Application for Citizenship and Issuance of Certificate Under Section 322

OMB No. 1615-0087
Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions for Form N-600K, Application for
Citizenship and Issuance of Certificate Under Section 322
Instructions

Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (USCIS 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.

What Is the Purpose of This Form?
This form, the N-600K, is an application for the
naturalization of a child who regularly resides outside the
United States and for the issuance of a Certificate of
Citizenship to the child.

4. Is a biological child who is a legitimate child or is a child
who was legitimated, while in the legal custody of the
legitimating parent(s), prior to reaching the sixteenth
birthday; or
5. Is an adopted child who has a full and final adoption and
the child either is the beneficiary of an approved I-600 or
fulfilled the two-years legal custody, two-years joint
residence requirements of INA section 101(b)(1)(E).

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Who May Use This Form?

The following individuals may use this form:

1. A U.S. citizen parent seeking citizenship on behalf of a
minor adopted or biological child under section 322 of the
Immigration and Nationality Act (INA) (providing for
citizenship through an application process for biological
and adopted children who regularly reside outside of the
United States and meet certain conditions while under the
age of 18 years).

2. If a U.S. citizen parent of a child who otherwise meets the
eligibility requirements of INA 322 has died, a U.S. citizen
parent of the U.S. citizen parent or a U.S. legal guardian
can file this application at any time within five years of the
U.S. citizen parent's death.

Who May File This Form?

This form should be filed only if the child:

1. In the case of minor adopted or biological children (under
18 years) qualifying for citizenship under section 322 of
the INA, the application must be filed by the U.S. citizen
parent with legal and physical custody of the child.

2. In the case of an application filed by a U.S. citizen parent
of a deceased citizen parent or of an application filed by a
U.S. citizen legal guardian, the child does not have to be
residing in the legal and physical custody of the applicant.
The application can be filed and approved if the child is
residing in the legal and physical custody of a person who
does not object to the application.
3. Will not yet have reached their eighteenth birthday at the
time of fulfilling all of the requirements for citizenship,
including the required interview of U.S. citizen parent and
the child; and

Who May Not File This Form?

This form should not be used for stepchildren, children who
are not legitimate, and children who were not legitimated prior
to their 16th birthday. Such children are not eligible for
benefits under section 322 of the INA. Any person other than
a citizen parent should not use this form except in cases in
which a U.S. citizen parent has died.

What Is the Filing Fee?

The fee for Form N-600K is $600. Except for a person who is
requesting a Certificate of Citizenship for an adopted child,
(checking Part 2, Box A or C on the form), all applicants
must pay the fee for filing Form N-600K, under section 322 of
the INA .
For U.S. citizen parents, or a U.S. citizen grandparent, or U.S.
citizen legal guardian filing in lieu of a deceased U.S. citizen
parent, filing on behalf of an adopted minor child under
section 322 of the INA (checking Part 2, Box B on the form),
the fee for this form is $550.
Use the following guidelines when you prepare your check or
money order for the Form N-600K.
1. The check or money order must be drawn on a bank or
other financial institution located in the United States and
must be payable in U.S. currency; and
2. Make the check or money order payable to U.S.
Department of Homeland Security.
If you live outside the United Sates, Guam, or the U.S.
Virgin Islands, contact the nearest U.S. Embassy or
consulate for instructions on the method of payment.
NOTE: Spell out U.S. Department of Homeland Security; do
not use the initials "USDHS" or "DHS."
Form N-600K Instructions (Rev. 04/13/11) N

Notice to Those Making Payment by Check. If you send us
a check, it will be converted into an electronic funds transfer
(EFT). This means we will copy your check and use the
account information on it to electronically debit your account
for the amount of the check. The debit from your account will
usually take 24 hours, and will be shown on your regular
account statement.
You will not receive your original check back. We will
destroy your original check, but we will keep a copy of it. If
the EFT cannot be processed for technical reasons, you
authorize us to process the copy in place of your original
check. If the EFT cannot be completed because of insufficient
funds, we may try to make the transfer up to two times.

