Table of Changes

PRA I-821 Table of Form Changes 6-25-07.doc

Application for Temporary Protected Status

Table of Changes

OMB: 1615-0043

Document [doc]
Download: doc | pdf


I-821 Instructions

Old

New

Page 1

Instructions




















Page 1, Section 2

What Documents Should You Submit?










Page 2, Section 7:

Will TPS Applicants Need to Provide Fingerprints and Photographs?




























Page 2, Section 8:

How Should You Prepare This Form?





Page 2, Section 9:

Where Should You File This Form?






Page 2, Section 10:

What Is the Fee?



























Page 3, Section 10:

How to Check If the Fees Are Correct.



Page 3, Section 11:

Are You Also Required to File Form I-765, Application for Employment Authorization?















Page 3, Section 12:

May the Filing Fees for Forms I-821 and I-765 Be Waived?















Page 3, Section 13:

What if I Change My Address?























Page 3, Section 16:

Need to Make an Appointment at a USCIS Office? Use InfoPass.











Page 3, Section 17:

Reporting Burden

NOTE: This revision of Form I-821 updates instructions required for TPS registration and re-registration at questions 7 and 10(B) on Page 2. This revision also combines instructions in questions 7 and 13 from prior editions of this form into a new question 7 on Page 2. The new question 7 updates instructions on biometric services.


Please read these instructions carefully to properly complete this form. If you need more space to answer a question, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A#) at the top of each sheet and indicate the number of the item to which the answer refers. An incomplete application may be returned to you, causing a delay in the processing of your application.




C. Documentation exception: If you are

filing this application for annual

registration, re-registration, or renewal of

temporary treatment benefits (Parts 1 and 2

on Form I-821), you do not have to submit

any copies of documentation. You may,

however, be asked for additional

information and/or documentation in certain

circumstances.




  • Except as noted below, all applicants for initial registration, re-registration or renewal of temporary treatment benefits…must submit the $70.00 biometrics services fee.

  • TPS applicants under 14 years of age who are not filing for an EAD are exempt from biometrics collection and the associated biometrics fee.

  • USCIS may, in its discretion, waive the collection of certain biometrics such as fingerprints and signatures.





If the Federal Register notice announcing the designation or extension of a particular country required photos to be submitted…lightly print your name and Alien Registration Number (A#), if any, on the back of the photographs.











B. If you need extra space to complete any item, attach a continuation sheet, indicated the item number and date and sign each sheet.





The USCIS office having jurisdiction over your place of residence will accept this application, either in person, or through the mail, or both. For filing instructions, please inquire by calling the USCIS National Customer Service Center at 1-800-375-5283.



A. An initial (i.e.,) first-time) applicant must submit:

1. A $50.00 application fee for the Form I-

821; and

2. A $70.00 fee for biometric services,

including fingerprints, photograph and

signature, if required. (See No. 7, Will

TPS Applicants Need to Provide

Fingerprints and Photographs?); and

3. A $180.00 fee for the Form I-765,

Application for Employment

Authorization, if you are between the ages

of 14 and 64 years and seeking

employment.


B. An applicant for TPS re-registration must submit:

1. A $70.00 fee for biometric services,

including fingerprints, photograph and

signature, if required. (See No. 7, Will

TPS Applicants Need to Provide

Fingerprints and Photographs?); and

2. A $180.00 fee for the Form I-765,

Application for Employment

Authorization, if you wish to apply for

employment authorization.



  • Visit our website at www.uscis.gov and scroll down to “Forms and E Filing” to check the appropriate fees, or



A. Yes. Each applicant, regardless of age, must also submit a completed Form I-765, even if employment authorization is not being requested.


If your application for TPS is granted and you must travel outside the United States and return, you must request advanced parole from USCIS by filing a Form I-131, Application for Travel Document, with the appropriate USCIS office. A Form I-512 travel document will be issued to you if your request is granted.


B. As noted in No. 10, What is the Fee?, only those applicants requesting employment authorization must pay the fee for Form I-765.



May the Filing Fees for Forms I-821 and I-765 Be Waived?

Yes. If you are unable to pay the filing fees, 8 CFR 103.7(c) states that you may apply for a waiver of the filing fees. In order to obtain a fee waiver, you must submit with these forms a written statement, made under oath, affirmation, or pursuant to 28 USC 1746, under penalty of perjury. In the written statement you must state that you believe you are eligible for TPS and that you want the filing fees waived. You must also explain why you are unable to pay the required fees.





