbp.gov/i94to obtain a paper version of an electronic Form I-94. CBP does not charge a fee for this service. Some travelers admitted to the United States at a land border, airport, or seaport, after April 30, 2013 with a passport or travel document, who were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form I-94 from the CBP website without charge. If the Form I-94 cannot be obtained from the CBP website, it may be obtained by filing Form

I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a fee for this service.

Passport and Travel Document Numbers. If you used a passport or travel document to travel to the United States, record either the passport or travel document information in the appropriate space on the form, even if the passport or travel document is currently expired. In Part 1., Item Number 11.b., provide the principal applicant’s passport number at the time he or she was granted the Form I-94. In Part 4., indicate the principal applicant’s current passport number. These numbers may or may not be the same.

Valid Passport. If you were required to have a passport to be admitted into the United States, you must maintain the validity of your passport during your nonimmigrant stay. If a required passport is not valid when you file Form I-539, submit an explanation with your form.

 

The filing fee for Form I-539 is $370, except for certain A and G nonimmigrants who are not required to pay a fee, as

noted in these Instructions.

An additional biometrics services fee of $85 is required for you and for each person included on a Form I-539A, except for certain A, G, and NATO nonimmigrants who are not required to pay a fee. After you submit Form I-539, USCIS will notify you about when and where to go for biometrics services.

The following nonimmigrants are not required to submit either the filing fee or the biometrics fee:

  1. Individuals changing into or out of A-1, A-2, A-3 status;
  2. Individuals changing into or out of G-1, G-2, G-3, G-4, G-5 status; and
  3. Individuals changing into or out of NATO-1, NATO-2, NATO-3, NATO-4, NATO-5, NATO-6

NOTE: The filing fee and biometric services fee are not refundable, regardless of any action USCIS takes on this

application. DO NOT MAIL CASH. You must submit all fees in the exact amounts.

NOTE: A fee waiver request will be accepted in accordance to 8 CFR 103.7(c)(3)(xviii) for T and U nonimmigrants.

 

Payments by Checks or Money Orders

Use the following guidelines when you prepare your checks or money orders for the Form I-539 filing fee and

biometrics services 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

  1. Make the checks or money orders payable to S. Department of Homeland Security.

NOTE: 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, USCIS will convert it 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 your bank will show it on your regular account statement.

You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If your check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the check is returned as unpayable a second time, we will reject your application and charge you a returned check fee.

 

How To Check If the Fees Are Correct

Form I-539’s filing fee and biometric services fees are current as of the edition date in the lower left corner of this page. However, because USCIS fees change periodically, you can verify that the fees are correct by following one of the steps below.

  1. Visit the USCIS website at uscis.gov, select “FORMS” and check the appropriate fee; or
  2. Visit the USCIS Contact Center at uscis.gov/contactcenterto get answers to your questions and connect with a live USCIS representative. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

Payments by Credit Card

If you are filing your application at a USCIS Lockbox facility, you can pay your filing fee and biometric services fee using a credit card. Please see Form G-1450, Authorization for Credit Card Transactions, at www.uscis.gov/G-1450for more information.

 

Please see our website at www.uscis.gov/I-539 or visit the USCIS Contact Center at www.uscis.gov/contactcenterto connect with a USCIS representative for the most current information about where to file this application. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

E-Filing Form I-539

Certain Form I-539 filings may be electronically filed with USCIS. View our website at www.uscis.gov“FORMS,” and click on the link “E-Filing and Online Service” for information on who is eligible to e-file this form.

Special Information for Applicants Residing in the Commonwealth of the Northern Mariana Islands (CNMI)

If the applicant is lawfully present in the CNMI, the applicant may be eligible to apply for a grant of status with this form without having to seek consular processing.  The request for the initial grant of status must be accompanied by an additional biometrics service fee as described in section 8 CFR 103.7(b)(1) and evidence of the applicant’s lawful presence. The applicant will be required to submit biometric information before the application for a grant of status is

approved. Although this is a request for an initial grant of status rather than a change of nonimmigrant status, in Part 2., the applicant should select Item Number 2.a., and identify the nonimmigrant status he or she is initially requesting in Item Number 2.b.

An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address, go to the USCIS website at www.uscis.gov/addresschangeor reach out to the USCIS Contact Center at www.uscis.gov/contactcenterfor help. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing)

call: 1-800-767-1833.

NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because these facilities do not

process change of address requests.

 

USCIS will reject any Form I-539 that is not signed or accompanied by the correct fee. You may correct the

deficiency and resubmit Form I-539. An application is not considered properly filed until accepted by USCIS.

Initial Processing

Once the application has been accepted, USCIS will check it for completeness. If you do not completely fill out the form,

you will not establish a basis for eligibility, and we may deny your application.

Requests for More Information or Interview

We may request more information or evidence from you 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 copies you submit. We will return these originals when they are no longer required.

 

Decision

The decision on Form I-539 involves a determination of whether you have established eligibility for the requested benefit.

USCIS will notify you of the decision in writing.

 

To ensure you are using the latest version of this application, visit the USCIS website at www.uscis.gov where you can obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.

 

If you knowingly willfully falsify or conceal a material fact or submit a false document with your Form I-539, we will

deny your Form I-539 and may deny any other immigration benefit.

In addition, you will face severe penalties provided by law, and may be subject to criminal prosecution.

 

By signing this application, you have stated under penalty of perjury (28 U.S.C. section 1746) that all information and documentation submitted with this application are complete, true, and correct. You also authorize the release of any information from your records that USCIS may need to determine your eligibility for the immigration benefit you are seeking and consent to USCIS verifying such information.

DHS has the authority to verify any information you submit to establish eligibility for the immigration benefit you are seeking at any time. USCIS’ legal authority to verify this information is in 8 U.S.C. sections 1103, 1155, and 1184, and 8 CFR parts 103, 204, 205, and 214. To ensure compliance with applicable laws and authorities, USCIS may verify information before or after your case is decided.

Agency verification methods may include, but are not limited to: review of public records and information; contact through written correspondence, the internet, fax, other electronic transmission, or telephone; unannounced physical site inspections of residences and locations of employment; and interviews. USCIS will use information obtained through verification to assess your compliance with the laws and to determine your eligibility for an immigration benefit.

Subject to the restrictions under 8 CFR 103.2(b)(16), USCIS will provide you with an opportunity to address any adverse or derogatory information that may result from a USCIS compliance review, verification, or site visit after a formal decision is made on your case or after the agency has initiated an adverse action which may result in revocation or termination of an approval.

