Form I-824 Application for Action on an Approved Application

USCIS
Form I-824

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

OMB No. 1615-0044
Expires 11/30/2014

Returned
Date

Fee Stamp

Date

Resubmitted
Date

For
USCIS
Use
Only

Date

Relocated
Received

DRAFT - Not For Production

Application for Action on an
Approved Application or Petition

Sent

Action Block

Remarks

Priority Date:
Country of Chargeability:
Classification Code:

To Be Completed by an Attorney or a BIAAccredited Representative, if any.

Fill in box if G-28 is attached to
represent the applicant.

► START HERE - Type or print in black ink.

Part 1. Information About You (Person filing this
Application)
1.

I am the (select only one):

Applicant

Date the Previously Approved Visa Petition Was
Filed (Form I-130, I-140 or I-360):
Date the Previous Visa Petition Was Approved
(Form I-130, I-140 or I-360):

Petitioner

on the previously approved application or petition.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

Attorney License Number:

Physical Address

11.a. Street Number
and Name
11.b. Apt.

Ste.

Flr.

11.c. City or Town
11.e. Zip Code

11.d. State

2.c. Middle Name

11.f. Postal Code

3. Company or Organization Name

11.g. Province
11.h. Country

Provide the following information about the petitioner or
applicant for the previous petition or application.
4.

Current/Recent Immigration Status

Mailing Address
12.a. In Care Of Name

5.

Certificate of Naturalization or Citizenship Number

12.b. Street Number
and Name

6.

Alien Registration Number (A-Number)
► A-

7.

Date of Birth

(mm/dd/yyyy) ►

12.c. Apt.

Ste.

12.d. City or Town
12.e. State

8. Country of Birth

Flr.

12.f. Zip Code

12.g. Postal Code
9. IRS Tax Number (if any)

12.h. Province

10. U.S. Social Security
Number (if any)

12.i. Country

Form I-824 02/22/13 N

►

Page 1 of 4

Application) (continued)

(

)

Extension

-

14. Mobile Phone Number (if any)

(

)

1.c. Filing Date of Application or Petition
(mm/dd/yyyy) ►

1.d. Approval Date

Contact Information
13. Daytime Phone Number (if any)

DRAFT - Not For Production

Part 1. Information About You (Person filing this

-

15. E-mail Address (if any)

Provide the following information about the principal
beneficiary of the previous application or petition.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name

2.d. Date of Birth

Part 2. Reason for Request
I am requesting (select one):
a.

A duplicate approval notice.

b.

USCIS to notify a new U.S. Consulate, different from
that originally requested, through the U.S. Department
of State's National Visa Center or Kentucky Consular
Center about the approval of a nonimmigrant visa
petition or to notify a new Port-of-Entry, different from
that originally requested, about the approval of a
waiver application. Please notify the U.S. Consulate or
Port-of-Entry at:

c.

USCIS to notify a U.S. Consulate through the National
Visa Center that I adjusted status to permanent resident
in the U.S. Please notify the U.S. Consulate at:

(mm/dd/yyyy) ►

(mm/dd/yyyy) ►

2.e. Country of Birth

2.f. Alien Registration Number (A-Number)
► A-

2.g. Daytime Phone Number (if any)

(

)

Extension

-

Physical Address
3.a. Street Number
and Name
3.b. Apt.

Ste.

Flr.

3.c. City or Town
3.d. State

3.e. Zip Code

so that my spouse and/or child(ren) may accompany or
follow-to-join me.
d.

USCIS to send my approved immigrant visa petition to
the National Visa Center (NVC).

e.

USCIS to notify the U.S. Department of State that I
have become a U.S. Citizen through naturalization.

Mailing Address
4.a. In Care Of Name

4.b. Street Number
and Name

Part 3. Additional Information
Provide the following information about the previously
approved application or petition.
1.a. Form Number of Application
or Petition
1.b. Receipt Number (On Form I-797, Notice of Action)
►

4.c. Apt.

Ste.

Flr.

4.d. City or Town
4.e. State

4.f.

Zip Code

4.g. Postal Code
4.h. Province
4.i. Country

Form I-824 02/22/13 N

Page 2 of 4

Dependents

DRAFT - Not For Production

Part 3. Additional Information (continued)

7.e. Country of Birth

7.f. Country of Citizenship

If you selected Box "c" in Part 2. Reason for Request, provide
the following information about the dependent(s) for whom you
are requesting follow-to-join. If you need additional space for
your dependents, attach a separate sheet(s) of paper and include
all the information collected in Items Number 5.a. - 10.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)

7.g. Relationship to the Principal Alien

8.a. Family Name
(Last Name)
8.b. Given Name
(First Name)

5.c. Middle Name

8.c. Middle Name

5.d. Date of Birth

(mm/dd/yyyy) ►

8.d. Date of Birth

5.e. Country of Birth

(mm/dd/yyyy) ►

8.e. Country of Birth

5.f. Country of Citizenship

8.f. Country of Citizenship

5.g. Relationship to the Principal Alien

8.g. Relationship to the Principal Alien

6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)

Foreign Address of Dependents

9.a. In Care Of Name

6.c. Middle Name
6.d. Date of Birth

(mm/dd/yyyy) ►

6.e. Country of Birth

9.b. Street Number
and Name
9.c. Apt.

Ste.

Flr.

9.d. City or Town

6.f. Country of Citizenship

9.e. Postal Code

6.g. Relationship to the Principal Alien

9.f. Province
9.g. Country

7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)

Contact Information of Dependents
10.

7.c. Middle Name
7.d. Date of Birth

Form I-824 02/22/13 N

(mm/dd/yyyy) ►

Foreign Telephone Number

(

0 11

)

Extension
-

Page 3 of 4

(Read the information on penalties in the Form I-824
instructions before completing this part.)

DRAFT - Not For Production

Part 4. Signature of Applicant

I certify, under penalty of perjury under the laws of the United
States of America, that this application and the evidence
submitted with it are all true and correct to the best of my
knowledge and abilities. I authorize the release of any
information from my records that U.S. Citizenship and
Immigration Services (USCIS) needs to determine my eligibility
for this benefit.
I furthermore authorize release of information contained in this
form, supporting documents, and my USCIS records to other
entities and persons where necessary for the administration of
U.S. immigration laws.
1.a. Signature of Applicant

Preparer's Mailing Address

3.a. Street Number
and Name

3.b. Apt.

Ste.

Flr.

3.c. City or Town
3.d. State

3.e. Zip Code

3.f. Postal Code
3.g. Province
3.h. Country

Preparer's Contact Information

1.b. Date of Signature

(mm/dd/yyyy) ►

NOTE: If you do not completely fill out this form or fail to
submit required documents listed in the instructions, your
application may be denied.

Part 5. Signature of Person Preparing This
Form, If Other Than the Applicant
NOTE: If you are an attorney or a BIA-Accredited
Representative, you must submit a completed Form G-28,
Notice of Entry of Appearance as Attorney or Accredited
Representative, along with this application.

Preparer's Information
Provide the following information concerning the preparer:
1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2. Preparer's Business or Organization Name

Form I-824 02/22/13 N

4.

5.

Preparer's Daytime Phone Number

(

)

Extension

-

Preparer's E-mail Address (if any)

Declaration
I declare that this document was prepared by me at the request of
the applicant or other individual authorized by the form
instructions to sign this application (see the instructions), and it is
based on all information of which I have knowledge and/or was
provided to me by the above named person in response to the
exact questions contained on this form. I have not knowingly
withheld any information.
6.a. Signature of Preparer

6.b. Date of Signature

(mm/dd/yyyy) ►

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