If you change your address after filing for TPS, you must complete and mail us a Form AR-11, Alien’s Change of Address Card. Enclose the AR-11 in an envelope addressed to the office having jurisdiction over your residence. Include copies of your application and any correspondence relating to your case.


NOTE: If you informed your U.S. Post Office but not USCIS about your address change, please be advised that the Postal Service will not forward USCIS mail to you. The mail will be returned to USCIS as undeliverable.












As an alternative to waiting in line for assistance at your local USCIS office, you can 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.


17. Reporting Burden.

Under the Paperwork Reduction Act, an agency may not conduct or sponsor an information collection. A person is not required to respond to an information collection unless it displays a currently valid OMB control number.


We try to create forms and instructions that are accurate, can easily be understood and impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex.


The estimated average time to complete this application is 1 hour and 30 minutes computed as follows: 1)learning about the form and understanding the instructions, 30 minutes; 2) collecting the necessary supporting documents 15 minutes; 3) completing the form, 15 minutes; and 4) traveling to and waiting at a preparer’s office (e.g. attorney or voluntary agency), 30 minutes.


If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue N.W., 3rd Floor, Suite 3008, Washington, DC 20529; OMB No. 1615-0043. Do not mail your completed application to this address.

NOTE: This revision of Form I-821 updates instructions required for TPS registration and re-registration at questions 2, 7, 8, 9, 10, 11, 12, 13 and 16 on Pages 2 and 3. Information on fees and fee waiver requests has also been updated in these instructions.


Please read these instructions carefully to properly complete this form. If you need more space to answer a question, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A#) at the top of each sheet and indicate the number of the item to which the answer refers. An incomplete application may be returned to you, causing a delay in the processing of your application.






C. Documentation exception: If you are

filing this application for re-registration or

renewal of temporary treatment benefits

(Parts 1 and 2 on Form I-821), you do not

have to submit any copies of documentation.

You may, however, be asked for additional

information and/or documentation in certain

circumstances.




  • Yes, except as noted below, all applicants for initial registration, re-registration or renewal of temporary treatment benefits must provide fingerprints, photographs and signatures. These are examples of biometrics. Applicants must submit the $80.00 biometrics services fee or a fee waiver request in accordance with 8 CFR 244.20. Please see No. 12 for more information about fee waiver requests.

  • TPS applicants under 14 years of age who are not filing for an EAD are exempt from biometrics collection and the associated biometrics fee.

  • USCIS may, in its discretion, waive the collection of certain biometrics.

  • TPS applicants will be sent a notice scheduling them to appear at an Application Support Center (ASC) for biometrics collection. Failure to comply with this notice may result in the denial of the TPS application.



DELETE ENTIRE PARAGRAPH.







B. If you need extra space to complete any item, attach a continuation sheet. Write your name and Alien Registration Number (A#), if any, at the top of each sheet, indicated the item number to which the answer refers, and date and sign each sheet.



For filing instructions, refer to the most recently published Federal Register notice specific to the designation under which you are applying. You may also check the USCIS Internet Site at: www.uscis.gov or contact the USCIS National Customer Service Center at 1-800-375-5283.



A. An initial (i.e., first-time) applicant must submit:

1. A $50.00 application fee for the Form I-

821; and

2. A $80.00 fee for biometric services,

including fingerprints, photograph and

signature, if required. (See No. 7, Will

TPS Applicants Need to Provide

Fingerprints and Photographs?); and

3. A $340.00 fee for the Form I-765,

Application for Employment Authorization,

if you are between the ages of 14 and 65

(inclusive) and seeking employment.


B. An applicant for TPS re-registration must submit:

1. A $80.00 fee for biometric services,

including fingerprints, photograph and

signature, if required. (See No. 7, Will

TPS Applicants Need to Provide

Fingerprints and Photographs?); and

  1. A $340.00 fee for the Form I-765,

Application for Employment

Authorization, if you wish to apply for

employment authorization, regardless of

age.



