Form I-212 Application for permission to reapply for admission into

OMB No. 1615-0018; Exp. 03/31/07

I-212, Application for Consent to Reapply for
Admission to the United States

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions
Submit application in duplicate.

I. Persons who must obtain permission to reapply
for admission to the United States.

(c) You are inadmissible under section 212
(a)(9)(C)(i)(I) of the INA because you (1)
were unlawfully present in the United States
after April 1, 1997, for an aggregate period
of more than 1 year, and (2) subsequently
entered attempted to enter the United States
without being admitted.

You must file this application to obtain permission
to reapply for admission to the United States if:
(a) You are inadmissible under section 212(a)
(9)(A)(i) of the Immigration & Nationality Act
(INA), because you were removed or deported
as an arriving alien under section 235(b)(1) or at
the end of proceedings under section 240
initiated upon arrival in the United States (or
departed while a removal or deportation order
was in effect); and you are
- Seeking admission to the United States again
within 5 years of the only time you were
removed or deported (or departed while a
removal or deportation order was in effect).
- Seeking admission to the United States again
within 20 years of a second or subsequent time
you were removed or deported (or departed
while a removal or deportation order was in
effect).
- Seeking admission to the United States again
at any time after you were removed or deported
(or departed while a removal or deportation
order was in effect), if you have been convicted
of an aggravated felony.
(b)You are inadmissible under section 212
(a)(9)(A)(ii) of the INA because you were
removed or deported (or departed while a
removal or deportation order was in
effect), in a manner not covered in section
(a) above; and you are
- Seeking admission to the United States again
within 10 years of the only time you were
removed or deported (or departed while a
removal or deportation order was in effect).
- Seeking admission to the United States again
within 20 years of a second or subsequent time
you were removed or deported (or departed
while a removal or deportation order was in
effect).
- Seeking admission to the United States again
at any time after you were removed or deported
(or departed while a removal or deportation
order was in effect), if you have been convicted
of an aggravated felony.

(d) You are inadmissible under section 212(a)
(9)(C)(i)(II) of the INA because you (1) were
removed or deported at any time (or
departed while a removal or deportation
order was in effect), and (2) subsequently
entered or attempted to enter the United
States on or after April 1, 1997 without
being admitted.

II. Where to Submit Your Application.
A.

If you are abroad and intend to apply for an immigrant
visa, submit the application to the District Director of
U.S. Citizenship and Immigration Services (USCIS) of
the district where your removal or deportation
proceedings were held, unless you are concurrently
applying for a waiver of inadmissibility under section
212 (g), (h) or (i) of the INA, as amended.

B.

If you are abroad and intend to apply for an immigrant
visa concurrently with an application for a waiver of
inadmissibility under section 212(g),(h), or (i) of the
INA, this application should be filed with the American
Consul with whom you are filing your application for a
waiver of the grounds of inadmissibility.

C.

If you are abroad and intend to apply to an American
Consul for a nonimmigrant visa or a border crossing
card, this application should be filed with the American
Consul with whom you are also filing your application
for a nonimmigrant visa or border crossing card, if
requested to do so by the Consul.

D.

If you are at a port of entry applying for admission into
the United States, submit the application to the
Department of Homeland Security (DHS) field office
having jurisdiction over that port.

E.

If you are in the United States and will file an
application for waiver under section 212(g),(h) or (i) of
the INA with an American Consul, you should file this
application and the application for the waiver
simultaneously with the American Consul.
If you are in the United States and are applying for
adjustment of your status under section 245 of the INA,
or are seeking to be granted advance permission to
reapply prior to your departure from the United States,
submit this application with a Form I-485 to the USCIS
District Director having jurisdiction over the place
where you are residing.

F.

Form I-212 (Rev. 12/18/06)N

G.

Haitian Refugee Immigrant Fairness Act Applicants
If you have applied for adjustment of status under the
Haitian Refugee Immigrant Fairness Act, and you also
applied for advance parole (Form I-131) to travel while
your application is pending, and your departure will
execute a deportation or removal order that was entered
against you, you should submit this Form I-212 and your
Form I-131 to the Nebraska Service Center.

H.

