Request for Fee Waiver

OMB No. XXXX-XXX; Expires XX/XX/XXXX
Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions Form I-912,
Request for Fee Waiver

DRAFT
Instructions

Read these instructions carefully to properly complete Form I-912. If you need more space to complete an answer, use a
separate sheet of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of
paper and indicate the section and number of the item to which the answer refers.

Introduction
U.S. Citizenship and Immigration Services (USCIS) is funded
largely by application and petition fees. Waiving a fee
transfers the cost of processing applications and petitions to
others through higher fees. However, we recognize that some
individuals may not be able to pay the filing fee. If you want
USCIS to consider waiving the fee for your application, or
petition, follow the instructions below to complete Form
I-912, Fee Waiver Request. When you request a fee waiver,
you must clearly demonstrate that you are unable to pay the
fee. USCIS officers will evaluate all factors, circumstances,
and evidence supplied in support of a fee waiver request
when making a final determination. Each case is unique and
will be considered on its own merits.
For further fee waiver request guidance, please visit our Web
site at: www/uscis.gov and under "Before I file" click on
"Check Filing Fees" and then under "Forms Information"
click on "Fee Waiver Guidance."

Which applications and petitions will USCIS
consider for an individual fee waiver?

1. "T" nonimmigrant status (victim of human
trafficking) or "U" nonimmigrant status (victim of
certain crimes who has assisted in prosecution);
2. Asylum status in the United States;
3. Approved status as a battered or abused spouse,
child, or parent of a U.S. citizen or lawful
permanent resident, or for a special immigrant
juvenile;
4. Special Immigrant Juvenile status based on an
approved Form I-360, Petition for Amerasian,
Widow(er), or Special Immigrant.
5. An adjustment provision that does not require you
to prove that you are not likely to become a public
charge, such as the Cuban Adjustment Act, the
Haitian Refugee Immigration Fairness Act, or
similar provision; and
6. Continuous residence in the United States since
before January 1, 1972, ("Registry").
F. Form I-539, Application to Extend/Change Nonimmigrant
Status, for individuals with any benefit request as
specified by section 245(l)(7) of the INA;

You may use Form I-912 to request a fee waiver for any of
the following benefit requests or services:

G. Form I-751, Petition to Remove Conditions on
Residence;

A. Form I-90, Application to Replace Permanent Resident
Card;

H. Form I-765, Application for Employment
Authorization;

B. Form I-131, Application for Travel Document can be
waived for those applying for humanitarian parole.

I. Form I-817, Application for Family Unity Benefits;

C. Form I-192, Application for Advance Permission to Enter
as Nonimmigrant (Under Section 212(d)(3)(A)(ii) of
the Immigration and Nationality Act (INA)). The fee for
Form I-192 can only be waived for an alien who is not
subject to a determination of their likelihood of becoming a
public charge under section 212(a)(4) of the INA;

J. Form I-821, Application for Temporary Protected
Status;
K. Form I-601, Application for Waiver of Grounds of
Inadmissibility. The fee for Form I-601 can only
be waived for an alien who is not subject to a
determination of their likelihood of becoming a public
charge under section 212(a)(4) of the INA;

D. Form I-290B, Notice of Appeal or Motion. The fee for
Form I-290B can be waived only if the underlying
application or petition was fee exempt, the fee was waived,
or it was eligible for a fee waiver;

L. Form N-300, Application to File Declaration of Intention;

E. Form I-485, Application to Register Permanent Residence
or Adjust Status. A fee waiver is only available if you are
applying for lawful permanent resident status based on:

N. Form N-400, Application for Naturalization;

M. Form N-336, Request for Hearing on a Decision
in Naturalization Procedures Under section 336
of the Act;
O. Form N-470, Application to Preserve Residence
for Naturalization Purpose;
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P. Form N-565, Application for Replacement
Naturalization/Citizenship Document;
Q. Form N-600, Application for Certification of
Citizenship;
R. Form N-600K, Application for Citizenship and
Issuance of Certificate Under Section 322; and
S. Biometric services in connection with any application
or petition, regardless of whether it is listed above.
Some applications and petitions do not require a fee at all and
do not require you to submit a Form I-912. Other USCIS
applications and petitions have fee exemption requirements
for certain types of applicants and petitioners. In these cases,
the fee exemption is outlined on the particular USCIS form
and instructions and submission of a separate Form I-912 is
not required. Consult our Web site for the instructions and
fees for specific USCIS applications and petitions at:
www.uscis.gov.