  • Visit our website at www.uscis.gov, link to “Immigration Forms,” and scroll down to check the appropriate fees by form, or



Yes. Each applicant, regardless of age, must also submit a completed Form I-765, even if employment authorization is not being requested. As noted in No. 10, What is the Fee?, only those applicants requesting employment authorization must pay the fee for Form I-765.


NOTE: An Employment Authorization Document is not a travel document. If your application for TPS is granted and you must travel outside the United States and return, you must request advance parole from USCIS by filing a Form I-131, Application for Travel Document, with the appropriate USCIS office. A Form I-512 travel document will be issued to you if your request is granted.



May the Filing and Biometrics Fees for Forms I-821 and I-765 Be Waived?

Yes. If you are unable to pay the filing fees, 8 CFR 103.7(c) states that you may apply for a waiver of the filing and biometrics fees. In order to obtain a fee waiver, you must submit with these forms a written statement, made under oath, affirmation, or pursuant to 28 USC 1746, under penalty of perjury. In the written statement you must state that you believe you are eligible for TPS and that you want the fees waived. You must also explain why you are unable to pay the required fees. Additional details on the waiver of the TPS fees are at 8 CFR 244.20.




If you change your address after filing for TPS, you must complete and mail us a Form AR-11, Alien’s Change of Address Card. Mail the completed form to the address specified on the form. You are also advised to mail a copy of your completed AR-11, together with copies of your application and any related USCIS documents or correspondence to the USCIS office having jurisdiction over your application for TPS. Retain a copy of your Form AR-11 for your records. You can also file your Form AR-11 online. To do so, go to our website at www.uscis.gov, link to Immigration Forms, and click “Online Change of Address” in Related Links.


NOTE: If you informed your U.S. Post Office but not USCIS about your address change, please be advised that notifying the U.S. Post Office of a change of address does not fulfill your obligation to file Form AR-11. The U.S. Post Office will not forward certain USCIS correspondence.


DELETE THIS SECTION/PARAGRAPH.














16. Reporting Burden.

Under the Paperwork Reduction Act, an agency may not conduct or sponsor an information collection, and a person is not required to respond to an information collection unless it displays a currently valid OMB control number.


We try to create forms and instructions that are accurate, can easily be understood and impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex.


The estimated average time to complete this application is 1 hour and 30 minutes computed as follows: 1)learning about the form and understanding the instructions, 30 minutes; 2) collecting the necessary supporting documents 15 minutes; 3) completing the form, 15 minutes; and 4) traveling to and waiting at a preparer’s office (e.g. attorney or voluntary agency), 30 minutes.


If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue N.W., 3rd Floor, Suite 3008, Washington, DC 20529; OMB No. 1615-0043. Do not mail your completed application to this address.


I-821 Form


Old


New

Page 2, Part 4:

Eligibility Standards.































































































































































































































Page 4, Part 5:

Signature.


































Page 4-5, Part 6.

(old)

Signature of person preparing form, if other than above.

(new)

Signature of interpreter.

















Page 5, Part 7.

(old)

Checklist.

(new)

Signature of Person Preparing Form, if other than above.




















Page 5, Part 8

Checklist



2. To be eligible for Temporary Protected Status, you must be admissible as an immigrant to the United States, with certain exceptions.


If any of the questions beginning below on this page and continuing on Page 3 apply to you, number which one(s) in the box(es): (for example, 2k for Have you entered the United States as a stowaway;) and include a full explanation on a separate sheet(s) of paper. Use the number 2 before each letter referring to the specific question (2a, 2b, etc).


If you were ever arrested, provide the disposition (outcome) of the arrest. For example, “case dismissed” from the appropriate authority.


NOTE: For information about waivers concerning the grounds of inadmissibility, see Page 3.


2a. Have you been convicted of any felony or

two or more misdemeanors committed in

the United States;


2b. (i) Have you ordered, incited, assisted or

otherwise participated in the persecution of

any person on account of race, religion,

nationality, membership in a particular

social group or political opinion;


(ii) Have you been convicted by a final

judgment of a particularly serious crime,

constituting a danger to the community of

the United States (an alien convicted of an

aggravated felony is considered to have

committed a particularly serious crime);


(iii) Have you committed a serious

nonpolitical crime outside of the United

States prior to your arrival in the United

States; or


(iv) Have you engaged in or are you still

engaged in activities that could be

reasonable grounds for concluding that you

are a danger to the security of the United

States?


