I-690 Form TOC

Form I-690 Form TOC,

Application for Waiver of Grounds of Inadmissibility

OMB Control No.: 1615-0032

02/25/2015

Reason for Revision: Incorporated revisions to format and standard language;

Current Location	Current Text	Proposed Text
Page 1, For Government Use Only.	Fee Receipt Number (This application): Alien Registration Number (A# of This Applicant): Fee Stamp	Page 1, For Government Use Only. Fee Receipt Number (This application): Alien Registration Number (A-Number of this Applicant) Action Block To be completed by an attorney or accredited representative (if any) __ Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS ELIS Account Number (if any)
Page 1, Below “For Government Use Only” section	APPLICANT: Start here. See instructions before completing this application. If you need more space to answer fully any question on this form, use a separate sheet and identify each answer with the number of the corresponding question. Type or print in black ink.	Page 1, APPLICANT: Start here. Type or print in black ink. Read the instructions before completing this application. If you need extra space to complete any item within this application, use Part 6. Additional Information or attach a separate sheet of paper; type or print your name and Alien Registration Number (A-Number) (if any), at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
Page 1,	Family Name (Last Name in CAPITAL letters) (First Name) (Middle Name) Date of Birth (mm/dd/yyyy) Address (No. and Street) (Apt. No.) (City /Town) (State/Country) (Zip/Postal Code) Place of Birth(City or Town and County, Province, or State) U.S. Social Security Number Date of Visa Application (mm/dd/yyyy) for: Permanent Residence Temporary Residence Visa applied for at: I am applying for a waiver of: List reasons of inadmissibility: List all immediate relatives in the United States (Parents, spouse and children) I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for granting a waiver. If more space is needed, attach an additional sheet.) Applicant’s Signature Date	Page 1, Part 1. Information About You (the Applicant) Your Current Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) [moved below] Mailing Address In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Is your current mailing address the same as your physical address? __Yes __No If you answered “No” to Item Number 3., provide your physical address in Item Number 4. Physical Address Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Other Information City/Town/Village of Birth Country of Birth Date of Birth (mm/dd/yyyy) Alien Registration Number (if any) [see below] USCIS ELIS Account Number (if any) U.S. Social Security Number (if any) [moved to Part 2]… [Moved to Part 3]
Page 1, Part 1. Information About You	Date of Visa Application (mm/dd/yyyy) for: Permanent Residence Temporary Residence Visa applied for at: I am applying for a waiver of:…. List reasons of inadmissibility: List all immediate relatives in the United States (Parents, spouse and children): I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for granting a waiver.)	Page 1, Part 2. Additional Information About You Date Primary Application Filed (mm/dd/yyyy): Type of Primary Application: __Permanent Residence (Form I-698) __Temporary Residence (Form I-687 or Form I-700) Relating Receipt Number I am applying for a waiver of (Select all that apply): INA section (Please see the instructions for more information on these sections) 212 (a) (1)(A)(i), (ii), (iii) or (iv) 212 (a)(2)(A)(i)(II) 212 (a)(6)(A)(i) 212(a)(6)(C)(i) or (ii) 212(a)(6)(D) and/or (E) 212(a)(8)(A) and/or (B) 212(a)(9)(A)(i) or (ii) 212(a)(9)(B)(i)(I) or (i)(II) 212(a)(9)(C)(i)(I) or (i)(II) 212 (a)(10)(A), (B), (C), (D) and/or Other Inadmissibility - Specify below List specific reasons for inadmissibility. List all immediate relatives in the United States (Parents, spouse, and children). If you need more space, use Part 6. Additional Information or attach an additional sheet. Your Relative’s Information Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) Relationship A-Number (if any) Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status, deferred action recipient) B. Your Relative’s Information Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) Relationship A-Number (if any) Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status, deferred action recipient) C. Your Relative’s Information Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) Relationship A-Number (if any) Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status, deferred action recipient) D. Your Relative’s Information Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) Relationship A-Number (if any) Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status, deferred action recipient) I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for granting a waiver. If you need more space, use Part 6. Additional Information or attach a separate sheet of paper; type or print your name and Alien Registration (A-Number) (if any), at the top of the sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date the sheet.