Fee Waiver Request Review Process
1. How will USCIS determine if you qualify for a fee waiver?
USCIS will review your Form I-912 according to the process
described below. Additional details, including evidence, need
to be followed as explained in each step:
Step 1. Are you receiving a means-tested benefit?
If you are and you have provided sufficient evidence,
your fee waiver will normally be approved.
Step 2. Is your household income is at or below 150% of the
Federal Poverty Guidelines at the time of filing? If it
is, and you have provided evidence, your fee waiver
request will normally be approved.
Step 3. Do you have some financial hardship situation such
as recent unemployment, high medical expenses, and/
or other unexpected large expenses that you would
want USCIS to consider when determining eligibility
for a fee waiver? If you do, you must provide
evidence to support your claim.
STEP 1
2. What is a means-tested benefit and what effect does it
have on my eligibility for a fee waiver?
A. A means-tested benefit is a public benefit where a
person's eligibility for the benefit, or the amount of such
benefits, or both, are determined on the basis of the
person's income and resources, including those that may
lawfully be deemed available to the person by the benefitgranting agency. Means-tested benefits may be either

federally or state funded. For purposes of this waiver
application only, USCIS will consider federal public
benefits that you are receiving based on your means,
regardless of whether the benefit is funded under the
benefit-granting agency's mandatory or discretionary
spending programs. In other words, the benefit does not
need to have been specifically designated by the benefitgranting agency as a "federal means-tested benefit" for
purposes of the Personal Responsibility and Work
Opportunity Act (PRWORA) of 1996, P.L. 104-193, but
your eligibility for the benefit must still depend on your
income and other resources available to you. State
agencies may assist in the local administration of federal
means-tested public benefits.
B. Examples of means-tested benefit programs are Medicaid,
Food Stamps (now a part of the "Supplemental Nutrition
Assistance Program" or "SNAP" benefits), Temporary
Assistance to Needy Families (TANF), Supplemental
Security Income (SSI), among others. These benefits have
been designated as such for PRWORA purposes, however,
there are also other federal public benefits that you may be
receiving which are also "means-tested," but that are
funded by the benefit-granting agency's discretionary
spending programs. USCIS will consider your receipt of
these benefits as well in determining your eligibility for a
fee waiver. Please consult with your benefit-granting
agency or your legal advisor to determine whether any
federal public benefit that you are receiving qualifies as a
benefit for which your eligibility is determined based on
your "means."
C. States may also provide eligible individuals with statefunded public benefits where a person's eligibility for the
benefit, the amount of the benefit, or both, are determined
by the person's income and resources, including those that
the state benefit-granting agency lawfully deems available
to the person. Such benefits may also be considered
"means-tested" benefits for purposes of this fee waiver
application.
D. If you are receiving a means-tested benefit when you file
Form I-912, we will consider you eligible for a fee waiver.
E. You must provide evidence that you currently are receiving
a means-tested benefit. This evidence should be in the
form of a letter, notice, and/or other official document(s)
containing the name of the agency granting you the public
benefit. The document(s) submitted must show the name
of the recipient of the means-tested benefit and the name
of the benefit received.

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3. Can other members of the family use the means-tested
benefit as support for a fee waiver if not specifically
identified in the evidence supporting the benefit?
A. If an applicant is receiving a means-tested benefit, then the
spouse of the applicant will normally qualify for a fee
waiver on that basis.
B. If a parent is receiving a means-tested benefit, then his or
her unmarried children under 21 years of age living with
him or her will normally qualify for a fee waiver on that
basis.
C. If a child or grandchild is receiving a means-tested benefit,
parents or other family members will not necessarily
qualify for a fee waiver.
D. If an elderly parent living with his or her adult child is
receiving SSI, the adult child cannot use this as evidence
of eligibility for a fee waiver.
E. If you are not receiving a means-tested benefit or do not
want USCIS to consider receipt of a means-tested benefit
in determining your eligibility for a fee waiver, we will
look at the income level of your household and compare it
to the Federal Poverty Guidelines.
STEP 2
4. How will you use my household income information
to determine my eligibility for a fee waiver?
A. We will compare your household income with the Federal
Poverty Guidelines in effect at the time of filing as
established by the Secretary of Health and Human
Services. These guidelines change every year. To view
the most current Federal Poverty Guidelines, go to
http://aspe.hhs.gov/poverty. You can also call toll-free
1-866-758-1060 to obtain information or the current
Federal Poverty Guidelines.
B. If your household income is at or below 150% of the
Federal Poverty Guidelines; you will qualify for a fee
waiver. If your household income is over 150% of the
Federal Poverty Guidelines and if you have an financial
hardship that would impact your ability to pay, such as
large medical bills or other unexpected expenses, please
see step 3 below.
5. What evidence do I need to provide concerning
household income?
You will have to document your household size and income.
Household income includes all forms of income and financial
assistance. Evidence may include:

A. A copy of your most recent Federal tax return, if filed,
or if not available;
B. Paycheck stubs for a minimum of the past month,
statement(s) from your employer(s) on business
stationary showing salary or wages paid if Federal tax
returns are not filed or do not properly reflect current
income.
If you do not have any income or cannot provide evidence of
income, please discuss this in Section 6 of Form I-912.
6. Who should I include when determining my household
size?
A. If available, the members of your household should be
identified on your Federal tax return(s).
B. If a Federal tax return has not been filed, or is not
available, the following members of the household should
be identified and included in determining size:
1. You;
2. Your spouse; and
3. The following family members;
a. Your children or legal wards, who are unmarried
and under 21 years of age, and who live with you;
b. Your children or legal wards, who are unmarried
and are over 21years of age but under 24 years of
age, are full-time students, and who live with you
when not at school; and/or
c. Your children or legal wards, who are unmarried
and for whom you are the legal guardian because
they are physically or mentally disabled to the
extent they cannot adequately care for
themselves and cannot establish, maintain, or reestablish their own household.
C. If your parents live with you, they can also be included as
members of the household when determining size.
7. Will you include the income of a person living with me
if that person is not part of my household for tax
purposes?
A. If a person is living with you but is not claimed as a
member of your household for tax purposes, that person's
income will not be considered when determining your
household income. You do not need to provide this
person's income.

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B. Similarly, if the applicant is living with someone but is not
a member of that person's household for tax purposes, that
person's income will not be considered when determining
the applicant's household income. You do not need to
provide income for that person.
8. If I am separated, do I need to count my spouse,
household size and include their income as part of
household income?
A. If you are legally separated you do not need to include
your spouse in your family size. However, be sure you
include in your household income any support that your
spouse provides to your household.
B. Persons applying for immigration benefits under the
provisions of the Violence Against Women Act
(VAWA), and those applying for T or U Visas under the
Victims of Violence and Trafficking Protection
Reauthorization Act, should not provide spouse's income.
9. What if I am a full-time college or vocational student?
A. If under 24 years of age and over 21 years of age and
unmarried, the student can still be claimed as a dependent
on the parents' Federal tax return if living at home under
these circumstances. The student should provide a copy of
their parents' income tax statement along with their own
income tax statement.
B. If a student is not claimed as a dependent on a parent's
Federal tax return, the fee waiver request will be based
on the student's income only.
10. What if I am recently unemployed and my last year's
income tax statement shows my household income
above 150% of the Federal Poverty Guidelines?
If you are recently unemployed, you may not be able to
show that your annual income is at or below 150% of the
Federal Poverty Guidelines based on your most recent tax
return. Please see information in step 3.
11. What if I cannot provide evidence of income?

2. A letter from a foster care home or similar agency
overseeing the SIJ's custodial placement that describes
the SIJ's inability to pay; or
3. An approval notice on a Form I-797, Notice of Action,
for a Form I-360, filed for the SIJ.
STEP 3
13. What if I believe special circumstances warrant a fee
waiver even though my income puts me above 150% of
the Federal Poverty Guidelines?
A. You will need to provide us with a description of your
financial hardship as well as the following:
1. Income as described above; and
2. Information concerning your assets. Assets include:
real estate, property, cash, checking and savings
accounts, stocks, bonds, and annuities (except for
pension plans and Individual Retirement Accounts
(IRAs)). You need to provide evidence regarding the
types and value of your assets.
B. Information concerning your liabilities and expenses.
Liabilities and expenses for this purpose include: the cost
of rent, mortgages, lease, the average monthly cost for
food, utilities, child care and elder care, medical expenses,
any tuition costs, commuting costs, and monthly payments
on any lawful debts. You need to provide evidence, where
possible, such as copies of monthly bills and/or payments.
14. What if I cannot provide evidence of income?
You will need to provide us with a description of your
financial hardship and why you cannot provide any evidence
in support of your income. If possible, additional evidence
could be provided by affidavits from churches and other
community-based organizations indicating that the applicant
is currently receiving some benefit from that entity.

General

Please refer to Step 3 for guidance on evidence to provide.

1. Is there a fee for filing Form I-912?

12. What if I am filing on behalf of, or as a Special
Immigrant Juvenile (SIJ)?

There is no filing fee for the Form I-912.