2c. (i) Have you been convicted of, or have yu

committed acts which constitute the

essential elements of a crime (other than a

purely political offense) or a violation of or

a conspiracy to violate any law relating to a

controlled substance as defined in Section

102 of the Controlled Substance Act;


(ii) Have you been convicted of two or more

offenses (other than purely political

offenses) for which the aggregate sentences

to confinement actually imposed were five

years or more;


(iii) Have you trafficked in or do you

continue to traffic in any controlled

substance or are or have been a knowing

assister, abettor, conspirator, or colluder

with others in the illicit trafficking of any

controlled substance;


(iv) Have you engaged or do you continue

to engage solely, principally, or incidentally

in any activity related to espionage or

sabotage or violate any law involving the

export of goods, technology, or sensitive

information, any other unlawful activity, or

any activity the purpose of which is in

opposition, or the control, or overthrow of

the government of the United States;



(v) Have you engaged in or do you continue

to engage in terrorist activities;


(vi) Have you engaged in or do you

continue to engage or plan to engage in

activities in the United States that would

have potentially serious adverse foreign

policy consequences for the United States;


(vii) Have you been or do you continue to

be a member of the Communist or other

totalitarian party, except when membership

was involuntary; and


(viii) Have you participated in Nazi

persecution or genocide;


2d. Have you been arrested, cited, charged,

indicted, fined, or imprisoned for breaking

or violating any law or ordinance, excluding

traffic violations, or been the beneficiary of

a pardon, amnesty, rehabilitation decree,

other act of clemency or similar action;


2e. Have you committed a serious criminal

offense in the United States and asserted

immunity from prosecution;


2f. Have you within the past ten years engaged

in prostitution or procurement of

prostitution or do you continue to engage in

prostitution or procurement of prostitution;


2g. Have you been or do you intend to be

involved in any other commercial vice;


2h. Have you been excluded and deported from

the United States within the past year, or

have you been deported or removed from

the United States at government expense

within the last five years (20 years if you

have been convicted of an aggravated

felony);


2i. Have you ever assisted any other person to

enter the United States in violation of the

law;


2j. (i) Do you have a communicable disease of

public health significance.


(ii) Do you have or have you had a physical

or mental disorder and behavior (or a

history of behavior that is likely to recur)

associated with the disorder which has

posed or may pose a threat to the property,

safety or welfare of yourself or others;


(iii) Are you now or have you been a drug

abuser or drug addict;


2k. Have you entered the United States as a

stowaway;


2l. Are you subject to a final order for violation

of section 274C (producing and/or using

false documentation to unlawfully satisfy a

requirement of the Immigration and

Nationality Act);


2m. Do you practice polygamy;


2n. Were you the guardian of, and did you

accompany another alien who was ordered

excluded and deported (or removed) from t

he United States;


2o. Have you detained, retained, or withheld the

custody of a child, having a lawful claim to

United States citizenship, outside the United

States from a United States citizen granted

custody?


NOTE ABOUT WAIVERS: If you placed any of the following numbered references in the boxes on Page 2, you may be eligible for a waiver of the grounds described in the questions: 2e; 2f; 2g; 2h; 2i; 2j; 2k; 2l; 2m; 2n or 2o. The Form I-601 is the USCIS application used to request a waiver. The form is available at local USCIS offices, or on our website at www.uscis.gov or by calling the USCIS toll-free forms line at 1-800-870-3676.


















































YOUR CERTIFICATION: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct. Copies of documents submitted are exact photocopies of unaltered original documents and I understand that I may be required to submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefits that I am seeking.
























I declare that I prepared this petition at the request of the above person and it is based on all the information of which I have knowledge.


Attorney or Representative: In the event of a Request for Evidence (RFE), may USCIS contact you by Fax or E-Mail?

 Yes No

Signature_____________________ Print Your Name_________________ Date (mm/dd/yyyy)__________________

Firm Name and Address_______________

Daytime Phone Number (Area/Country Codes)__________________Fax Number (Area/Country Codes)_________________ E-Mail Address____________________





 Did you answer each question?

 Did you sign the Form I-821 application?

 Did you submit the required application and biometric services (fingerprinting) fees?

 Did you submit the necessary documents and photos, if so required?