 

AUTHORITIES: The information requested on this application, and the associated evidence, is collected pursuant to the Immigration and Nationality Act sections 1103 and 1184, and Title 8 of the Code of Federal Regulations (CFR) parts 103, 214 and 248.

PURPOSE: The primary purpose for providing the requested information on this application is to apply for an extension of stay or a change from one nonimmigrant category to another nonimmigrant category. DHS will use the information you provide to grant or deny the immigration benefit you are seeking.

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number, and any requested evidence, may delay a final decision or result in denial of your application.

ROUTINE USES:  DHS may share the information you provide on this application and any additional requested evidence with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records notices [DHS/USCIS-001 Alien File, Index, and National File Tracking System and DHS/USCIS-007 – Benefits Information System] and the published privacy impact assessment [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System and Associated Systems], which can be found at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law enforcement purposes or in the interest of national security.

 

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 Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 2.00 hours per response, including the time for reviewing instructions, gathering the required documentation and information, completing the application, preparing statements, attaching necessary documentation, and submitting the application. The collection of biometrics is estimated to require 1 hour and 10 minutes. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140;

OMB No. 1615-0003. Do not mail your completed Form I-539 to this address.

USCIS – Form I-693 – Report of Medical Examination and Vaccination Record by Department of Homeland Security – U.S. Citizenship and Immigration Services

https://www.uscis.gov/i-693

I-693, Report of Medical Examination and Vaccination Record

If you are applying for adjustment status to become a lawful permanent resident, use this form to establish that you are not inadmissible to the United States on public health grounds.

A list of those health grounds can be found in section 212(a)(1) of the Immigration and Nationality Act. For more information on the validity of Form I-693, see the USCIS Policy Manual Volume 8, Part B, Chapter 4.

Instructions for Report of Medical Examination and Vaccination Record

Department of Homeland Security

U.S. Citizenship and Immigration Services

 

USCIS

Form I-693

OMB No. 1615-0033

Expires 07/31/2022

 

 

Form I-693 reports results of a medical examination to U.S. Citizenship and Immigration Services (USCIS). USCIS requires the examination to establish that applicants who are seeking immigration benefits are not inadmissible to the United States on public health grounds. You can find a list of those health-related grounds in section 212(a)(1) of

the Immigration and Nationality Act (INA). The list is also available in these Instructions in the Frequently Asked Questions section, Item Number 9.

The results of your medical examination are confidential, and USCIS uses them rimarily for immigration purposes. When required by law, the civil surgeon may share your results with public health authorities. USCIS will generally not discuss your medical issues with other individuals, such as your attorney or BIA-accredited representative, immigration officers, or other government officials, unless they have a need to know the information.

NOTE: If you are applying for adjustment of status as a refugee, a derivative of an asylee, or a K or V nonimmigrant visa holder, before reading any further, see section entitled Frequently Asked Questions, Item Numbers 2. – 5., of these Instructions.

 

 

 

  How Do I File Form I-693?

 

You must submit a separate Form I-693 for each applicant. There is no filing fee for this form.

  1. Carefully read all these instructions, including the Frequently Asked Questions
  2. Contact a doctor who is designated as a civil surgeon by USCIS to make an

3.                         Fill out Part 1. Information About You of Form I-693. Do not sign the form until the civil surgeon tells you to sign it. You must sign in the presence of the civil surgeon.

  1. Attend your medical examination appointment and all follow-up examinations, as required. If you have any medical records, including vaccination records, take them with you to the initial
  2. The civil surgeon must give you the completed Form I-693 in a sealed envelope for you to submit to USCIS. Do not accept the form from the civil surgeon unless it is in a sealed envelope. USCIS will return your Form I-693 to you if it is not in a sealed envelope or if the envelope is opened or altered in any The civil surgeon should also give you a copy of the completed Form I-693 for your records.
  3. Submit your completed Form I-693 in the sealed envelope to USCIS. Please see our website at uscis.gov/I-693. The Form I-693 must be dated no earlier than 60 days before you filed your underlying application. A properly and timely completed Form I-693 remains valid for two years from the date of the civil surgeon’s signature.
    1. If you are applying for adjustment of status, Form I-485: Submit Form I-693 according to the instructions on Form I-485, Application to Register for Permanent Residence or Adjust

 

 

  1. For all other applicants: Follow the application’s instructions, follow the instructions that the office requesting the medical examination gave you, or visit the USCIS Contact Center at uscis.gov/contactcenter to learn more, including where to file this application. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

NOTE: The civil surgeon will ask you to verify your identity. Bring a valid government-issued form of photo identification to your appointment (for example, your unexpired passport or driver’s license). If you are under 14 years of age, acceptable documents for proof of identity must show your name, date and place of birth, parents’ full names, and any other identifying information about you. Acceptable documents include birth certificates (with a translation, if necessary) or affidavits.

 

 

To find a designated civil surgeon in your area, visit the USCIS website at www.uscis.gov. (Select “TOOLS,” choose “Find a Doctor,” enter your ZIP Code or address, and click “Search.”)

 

USCIS provides forms free of charge through our website. In order to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

Signature. Each Form I-693 must be properly signed and filed. In general, USCIS will not accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may sign the form on your behalf. A legal guardian may also sign for a mentally incompetent person.

There are special rules for blanket designated health departments or military physicians. Refer to these Instructions for additional information on how blanket designated civil surgeons may sign the form. (See section entitled How Do I, as a Civil Surgeon, Fill Out My Portion of This Form I-693?, subsection “Military physicians performing the

medical examination for members and veterans of the U.S. Armed Forces or U.S. Coast Guard and certain eligible

dependents”.)

 

Filing Fee. There is no filing fee for this form.

 

Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific

Instructions section of these Instructions.

 

Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you must submit an original document. USCIS may request an original document at the time of filing or at any time during processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original.

NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be

immediately destroyed upon receipt.

 

Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English. The certification must include the translator’s signature, should contain the translator’s printed name and the date, and it may also contain the translator’s contact information.

 

 

How To Fill Out Form I-693

  1. Type or print legibly in black
  2. If you (the applicant or the civil surgeon) need extra space to complete any item within this application, use the space provided in Part Additional Information or attach a separate sheet of paper. Type or print the applicant’s name and Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
  3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None” unless otherwise directed.

 

Form I-693 is divided into 11 parts. These instructions will help you and the civil surgeon complete Form I-693.

