Form I-600A Application for advance processing of orphan petition

OMB No. 1615-0028; Expires 01/31/13

Form I-600A, Application for Advance
Processing of Orphan Petition

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

Do not write in this block

For USCIS Use Only
Fee Stamp

It has been determined that the:
Married
Unmarried
prospective adoptive parent will furnish proper care to a beneficiary
orphan if admitted to the United States.
There:
are
are not
preadoptive requirements in the State of the child's proposed residence.
The following is a description of the preadoption requirements, if any,
of the State of the child's proposed residence:

DATE OF FAVORABLE
DETERMINATION
DD
DISTRICT

The preadoption requirements, if any:
have been met.

have not been met.

File number of applicant, if applicable: _______________________

DRAFT
Not For
Reproduction

Type or print legibly in black ink.
This application is made by the named prospective adoptive parent for advance processing of an orphan petition.
BLOCK I - Information About the Prospective Adoptive Parent
1. My name is: (Last)

(First)

(Middle)

2. Other names used (including maiden name if appropriate):

3. I reside in the U.S. at:

6. My telephone number is: (include area code)

7. I am a citizen of the United States through:
Birth
Parents
Naturalization
If acquired through naturalization, provide the following:

(C/O if appropriate)

a. Name under which you naturalized:

(Apt. No.)

(Number and Street)

b. Naturalization certificate number:

(Town or City)

(State) (Zip Code)

c. Date of naturalization (mm/dd/yyyy):

4. Address abroad (if any):

d. Place of naturalization:
(Apt. No.)

(Number and Street)
(Town or City)

If acquired through parentage, have you obtained a
certificate in your own name based on that acquisition?

(State or Province)

No

(Country)

Yes

If not, submit evidence of citizenship. See Page 2 of the
instructions.

5. I was born on: (mm/dd/yyyy)
In:
(Town or City)

Have you or any person through whom you claimed
citizenship ever lost U.S. citizenship?

(State or Province)

No
(Country)
Received

Trans. In

Ret'd Trans. Out

Yes (If "Yes," attach detailed
explanation)

Completed

Form I-600A 12/20/12 N Page 1

BLOCK I - Information About the Prospective Adoptive Parent (Continued)
8. My marital status is:
a.

Married

Widowed

Single

Divorced

b. If you are now or if you have been married, how may time have you been married (include current marriage if married):
9. If you are now married, provide the following information:
Date of present marriage (mm/dd/yyyy):

Place of present marriage:

Name of present spouse:
(Last)

(First)

(Middle)

Date of birth of present spouse (mm/dd/yyyy):

(Maiden, if any)

Place of birth of present spouse:

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My spouse has been married
My spouse resides:

With me

time(s) (include current marriage)

Apart from me (provide address below)

Number and Street

Apt. No. City

Country

State

BLOCK II - General Information

10. Name and address of organization or individual assisting you in locating or identifying an orphan.
Name of organization or individual:

Address of organization or individual:

11. Do you plan to travel abroad to locate or adopt a child?

No

Yes

12. Does your spouse, if any, plan to travel abroad to locate or adopt a child?

No

Yes

13. If the answer to Question 11 or 12 is "Yes," provide the following information, if known:
a. Your date of intended departure (mm/dd/yyyy):

b. Your spouse's date of intended departure (mm/dd/yyyy):

c. Names of city, province, country you are traveling to:

14. Will the child be adopted abroad after having been personally seen and observed by you and your
spouse (if married)?

No

Yes

15. Will the preadoption requirements, if any, of the child's proposed State of residence be met prior to or
after the child enters the United States?

No

Yes

16. From what country do you plan to adopt, if known?

17. Where do you wish to file your orphan petition? (Complete one of the options below)
The USCIS office located at:

The U.S. Embassy or consulate at:
OR
Form I-600A 12/20/12 N Page 2

BLOCK II - General Information (Continued)
18. Do you plan to adopt more than one child?

No

Yes

If "Yes," how many children do you plan to adopt?

BLOCK III - Accommodations for Individuals With Disabilities and Impairments (Read the information in the
instructions before completing this section.)
19. I am requesting an accommodation:
1. Because of my disability(ies) and/or impairment(s).

No

Yes

2. For my spouse because of his or her disability(ies) and/or impairment(s).

No

Yes

3. For my household member because of his or her disability(ies) and/or impairment(s).

No

Yes

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If you answered "Yes," check any applicable box. Provide information on the disability(ies) and/or impairment(s) for each
person:
Deaf or hard of hearing and request the following accommodation(s) (if requesting a sign-language interpreter, indicate
which language (e.g., American Sign Language)):

Blind or sight-impaired and request the following accommodation(s):

Other type of disability(ies) and/or impairment(s) (describe the nature of the disability(ies) and/or impairment(s) and
accommodation(s) being requested):

Certification of Prospective Adoptive Parent

I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct and that I will care
for an orphan/orphans properly if admitted to the United States.

Certification of Married Prospective Adoptive Parent
Spouse
I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct and that my spouse
and I will care for an orphan/orphans properly if admitted to the
United States.

(Signature of Prospective Adoptive Parent)

(Signature of Prospective Adoptive Parent Spouse)

Executed on (Date)

Executed on (Date)

Signature of Person Preparing Form, If Other Than Petitioner
I declare that this document was prepared by me at the request of the petitioner and is based entirely on information of which I have knowledge.

(Signature)

Executed on (Date)

Street Address and Room or Suite No./City/State/Zip Code
Form I-600A 12/20/12 N Page 3