Genealogy Index Search Request (Submitted by Mail)

OMB 1615-0096; Expires 04/30/2012

Instructions for G-1041, Genealogy
Index Search Request

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

Instructions
Read all instructions carefully before completing this form.

What Is the Purpose of This Form?

What Information Is Required To Begin an
Index Search?

Use Form G-1041 to request a search of U.S. Citizenship and
Immigration Services (USCIS) historical databases. (To obtain
copies of USCIS historical records, use Form G-1041A,
Genealogy Records Request.)

The following information is required to initiate a search of
USCIS historical indices:

DRAFT - Not
For Production
1. Required Information:

Requests for searches of USCIS historical databases are used
to determine whether any USCIS records exist on the subject
and, if such records exist, to capture the file number and/or
other identifier of each record.

Who Should Use This Form?

A. Immigrant's full name (last, first, and middle);
B. Alias names or variant spellings, if any;

C. Date of birth (state whether date given is exact or an
estimated year); and
D. Country or place of birth.

Use this form if you are a:

1. Researcher seeking records of your ancestors for
genealogical or family history purposes;

2. Historian or social scientist seeking historical records of
persons you can identify by name, date of birth, and place
of birth; or
3. Researcher involved in heir location.

When Should This Form Not Be Used?
This form should not be used to request a copy of a USCIS
historical record or a copy of any record.
Do not use this form to request index searches for:
1. Records of naturalization prior to September 27, 1906.
Consult Federal records stored at the National Archives
and Records Administration (NARA) Record Group 21, or
write to the clerk of the court where the naturalization
occurred; or
2. Sea, land, or air passenger manifest lists recording arrivals
prior to December 1982. For these documents, contact
NARA.
NOTE: For any records not specifically mentioned in Form
G-1041 or not available through any other USCIS program,
use Form G-639, Freedom of Information/Privacy Act
Request.

2. Additional data will help identify a certain immigrant from
others with the same name, such as:
A. Date of immigrant's arrival in the United States (state
whether the date is actual or estimated); and
B. Immigrant's residence(s) in the United States (State,
city, or exact street address - Example: "in
Pennsylvania until 1938, then lived in Madison,
Wisconsin.")
3. If the immigrant's date of birth is less than 100 years
before today's date, you must attach documentary proof of
death to this request form. Examples of acceptable
documentary proof of death include:
A. Death certificate (uncertified copy);
B. Printed obituaries, funeral programs, or photographs
of gravestones;
C. Bible, church, or other religious records;
D. U.S. Social Security Death Index records (individual
records only, not lists);
E. Records relating to the payment of death benefits; and/
or
F. Other documents demonstrating that the immigrant
subject of the request is deceased.
Submit copies of these items with this request form. Do not
include original records because such documents will not be
returned.

G-1041 Instructions (12/06/11) Y

What If the Required Information Is Not
Provided?
No search can be made without you providing at least the
immigrant's name, year of birth, and country of birth.
If the immigrant appears in USCIS records under a name
other than that provided, no matching record will be returned.
We will search alternative names only if you provide the
names, spellings, and aliases. Similarly, if multiple
immigrants with the same name appear having the identical
birth year and country, no matching record will be returned.
Only if you provide additional information (e.g., actual or
estimated date of arrival or naturalization, or place of
residence when naturalized) can we identify an immigrant
from among others with the same name.

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.

DRAFT - Not
For Production

NOTE: We will consider foreign versions to be the same
name. Example: Giuseppe and Joseph, which are different
spellings of the same name.

To learn about various foreign spellings of common names
and about alternate sources for some USCIS record file
numbers, visit the USCIS Genealogy Program Web site at
www.uscis.gov/genealogy.

What Is the Fee?
You must submit a fee of $20 with this form to request a
genealogy index search.

Where Should You Mail the Request?

Mail your request to:

U.S. Citizenship and Immigration Services
Genealogy Program
P.O. Box 805925
Chicago, IL 60680-4120

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.

Use the following guidelines when you prepare your check or
money order for the Form G-1041 fee:

NOTE: Do not submit a change of address request to the
USCIS Lockbox facilities because the USCIS Lockbox
facilities do not process change of address requests.

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

USCIS Forms and Information

2. Make the check or money order payable to U.S.
Department of Homeland Security.
NOTE: Spell out U.S. Department of Homeland Security;
do not use the initials "USDHS" or "DHS."
3. If you live outside the United States, Guam, or the U.S.
Virgin Islands, contact the nearest U.S. Embassy or
consulate for instructions on the method of payment.

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
1-800-870-3676. You may also obtain forms and information
by telephoning our USCIS 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
the USCIS Internet-based system, InfoPass. To access the
system, visit the USCIS 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.
G-1041 Instructions (12/06/11) Y Page 2

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this form,
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 form 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.

DRAFT - Not
For Production

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 Form G-1041.

ROUTINE USES: The information you provide on this form
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, Index,
and National File Tracking System of Records, 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.

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 30 minutes per
response, including the time for reviewing instructions and
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 1615-0096. Do not mail your
completed Form G-1041 to this address.

G-1041 Instructions (12/06/11) Y Page 3