Only complete Part 1. of Form I-693 and the identifying information at the top of each page. The civil surgeon and any other doctors, clinics, or health departments that you are referred to will complete the remaining parts of Form I-693.

 

Part 1. Information About You

Complete this part before your medical examination appointment. Fill out your name and A-Number (if any) at the top of each page of Form I-693. The civil surgeon will check that this information matches Part 1.

 

Item Number 1. Your Full Name. Use your legal name, which is the name that appears on your birth certificate, unless it was changed after birth by a legal action such as marriage or a court order. If you do not have and cannot obtain your birth certificate, use your full legal name as it appears on government issued identity documents such as a passport, refugee travel document, or similar official record. Do not provide a nickname. If you have two last names, include both and use a hyphen (-) between the names, if appropriate.

 

Item Number 2. Physical Address. Provide your physical street address. This must include a street number and name

or a rural route number. Do not provide a post office box (PO Box) number here.

 

Item Number 3.A. Gender. Select the box that indicates whether you are male or female.

 

Item Number 3.B. Date of Birth. Use eight numbers to show your date of birth in mm/dd/yyyy format (for example, type or print May 1, 1979 as 05/01/1979).

 

Item Number 3.C. City/Town/Village of Birth. Provide the name of the city, town, or village where you were born.

 

Item Number 3.D. Country of Birth. Provide the name of the country where you were born.

 

Item Number 3.E. Alien Registration Number (A-Number) (if any). This is your alien registration file number.  If you are not sure if you have one, look at any letters or notices that you have received from the Department of Homeland Security (DHS). Look for a number that begins with a letter “A” followed by 8 or 9 digits (for example: A 000 000 000). If you do not have one, or if you cannot remember what it is, leave this space blank.

 

 

Item Number 3.F. USCIS Online Account Number (if any). If you have previously filed an application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions, or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not the same as an A-Number.

 

Part 2. Applicant’s Statement, Contact Information, Certification, and Signature

Item Numbers 1. – 6. Select the appropriate box to indicate that you either read this application yourself or whether you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must sign and date your Form I-693 in front of the civil surgeon, and provide your daytime telephone number, mobile telephone number (if any), and email address (if any). Every Form I-693 MUST contain

the signature of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

Note Regarding Applicant’s Signature: The civil surgeon must witness you signing Form I-693. The civil surgeon will type or print the form of applicant identification document presented, and the identification number from your identification document.

 

Part 3. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1. – 7. If you used anyone as an interpreter to read the Instructions and questions on this application to you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date Form I-693. A stamped or typewritten name in place of a signature is not acceptable.

 

Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than

the Applicant

Item Numbers 1. – 8. This section must contain the signature of the person who completed your application, if other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both Part 3. and Part 4. If the person who completed this application is associated with a business or organization, that person should complete the business or organization name and address information. Anyone who helped you complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited representative, he or she may also need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your application.

 

 

 

 

 

  1. Truthfully and accurately report the results. You are responsible for reporting the results of the medical examination and all laboratory reports on Form I-693 where indicated, and for signing the civil surgeon’s certification provided on the form.

You must take reasonable steps to ensure that the person appearing for the medical examination is the same person applying for the requested immigration benefit. All applicants must present a valid government-issued form of photo identification or another form of government-recognized identity documentation. You must note in Part 5.,

Applicant’s Identification Information, Item Numbers 1. – 2., the form of identification presented and identification number, if applicable. The law imposes severe penalties for knowingly and willfully falsifying or concealing a material fact or using any false documents in connection with this medical examination.

You should direct the applicant to complete and sign in Part 2., Item Numbers 1. – 5., in your presence. You should also ensure that the applicant’s name and A-Number (if any) are at the top of each page of the Form I-693 and match the information provided in Part 1.

  1. Follow U. S. Department of Health and Human Services (HHS) regulations and Centers for Disease Control and Prevention (CDC) guidelines. As a USCIS-designated civil surgeon, you are required to perform the medical examination according to HHS regulations. These regulations include the specific guidelines found in the Technical Instructions for the Medical Examination of Aliens in the United States, published by the CDC. The Technical Instructions (including periodic updates posted by the CDC) are available at cdc.gov/immigrantrefugeehealth/ exams/ti/civil/technical-instructions-civil-surgeons.html.
  2. Make referrals and file case reports, as required. According to the CDC’s Technical Instructions, you are required to:
    1. Refer the applicant to the local health department if a chest X-ray suggests TB or other circumstances described in the CDC’s Technical Instructions.
    2. Ensure that any applicant diagnosed with syphilis is treated with the standard treatment regimen described in the CDC’s Technical Instructions.
    3. Ensure that the applicant is tested for gonorrhea and given therapy, if
    4. Refer the applicant to a Hansen’s disease specialist for evaluation to confirm a suspected diagnosis of Hansen’s

disease (leprosy).

  1. File a case report with the appropriate public health authorities if a case report is required by local laws or

regulations. You must also advise the applicant that a case report is being filed.

 

 

You, as the civil surgeon, are responsible for ensuring that Form I-693 is completed and signed as follows.

  1. Part 5. Applicant’s Identification Information. You are responsible for verifying the identity of the applicant and noting in Part 5., Applicant’s Identification Information, Item Numbers 1. – 2., the form of identification that the applicant presents to you and the identification number, if applicable. You are also required to check the top of each page of Form I-693 to make sure the name and A-Number (if any) are correct. Finally, you must require the applicant to sign the Applicant’s Certification in Part 2. in your presence. The applicant should not sign Part 2. until the medical examination is completed and all health-related follow-up requirements, if any, are

 

 

  1. Part 6. Summary of Overall Findings. After the medical examination and any required follow-up, summarize the results in Part 6.
  2. Part 7. Civil Surgeon’s Contact Information, Certification, and Signature. You must sign the certification after the medical examination is complete. Fill out your identifying information in this part before referring an applicant for further tests or evaluation. Do not sign and date this part until the referral or follow-up evaluation (if required) is completed and the applicant is medically cleared. Your signature must be original. Stamped signatures or typewritten names are not acceptable (except for blanket-designated health department or military physicians as described below).

In signing the Form I-693 in this part, you certify under penalty of perjury that you have a valid, unrestricted license in the jurisdiction in the United States in which you are conducting immigration related medical examinations. You also certify under penalty of perjury that no other jurisdiction in the United States in which you conduct immigration- related medical examinations has revoked or placed restrictions on your license to practice medicine in that jurisdiction.