A. The fee waiver request should be supported by one of the
forms of evidence listed below:
1. A recent state or juvenile court order establishing
dependency or custodial assignment of the SIJ; or

2. Can I file one fee waiver request for all members of
my family applying for immigration benefits ?
Yes. However, each person applying for a fee waiver must
sign Form I-912. These individuals should be identified in
Sections 1 and 2 of Form I-912. Please see "Who Must Sign
Form I-912" on Page 5.
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3. Can I file a Form I-912 without an application or
petition?
No. Form I-912 must be filed with an application or petition
requesting an immigration benefit. In addition, you must file a
new Form I-912 with any subsequent application or petition.
4. If I am filing more than one application or petition at
the same time, do I need to include a fee waiver request
for each application and petition?
No. You can file one fee waiver request covering all
applications and biometric fees filed for that applicant in the
same envelope.
5. Some form instructions mention a filing fee and a
biometric services fee; can both be waived? Do I have to
file a separate Form I-912?
You do not have to file a separate Form I-912 for the filing
fee and the biometric services fee. If we approve your Form
I-912, we will waive both the filing and biometric services
fee.
6. Will requesting a fee waiver affect my current
immigration status?
A. Relying primarily on public cash assistance for
income maintenance can affect an individual's eligibility
for some immigration benefits, depending on the totality
of the circumstances. The applicant may be inadmissible
as an alien likely to become a public charge, or may be
deportable for already having become a public charge
within 5 years of entry for reasons that arose before entry.
You will find detailed guidance on these issues published
in the May 26, 1999, edition of the Federal Register (64
Fed. Reg. 28689) and on the USCIS Web site at
www.uscis.gov under "Public Charge."
B. USCIS will not consider the possibility that you might be
inadmissible or deportable as a "public charge" in deciding
your fee waiver request. However, being inadmissible as a
public charge may make you ineligible for the benefit you
seek. The fee waiver determination, however, is made
separately from the adjudication of your eligibility of the
benefit.
C. USCIS will deny an application or petition that has been
determined to involve false document, misrepresentations
of facts, or other fraud in and filing including this fee
waiver request .

7. What if someone filed an affidavit of support for me?
If someone filed a Form I-134, Affidavit of Support, or Form
I-864, Affidavit of Support under Section 213A of the Act,
that person may still be responsible for supporting you, and
may be sued for repayment of public assistance provided to
you. However, we will not consider that person's income or
assets in deciding whether you are eligible for a fee waiver.

Who Must Sign Form I-912?
A. If you are at least 14 years of age or older, you must sign
the Form I-912.
B. Your parent or legal guardian may sign Form I-912 for you
if you are under 14 years of age.
C. Your legal guardian may also sign Form I-912 for you if
you are not mentally competent to manage your own
affairs no matter what your age is.

General Instructions for Completing Form I-912
A. This section provides you with line-by-line instructions
for completing Form I-912.
B. We recommend that you use the Adobe-fillable form
available on the USCIS Web site. If not available, type or
print in blue or black ink.
C. If an item does not apply to you, enter "Not Applicable" or
"N/A" unless the instructions direct you to do something
else. If the answer is none, write “None.”
D. If you need more space to complete an answer, use a
separate sheet of paper. At the top of each continuation
sheet, write your name and Alien Registration Number
(A-Number), if you have one, and indicate the section
and number of the item to which the answer refers.
SECTION 1 - INFORMATION ABOUT YOU
This section is for the person who needs the fee waiver. If
you have dependents whose applications are part of the fee
waiver request, please provide additional information in
Section 2.
Line 1. a. Family Name (last name).
Line 1. b. Given Name (first name).
Line 1. c. Middle Initial.
If you have two last names, include both in the Family Name
box and use a hyphen (-) if appropriate.

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Line 2. Alien Registration Number. Enter your A-Number.
If you do not have an A-Number, enter "Not Applicable" or
"N/A."
Line 3. U.S. Social Security Number. Enter your Social
Security Number. If you do not have a Social Security
Number, enter "Not Applicable" or "N/A."
Line 4. Date of Birth. Enter your date of birth as "mm/dd/
yyyy." For example, enter May 1, 1979, as 05/01/1979.

SECTION 5 - HOUSEHOLD INCOME
Line 10. Enter the number of dependents who live with you.
Line 11. Enter your average monthly income from wages for
all members of the household.
Line 12. Enter other money received each month that is not
included in Line 16. This could include spousal support, child
support, unemployment compensation, etc.

Line 5. Marital Status. Enter "Never Married," "Married,"
"Marriage Annulled," "Legally Separated," "Divorced," or
“Widow(er).”