Page 1,	12. Applicant’s Signature 13. Date	Page4, [new] Part 3. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature NOTE: Read the information on penalties in the Penalties section of the Form I-690 Instructions before completing this part. Applicant’s Statement NOTE: Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2. 1.Applicant’s Statement Regarding the Interpreter A. __I can read and understand English, and have read and understand every question and instruction on this application, as well as my answer to every question. I have read the Acknowledgement of Appointment at USCIS Application Support Center. B.  __The interpreter named in Part 4. has also read to me every question and instruction on this application, as well as my answer to every question, in [Fillable Field], a language in which I am fluent. I understand every question and instruction on this application as translated to me by my interpreter, and have provided complete, true, and correct responses in the language indicated above. The interpreter named in Part 4. has also has read the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter. 2. Applicant’s Statement Regarding the Preparer __ I have requested the services of and consented to [Fillable Field], who __is __ is not an attorney or accredited representative, preparing this application for me. This person who assisted me in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center with me, and I understand the ASC Acknowledgement. Applicant’s Contact Information 3. Applicant's Daytime Telephone Number 4. Applicant's Mobile Telephone Number (if any) 5. Applicant's Email Address (if any) Acknowledgement of Appointment at USCIS Application Support Center I, [Auto-populate Field Applicant Full Name], understand that the purpose of a USCIS ASC appointment is for me to provide my fingerprints, photograph, and/or signature and to re-affirm that all of the information in my application is complete, true, and correct and was provided by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC appointment. By signing here, I declare under penalty of perjury that I have reviewed and understand my application, as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct.  I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center with me. Applicant’s Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I certify, under penalty of perjury, that the information in my application and any document submitted with my application were provided by me and are complete, true, and correct. Applicant’s Signature 6. Applicant's Signature Date of Signature (mm/dd/yyyy)  Part 4. Interpreter’s Contact Information, Certification, and Signature Provide the following information concerning the interpreter. Interpreter’s Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) 3. Interpreter’s Mailing Address Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country Interpreter’s Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter’s Email Address (if any) Interpreter’s Certification I certify that: I am fluent in English and [Fillable Field], which is the same language provided in Part 3., Item B., in Item Number 1. I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language provided in Part 3., Item B., in Item Number 1.; and I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant, in the same language provided in Part 3., Item B., Item Number 1. The applicant has informed me that he or she understands every instruction and question on the application, as well as the answer to every question, and the applicant verified the accuracy of every answer; and The applicant has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the contents of this application and all supporting documentation are complete, true, and correct. Interpreter’s Signature 6.   Interpreter's Signature Date of Signature (mm/dd/yyyy)  Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If Other Than the Applicant Provide the following information concerning the preparer. Preparer’s Full Name 1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) 3. Preparer’s Mailing Address Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Fax Number (if any) 6. Preparer’s Email Address (if any) Preparer’s Statement 7.A. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant’s consent. 7.B. I am an attorney or accredited representative and my representation of the applicant in this case (choose one) __extends __ does not extend_ beyond the preparation of this application. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you must submit a completed Form G-28, Notice of Attorney or Accredited Representative, with this petition. Preparer’s Certification By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this application on behalf of, at the request of, and with the express consent of the applicant. I completed this application based only on responses the applicant provided to me. After completing the application, I reviewed it and all of the applicant’s responses with the applicant, who agreed with every answer on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and the applicant has informed me that he or she understands the ASC Acknowledgement. Preparer’s Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)  NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the instructions, your application may be denied. NOTE: We recommend that you print a copy of your completed application for your records. If you are required to appear for a biometric services appointment at a USCIS ASC, you should bring a copy of your completed application with you.
Page 1, FOR USCIS USE ONLY…	For USCIS USE ONLY. Recommended by: (Print Name and Title) Date Signature Stamp # Director ….	[deleted per POC]
		Page 8, [New] Part 6. Additional Information If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. Family Name (Last Name) [Auto-populated field] Given Name (First Name) [Auto-populated field] Middle Name [Auto-populated field] 2. A-Number (if any) [Auto-populated field] 3.A. Page Number 3.B. Part Number 3.C. Item Number 3.D. _______________________________ 4.A. Page Number 4.B. Part Number 4.C. Item Number 4.D. ________________________________ 5.A. Page Number 5.B. Part Number 5.C. Item Number 5.D. ________________________________ 6.A. Page Number 6.B. Part Number 6.C. Item Number 6.D. ________________________________ 7. Signature Date of Signature (mm/dd/yyyy)

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