Genealogy Records Request (Submission by Mail)

OMB 1615-0096; Expires 04/30/2012

Instructions for G-1041A, Genealogy
Records Request

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

Instructions
Read all instructions carefully before completing this form.

DRAFT - Not
For Production

What Is the Purpose of This Form?

How Are Historical Records
and Files Identified?

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

Records and files are identified by file numbers.

Who Should Use This Form?
Use this form if you are a:

1. Researcher requesting a copy of a USCIS historical record
by file number. (See descriptions of USCIS historical
records on Page 2 of these instructions.);

To help identify historical USCIS file numbers, review the
chart on Page 2 of these instructions, which lists available
series of USCIS historical files and shows sample file
numbers.
Requests for copies of USCIS historical records or files must
identify the record by the file number or another file identifier.
No record can be retrieved without a file number. If you do
not have the file number as described in the chart on Page 2,
you should submit Form G-1041, Genealogy Index Search
Request.

2. Researcher who has received file numbers resulting from
the Genealogy Index Search Request (G-1041); or
3. Researcher seeking records for genealogical or family
history purposes or heir location, and who can provide a
precise historical record series file number and can
identify the immigrant by name and/or other information.

When Should This Form Not Be Used?

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

Do not use this form to request:
1. Records of naturalization prior to September 27, 1906. For
such records, consult Federal court 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;
2. Copies of sea, land, or air manifest lists prior to December
1982. For these lists, write to NARA;
3. The return of original documents. For such documents, use
Form G-884, Request for Return of Original Documents.

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 USCIS Lockbox
facilities do not process change of address requests.

NOTE: For any records not specifically mentioned in this
Form G-1041A or not available through any other USCIS
program, use Form G-639, Freedom of Information/Privacy
Act Request.

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

Identifying USCIS Historical Records and File Numbers
If you are requesting a...

Then...

Examples...

Naturalization Certificate File (C-File)

Provide:

Records relating to all U.S. naturalization certificates,
replacement certificates and Certificates of Citizenship
issued between September 27, 1906, and March 31,
1956. The majority of C-Files exist only on microfilm.

(1) The certificate number; and

C-1234567, Supreme Ct.,
Kings Co., NY, March
1922.

Non-Standard C-Files

Provide:

Repatriation - Certificates issued to persons who
regained U.S. citizenship between 1918 and 1956.

The certificate number obtained
from the original certificate or
from prior Genealogy Search
Request (G-1041).

DRAFT - Not
For Production

Military Naturalization - Certificates issued to persons
who served in the U.S. Armed Forces from 1942 to
1956.

(2) The name of court, location,
and date of naturalization.

B-

D-

OMOS-

Derivative - Certificates issued to persons who derived
U.S. citizenship through the naturalization of a parent
while they were a minor, or through birth abroad to U.S.
citizen parent(s).

AAADA-

Old Law - Replacement certificates issued to persons
who naturalized prior to September 27, 1906 (i.e., under
the Old Law), and who applied for a replacement
certificate during or after 1929.

OL-

Alien Registration Form (AR-2).

Provide:

Microfilmed copies of Form AR-2 completed by all
aliens age 14 years and older residing in or entering the
United States between August 1940 and March 31, 1944.

The Alien Registration Number.

A-1234567, A-0002345,
A-001234
AR-1234567, A 1 234 567
AR-0002345

or
A-File numbered below 8 million.
Visa File

Provide:

Original arrival records of immigrants admitted for
permanent residence between July 1, 1924, and March
31, 1944. The Visa File number does not appear on a
ship passenger list.

The visa number and arrival
information as obtained from
prior Genealogy Search Request
(Form G-1041).

Visa 2046367, 12/17/1933;
(land port)-Detroit, MI.

Registry File

Provide:

R-12345, R-1234567, R-123

March 2, 1929, to March 31, 1944. Original records
documenting the creation of immigrant arrival records
for persons who entered the United States prior to July
1, 1924, and for whom no arrival record could be found.

The Registry file number as
obtained from prior Genealogy
Search Request (Form G-1041).

Visa 2025432, 04/29/1933;
(seaport)- Boston, MA; SS
Brittanic.

Do not provide Certificate
of Registry number (i.e.,
CR-12345).

G-1041A Instructions (12/06/11)Y Page 2

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

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-1041A.

DRAFT - Not
For Production

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

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.

NOTE: Spell out U.S. Department of Homeland Security; do
not use the initials "USDHS" or "DHS."
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.

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.

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.

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
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.

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-1041A to this address.

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