For health departments performing the vaccination assessment for refugee adjustment applicants ONLY: You must complete Part 7. Civil Surgeon’s Contact Information, Certification, and Signature of Form I-693. The original or stamped signature of the physician on staff at the health department must be present in Part 7. USCIS will reject signatures by attending nurses, physician assistants, or other medical professionals who are not licensed

physicians. Health departments must also place either the official stamp or raised seal, whichever is customarily used,

in Part 7. where indicated.

Military physicians performing the medical examination for members and veterans of the U.S. Armed Forces or U.S. Coast Guard and certain eligible dependents must also complete Part 7. The original or stamped signature of the military physician operating under the blanket civil surgeon designation must appear in Part 7. USCIS will reject signatures by attending nurses, physician assistants, or other medical professionals who are not licensed physicians. Military treatment facilities must also place either their official stamp or raised seal in Part 7. where indicated.

  1. Part 8. Civil Surgeon Worksheet and Part 10. Vaccination Record. You must fill out this worksheet and provide the results of each component of the medical examination relating to: communicable diseases of public health significance, physical or mental disorders with associated harmful behavior, drug abuse or drug addiction, and vaccinations. You must also include the results of any lab work or other studies required to determine whether the applicant is inadmissible on health-related grounds.
  2. Part 9. Referral Evaluation. If you refer the applicant to a local health department or to another physician or clinic, you must also fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 8. Civil Surgeon Worksheet in Form I-693. The health care professional receiving the referral must fill out and sign Part 9. Referral Evaluation. Do not complete Item Number 5. in Part 8. if the referral is recommended and not

 

 

Advise applicants that they must complete all health-related follow-up requirements before you can certify Form I-693. You must fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 8. Civil Surgeon Worksheet with the contact information of the physician or public health facility that will conduct further evaluation or provide treatment. You should also specify the type of examination and additional tests or treatment that the applicant should receive in the Remarks section of Item Number 5. The health care professional receiving the referral must fill out and sign Part 9. Referral Evaluation. Complete your identifying information in Part 7., but do not sign or date the application. Make a copy of the Form I-693 for your records and give the original to the applicant in a sealed envelope. (See the next section for additional instructions for sealing the envelope.)

 

 

After the medical examination and any health-related required follow-up is complete, summarize the results in Part 6. of Form I-693. Do not sign Form I-693 until the applicant has met all health-related follow-up requirements. After that, sign the civil surgeon’s certification in Part 7., Item Number 8.

 

Make two copies of the completed and signed Form I-693 and any supporting documents. Keep one copy for your records. Give the other copy to the applicant. The vaccination portion of Form I-693 will serve as the applicant’s official vaccination record for future use (for example, school or employment purposes.)

 

Prepare the original of the completed and signed Form I-693 for submission to USCIS.

Follow these steps:

  1. Place the Form I-693 and any supporting documentation into an
  2. Seal the
  3. On the front, write in capital letters: “DO NOT OPEN. FOR USCIS USE ”
  4. On the back, write your initials across the seal where the flap meets the
  5. Seal the entire flap with clear tape. Make sure the tape covers your initials as well as the
  6. Give the sealed envelope to the

 

 

1.                         Who must submit Form I-693?

Most applicants filing for adjustment of status to become a lawful permanent resident must submit Form I-693 completed by a designated civil surgeon. Certain other applicants may also be required to submit Form I-693 completed by a civil surgeon.

2.                         What if I am a refugee and already had a medical examination overseas?

If you are now applying for adjustment of status under INA section 209 one year after your first admission, you only need to repeat the entire examination if the panel physician found a class A medical condition during your overseas examination.

If you do not have a Class A medical condition and therefore do not need to repeat the full medical examination, you must still comply with the vaccination requirements. This means you only need to submit Part 10. Vaccination

Record and Parts 1. – 5., and Part 7. of Form I-693. Contact your state or local refugee health coordinator to find out whether a state or local health department can complete the Part 10. of Form I-693. The health department must also complete Part 7. of the benefit request.

3.                         What if I am a K nonimmigrant visa holder and already had a medical examination overseas?

 

 

If you were admitted as a:

  1. K-1 fiancé(e) or a K-2 child of a K-1 fiancé(e); or
  2. K-3 spouse of a U.S. citizen or a K-4 child of a K-3 spouse of a U.S. citizen; and
  3. You received a medical examination prior to admission, then:
    • You are not required to have another medical examination as long as you file your Form I-485 within one year

of an overseas medical examination; and

  • The panel physician did not find a class A medical condition during your overseas examination; or
  • The panel physician did find a class A medical condition, you received a waiver of inadmissibility, and

you have complied with the terms and conditions of the waiver.

  • Even if a new medical examination is not required, you must still show proof that you complied with the vaccination requirements. If the vaccination record (DS 3025) was not properly completed and included as part of the original overseas medical examination report, you will need to have the Part 10. Vaccination Record completed by a designated civil surgeon. In this case, you must submit Parts 1. – 5., 7., and

of Form I-693.

4.                         What if I am a V nonimmigrant visa holder and already had a medical examination overseas?

If you were admitted to the United States or obtained status while in the United States as a:

  1. V-1 spouse of a lawful permanent resident or are waiting for a V-1 visa; or
  2. V-2 child of a V-1 spouse of a lawful permanent resident; or
  3. V-3 child of a V-2 unmarried son or daughter of a V-1 spouse of a lawful permanent resident; and
  4. You received a medical examination prior to admission or obtaining V status, then:
    • You are not required to have another medical examination as long as you file your Form I-485 within one year

of an overseas examination, and:

  • The panel physician did not find a class A medical condition; or
  • The panel physician did find a class A medical condition, you received a waiver of inadmissibility, and

you have complied with the terms and conditions of the waiver.

  • Even if a new medical examination is not required, you still must show proof that you complied with the vaccination requirements. If the vaccination record was not properly completed and included as part of the original medical examination report, you will need to have the Part 10. Vaccination Record completed by a designated civil surgeon. In this case, you must submit Parts 1. – 5., 7., and of Form I-693.

5.                         What if I am an asylee derivative applying for adjustment of status and already had a medical examination overseas?

If you were admitted to the United States as an asylee derivative, you generally do not need to repeat, at the time you submit Form I-485, the entire medical examination you had overseas, provided that:

  1. The panel physician found no class A condition during your overseas examination; and
  2. You are applying for adjustment of status within one year of becoming eligible to file.

