Form G-28 Table of Changes

TABLE OF CHANGES – FORM

Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

OMB Number: 1615-0105

02/25/2015

Reason for Revision: USCIS ELIS Account Number field for attorney/accredited representative and applicant added to form in order to facilitate matching with any existing USCIS ELIS account for the attorney/accredited representative and/or the applicant.

Current Section and Page Number	Current Text	Proposed Text
Page 1, Part 1. Information About Attorney or Accredited Representative	Part 1. Information About Attorney or Accredited Representative Name and Address of Attorney or Accredited Representative 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. Name of Law Firm or Recognized Organization 3. Name of Law Student or Law Graduate 4. State Bar Number 5.a. Street Number 5.b. Street Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.f. Zip Code 5.g. Postal Code 5.h. Province 5.i. Country 6. Daytime Phone Number 7. E-Mail Address of Attorney or Accredited Representative	[Page 1] Part 1. Information About Attorney or Accredited Representative 1. USCIS ELIS Account Number (if any): Name and Address of Attorney or Accredited Representative 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name [Delete] [Delete] [Delete] 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. Province 3.g. Postal Code 3.h. Country 4. Daytime Telephone Number 5. Fax Number 6. E-mail Address (if any) 7. Mobile Telephone Number (if any)
Page 2, Part 3. Notice of Appearance and Attorney or Accredited Representative	Part 3. Notice of Appearance as Attorney or Accredited Representative This appearance relates to immigration matters before (select one): 1. USCIS - List the form number(s) 1.a. [Fillable Field] 2. ICE - List the specific matter in which appearance is entered 2.a. [Fillable Field] 3. CBP - List the specific matter in which appearance is entered 3.a. [Fillable Field] I hereby enter my appearance as attorney or accredited representative at the request of: 4. Select only one: Applicant/Petitioner/ Respondent (ICE, CBP) Name of Applicant, Petitioner, or Respondent 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name 5.d. Name of Company or Organization, if applicable 7. Provide A-Number and/or Receipt Number NOTE: Provide the mailing address of Petitioner, Applicant, or Respondent and not the address of the attorney or accredited representative, except when a safe mailing address is permitted on an application or petition filed with Form G-28. 6.a. Street Number and Name 6.b. Apt. Ste. Flr. 6.c. City or Town 6.d. State 6.e. Zip Code	[Page 1] Part 2. Notice of Appearance as Attorney or Accredited Representative This appearance relates to immigration matters before (Select only one box) 1.a. USCIS 1.b. List the form numbers 2.a. ICE 2.b. List the specific matter in which appearance is entered 3.a. CBP 3.b. List the specific matter in which appearance is entered I enter my appearance as attorney or accredited representative at the request of: 4. Select only one box… Applicant/Petitioner/Requestor/Respondent (ICE. CBP) Information About Applicant, Petitioner, Requestor, or Respondent 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name 6. Name of Company or Organization (if applicable) [Page 2] 7. USCIS ELIS Account Number (if any): 8. Alien Registration Number (A-Number) or Receipt Number (if any) 9. Daytime Telephone number (if any) 10. Mobile Telephone Number (if any) 11. E-Mail Address (if any) Mailing Address of Applicant, Petitioner, Requestor, or Respondent NOTE: Provide the mailing address of the petitioner, applicant, requestor, or respondent. If the applicant, petitioner, requestor, or respondent has used a safe mailing address on the application, petition, or request being filed with this Form G-28, provide it in these spaces. 12.a. Street Number and Name 12.b. Apt. Ste. Flr. 12.c. City or Town 12.d. State 12.e. ZIP Code 12.f. Province 12.g. Postal Code 12.h. Country
Page 1, Part 2. Eligibility Information For Attorney or Accredited Representative	Part 2. Eligibility Information For Attorney or Accredited Representative (Check applicable items(s) below) 1. I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest court(s) of the following State(s), possession(s), territory(ies), commonwealth(s), or the District of Columbia. 1.a. [Fillable Field] 1.b. I (choose one) am/not am subject to any order of any court or administrative agency disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law. (If you are subject to any order(s), explain fully in the space below.) 1.b.1. [Fillable Field] 2. I am an accredited representative of the following qualified nonprofit religious, charitable, social service, or similar organization established in the United States, so recognized by the Department of Justice, Board of Immigration Appeals pursuant to 8 CFR 292.2. Provide the name of the organization and the expiration date of accreditation. 2.a. Name of Recognized Organization 2.b. Date Accreditation expires (mm/dd/yyyy) 3. I am associated with 3.a. [Fillable Field] the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an attorney or accredited representative is at his or her request. If you check this item, also complete number 1 (1.a. - 1.b.1.) or number 2 (2.a. - 2.b.) in Part 2 (whichever is appropriate). 