Child of a member of the U.S. Armed Forces only
Mail your completed Form N-600K to the USCIS Nebraska
Service Center (NSC). The NSC will initially process the
Form N-600K and then forward it to the appropriate USCIS
field office for interview and adjudication.
The USCIS Nebraska Service Center mailing addresses is:
USCIS Nebraska Service Center
P.O. Box 87426
Lincoln, NE 68501-7426
For express/courier delivery to the USCIS Nebraska Service
Center use the following address:

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How to Check If the Fees Are Correct

The form and biometric fees on this form are current as of the
edition date appearing in the lower right corner of this page.
However, because USCIS fees change periodically, you can
verify if the fees are correct by following one of the steps
below:

1. Visit our Web site at www.uscis.gov, select "FORMS" and
check the appropriate fee; or
2. Review the Fee Schedule included in your form package,
if you called us to request the form; or
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.

NOTE: If your Form N-600K requires payment of a
biometric service fee for USCIS to take your fingerprints,
photograph, or signature, you can use the same procedure to
obtain the correct biometric fee.

Where To File

Mail your completed Form N-600K and accompanying
documentation to the USCIS Lockbox facility at the following
address:
USCIS
P.O. Box 20100
Phoenix, AZ 85036
For Express Mail or courier deliveries, use the following
address:
USCIS
Attn: Form N-600K
1820 E. Skyharbor Circle S
Suite 100
Phoenix, AZ 85034

USCIS Nebraska Service Center
850 S. Street
Lincoln, NE 68508

E-Notification

If you are filing your Form N-600K at one of the USCIS
Lockbox facilities, you may elect to receive an e-mail and/or
text message notifying you that your Form N-600K has been
accepted. You must complete Form G-1145, E-Notification of
Application/Petition Acceptance, and attach it to the first page
of your Form N-600K. To download a copy of Form G-1145,
including the instructions, click on the “FORMS” link on the
USCIS Web site at www.uscis.gov.
Filing Addresses

The filing addresses provided on this form reflect the most
current information as of the date this form was last
printed. If you are filing Form N-600K more than 30 days
after the latest edition date shown in the lower right
corner, visit the USCIS Web site at www.uscis.gov before
you file, and check the “FORMS” page to confirm the correct
filing address and version currently in use. Check the edition
date located at the lower right corner of the form. If the edition
date on your Form N-600K matches the edition date listed for
Form N-600K on the online “FORMS” page, your version is
current. If the edition date on the online version is more
recent, download a copy and use it. If you do not have
Internet access, call the National Customer Service Center at
1-800-375-5283 to verify the current filing address and edition
date. USCIS will reject forms with the wrong revision date
and return the fee with instructions to resubmit the entire
filing using the current form.

General Instructions
Step 1. Fill Out Form N-600K
1. Type or print legibly in black ink.
Form N-600K Instructions (Rev. 04/13/11) N Page 2

2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.
3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is "none,"
write none.
4. If the child has a USCIS A-Number, write the USCIS ANumber in the place indicated on the top right hand
corner of the first page. Use the USCIS A-Number on the
Permanent Resident Card (formerly known as the Alien
Registration or ''Green'' Card), if the child has one.
Otherwise, use the USCIS A-Number shown on the USCIS
or former INS-issued correspondence about the child.

Passport-style photos must be 2" x 2." The photos must be
in color with full face, frontal view on a white to off-white
background. Head height should measure 1" to 1 3/8" from
top of hair to bottom of chin, and eye height is between 1
1/8" to 1 3/8" from bottom of photo. Your head must be
bare unless you are wearing a headdress as required by a
religious order of which you are a member. Using pencil or
felt pen, lightly print your name and Alien Registration
Number on the back of the photo.
2. Birth Certificate or Record of the Child - A certified
birth certificate or record issued by a civil authority in the
country of birth.

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Step 2. General Requirements

Translations. Any document containing foreign language

3. Birth Certificate or Record of the U.S. Citizen Parent A certified birth certificate or record issued by a civil
authority in the country of birth is required for applications
filed by a U.S. citizen parent of a U.S. citizen parent.

submitted to USCIS shall be accompanied by a full English
language translation which the translator has certified as
complete and accurate, and by the translator's certification that
he or she is competent to translate from the foreign language
into English.

4. Marriage Certificate(s) - Certified marriage certificate(s)
issued by a civil authority in the state or country of
marriage.

Copies. Unless specifically required that an original

5. Documents Showing the Termination of a Marriage Examples include a divorce decree, death certificate, or
annulment document.

document be filed with an application or petition, an ordinary
legible photocopy may be submitted. Original documents
submitted when not required will remain a part of the record,
even if the submission was not required. Do not send an
original Certificate of Citizenship or Certificate of
Naturalization. USCIS may request that you present original
documents at the interview.

What Documents or Evidence
Must I Send With the Application?

