E-26A Fee Waiver Request

Fee Waiver Request

eoir26a_01_15

Fee Waiver Request

OMB: 1125-0003

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OMB# 1125-0003

U.S. Department of Justice
Executive Office for Immigration Review
Board of Immigration Appeals

Fee Waiver Request

If more than one alien is included in your
appeal or motion, only the lead alien need
file this form. This form is to be signed by
the alien, not the alien’s attorney or representative of record.

Name:

Alien Number (“A” Number):

I,
, declare under penalty of perjury, pursuant to 28 U.S.C. section
1746, that I am the person above and that I am unable to pay the fee. I believe that my appeal/motion is valid, and I
declare that the following information is true and correct to the best of my knowledge:

Expenses (including dependents)

Assets
Wages, Salary

$

$
Other Income
(business, professional services, selfemployed/independent contracting,
rental payments, etc.)

/month
/month

Housing
(rent, mortgage, etc.)

$

/month

Food

$

/month

Medical/Health

$

/month

$

/month

Cash

$

Checking and/or Savings

$

Utilities
(phone, electric, gas,
water, etc.)

Property
(real estate, automobile(s),
stocks, bonds, etc.)

$

Transportation

$

/month

Debts, Liabilities

$

/month

Other

$

/month

$
Other Financial Support
(public assistance, alimony,
child support, gift, parent,
spouse, other family members, etc.)

/month

Under the Paperwork Reduction Act, a person is not required to
respond to a collection of information unless it displays a valid OMB
control number. We try to create forms and instructions that are
accurate, can be easily understood, and which impose the least
possible burden on you to provide us with information. The estimated
average time to complete this form is one (1) hour. If you have
comments regarding the accuracy of this estimate, or suggestions for
making this form simpler, you can write to the Executive Office for
Immigration Review, Office of the General Counsel, 5107 Leesburg
Pike, Suite 2600, Falls Church, Virginia 20530.
Privacy Act Notice
The information on this form is requested to determine if you have
established eligibility for the fee waiver you are seeking. The legal
right to ask for this information is located at 8 C.F.R. § 1003.8(a)(3).
EOIR may provide this information to other Government agencies.
Failure to provide this information may result in denial of your
request.

(specify)
_________________________
Signature of Alien

________________
Date

___________________________________________________________

Attorney or Representative (if any):
I hereby attest that I have reviewed the details provided herein and I am
satisfied that this fee waiver request is made in good faith.
_____________________________________

________________

Signature of Attorney or Representative

Date

_____________________________________
Print Name
Form EOIR-26A
Rev. January 2015


File Typeapplication/pdf
AuthorEOIR
File Modified2015-01-08
File Created2015-01-08

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