Nicaraguan Adjustment and Central American
Relief Act Applicants
If you have applied for adjustment of status under the
Nicaraguan Adjustment and Central American Relief Act ,
and you also applied for advance parole (Form I-131) to
travel while your application is pending, and your departure
will execute a deportation or removal order that was
entered against you, you should submit this Form I-212
with your Form I-131 to the USCIS office having
jurisdiction over where your adjustment application is
pending.

III. What Must Accompany Your Application?
A.

Attach all correspondence that you have in your
possession relating to your deportation or removal.

B.

If you have listed any relative under Item 18 on the form,
you must submit documentary evidence of your
relationship to that person. In addition, if such person is a
U.S. citizen, you must submit proof of his or her
citizenship. If he or she is not a U. S. citizen, you must
furnish such person's full name, date and place of birth
and place of admission to the United States, and his or her
Alien Registration Number (A#), if known.

C.

If you wish, you may attach a statement giving the facts
that you believe USCIS should consider in making a
decision on your application. You may attach any
evidence in support of your statement.

IV. What Is the Fee?

If you reside in the U.S. Virgin Islands and you are
filing your application there, the check or money
order must be payable to the "Commissioner of
Finance of the Virgin Islands."
All other applicants must make the check or money order
payable to the Department of Homeland Security.
When a check is drawn on account of a person other than
yourself, your name must be entered on the face of the
check. If application is submitted from outside of the
United States, remittance may be made by bank
international money order or foreign draft drawn on a
financial institution in the United States and payable to the
Department of Homeland Security in U.S. currency.
Personal checks are accepted subject to collection. An
uncollectible check will render the application and any
document issued pursuant thereto invalid. A charge of
$30.00 will be imposed if a check in payment of a fee is
not honored by the bank on which it is drawn.
How to Check If the Fee Is Correct.
The fee on this form is current as of the edition date
appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if
the fee is correct by following one of the steps:
Visit our website at www.uscis.gov and scroll down to
"Immigration Forms" to check the appropriate fee, or
Review the Fee Schedule included in your form
package, if you called us to request the form, or
Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.

V. USCIS Forms and Information.
To order USCIS forms, telephone our toll-free forms line at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations and
procedures, by calling our National Customer Service
Center at 1-800-375-5283 or visiting our internet website at
www.uscis.gov.

You must pay a fee of $265.00 for filing this application.
The fee cannot be refunded, regardless of the action taken
on the application. Do not mail cash. All fees must be
submitted in the exact amount.
Payment by check or money order must be drawn on a
bank or other institution located in the United States and
be payable in United States currency, unless:
If you reside in Guam and are filing your
application there, the check or money order must
be payable to the "Treasurer, Guam."

VI. Use InfoPass for Appointments.
As an alternative to waiting in line for assistance at your
local USCIS office, you can now schedule an appointment
through our internet-based system, InfoPass. To access the
system, visit our website at www.uscis.gov. Use the
InfoPass appointment scheduler and follow the screen
prompts to set up your appointment. InfoPass generates an
electronic appointment notice that appears on the screen.
Print the notice and take it with you to your appointment.
The notice gives the time and date of your appointment,
along with the address of the USCIS office.

Form I-212 (Rev. 12/18/06)N Page 2

VII. Authority for Collecting Information.
We request the information on this form to carry out the
immigration laws contained in Title 8, United States Code
1304(c). We need this information to determine whether a
person is eligible for immigration benefits. The
information you provide may also be disclosed to other
federal, state, local and foreign law enforcement and
regulatory agencies during the course of the investigation
required by USCIS. You do not have to give this
information. However, if you refuse to give some or all of
it, your application may be denied.

VIII. Reporting Burden.
Public reporting burden for this collection of
information is estimated to average two hours per
response, including the time for reviewing instructions,
searching existing data sources, gathering and
maintaining the data needed, and completing and
reviewing the collection of information. Send
comments regarding this burden estimate or any other
aspect of this collection of information, including
suggestions for reducing this burden to U.S. Citizenship
and Immigration Services, Regulatory Management
Division, 111 Massachusetts Avenue, N.W., 3rd Floor,
Suite 3008,Washington, DC 20529. OMB No.
1615-0018. Do not mail your application to this
address.