The following is a list of documents that must be submitted
with the Form N-600K. Unless specifically noted otherwise,
every applicant must submit each of the documents listed
below for himself/herself and the U.S. citizen parent(s) (or
grandparent(s) if applicable) through whom the applicant
is claiming U.S. citizenship.

1. Photographs
You must submit two identical color photographs of
yourself taken within 30 days of the filing of this
application. The photos must have a white to off-white
background, be printed on thin paper with a glossy finish,
and be unmounted and unretouched.
NOTE: Because of the current USCIS scanning
process, if a digital photo is submitted, it needs to be
produced from a high resolution camera, which has at
least a 3.5 mega pixel.

6. Proof of U.S. Citizenship - Examples of this are birth
certificates showing birth in the United States; an
N-550, Certificate of Naturalization; an N-560,
Certificate of Citizenship; an FS-240, Report of Birth
Abroad of United States Citizen; or a valid unexpired
U.S passport.
7. Proof of Legitimation - (Only required for applicants
who were born out-of-wedlock).
Documents must establish legitimation according to the
laws of the child's residence or domicile or father's
residence or domicile (if applicable).
Legitimation for INA benefits requires that the child is in
the legal custody of the legitimating parent(s) at the time
of legitimation.
8. Proof of Legal Guardianship - Proof of legal
guardianship issued by competent authority in the place of
residence of the legal guardian must be submitted for any
application filed by a legal guardian in lieu of a deceased
citizen parent.
9. Proof of Legal Custody - (Only required for applicants
whose U.S. citizen parent(s) divorced and/or separated
and for applicants who are adopted or legitimated).
Form N-600K Instructions (Rev. 04/13/11) N Page 3

10. Evidence of Lawful Admission and Maintenance of
Such Lawful Status (e.g. Form I-94, Arrival/Departure
Record) - (Required at time of interview for all applicants
seeking citizenship under section 322 of the INA).

15. Copy of Full, Final Adoption Decree - (Only required
for adopted applicants).

11. Proof of Required Residence or Physical Presence in
the United States - Any document that proves the U.S
citizen parent(s)' residence or physical presence in the
United States. This proof may include but is not limited to
the following:

What If a Document Is Not Available?

A. School, employment, military records;
B. Deeds, mortgages, leases showing residence;

16. Evidence of All Legal Name Changes

If it is not possible to obtain any one of the above-required
documents, you must establish why the evidence is not
available. You may be required to submit an original written
statement from the relevant government or other authority
explaining the reason for the unavailability of the document(s).
You may submit the following secondary evidence for
consideration. However, secondary documents that do not
overcome the availability of primary documents may result in
denial of the application:

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C. Attestations by churches, unions, or other organizations;
D. U.S. Social Security quarterly reports;

E. Affidavits of third parties having knowledge of the
residence and physical presence.

12. Proof of U.S. Citizen Grandparent(s)' Required
Physical Presence in the United States - (Only required
for applicants seeking citizenship under section 322 of the
INA whose U.S. citizen parent(s) does not meet the
physical presence requirement of five years in the United
States, two years of which were after the age of 14).
Documentation establishing that the U.S. citizen
grandparent(s) met the required physical presence
requirements.
13. Current Status of U.S. Citizen Grandparent

An application filed by a citizen parent that relies on the
physical presence in the United States of a citizen
grandparent cannot be approved unless the citizen
grandparent is a U.S. citizen, if living, or if deceased, was
a U.S. citizen at the time of his or her death.

An application filed by any grandparent or legal guardian
in lieu of a deceased citizen parent that relies on the
physical presence of a citizen grandparent cannot be
approved unless evidence is submitted that the citizen
grandparent was a U.S. citizen and still alive at the time of
the death of the citizen parent.

14. Copy of Notice of Approval of a Form I-600, Petition to
Classify Orphan as an Immediate Relative, and
Supporting Documentation for Such Form (Except
Home Study) - (All adopted orphans applying under
section 322 of the INA must either have this form or have
complied with the two years legal custody and two years of
joint residence requirement of INA 101(b)(1)(E)).

1. Baptismal Certificate: A certificate under the seal of the
church where the baptism occurred, showing the date and
place of the child's birth, date of baptism, the names of the
godparents, if known.
2. Church Records: A certificate under the church seal
issued within two months of birth.

