Table of change (form)

TABLE OF CHANGES – FORM

FORM I-407

Record of Abandonment of Lawful Permanent Resident Status

OMB Number: 1615-NEW

Submission Date 09/19/2014

Reason for Revision: Making this available public form.

Current Section and Page Number	Current Text	Proposed Text
Page 1, Item Numbers 1.- 6(e)	1. Family Name (Capital Letters)… 2. Last Permanent…. 3. Date of Birth… 4. Date of Last…. 5. Intended or….. 6(a). I voluntarily…. 6(b). Documents Surrendered: 6(c). Date of…. 6(d). Remarks of….. 6(e). I have read and….	Part 1. Information About the Alien [section header] 1. Alien Registration Number (A-Number) 2. USCIS ELIS Account Number (if any) Your Full Legal Name [sub-header] 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name Other Information [sub-header] 4. Date of Birth (mm/dd/yyyy) 5. Country of Birth 6. Country of Citizenship or Nationality 7. Date of Last Departure from the United States (mm/dd/yyyy) Mailing Address Abroad 8.a. In Care of Name (if applicable) 8.b. Street Number and Name 8.c. Apt. Ste. Flr. 8.d. City of Town 8.e. Province or State 8.f. Postal Code 8.g. Country 9. E-mail Address (if any) 10. State the reason(s) for abandoning lawful permanent resident status. Document(s) Surrendered and Location of Submission[sub-header] 11.a. Form I-551 (Permanent Resident Card) Y/N 11.b. If the I-551 is not surrendered, check the reason why. Lost/Stolen/Mutilated/Other 11.c. List other document(s) surrendered (if any). 12.a. [ ] I am submitting Form I-407 outside of the United States in-person. 12.b. [ ] I am submitting Form I-407 outside of the United States by mail. 12.c. [ ] I am submitting Form I-407 at a U.S. Port of Entry. Certification [sub-header] I knowingly, willingly, and affirmatively declare that I have no intention of residing permanently in the United States, and that by signing and submitting this form, I intend to record the fact that I have knowingly and willingly abandoned my lawful permanent resident status in the United States. I have been informed of, and I understand my rights to a hearing before an immigration judge about whether I have abandoned my lawful permanent resident status in the United States. By signing and submitting this form, I knowingly, willingly, and affirmatively waive my rights to such a hearing. 13.a. Signature of Alien 13.b. Date of Signature (mm/dd/yyyy) For Consent of Parent(s), Custodial Parent(s), or Legal Guardian to Submit Form I-407 for Minors 17 Years of Age or Younger [sub-header] As the parent(s) or guardian of the alien minor who is identified in Part 1. of this form, I/we consent to the alien minor’s submission of this form. 14.a. Signature of Parent(s), Custodial Parent(s), or Legal Guardians 14.b. Name of Parent(s), Custodial Parent(s), or Legal Guardians 14.c. Date of Signature (mm/dd/yyyy) If signed by only one parent, custodian, or legal guardian, indicate evidence to show sole parental, custodial, or legal guardianship responsibility. 14.d. Check all that apply: [ ] Death of other parent [text field] [ ] Termination of other parent’s rights [text field] [ ] Award of sole legal custody [text field] [ ] Appointment as guardian [text field]
New		Part 2. Certification and Signature of the Interpreter [section header] Interpreter Certification [sub-header] I certify that: I am fluent in English and [text field] (write the other language in the box provided above). I further certify that I have read each and every question and instruction on this form, as well as the answer to each and every question on this form, in the language provided above; and The alien has informed me that he or she understands each and every instruction and question on the form, as well as the answer to each and every question. 1.a. Signature of Interpreter (if applicable) 1.b. Full Name of Interpreter 1.c. Date of Signature (mm/dd/yyyy)
Page 1, For Government Use Only, Item Numbers 7.- 10.	7. I hereby certify….	Part 3. For Government Use Only [section header] Instructions to officer: Select Item Number 1. if you interviewed the alien. If you did not, select Item Number 2. and state the basis for your conclusion that the alien may have abandoned lawful permanent resident status. Sign the form and provide other information requested. 1. [ ] I certify that I personally interviewed the alien who is identified in Part 1., who has signed this Form I-407, and that I advised the alien of the hearing rights specified in the Instructions. The alien stated he or she fully understands the effect of signing the Form I-407. I further certify that, if an interpreter was used, I confirmed that the alien understood the interpreter. 2. [ ] I certify that I was not able to interview the alien who is identified in Part 1. of this Form I-407. My basis for concluding that the alien may have abandoned lawful permanent resident status is: ______________________________________ ______________________________________ 3. A copy of the signed Form I-407 was provided to the alien. Y/N DHS/Consular Officer Information [sub-header] 4.a. Name of DHS/Consular Officer [text field] 4.b. Signature of DHS/Consular Officer [text field] 4.c. Title of DHS/Consular Officer [text field] 4.d. Name of DHS Component, if signed by a DHS officer [text field] 4.e. Date of Signature (mm/dd/yyyy)

3