Form I-212 (Rev. 12/18/06)N Page 3

OMB No. 1615-0018; Exp.03/31/07

I-212, Application for Consent to Reapply for
Admission to the United States

Department of Homeland Security
U.S. Citizenship and Immigration Services

Fee Stamp

(To be filed in duplicate)
Date (mm/dd/yyyy)
I request permission to reapply for admission into the United States.
1. Name

( Last)

(First)

(Middle)

2. File numbers on correspondence from U.S. Citizenship and
Immigration Services (USCIS) or former Immigration and
Naturalization Service (INS) (if known)

3. Name used when last deported or removed from the U.S.

4. Date of Birth (mm/dd/yyyy)

5. Other names used or known by

6a. Place of Birth (city or town; state or province; and country)
6b. Country of Citizenship/Nationality

7. Please indicate why you need to obtain consent to reapply for
admission (check all boxes that apply).
(a) I am inadmissible under section 212(a)(9)(A)(i) of the Act
because I was removed or deported as an arriving alien under section
235(b)(1) or at the end of proceedings under section 240 initiated
upon arrival in the United States (or departed while a removal or
deportation order was in effect); and I am
Seeking admission to the U.S. again within 5 years of the only
time I was removed, deported or departed while a removal or
deportation order was in effect.
Seeking admission to the U.S. again within 20 years of a second
or subsequent time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again, and I have been
convicted of an aggravated felony.
(b) I am inadmissible under section 212(a)(9)(A)(ii) of the Act
because I was removed or deported (or departed while a removal or
deportation order was in effect) in a manner not covered in section
(a) above; and I am
Seeking admission to the U.S. again within 10 years of the
only time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again within 20 years of a second
or subsequent time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again, and I have been convicted
of an aggravated felony.
(c) I am inadmissible under section 212(a)(9)(C)(i)(I) of the Act
because I (1) was unlawfully present in the United States after April 1,
1997, for an aggregate period of more than 1 year, and (2) subsequently
entered or attempted to enter the United States without being admitted.
The date of my most recent departure from the United States was
(specify date).
(d) I am inadmissible under section 212(a)(9)(C)(i)(II) of the Act
because I (1) was removed or deported (at any time) (or departed while
a removal or deportation order was in effect), and (2) subsequently
entered or attempted to enter the United States on or after April 1,
1997 without being admitted. The date of my most recent departure
from the United States was
(specify date).

8. Length of residence in the United States (years)

9. Place of residence at time of deportation or removal from
United States (city and state)

10. Place deportation hearing held or application for removal made
(city)

11. Country to which deported or removed

12. Detention facility or jail where detained (city and state) (If not
detained, write "None")
13. Date of deportation or removal from United States (mm/dd/yyyy)

14. Port of departure from United States

15. Status desired if permitted to re-enter United States
Permanent Resident

Visitor

Student

Other (specify)

16. Reasons for desiring to re-enter the United States

Form I-212 (Rev. 12/18/06)N

17. Location of American Embassy/Consulate where application for visa 18. Name and relationship of U.S. citizen or lawful permanent resident
alien spouse, parent or children, if any
will be made (city and country)

19. (a) Since you were deported or removed from the United States,
have you ever, at any time, returned to the United States?
Yes

20. Signature of Applicant

No

(b) If your answer to question 19a is "Yes," please provide the
following information concerning each time you returned to the United
States. Attach additional sheet(s) if necessary.
Date of Return

Place of Return

Manner of Return

Date of Departure

Inspected and admitted

21. Street and number; city or town; state or province; and country
of present residence

22. Signature of person preparing form, if other than applicant.
I declare that this document was prepared by me at the request of the
applicant and is based on all information of which I have any
knowledge.