3. School Record: A letter from authorities of the school
attended (preferably the first school), showing the date of
admission to the school, the child's date of birth or age at
that time, place of birth, and the names and places of birth
of parents, if shown in the school records.
4. Census Records: State or Federal census records showing
the name(s) and place(s) of birth, and the date(s) of birth or
age(s) of the person(s) listed.
5. Affidavits: Written statements sworn to (or affirmed) by
two persons who have personal knowledge of the claimed
event (i.e., the date and place of a birth, marriage, or
death). The persons may be relatives and need not be
citizens of the United States. Each affidavit should contain
the following information regarding the person making the
affidavit: his/her full name and address; date and place of
birth; relationship to the applicant, if any; full information
concerning the event; and complete details concerning how
he/she acquired knowledge of the event.

Step-By-Step Instructions
This form is divided into ten parts. The information on the
next page will help you fill out the form.

Form N-600K Instructions (Rev. 04/13/11) N Page 4

Part 1. Information about your child.
NOTE: If you are a U.S. citizen parent, grandparent or legal
guardian applying for a certificate of citizenship on behalf of
your minor biological, or adopted child, give information for
your minor child.
A. Current legal name - The child's current legal name is the
name on the birth certificate unless it has been changed
after birth by a legal action such as a marriage, adoption,
or court order.
B. Name exactly as it appears on the child's Permanent
Resident Card (if applicable and if different from above).
Write the child's name exactly as it appears on the card,
even if it is misspelled.

If you are a U.S. citizen parent applying for a Certificate of
Citizenship on behalf of a minor biological child, check the
box in Section A. If you are a U.S. citizen parent applying for
a Certificate of Citizenship on behalf of a minor adopted child,
check the box in Section B. If you are the U.S. citizen parent
of a deceased U.S. citizen parent applying for your grandchild,
check the box in Section C. If you are the U.S. citizen legal
guardian of an eligible child, check the box in Section C.

Part 3. Additional Information About the Child
The information in this section should be about the child who
will be issued the Certificate of Citizenship.

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C. Other names used since birth - If the child has ever used
any other names since birth, write them in this section. If
you need more space, use a separate sheet of paper.

D. U.S. Social Security Number - Print the child's U.S.
Social Security number. If the child does not have a Social
Security number, write "N/A" in the space provided.

E. Date of Birth - Use eight numbers to show the child's date
of birth (example: May 1, 1992, should be written
05/01/1992).

F. Country of Birth - Give the name of the country where
the child was born. Write the name of the country even if it
no longer exists. If the name of the country has changed,
write the name of the country as it was at the time of the
child's birth.
G. Country of Citizenship/Nationality - Write the name of
the country of the child's citizenship/nationality.

1. If the country no longer exists and/or the child is
stateless, write the name of the country where the child
was last a citizen or national.
2. If the child is a citizen or national of more than one
country, write the name of the foreign country that
issued the last passport.

NOTE: If you are a U.S. citizen parent, grandparent, or legal
guardian applying for a Certificate of Citizenship on behalf of
a minor biological or adopted child, give information for your
minor child.
A. Home Address - Give the address where the child now
lives. Do not put post office (P.O.) box numbers here.
B. Mailing Address - If the mailing address is the same as
the home address, write "same." If the mailing address is
different from the home address, write it in this part.
Provide "Care Of" information if applicable.

C. Telephone Numbers - Telephone numbers and e-mail
addresses allow USCIS to contact you more quickly about
the application. If you are hearing impaired and use a
TTY telephone connection, please indicate this by writing
"(TTY)" after the telephone number.
D. Marital Status - Check the marital status of the child on
the date you are filing this application.
E. Information about the entry into the United States and
current immigration status Do not complete this section. The USCIS Adjudicator
will complete this during the interview.

Part 2. Information About the Child's Eligibility

F. Previous Application for Certificate of Citizenship or
U.S. Passport - If you know of any prior application for a
Certificate of Citizenship or a U.S. passport (or you are a
U.S. citizen parent who previously applied for a Certificate
of Citizenship or U.S. passport for your minor child),
indicate on a separate piece of paper what happened with
the application and whether a Certificate of Citizenship or
U.S. passport was or was not issued.

Check the box that indicates why the child is eligible to apply
for a Certificate of Citizenship.

