Form I-290B Form I-290B Notice of Appeal to the Office of Administrative Appeals

OMB No. 1615-0095; Expires 04/30/2011

Form I-290B, Notice
of Appeal or Motion

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

In the Matter of:

File Number: A For USCIS Use Only

START HERE - Please Type or Print (Use black ink)

Part 1. Information About Petitioner/Applicant (Individual/Business/

Returned

Receipt

Organization/Attorney/Representative filing appeal or motion)
Family Name

Given Name

Middle Name

Date
Date

Name of Business/Organization (if applicable)

Resubmitted
Apt. #

Mailing Address - Street Number and Name

Date
Date

C/O (in care of):

Reloc Sent
State or Province

City
Country

Daytime Phone # (Area/Country Code)
(

Fax # (Area/Country Code)
(

Zip/Postal Code

)

Date
Date
Reloc Rec'd

E-Mail Address (if any)
Date

)

I am an attorney or representative. If you check this box, you must provide the
following information about the person or organization for whom you are
appearing. (NOTE: You must attach a Form G-28, Notice of Entry of Appearance
as Attorney or Representative.)
Family Name
Given Name
Middle Name

Date
Remarks

Complete Name of Business/Organization/School (if applicable)
A # (if any)

Daytime Phone # (Area/Country Code)
(

Fax # (Area/Country Code)
(

)

E-mail Address (if any)

)

Part 2. Information About the Appeal or Motion (Check one box below that best describes your request)
NOTE: If you indicate that you are filing an appeal, it may be considered by USCIS as a motion before it is forwarded to the AAO.
A.

I am filing an appeal. My brief and/or additional evidence is attached.

B.

I am filing an appeal. My brief and/or additional evidence will be submitted to the AAO within 30 days.

C.

I am filing an appeal. No supplemental brief and/or additional evidence will be submitted.

D.

I am filing a motion to reopen a decision. My brief and/or additional evidence is attached.

E.

I am filing a motion to reconsider a decision. My brief is attached.

F.

I am filing a motion to reopen and a motion to reconsider a decision. My brief and/or additional evidence is attached.
Form I-290B (Rev. 11/23/10) Y

In the Matter of:

File Number: A -

Part 2. Information About the Appeal or Motion
Information on the relating application/petition.
Application/Petition Form #
Receipt #

(Continued)
Date of Denial (mm/dd/yyyy)

USCIS Office Where Decision Issued

Part 3. Basis for the Appeal or Motion
Motion to Reopen: The motion must state new facts and must be supported by affidavits and/or documentary evidence.
Motion to Reconsider: The motion must be supported by citations to appropriate statutes, regulations, or precedent decisions.
Appeal: Provide a statement explaining any erroneous conclusion of law or fact in the decision being appealed.

Part 4. Signature of Person Filing the Appeal/Motion or His or Her Authorized Representative
Signature

Printed Name

Date (mm/dd/yyyy)

Make sure your appeal or motion is complete before filing.

Form I-290B (Rev. 11/23/10) Y Page 2