4. I am a law student or law graduate working under the direct supervision of the attorney or accredited representative of record on this form in accordance with the requirements in 8 CFR 292.1(a)(2)(iv).	[Page 2] Part 3. Eligibility Information for Attorney or Accredited Representative Select all applicable items. 1.a. I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest courts of the following states, possessions, territories, commonwealths, or the District of Columbia. (If you need additional space, use Part 6.) Licensing Authority 1.b. Bar Number (if applicable) 1.c. Name of Law Firm 1.d. I (choose one) am not/am subject to any order of any court or administrative agency disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law. If you are subject to any orders, explain in the space below. (If you need additional space, use Part 6.) [Fillable Field] 2.a. I am an accredited representative of the following qualified nonprofit religious, charitable, social service, or similar organization established in the United States, so recognized by the Department of Justice, Board of Immigration Appeals, in accordance with 8 CFR 292.2. Provide the name of the organization and the expiration date of accreditation. 2.b. Name of Recognized Organization 2.c. Date accreditation expires mm/dd/yyyy 3. I am associated with [Fillable Field] the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an attorney or accredited representative is at his or her request. NOTE: If you select this item, also complete Item Numbers 1.a. – 1.b. or Item Numbers 2.a. – 2.c. in Part 3. (whichever is appropriate) 4.a. I am a law student or law graduate working under the direct supervision of the attorney or accredited representative of record on this form in accordance with the requirements in 8 CFR 292.2(a)(2)(iv). 4.b. Name of Law Student or Law Graduate
Page 2, Part 3. Notice of Appearance and Attorney or Accredited Representative (continued)	Part 3. Notice of Appearance and Attorney or Accredited Representative Pursuant to the Privacy Act of 1974 and DHS policy, I hereby consent to the disclosure to the named Attorney or Accredited Representative of any record pertaining to me that appears in any system of records of USCIS, ICE, or CBP. 8.a. Signature of Applicant, Petitioner, or Respondent 8.b. Date (mm/dd/yyyy)	[Page 3] Part 4. Applicant, Petitioner, Requestor, or Respondent Consent to Representation, Contact Information, and Signature Consent to Representation and Release of Information 1. I have requested the representation of and consented to being represented by the attorney or accredited representative named in Part 1. of this form. According to the Privacy Act of 1974 and DHS policy, I also consent to the disclosure to the named attorney or accredited representative of any record pertaining to me that appears in any system of records of USCIS, ICE or CBP. When you (the applicant, petitioner, requestor, or respondent) are represented, DHS will send notices to both you and your attorney or accredited representative either through mail or electronic delivery. DHS will also send the Form I-94, Arrival Departure Record, to you unless you select Item Number 2.a. in Part 4. All secure identity documents and Travel Documents will be sent to you (the applicant, petitioner, requestor, or respondent) unless you ask us to send those documents to your attorney of record or accredited representative. If you do not want to receive original notices or secure identity documents directly, but would rather have such notices and documents sent to your attorney of record or accredited representative, please select all applicable boxes below: 2.a. I request DHS send any notice (including Form I-94) on an application, petition, or request to the business address of my attorney of record or accredited representative as listed in this form. I understand that I may change this election at any future date through written notice to DHS. 2.b. I request that DHS send any secure identity document, such as a Permanent Resident Card or Employment Authorization Document, or Travel Document, that I am approved to receive and authorized to possess, to the business address of my attorney of record or accredited representative as listed in this form. I consent to having my secure identity document sent to my attorney of record or accredited representative and understand that I may request, at any future date and through written notice to DHS, that DHS send any secure identity document to me directly. 3.a. Signature of Applicant, Petitioner, Requestor, or Respondent 3.b. Date (mm/dd/yyyy)
Page 3, Part 4. Signature of Attorney or Accredited Representative	Part 4. Signature of Attorney or Accredited Representative I have read…	[Page 3] Part 5. Signature of Attorney or Accredited Representative I have read…
Page 2, Part 5. Additional Information	Part 5. Additional Information 1. [Fillable Field]	[Page 4] Part 6. Additional Information Use the space below to provide additional information pertaining to Part 3., Item Numbers 1.a.-1.d. [Fillable Field]

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