G. Information on Adoption - If the child was adopted,
provide information as to the place and date of adoption.

H. Gender - Indicate whether male or female.
I. Height - Give the child's height in feet and inches.

Form N-600K Instructions (Rev. 04/13/11) N Page 5

H. Marital Status of Parents at Time of Birth (or
Adoption) - Indicate whether the child's parents were
married to each other at the time of the child's birth. If the
child was born out-of-wedlock, indicate "No," even if the
parents subsequently married. If the child was adopted,
indicate whether the adoptive parents were married to
each other at the time of the adoption.

Part 4. Information About Child's U.S. Citizen Father
or Mother (or Adoptive Father or Mother)
NOTE: If you are a U.S. citizen father or mother (or
adoptive father or mother) applying for citizenship and a
certificate of citizenship on behalf of your minor child, where
information is requested about in this section, provide
information about YOURSELF in the sections noted. If you
are a U.S. citizen grandparent or legal guardian, provide
information about the child's U.S. citizen PARENT in the
sections noted.

H. Marital History
1. Write the number of times the U.S. citizen father or
mother was married. Include any annulled marriages. If
there was more than one marriage to the same spouse,
count each time as a separate marriage.
2. If now married, provide information about the U.S.
citizen father or mother's current spouse. Check
appropriate box to indicate immigration status.
3. Indicate whether the U.S. citizen father or mother's
current spouse is also your parent. If "No," you will be
asked to provide information about your father or
mother's previous spouse or spouses.

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A. Current legal name - Give current legal name, or name at
time of death, of the U.S. citizen father or mother. It is the
name on the birth certificate unless it was changed after
birth by a legal action such as a marriage, adoption, or
court order.

B. Date of Birth - Use eight numbers to show the U.S. citizen
father or mother's date of birth (example: May 1, 1969,
should be written 05/01/1969).
C. Country of Birth - Give the name of the country where
the U.S. citizen father or mother was born. Write the name
of the country even if it no longer exists. If the name of the
country has changed, write the name of the country as it
was at the time of your U.S. citizen father or mother's
birth.
D. Home Address - Give the address where the U.S. citizen
father or mother now lives. Do not put post office (P.O.)
box numbers here.

E. U.S. Citizenship - Indicate how the U.S. citizen father or
mother became a U.S. citizen. Provide all the requested
information.
F. Loss of U.S. Citizenship - Indicate whether the U.S.
citizen father or mother ever lost U.S. citizenship. Provide
this information even if the U.S. citizen father or mother
regained citizenship at a later date.
G. Residence and/or Physical Presence - Provide all the
dates when the U.S. citizen father or mother was in United
States. Dates should include all time immediately after
birth as well as after the age of 14 years and older.

Part 5. Information about the U.S. citizen
grandfather or grandmother
Complete This Section Only If:

1. You are a U.S. citizen parent, grandparent, or legal
guardian applying for citizenship on behalf of a United
States citizen's adopted or biological child who regularly
resides outside the United States;

2. The U.S. citizen parent, has not been physically present in
the U.S. for five years, two years of which were after the
age of 14 years; and
3. If the eligible applicant is relying on the physical presence
in the United States of the U.S citizen father or mother of
the United States citizen parent (the child's grandfather or
grandmother) to get citizenship for the adopted or
biological child.
4. The applicant should provide information about the U.S.
citizen parent (the grandparent of the child) of the U.S.
citizen father or mother in the sections noted.
A. Current legal name - Give current legal name of the
U.S. citizen grandfather or grandmother. It is the name
on his or her birth certificate unless it was changed
after birth by a legal action such as a marriage,
adoption, or court order.
B. Date of Birth - Use eight numbers to show the U.S.
citizen grandfather or grandmother's date of birth
(example: May 1, 1949, should be written 05/01/1949).
C. Country of Birth - Give the name of the country
where the U.S. citizen grandfather or grandmother was
born. Write the name of the country even if it no
longer exists. If the name of the country has changed,
write the name of the country as it was at the time of
the U.S. citizen grandfather or grandmother's birth.

Form N-600K Instructions (Rev. 04/13/11) N Page 6

D. Home Address - Give the address where the U.S.
citizen grandfather or grandmother now lives. Do not
put post office (P.O.) box numbers here.
E. U.S. Citizenship - Indicate how the U.S. citizen
grandfather or grandmother became a U.S. citizen.
Provide all the requested information.
F. Loss of U.S. Citizenship - Indicate whether the U.S.
citizen grandfather or grandmother ever lost U.S.
citizenship. Provide this information even if the U.S.
citizen grandfather or grandmother regained citizenship
at a later date.