You must, however, comply with the vaccination requirement and submit Part 10. Vaccination Record and

Parts 1. – 5., and 7. of Form I-693 with your Form I-485.

6.                         May any doctor perform the required medical examination?

Only a doctor who was designated by USCIS as a civil surgeon may perform the medical examination. USCIS will not accept a Form I-693 completed by a doctor who is not a currently designated civil surgeon.

 

 

7.                         How do I know if a doctor is a designated civil surgeon?

Doctors found through the USCIS website at www.uscis.gov or through the USCIS Contact Center are generally current in their designation as civil surgeons. Applicants who are unsure should ask doctors to confirm their status as a civil surgeon.

8.                         Who pays for the medical examination?

You, the applicant, must pay all costs of the medical examination, including the cost of any follow-up tests or treatment that is required. Make payments directly to the civil surgeon or other health care provider.

9.                         What are the health-related grounds of inadmissibility?

U.S. immigration law divides the health-related grounds of inadmissibility into the following four general categories:

  1. Communicable diseases of public health significance;
  2. Lack of proof of having received required vaccinations;
  3. Physical or mental disorders with associated harmful behavior or a history of associated harmful behavior; and
  4. Drug abuse or

See INA section 212(a)(1)(A). HHS regulations classify these and other medical conditions into class A or B conditions. Class A conditions result in inadmissibility while class B conditions do not. See 42 CFR 34.2(d) – (e).

 

1.  Communicable Diseases of Public Health Significance

The civil surgeon is required to perform specific tests for tuberculosis, syphilis, and gonorrhea. The medical examination also requires the civil surgeon to evaluate for other sexually transmitted diseases and Hansen’s disease (leprosy).

If you have a communicable disease of public health significance, the civil surgeon will advise you on how to obtain treatment. USCIS will inform you of whether you also need to apply for a waiver of inadmissibility. To learn more about this waiver, visit the USCIS website at www.uscis.gov.

A.          Testing for Tuberculosis

All applicants two years of age and older must be tested for tuberculosis (TB) with an initial screening test. Civil surgeons may require an applicant younger than two years of age to undergo testing if there is evidence of contact with a person known to have TB or other reasons to suspect TB. Testing must be completed per CDC guidelines, which can found at the CDC’s website at https://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/ technical-instructions-civil-surgeons.html.

B.          Testing for Syphilis

All applicants 15 years of age and older must have a blood test for syphilis. Civil surgeons may require testing for applicants under 15 years of age if there is reason to suspect the possibility of infection.

Civil surgeons should consult the latest version of CDC’s Technical Instructions to ensure they are using an approved type of test and following appropriate screening and testing procedures: https://www.cdc.gov/ immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.

C.          Testing for Gonorrhea

All applicants 15 years of age and older must be tested for gonorrhea. Civil surgeons may require testing for applicants under 15 years of age if there is reason to suspect the possibility of infection.

 

 

Civil surgeons should consult the latest version of CDC’s Technical Instructions to ensure they are using an approved type of test and following appropriate screening and testing procedures: https://www.cdc.gov/ immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.

2.  Physical or Mental Disorders

This category of physical or mental disorders includes any diagnosis of substance-related disorders that involve any substance that is not listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act (for example, diagnosis of an alcohol-related disorder). Mental disorders are diagnosed according to the diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual (DSM) or by another authoritative source as determined by the CDC director.  Physical disorders are diagnosed according to the diagnostic criteria in the most recent edition of the World Health Organization’s Manual of the International Classification of Diseases, Injuries, and Causes

of Death (ICD) or by another authoritative source as determined by the CDC director. See the CDC’s Technical Instructions for more information.

The presence of a physical or mental disorder alone does not make you inadmissible on health-related grounds. The civil surgeon must also determine that there is behavior associated with the disorder that is harmful to you, to others, or to property. USCIS will only consider you inadmissible if there is a current associated harmful behavior or a history of associated harmful behavior that is likely to recur.

The civil surgeon will ask you general questions during the medical examination to determine whether you have such a condition. The civil surgeon may refer you to a specialist for further evaluation, if necessary.

If the civil surgeon finds that you have a physical or mental disorder with associated harmful behavior, you may apply for a waiver. If the waiver is granted, you may be subject to terms, conditions, and controls as determined by USCIS in consultation with HHS. For more information about these waivers, visit the USCIS website at www.uscis.gov.

3.  Drug Addiction and Drug Abuse

HHS sets the medical guidelines for determining drug abuse and drug addiction. The terms are defined at 42 CFR 34.2(h) and (i). The civil surgeon will review your medical history during the medical examination and ask you questions necessary to determine whether you are currently using any drugs or other psychoactive substances or have used them in the past.

“Drug abuse” is “current substance use disorder or substance-induced disorder, mild,” but only with respect to substances listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act. The diagnosis is made according to the diagnostic criteria in the most current edition of the DSM or by another authoritative source as determined by the CDC director.

“Drug addiction” is “current substance use disorder or substance-induced disorder, moderate or severe,” but only with respect to substances listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act. The civil surgeon will make a diagnosis according to the diagnostic criteria in the most current edition of the DSM or by another authoritative source as determined by the CDC director. See the CDC’s Technical Instructions for more information.

If the civil surgeon determines you have a substance-related disorder, you are not eligible to apply for a waiver unless

you are applying for adjustment of status one year after you were admitted as a refugee or granted asylum.

You will no longer be inadmissible based on drug abuse or drug addiction if, after a later medical examination by a civil surgeon, the civil surgeon finds your drug abuse or addiction is in remission. The diagnosis of remission is made according to the diagnostic criteria in the most current edition of the DSM or another authoritative source as determined by the CDC director.

 

 

All applicants for adjustment of status must present documents showing they were vaccinated against a broad range of vaccine-preventable diseases. The civil surgeon will review your vaccination history with you to determine whether you have had all the required vaccinations. Make sure you take your vaccination records with you to your appointment with the civil surgeon.

NOTE: Do not attempt to meet the requirements before the civil surgeon evaluates you, in case any of the required vaccines are not medically appropriate for you.

You can find a list of the required vaccines at

www.cdc.gov/immigrantrefugeehealth/exams/medical-examination-faqs.html#6.

If you never received certain vaccines, or you are unable to prove you received them, the civil surgeon can provide them to you. You also have the option to ask your family doctor to administer those vaccines to you after your evaluation by the civil surgeon. If you choose that option, show the records to the civil surgeon to note on Form I-693.

