Form ATF F 5330.20 ATF F 5330.20 Certification of Compliance with 18 U.S.C.922(g)(5)(B)

OMB No.1140-0061 (xx/xx/xxxx)
U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

Certification of Compliance with 18 U.S.C. 922 (g)(5)(B)

Note: The Person Certifying to Citizenship Must Complete this Form.

(All entries Must be in ink, printed in CAPITAL LETTERS, and legible.)

You Must complete this certification or ATF will not be able to act upon your application and the application will be returned to you.
18 U.S.C. 922(g)(5)(B) generally makes it unlawful for any nonimmigrant alien to ship or transport in interstate or foreign commerce, or possess in or affecting commerce,
any firearm or ammunition; or to receive any firearm or ammunition which has shipped or transported in interstate or foreign commerce.
A nonimmigrant alien is an alien in the United States in a nonimmigrant classification. The definition includes, in part, persons traveling temporarily in the United States for business
or pleasure, persons studing in the United States who maintain a residence abroad, and certain foreign workers.
The definition does NOT include permanent resident aliens.
or Name of Corporation, Partnership, or
1. Name under which the application was filed:
Last
First
Middle Initial
Association, (If applicable.)
2. Name of person CERTIFYING to citizenship:
First
Last

Middle Initial

*If applying for a Federal Firearms License (FFL), All listed responsible persons MUST complete a CERTIFICATION.
Country name (listed additional country (ies) below if applicable).
3. What is your COUNTRY of citizenship?
If you are a citizen of the UNITED STATES, skip to question 7.
4. Immigration and Naturalization Service (INS) issued alien number or admission number:
5. Are you a NONIMMIGRANT alien? Answer “Yes”

or “No”

If you answered “No”, skip to question 7.
6. If you answered “Yes” to question 5, you must answer the following questions:
a. Are you in possession of a valid hunting license or permit lawfully issued in the United States Answer “Yes”

or “No”

*If you answer “Yes”, complete the following:
hunting license/permit number, if any

expiration date, if any

state of issuance

b.

Are you an official representative of a foreign government who is accreditied to the United States Government or your Government’s mission to
an international organization having its headquarters in the United States? Answer “Yes”
or “No”

c
.

Are you an official of a foreign government or a distinguished foreign visitor who has been so designated by the United States Department of State?
Answer “Yes”
or “No”

d.

Have you received a waiver from the nonimmigrant alien prohibition from the Attorney General of the United States? Answer “Yes”

or “No”

*If you answered “Yes” to question 6a. or 6d., You must submit approriate documentation in support or your “Yes” Answer
7. Under penalties imposed by 18 U.S.C.924, I certify that the statements contained in this certification of compliance with
18 U.S.C. 922 (g)(5)(B) form, and any attached statements in support thereof, are true and correct to the best of my knowledge and belief.
Signature of Individual who is Identified in Question 2:

Date:
ATF Form 5330.20
Revised (
)

Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction of Act of 1995. The information collection is used to determine whether the operations will be in conformity with Federal
laws and regulations. The information requested is required to obtain or retain a benefit and is mandatory by statue
(26 U.S.C. 5172).
The estimated average burden associated with this collection of information 3 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning
the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to Reports Management Officer, Document Services Branch, Bureau of Alcohol,
Tobacco, Firearms and Explosives, Washington, DC 20226
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

ATF Form 5330.20
Revised (
)