Processing Information
Acceptance. Any Form N-600K that is not signed or
accompanied by the correct fee, except those accompanied
by a fee waiver request, will be rejected. A Form N-600K
that is not completed according to these instructions, is
missing pages or otherwise not executed in its entirety, or
is not accompanied by the required initial evidence may be
rejected or delayed. If USCIS rejects your Form N-600K
for the reasons above, the form and any fees will be
returned to you, and you will be notified why the form is
considered deficient. You may correct the deficiency and
refile Form N-600K. An application or petition is not
considered properly filed until accepted by USCIS.

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G. Residence and/or Physical Presence - Provide all the
dates when the U.S. citizen grandfather or grandmother
was in United States. Dates should include all time
immediately after birth as well as after the age of 14
years and older.

Part 6. Legal Guardian

Complete this part only for applications filed by a legal
guardian in lieu of a deceased U.S. citizen parent.

Part 7. The Child's Signature

The child must sign the Form N-600K as he or she normally
signs his or her name. The child may place an “X” mark
instead of a signature if she or he is unable to write in any
language.

A parent or legal guardian may sign for the child if the child is
less than 14 years of age. The child may also sign the Form
N-600K on her or his own behalf without the child's parent's
or legal guardian's signature.

Part 8. Signature of Person Preparing Form,
If Other Than Applicant

If you do not fill out the Form N-600K yourself, the preparer
must also sign, date, and give his or her address. If the
preparer is a business or organization, its' name must be
included on the form.

Part 9. Affidavit
Do not complete this part. You will be asked to complete
this part at the interview.

Part 10. Officer Report and Recommendation
Do not complete this part. This part is for USCIS use only.

Initial Processing. Once the application has been accepted, it
will be checked for completeness, including submission of the
required initial evidence. If you do not completely fill out the
form or file it without the required initial evidence, you will
not establish a basis for eligibility and we may deny your
application.
Requests for More Information. We may request more
information or evidence, or we may request that you appear at
a USCIS office for an interview. We may also request that
you submit the originals of any copy. We will return these
originals when they are no longer needed.
Decision. The decision on Form N-600K involves a
determination of whether you have established eligibility for
the requested benefit. You will be notified of the decision in
writing.

Address Changes

If you have changed your address, you must inform USCIS of
your new address. For information on filing a change of
address go to the USCIS Web site at www.uscis.gov/
addresschange or contact the National Customer Service
Center at 1-800-375-5283.
NOTE: Do not submit a change of address request to the
USCIS Lockbox facilities because the Lockbox facilities do
not process change of address requests.

USCIS Forms and Information
You can get USCIS forms and immigration-related
information on the USCIS Web site at www.uscis.gov. You
may order USCIS forms by calling our toll-free number at

Form N-600K Instructions (Rev. 04/13/11) N Page 7

1-800-870-3676. You may also obtain forms and information
by telephoning our National Customer Service Center at
1-800-375-5283.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system,
visit our Web site. 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.

DISCLOSURE: The information you provide is voluntary.
However, failure to provide the requested information, and
any requested evidence, may delay a final decision or result in
denial of your benefit request.
ROUTINE USES: The information you provide on this
benefit request may be shared with other Federal, State, local,
and foreign government agencies and authorized organizations
following approved routine uses described in the associated
published system of records notices [DHS-USCIS-007 Benefits Information System and DHS-USCIS-001 - Alien
File (A-File) and Central Index System (CIS), which can be
found at www.dhs.gov/privacy]. The information may also be
made available, as appropriate, for law enforcement purposes
or in the interest of national security.

DRAFT
NOT
FOR
PRODUCTION

Penalties

If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this request, we will deny
the benefit you are filing for, and may deny any other
immigration benefit. In addition, you will face severe penalties
provided by law, and may be subject to criminal prosecution.

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this benefit
request, and the associated evidence, is collected under the
Immigration and Nationality Act, section 101, et. seq.

PURPOSE: The primary purpose for providing the requested
information on this benefit request is to determine if you have
established eligibility for the immigration benefit for which
you are filing. The information you provide will be used to
grant or deny the benefit sought.

Paperwork Reduction Act

An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 1 hour and 35 minutes
per response, including the time for reviewing instructions,
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Products Division, Office of the Executive
Secretariat, 20 Massachusetts Avenue, N.W., Washington, DC
20529-2020. OMB No. 1615-0087. This form expires
November 30, 2011. Do not mail your application to this
address.

Form N-600K Instructions (Rev. 04/13/11) N Page 8