If you initially did not have documents proving you received all the required vaccines, but later submit those documents, USCIS may grant you a waiver based on the civil surgeon’s certification on Part 10. Vaccination Record of Form I-693. USCIS may also grant you a waiver if the civil surgeon certifies that it is not medically appropriate for you to have one or more of the required vaccines.

HHS has determined that a vaccine is “not medically appropriate” if:

  1. The vaccine is not recommended for your specific age group;
  2. There is a medical reason why it would not be safe to have the vaccine (for example, you are allergic to eggs and/or yeast or you had bad reactions to prior vaccines);
  3. You are unable to complete the entire series of a required vaccine within a reasonable amount of time; or
  4. For the influenza vaccine, it is not the flu

If you object to required vaccinations because of sincerely held religious beliefs or moral convictions, you may apply for a waiver of these requirements. If you hold these objections, inform the civil surgeon that you will apply for a waiver.

If USCIS denies the waiver application, we may also deny the immigration benefit that you are seeking. For more

information about these waivers, visit the USCIS website at www.uscis.gov.

 

An applicant or petitioner who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address, go to the USCIS website at www.uscis.gov/addresschange or reach out to the USCIS Contact Center at www.uscis.gov/contactcenter for help.

The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call:

1-800-767-1833.

NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because the Lockbox does not process change of address requests.

 

To ensure you (the applicant or the civil surgeon) are using the latest version of this form, visit the USCIS website at www.uscis.gov where you can obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

 

 

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.

 

If you (the applicant or the civil surgeon) knowingly and willfully falsify or conceal a material fact or submit a false document with the Form I-693, you will face severe penalties provided by law and may be subject to criminal prosecution.

 

 

AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act section 212(a)(1)(a).

 

PURPOSE: The primary purpose for providing the requested information on this form is to report results of a medical examination and provide vaccination records to USCIS. DHS uses the information to assist with determining eligibility for the immigration benefit you are seeking.

 

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in denial of your form.

 

ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence with other Federal, state, local, and foreign government agencies and authorized organizations in accordance with approved routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index, and National File Tracking System and DHS/USCIS-007 Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003 Integrated Digitization Document Management Program (IDDMP) and DHS/USCIS/PIA-067 Civil Surgeon Designation] which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.

 

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 Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 2 hours and 30 minutes per response, including the time for reviewing instructions, gathering the required documentation and information, completing the form, preparing statements, attaching necessary documentation, and submitting the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No. 1615-0033. Do not mail your completed Form I-693 to this address.

STATEMENT OF NON-IMPEDEMENT TO MARRIAGE – BẢN XÁC NHẬN KHÔNG CẢN TRỞ KẾT HÔN

STATEMENT OF NON-IMPEDEMENT TO MARRIAGE
Mr/Miss………………………………………………………………, a U.S. citizen/ a Legal Permanent Resident, born

on………………………………….in………………………………….,     Passport     No/     Permanent     Resident   Card

No:…………………………….. , has confirmed that he/she is entitled for legal marriage to a Vietnamese/U.S.

citizen and requested a “Certificate of Non-Impedement to Marriage” in relation to his/her proposed marriage in Viet Nam to Mr/Miss…………………………………………………………, a Vietnamese/U.S. citizen born on………………………………., in………………………….., Passport/ ID number: ………………………………….

This is to certify that there is no U.S. law that prohibits a US citizen or a person residing in the US from marrying a citizen of Vietnam/ U.S. in Vietnam. The marriage between a US citizen or a person residing in the U.S. and a citizen of Vietnam/U.S. would normally be recognized as valid in the United States.
Mr/Miss……………………………………………………………… has stated that information provided above is true and correct. The U.S. government is unable to verify this information, but on the legal basis, there is no reason why this U.S. citizen/permanent resident can not marry a Vietnamese citizen, according to the U.S. law.
BẢN XÁC NHẬN KHÔNG CẢN TRỞ KẾT HÔN
Ông/Bà……………………………………………………………………………..là  công  dân/Thường  trú  nhân  Hoa  Kỳ,

sinh ngày………………………………………, tại………………………………………., Hộ chiếu/Thẻ thường trú nhân số………….. , đã xác nhận rằng đương sự có đủ điều kiến để kết hôn với công dân Việt

Nam/Hoa Kỳ và yêu cầu cấp giấy chứng nhận “Không cản trở kết hôn” đối với việc dự kiến kết hôn của đương sự tại Việt Nam với Ông/Bà………………………………………………… là công dân Việt Nam/Hoa Kỳ, sinh ngày…………………………….., tại……………………………….., Hộ chiếu/CMND số…………………………………..

Giấy này để chứng nhận rằng luật pháp Hoa Kỳ không ngăn cấm công dân Hoa Kỳ hoặc người cư trú tại Hoa Kỳ kết hôn với công dân Việt Nam/Hoa Kỳ. Hôn nhân giữa một công dân Hoa Kỳ hoặc người cư trú tại Hoa Kỳ với công dân Việt Nam/Hoa Kỳ thông thường sẽ được công nhận hợp pháp tại Hoa Kỳ.
Ông/Bà……………………………………………………………………………… cam đoan rằng những thông tin được

cung cấp như trên là chính xác và trung thực. Chính phủ Hoa Kỳ không thể xác minh tính xác thực của những thông tin này; tuy nhiên dựa trên thông tin do đương sự cung cấp như trên thì không có lý do pháp lý nào cho thấy công dân/thường trú nhân Hoa Kỳ này không thể kết hôn với công dân Việt Nam theo luật pháp Hoa Kỳ.

Signature of Affiant…………………………………………..

 

Full name in Print:……………………………………………..

 

Người tuyên thệ ký và ghi đầy đủ họ tên

For the Notary Public –

Phần dành cho Công chứng viên Sworn to and subcribed before me on

………………………………………………

Tuyên thệ và ký trước mặt tôi ngày…………………………………..