 Did you also submit the Form I-765 with the filing fee or a written request for a waiver of the filing fee (See instructions, items 10, 11 and 12)?


Have you submitted:

 The filing fee for this application or a written request for a waiver of the filing fee (see instructions, items 10 and 12)?

 Supporting evidence to prove identity, nationality, date of entry and residence?

 Other required supporting documents (photos, etc.) for each application?

2. To be eligible for Temporary Protected Status, you must be admissible as an immigrant to the United States, with certain exceptions.


If any of the questions beginning below on this page and continuing on Pages 3, 4 and 5 apply to you, describe the circumstances and include a full explanation on a separate sheet(s) of paper. Use the number 2 before each letter referring to the specific question (2a, 2b, etc).


If you were ever arrested, provide the disposition (outcome) of the arrest. For example, “case dismissed” from the appropriate authority.


NOTE: For information about waivers concerning the grounds of inadmissibility, see Page 5.


AFTER EACH QUESTION, ADD THE FOLLOWING BOXES:

 Yes No


2a. Have you been convicted of any felony or

two or more misdemeanors committed in

the United States?


2b. (i) Have you ordered, incited, assisted, or

otherwise participated in the persecution of

any person on account of race, religion,

nationality, membership in a particular

social group or political opinion?


(ii) Have you been convicted by a final

judgment of a particularly serious crime,

constituting a danger to the community of

the United States (an alien convicted of an

aggravated felony is considered to have

committed a particularly serious crime)?


(iii) Have you committed a serious

nonpolitical crime outside of the United

States prior to your arrival in the United

States?


(iv) Have you engaged in or are you still

engaged in activities that could be

reasonable grounds for concluding that you

are a danger to the security of the United

States?


2c. (i) Have you been convicted of, or have yu

committed acts which constitute the

essential elements of a crime (other than a

purely political offense) or a violation of or

a conspiracy to violate any law relating to a

controlled substance as defined in Section

102 of the Controlled Substance Act?


(ii) Have you been convicted of two or more

offenses (other than purely political

offenses) for which the aggregate sentences

to confinement actually imposed were five

years or more?


(iii) Have you trafficked in or do you

continue to traffic in any controlled

substance or are or have been a knowing

assister, abettor, conspirator, or colluder

with others in the illicit trafficking of any

controlled substance?


(iv) Have you engaged or do you continue

to engage solely, principally, or incidentally

in any activity related to espionage or

sabotage or violate any law involving the

export of goods, technology, or sensitive

information, any other unlawful activity, or

any activity the purpose of which is in

opposition, or the control, or overthrow of

the government of the United States?



(v) Have you engaged in or do you continue

to engage in terrorist activities?


(vi) Have you engaged in or do you

continue to engage or plan to engage in

activities in the United States that would

have potentially serious adverse foreign

policy consequences for the United States?


(vii) Have you been or do you continue to

be a member of the Communist or other

totalitarian party, except when membership

was involuntary?


(viii) Have you participated in Nazi

persecution or genocide?


2d. Have you been arrested, cited, charged,

indicted, fined, or imprisoned for breaking

or violating any law or ordinance, excluding

traffic violations, or been the beneficiary of

a pardon, amnesty, rehabilitation decree,

other act of clemency or similar action?


2e. Have you committed a serious criminal

offense in the United States and asserted

immunity from prosecution?


2f. Have you within the past ten years engaged

in prostitution or procurement of

prostitution or do you continue to engage in

prostitution or procurement of prostitution?


2g. Have you been or do you intend to be

involved in any other commercial vice?


2h. Have you been excluded and deported from

the United States within the past year, or

have you been deported or removed from

the United States at government expense

within the last five years (20 years if you

have been convicted of an aggravated

felony)?


2i. Have you ever assisted any other person to

enter the United States in violation of the

law?


2j. (i) Do you have a communicable disease of

public health significance?


(ii) Do you have or have you had a physical

or mental disorder and behavior (or a

history of behavior that is likely to recur)

associated with the disorder which has

posed or may pose a threat to the property,

safety or welfare of yourself or others?


(iii) Are you now or have you been a drug

abuser or drug addict?


2k. Have you entered the United States as a

Stowaway?


2l. Are you subject to a final order for violation

of section 274C (producing and/or using

false documentation to unlawfully satisfy a

requirement of the Immigration and

Nationality Act)?