USCIS will compare the amount in Line 12 to the Federal
Poverty Guidelines.

Line 6. Applications and Petitions. Enter the form
number(s) of the application(s) and/or petition(s) for which
you are requesting a fee waiver. The fee waiver request
includes the biometric fee, where applicable.

SECTION 6 - FINANCIAL HARDSHIP

SECTION 2 - ADDITIONAL INFORMATION IF
DEPENDENT(s) ARE INCLUDED IN THIS REQUEST
Line 7. Provide requested information for each dependent
who is part of this request. This can include spouse, children
and wards.
SECTION 3 - BASIS FOR YOUR REQUEST
This choice relates to you, the person named in Section 1.
Line 8a. If you are currently receiving a means-tested benefit,
check "A" and attach documentation. Please complete
Sections 4, 7, and 8 of the form.
Line 8b. If your household income is at or below 150% of the
Federal Poverty Guidelines, check "B" and attach
documentation. Please complete Sections 5, 7, and 8 of the
form.
Line 8c. If you have a financial hardship, check "C" and
attach documentation. Please complete Sections 5, 6, 7, and
8 of the form.
SECTION 4 - MEANS-TESTED BENEFIT
Line 9. In the space provided, enter: the name of the person
receiving the benefit, the name of the benefit received, the
name of the agency awarding the benefit, the date the benefit
was awarded, and whether the recipient is currently receiving
the benefit.
If you are receiving a means-tested benefit and have
evidence to support your claim, you may go directly to
Section 7.

Line 13. In the space provided, describe your financial
hardship. Be sure to include how this situation has caused you
to incur costs (and what the costs were) or loss of income that
you have experienced (and what that loss was). If you need
additional space, attach a separate sheet of paper.
Line 14. If you are currently unemployed, enter the date that
you became unemployed.
Line 15. If you are currently unemployed, enter the monthly
dollar amount of unemployment compensation that you are
receiving.
Line 16. In the space provided, enter: the type(s) of asset(s)
you have, the dollar value of those asset(s), and the total
dollar value of your asset(s). If you need additional space,
attach a separate sheet of paper.
Line 17. In the space provided, enter your average monthly
costs for the categories provided.
SECTION 7 - YOUR SIGNATURE, ATTESTATION
Line 18. After you read the attestation, release, and
acknowledgement, sign and date your Form I-912. By doing
this, you take full responsibility for the accuracy of all the
information provided, including all supporting documentation.
NOTE: Each person applying for a fee waiver must sign the
Form I-912.
A. If you are at least 14 years of age or older, you must sign
Form I-912.
B. Your parent or legal guardian may sign Form I-912 for
you if you are under 14 years of age.
C. Your Legal guardian may also sign Form I-912 for you if
you are unable to sign because you are not mentally
competent to manage your own affairs no matter what
your age is.

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Filing Your Request

Paperwork Reduction Act

To file your completed Form I-912, attach it and all supporting
documentation to the application or petition that you are
submitting.

Immigration laws are often complex. We try to create forms
and instructions that are easy to understand and that impose
the least possible burden in terms of information and
evidence required. For Form I-912, we estimate that on
average it will take a customer 1 hour and 10 minutes to
learn about the law, the form, our process, download the
form from our Web site, and complete and submit the
request.

Your complete application or petition,Form I-912, and
supporting documentation should be mailed to the USCIS
office according to the "Where to File" directions identified in
the application or petition form instructions to which the
Form I-912 relates. Form I-912 cannot be submitted after
USCIS has received the underlying application or petition.

Additional Information
If we approve your fee waiver request, we will notify you
with a notice that your application or petition has been
receipted and the filing amount is $0. If we deny your request,
we will notify you with a notice rejecting your application or
petition and an explanation of why the fee waiver request was
denied. Your complete package will be returned to you. You
may either resubmit your application or petition and fee
waiver request with the required additional documentation or
submit the necessary fee for the application or petition.

If you have any comments about this estimate, or suggestions
for making the form simpler, contact: U.S. Citizenship and
Immigration Services, Regulatory Products Division, Office
of the Executive Secretariat, 20 Massachusetts Avenue N.W.,
Washington, DC 20529-2020. You can also write to the
Office of Management and Budget, Paperwork Reduction
Project, OMB No. 1615-XXXX, Washington, DC 20503.
(Do not mail your Form I-912 to either of these
addresses).

Privacy Act Notice
We ask for the information on Form I-912, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies.
Failure to provide this information, and any requested
evidence, may delay a final decision or result in denial of
your Form I-912.

Form I-912 Instructions 09/24/10 Page 7