I-824 Application for Action on an Approved Application

OMB No. 1615-0044: Expires 06/30/07

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

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

START HERE - Please type or print in black ink.

Part 1. Information about you. (Person filing this application)

Returned

Family Name (Last name)

Date

Given Name (First Name)

Middle Name

For USCIS Use Only
Receipt

Date
Resubmitted

Company or Organization Name
Home or Business Address - Street Number and Name
City

State or Province

Zip/Postal Code

Country

Mailing Address - Street Number and Name

Apt./Suite #

Date
Date
Reloc Sent
Date

Apt./Suite #

Date
Reloc Rec'd
Date

C/O (in care of):

Date

City

State or Province

Zip/Postal Code

Country

Remarks

Daytime Phone # (Area/Country Codes)
Country of Birth

Country of Citizenship

Date of Birth (mm/dd/yyyy)

IRS Tax # (if any)

A # (if any)

U.S. Social Security # (if any)

Action Block

Part 2. Reason for request (check one):
I am requesting: (Check one box.)
A.

A duplicate approval notice.

B.

USCIS to notify a different U.S. Consulate or Port-of-Entry about the approval of an
application or petition. Please notify the U.S. Consulate or Port-of-Entry at:

C.

USCIS to notify a U.S. Consulate that my status has been adjusted to permanent
resident. Please notify the U.S. Consulate at:

D.

USCIS to send my approved immigrant visa to the National Visa Center (NVC).

E.

USCIS to notify the U.S. Department of State of my U.S. citizenship status.

To Be Completed by
Attorney or Representative, if any.
Fill in box if G-28 is attached to
represent the applicant.
ATTY State License #

Form I-824 (Rev. 07/30/07) Y

Part 3. Additional information.
1. Give the following information about the original petition or application.
Type of Petition or Application (Form Number)
Receipt Number (On Form I-797, Notice of Action)
Filing Date of Petition or Application (mm/dd/yyyy)

Approval Date (mm/dd/yyyy)

2. Give the following information about the petitioner or applicant for the original petition or application.
Current/Most Recent Immigration Status
Naturalization/Citizenship Certificate Number
3. Give the following information about the principal beneficiary of the original petition or application.
Middle Name
Family Name (Last Name)
Given Name (First Name)
Date of Birth (mm/dd/yyyy)

A # (if any)

Country of Birth

Home Address - Street Number and Name
City

State or Province

Apt. #
Zip/Postal Code

Mailing Address - (if different from home address
Street Number and Name/P.O. Box Number
City

State or Province

Country

C/O (In Care Of)
Zip/Postal Code

Country

Daytime Phone (Area/Country Code and Number)

Part 4. Signature. Read the information on penalties in the instructions before completing this part.
I certify, under penalty of perjury under the laws of the United States of America, that this information and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
Signature
Daytime Phone Number (with area code)
Date (mm/dd/yyyy)
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested benefit and this application may be denied.

Part 5. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this at the request of the applicant and it is based on all information of which I have knowledge.
Print or Type Your Name
Signature
Firm Name and Address

Date (mm/dd/yyyy)

E-Mail Address (if any)

Daytime Phone Number (with area code)

Form I-824 (Rev. 07/30/07) Y Page 2