Hồ sơ Công hàm Độc thân

HỒ SƠ CÔNG HÀM ĐỘC THÂN ĐỂ ĐĂNG KÝ KẾT HÔN VỚI CÔNG DÂN VIỆT NAM

https://vietnamconsulate-sf.org/vi/2017/05/05/ho-so-cong-ham-doc-than/

Hồ sơ bao gồm:

Hồ sơ Công hàm Độc thân /đăng ký kết hôn gửi đến Tổng lãnh sự quán Việt Nam để hợp pháp hóa và dịch thuật theo quy định, trước khi mang về Việt Nam làm thủ tục kết hôn, gồm:

  1. Tuyên thệ độc thân (Affidavit of Single Status)
  2. Giấy chứng nhận chưa kết hôn (Certificate of Non-marriage/Certificate of No Record): Do Lục sự quận (County Clerk) hoặc cơ quan tương đương của địa phương Hoa Kỳ cấp, sau đó được Đổng lý Tiểu bang (Secretary of State) xác thực: chứng nhận đương sự không có vợ/chồng bắt đầu từ khi đủ tuổi kết hôn (nam 20, nữ 18) hoặc từ khi ly hôn hoặc khi vợ/chồng chết cho tới nay.
  3. Giấy xác nhận tình trạng hôn nhân  do Tổng Lãnh sự quán cấp (theo Thông tư số 22/2013/TT-BTP, hiệu lực từ ngày 17/02/2014) nhằm chứng nhận người Việt Nam định cư ở nước ngoài chưa từng đăng ký kết hôn tại Tổng Lãnh sự quán.

Quý vị lưu ý:

+ Đối với người xuất cảnh khi đã đủ tuổi kết hôn (nam từ 20 tuổi, nữ từ 18 tuổi trở lên): Khai từ thời điểm bắt đầu định cư ở Hoa Kỳ.

+ Đối với người xuất cảnh khi chưa đủ tuổi kết hôn (nam dưới 20 tuổi, nữ dưới 18 tuổi): Khai thời điểm khi đủ tuổi kết hôn (nam từ 20 tuổi, nữ từ 18 tuổi trở lên).

  1. Tờ khai đăng ký kết hôn (Application for Marriage Registration)
  2. Lý lịch cá nhân (Biographic Information Sheet)
  3. Giấy xác nhận sức khỏe của bác sĩ hoặc tổ chức y tế có thẩm quyền cấp, xác nhận hiện tại đương sự không mắc bệnh tâm thần hoặc không mắc bệnh khác mà không thể nhận thức, làm chủ được hành vi của mình. Chữ ký của bác sỹ phải được Công chứng viên chứng thực và Đổng lý văn phòng tiểu bang xác nhận chữ ký và thẩm quyền của Công chứng viên (Pre-marital Examination of Mental Health).
  4. Bản xác nhận không cản trở kết hôn,
  5. Bản sao hộ chiếu (Passport) hoặc Thẻ xanh (Green card)
  6. Phán quyết ly hôn của tòa án (đối với người đã ly hôn): Phải có chứng thực của Lục sự tòa (Court Clerk) hoặc Thẩm phán (Judge) và xác nhận của Đổng lý văn phòng tiểu bang nơi có tòa án đó (đối với con dấu, chữ ký và thẩm quyền của Lục sự tòa hoặc Thẩm phán).
  7. Bản sao giấy chứng tử (nếu vợ hoặc chồng đã chết): Phải có xác nhận của Hộ tịch viên/Lục sự…và xác nhận của Đổng lý văn phòng tiểu bang (đối với con dẫu, chữ ký và thẩm quyền của Hộ tịch viên/ Lục sự…).
  8. Giấy ủy quyền: Nếu chưa thể về Việt Nam nộp hồ sơ và để tránh mất thời gian chờ đợi ngày ký giấy đăng ký kết hôn tại Việt Nam,  quý vị vị cần làm giấy ủy quyền cho vị hôn thê/hôn phu ở Việt Nam thay mặt mình nộp các giấy tờ xin đăng ký kết hôn tại Sở Tư pháp tỉnh/thành phố ở Việt Nam.

 

* LƯU Ý:

 

– Các giấy tờ nêu tại Mục 1, 2, 3, 4, 5, 6, 11, phải được cấp hoặc chứng thực không quá 06 tháng, tính đến ngày nộp hồ sơ tại Sở tư pháp Việt Nam.

 

– Trước khi gửi đến Tổng Lãnh sự quán, các Giấy tờ có chữ ký của Đương đơn (nêu tại Mục 1,4,5,7,11 ) và bản sao Hộ chiếu hoặc thẻ xanh (nêu tại Mục 8) phải được Công chứng viên (Notary Public) tại địa phương chứng thực và Văn phòng Đổng lý tiểu bang (State- Level Secretary of State) xác nhận chữ ký, thẩm quyền của Công chứng viên.

 

– Nếu các giấy tờ trong hồ sơ được công chứng bởi cùng 1 công chứng viên, thì đương sự chỉ cần xin 01 bản xác nhận của Đổng lý văn phòng đối với chữ ký và thẩm quyền của công chứng viên đó.

 

 

* Lệ phí : có thể trả bằng tiền mặt nếu hồ sơ được nộp trực tiếp; hoặc bằng Money Order hoặc Cashier’s Check  cho “Vietnam Consulate” nếu hồ sơ được gửi qua đường bưu điện.

 

-Nếu muốn nhận kết quả qua đường bưu điện, Quý vị cần gửi kèm theo 01 bì thư đảm bảo (certified mail) có ghi rõ địa  chỉ người nhận và đã trả cước phí. Để tránh mất mát trong quá trình vận chuyển, đề nghị Quý vị sử dụng các dịch vụ chuyển phát bảo đảm của FEDEX hoặc UPS và ghi lại tracking number để theo dõi việc chuyển phát thư (Lưu ý KHÔNG sử dụng FEDEX Ground và UPS Ground – là bì thư không đảm bảo). Tổng Lãnh sự quán không chịu trách nhiệm trong trường hợp hồ sơ của Quý vị bị thất lạc do Quý vị dùng bì thư không đảm bảo.

 

Thời gian xử lý hồ sơ:

Tổng Lãnh sự quán xử lý hồ sơ và trả kết quả trong vòng 5-7 ngày làm việc. Nếu có yêu cầu làm gấp, Tổng Lãnh sự quán có thể trả hồ sơ trong vòng 1-2 ngày làm việc kể từ ngày nhận được hồ sơ hợp lệ.