Inspected and paroled

Signature:

Entered without
admission or parole

Address:
Date:

Complete and Submit Both Forms.
This space for use by DHS officer
File A Decision

Date of
Action
DD
or
OIC
Office
RECEIVED

TRANS. IN

RET'D-TRANS.-OUT

COMPLETED

Form I-212 (Rev. 12/18/06)N Page 2

OMB No. 1615-0018; Exp.03/31/07

I-212, Application for Consent to Reapply for
Admission to the United States

Department of Homeland Security
U.S. Citizenship and Immigration Services

Fee Stamp

(To be filed in duplicate)
Date (mm/dd/yyyy)
I request permission to reapply for admission into the United States.
1. Name

( Last)

(First)

(Middle)

2. File numbers on correspondence from U.S. Citizenship and
Immigration Services (USCIS) or former Immigration and
Naturalization Service (INS) (if known)

3. Name used when last deported or removed from the U.S.

4. Date of Birth (mm/dd/yyyy)

5. Other names used or known by

6a. Place of Birth (city or town; state or province; and country)
6b. Country of Citizenship/Nationality

7. Please indicate why you need to obtain consent to reapply for
admission (check all boxes that apply).
(a) I am inadmissible under section 212(a)(9)(A)(i) of the Act
because I was removed or deported as an arriving alien under section
235(b)(1) or at the end of proceedings under section 240 initiated
upon arrival in the United States (or departed while a removal or
deportation order was in effect); and I am
Seeking admission to the U.S. again within 5 years of the only
time I was removed, deported or departed while a removal or
deportation order was in effect.
Seeking admission to the U.S. again within 20 years of a second
or subsequent time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again, and I have been
convicted of an aggravated felony.
(b) I am inadmissible under section 212(a)(9)(A)(ii) of the Act
because I was removed or deported (or departed while a removal or
deportation order was in effect) in a manner not covered in section
(a) above; and I am
Seeking admission to the U.S. again within 10 years of the
only time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again within 20 years of a second
or subsequent time I was removed, deported or departed while a
removal or deportation order was in effect.
Seeking admission to the U.S. again, and I have been convicted
of an aggravated felony.
(c) I am inadmissible under section 212(a)(9)(C)(i)(I) of the Act
because I (1) was unlawfully present in the United States after April 1,
1997, for an aggregate period of more than 1 year, and (2)
subsequently entered or attempted to enter the United States without
being admitted. The date of my most recent departure from the United
States was
(specify date).
(d) I am inadmissible under section 212(a)(9)(C)(i)(II) of the Act
because I (1) was removed or deported (at any time) (or departed while
a removal or deportation order was in effect), and (2) subsequently
entered or attempted to enter the United States on or after April 1,
1997 without being admitted. The date of my most recent departure
from the United States was
(specify date).

8. Length of residence in the United States (years)

9. Place of residence at time of deportation or removal from
United States (city and state)

10. Place deportation hearing held or application for removal made
(city)

11. Country to which deported or removed

12. Detention facility or jail where detained (city and state) (If not
detained, write "None")
13. Date of deportation or removal from United States (mm/dd/yyyy)

14. Port of departure from United States

15. Status desired if permitted to re-enter United States
Permanent Resident

Visitor

Student

Other (specify)

16. Reasons for desiring to re-enter the United States

Form I-212 (Rev. 12/18/06)N

17. Location of American Embassy/Consulate where application for visa 18. Name and relationship of U.S. citizen or lawful permanent resident
alien spouse, parent or children, if any
will be made (city and country)

19. (a) Since you were deported or removed from the United States,
have you ever, at any time, returned to the United States?
Yes

20. Signature of Applicant

No

(b) If your answer to question 19a is "Yes," please provide the
following information concerning each time you returned to the United
States. Attach additional sheet(s) if necessary.
Date of Return

Place of Return

Manner of Return

Date of Departure

Inspected and admitted

21. Street and number; city or town; state or province; and country
of present residence

22. Signature of person preparing form, if other than applicant.
I declare that this document was prepared by me at the request of the
applicant and is based on all information of which I have any
knowledge.

Inspected and paroled

Signature:

Entered without
admission or parole

Address:
Date:

Complete and Submit Both Forms.
This space for use by DHS officer
File A Decision

Date of
Action
DD
or
OIC
Office
RECEIVED

TRANS. IN

RET'D-TRANS.-OUT

COMPLETED

Form I-212 (Rev. 12/18/06)N Page 2