2m. Do you practice polygamy?


2n. Were you the guardian of, and did you

accompany another alien who was ordered

excluded and deported (or removed) from the

United States?


2o. Have you detained, retained, or withheld the

custody of a child, having a lawful claim to

United States citizenship, outside the United

States from a United States citizen granted

custody?


2p. Have you EVER ordered, incited, called for,

committed, assisted, helped with, or otherwise

participated in any of the following:

 

(i) acts involving torture or genocide?

 

(ii) killing any person?

 

(iii) intentionally and severely injuring any

person?

 

(iv) engaging in any kind of sexual contact or

relations with any person who was being

forced or threatened?

 

(v) limiting or denying any person’s ability to

exercise religious beliefs?

     

2q. Have you EVER:

 

(i) served in, been a member of, assisted in, or

participated in any military unit, paramilitary

unit, police unit, self-defense unit, vigilante

unit, rebel group, guerrilla group, militia, or

insurgent organization?

 

(ii) served in any prison, jail, prison camp,

detention facility, labor camp, or any other

situation that involved detaining persons?

 

2r. Have you EVER been a member of, assisted

in, or participated in any group, unit, or

organization of any kind in which you or

other persons used any type of weapon

against any person or threatened to do so?

 

2s. Have you EVER assisted or participated in

selling or providing weapons to any

person who to your knowledge used them

against another person, or in transporting

weapons to any person who to your

knowledge used them against another person?

 

2t. Have you ever received any type of military,

paramilitary or weapons training?


NOTE ABOUT WAIVERS: You may be eligible for a waiver of the grounds described in the questions: 2e; 2f; 2g; 2h; 2i; 2j; 2k; 2l; 2m; 2n or 2o. The Form I-601 is the USCIS application used to request a waiver. The form is available at local USCIS offices, on our website at www.uscis.gov or by calling the USCIS toll-free forms line at 1-800-870-3676.




Applicant’s Statement (check one):

 I can read and understand English, and have read and understand each and every question and instruction on this form, as well as my answer to each question.

 

 Each and every question and instruction on this form, as well as my answer to each question, has been read to me by the person named below in _________________, a language in which I am fluent.  I understand each and every question and instruction on this form, as well as my answer to each question.


YOUR (APPLICANT’S) CERTIFICATION: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct. Copies of documents submitted are exact photocopies of unaltered original documents, and I understand that I may be required to submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefits that I am seeking.


Signature_________________ Daytime Phone Number (Area/Country Codes)_________________ Date (mm/dd/yyyy)_____________




DELETE PREPARER’S INFORMATION AND ADD INTERPRETER’S INFORMATION

Interpreter’s Statement:

Language used: _________________


I certify that I am fluent in English and the above-mentioned language. 


I further certify that I have read each and every question and instruction on this form, as well as the answer to each question, to this applicant in the above-mentioned language, and the applicant has understood each and every instruction and question on the form, as well as the answer to each question.

Signature________________

Print Your Name____________________

Date (mm/dd/yyyy)________________





DELETE CHECKLIST AND ADD PREPARER’S INFORMATION

I declare that I prepared this petition at the request of the above person and it is based on all the information of which I have knowledge.


Attorney or Representative: In the event of a Request for Evidence (RFE), may USCIS contact you by Fax or E-Mail?

 Yes No

Signature_____________________ Print Your Name_________________ Date (mm/dd/yyyy)__________________

Firm Name and Address_______________

Daytime Phone Number (Area/Country Codes)__________________Fax Number









ADD CHECKLIST

 Did you answer each question?

 Did you sign the Form I-821 application?

 Did you submit the required application and biometric services fees, or a written request for waiver of the fees?

 Did you submit the necessary documents and photos, if so required?

 Did you also submit the Form I-765 with the filing fee or a written request for a waiver of the filing fee (See instructions, items 10, 11 and 12)?


Have you submitted:

 The filing fee for this application or a written request for a waiver of the filing fee (see instructions, items 10 and 12)?

 Supporting evidence to prove identity, nationality, date of entry and residence?

 Other required supporting documents (photos, etc.) for each application?


File Typeapplication/msword
File TitleI-130
Authoruser_template
Last Modified ByUSCIS
File Modified2007-06-25
File Created2007-06-25

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