@ Để biết thêm thông tin, Quý vị có thể liên với Bộ phận Hợp pháp hóa của Tổng Lãnh sự quán:

  • Địa chỉ: 1700 California Street, Suite 580, San Francisco, CA 94109
  • Giờ làm việc: 8.30 am – 12.00pm và 2.30pm – 4.30pm, Thứ hai tới Thứ sáu
  • Điện thoại: +1 415 922 1707 ; 415 922 0707; 415 922 1238;
  • Fax: +1 415 922 1757
  • Email: legalization@vietnamconsulate-sf.org
  • Website: www.vietnamconsulate-sf.org

📌🇺🇸📑 DỊCH VỤ CÔNG CHỨNG 📌🇺🇸📑

Bộ phận dịch vụ công dân Hoa Kỳ thực hiện nhiều thể loại dịch vụ công chứng, bao gồm:

Để đặt cuộc hẹn cho dịch vụ công chứng, vui lòng truy cập trang Hệ thống đặt hẹn. Sau khi quý vị đặt hẹn thành công, vui lòng in trang xác nhận lịch hẹn để đến văn phòng chúng tôi vào ngày hẹn. Khi đến, quý vị sẽ được hỗ trợ thực hiện dịch vụ công chứng và thời gian thực hiện sẽ kéo dài từ 30 phút đến 1 tiếng.

Nếu quý vị không thấy có ngày hẹn trống trên Hệ thống đặt hẹn, vui lòng quay lại sau. Lịch hẹn thường được mở trước khoảng 2 tuần, và lịch hẹn bổ sung thường được mở thêm, nên chúng tôi khuyến khích quý vị nên thường xuyên kiểm tra hệ thống để theo dõi lịch hẹn.

Thông thường các dịch vụ công chứng đều được xem là không mang tính khẩn cấp. Do đó, nhằm bảo đảm công bằng cho tất cả đương đơn, văn phòng chúng tôi sẽ chỉ xem xét các yêu cầu xin lịch hẹn khẩn nếu quý vị thực sự có trường hợp vô cùng khẩn cấp. Nếu cần lịch hẹn khẩn cấp, trước hết quý vị phải đặt một cuộc hẹn trực tuyến như bình thường.  Sau khi đã đặt hẹn thành công, quý vị phải vào Mẫu đơn Trực tuyến để yêu cầu xin lịch hẹn khẩn.  Khi gửi yêu cầu xin lịch hẹn khẩn, Quý vị phải cung cấp đầy đủ:

1) lý do tại sao trường hợp của quý vị lại là trường hợp vô cùng khẩn cấp và quý vị phải xin lịch hẹn sớm hơn, 

2) ngày giờ cuộc hẹn mà quý vị đã đặt và ngày giờ cuộc hẹn mà quý vị muốn có nếu yêu cầu xin lịch hẹn khẩn được chấp thuận,

3) đính kèm giấy tờ bằng chứng thể hiện tình trạng khẩn cấp của quý vị hoặc lời giải thích rõ ràng tại sao một cuộc hẹn sớm hơn lại có thể giúp quý vị giải quyết được tình huống khẩn cấp của mình.

Nếu quý vị không cung cấp đủ TẤT CẢ các thông tin trên, văn phòng chúng tôi sẽ không xem xét yêu cầu của quý vị.

Phí công chứng là 50 đô la Mỹ cho mỗi con dấu. Để biết thêm thông tin vui lòng xem Bảng phí Dịch vụ Lãnh sự tại đây. Tất cả các phí dịch vụ lãnh sự có thể thanh toán bằng tiền mặt đô la Mỹ, Việt Nam đồng, hoặc bằng các loại thẻ tín dụng/thẻ ghi nợ thanh toán bằng đô la Mỹ như sau:  Visa, MasterCard, Discover và American Express.  Chúng tôi không chấp nhận thanh toán bằng ngân phiếu.  Ngoài ra, chúng tôi chỉ chấp nhận những tờ giấy bạc trong tình trạng còn tốt.  Xin lưu ý rằng những giấy bạc bị dán, phai mờ, rách, hư hại hay có những dấu vết hoặc hoen ố sẽ không được chấp nhận.

Các văn bản của công dân nước ngoài do Hoa Kỳ cấp hoặc để sử dụng ở Hoa Kỳ cũng có thể công chứng.  Để công chứng, yêu cầu quý vị mang theo hộ chiếu của mình hoặc giấy tờ tuỳ thân có dán ảnh dùng để nhận dạng.

Xin lưu ý rằng các văn bản học vị, văn bản thương mại và lý lịch tư pháp của công dân Hoa Kỳ không thể công chứng hoặc hợp pháp hoá tại Đại sứ quán và Lãnh sự quán.  Các loại văn bản này phải được hợp pháp hoá theo thủ tục hợp pháp hoá tại Hoa Kỳ. Tuy nhiên, công dân Hoa Kỳ có thể làm giấy tuyên thệ tại Đại sứ quán / Lãnh sự quán về độ xác thực của giấy tờ. Quý vị nên trao đổi với nơi yêu cầu các giấy tờ này xem họ có chấp nhận hình thức tuyên thệ này hay không và họ cần quý vị nộp loại giấy tờ cụ thể nào (chẳng hạn như bản chính hay bản sao). Quý vị có thể liệt kê nhiều loại giấy tờ trên một mẫu đơn tuyên thệ, và bấm kèm bản chính hoặc bản sao của các giấy tờ này để đóng giáp lai với đơn tuyên thệ.

Chuẩn bị cho cuộc hẹn làm công chứng

  • Vui lòng mang giấy tờ tuỳ thân có dán ảnh do cơ quan có thẩm quyền cấp.
  • Đảm bảo rằng quý vị hiểu rõ nội dung văn bản.  Chúng tôi không được phép giải thích nội dung của văn bản cho quý vị.
  • Xin vui lòng điền đầy đủ thông tin trước khi đến (nhưng không ký; quý vị sẽ ký tại văn phòng của chúng tôi trước mặt viên chức lãnh sự)
  • Nếu văn bản của quý vị cần có người làm chứng bên cạnh công chứng, quý vị phải chuẩn bị người làm chứng và những thông tin hướng dẫn cần thiết.  Nhân viên lãnh sự không thể làm người làm chứng.  Nếu quý vị không thể trả lời những câu hỏi đơn giản liên quan đến việc công chứng văn bản hoặc không hiểu rõ nội dung văn bản, quý vị có thể sẽ phải đặt một cuộc hẹn khác.  Nếu quý vị cần công chứng giấy tờ bản gốc, vui lòng mang theo cả bản gốc và một bản sao. Nếu quý vị không chuẩn bị sẵn bản sao, quý vị có thể phải đóng phí $1.00 cho mỗi trang được sao.

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