Application for Provisional Unlawful Presence Waiver

Instructions for Application for
Provisional Unlawful Presence Waiver
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-601A
OMB No. 1615-0123
Expires 03/31/2015

What Is the Purpose of Form I-601A?
Certain immediate relatives of U.S. citizens may use this application to request a provisional waiver of the unlawful
presence grounds of inadmissibility under section 212(a)(9)(B) of the Immigration and Nationality Act (INA), before they
depart the United States to appear at a U.S. Embassy or U.S. Consulate for an immigrant visa interview.

Who May File Form I-601A?
You may file this application to seek a provisional unlawful presence waiver if you:
1. Are physically present in the United States;

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2. Are at least 17 years of age at the time of filing;

3. Are the beneficiary of an approved Form I-130, Petition for Alien Relative, or Form I-360, Petition for Amerasian,
Widow(er), or Special Immigrant, that classifies you as the immediate relative of a U.S. citizen;
4. Have a pending immigrant visa case classifying you as an immediate relative with the Department of State (DOS);
5. Believe you are or will be inadmissible only for a period of unlawful presence in the United States that was:
A. More than 180 days, but less than 1 year, during a single stay (INA section 212(a)(9)(B)(i)(I)); or
B. One year or more during a single stay (INA section 212(a)(9)(B)(i)(II)).

Who Is NOT Eligible to Receive a Provisional Unlawful Presence Waiver?

You are not eligible for a provisional unlawful presence waiver and U.S. Citizenship and Immigration Services
(USCIS) will deny your application if any of the following apply to you:
1. You do not meet all of the requirements listed in the Who May File Form I-601A section of these Instructions;
2. You have Form I-485, Application to Register Permanent Residence or Adjust Status, pending with USCIS;

3. You are in removal proceedings, unless your removal proceedings are administratively closed and have not been
placed back on the Department of Justice, Executive Office for Immigration Review (EOIR), calendar to continue
your removal proceedings at the time you file your Form I-601A;
NOTE: Even if your removal proceedings are administratively closed, you are still "in removal proceedings" until
EOIR terminates or dismisses your case. You are, however, eligible to apply for a provisional unlawful presence
waiver if EOIR has not placed your removal proceedings back on its calendar to continue your removal proceedings.
4. You are subject to a final order of removal, exclusion, or deportation that has been entered or issued against you, or
you are subject to reinstatement of a prior order under INA section 241(a)(5);
5. DOS initially acted before January 3, 2013, to schedule your immigrant visa interview for the approved immediate
relative petition upon which your Form I-601A is based;
NOTE: The actual date and time that you are scheduled to appear for your immigrant visa interview is not the date
USCIS will use to determine if you are eligible to file Form I-601A. USCIS will use the date DOS initially acted to
schedule your immigrant visa interview for the approved immediate relative petition upon which your Form I-601A is
based. If DOS initially acted to schedule your immigrant visa interview before January 3, 2013, you are not eligible
to file Form I-601A, even if you failed to appear for your interview or you or DOS cancelled or rescheduled your
interview on or after January 3, 2013. If you are unsure if DOS scheduled your interview before January 3, 2013,
contact the DOS National Visa Center (NVC).

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6. You fail to establish that your U.S. citizen spouse or parent would experience extreme hardship if you are refused
admission to the United States or that USCIS should approve your application as a matter of discretion. You must
establish that refusal to admit you would result in extreme hardship to your U.S. citizen spouse or parent if the U.S.
citizen spouse or parent chooses to remain in the United States without you or chooses to relocate abroad to reside with
you outside of the United States. You must also establish that your case warrants a favorable exercise of discretion by
showing that favorable factors in your case should be given more weight than the unfavorable factors; and
7. USCIS has reason to believe that you may be subject to grounds of inadmissibility other than unlawful presence under
INA section 212(a)(9)(B)(i)(I) or (II) at the time of your immigrant visa interview with a DOS consular officer.

Can I File Other Applications with Form I-601A?
Form I-601A is a standalone application. You cannot file Form I-601A with any other applications, petitions, or requests.
You also should not file any other applications, petitions, or requests with Form I-601A or request that these forms be
considered with Form I-601A.
If you submit your Form I-601A with any of the following forms, your application will be REJECTED and returned to
you with the filing fee and biometric services fee:

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1. Application to Register Permanent Residence or Adjust Status (Form I-485);
2. Petition for Alien Relative (Form I-130);

3. Application for Permission to Reapply for Admission Into the United States After Deportation or Removal (Form
I-212);
4. Application for Travel Document (Form I-131); or

5. Application for Employment Authorization (Form I-765).

NOTE: Applicants for provisional unlawful presence waivers cannot seek adjustment of status in the United
States based on Form I-601A. A provisional unlawful presence waiver is effective only if the applicant departs the
United States, attends the immigrant visa interview scheduled by DOS at a U.S. Embassy or U.S. Consulate abroad,
and if the consular officer finds that the applicant is eligible for the immigrant visa. For more information about the
immigrant visa process, visit the DOS Web site at www.state.gov.

What Should I Do After I File Form I-601A?

After you file your Form I-601A, it is important that you provide all required paperwork for your immigrant visa to the
NVC. The NVC cannot schedule your immigrant visa interview until they receive all of your immigrant visa paperwork.
Failure to submit the required paperwork will delay your case.

What Should I Do Once USCIS Approves My Provisional Unlawful Presence Waiver?
1.

If you are in removal proceedings, obtain a termination or dismissal order from EOIR. If you are in removal
proceedings and USCIS approves your Form I-601A, it is important that you seek an order from EOIR that terminates
or dismisses your removal proceedings before you leave the United States. Leaving the United States before your
removal proceedings are terminated or dismissed may delay processing of your immigrant visa or render you
ineligible for the immigrant visa based on another ground of inadmissibility. Visit the USCIS Web site at
www.uscis.gov/provisionalwaiver for information about how to seek termination or dismissal of your removal
proceedings before you depart the United States.

2.

Depart the United States to attend your immigrant visa interview. You must depart the United States to attend
your immigrant visa interview for the provisional unlawful presence waiver to become fully effective. If you fail to
do this, your provisional unlawful presence waiver will not take effect and the approval may no longer be valid.

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How Long Is My Approved Provisional Unlawful Presence Waiver Valid and When Can USCIS
Revoke It?
1.

Validity of an approved waiver. An approved provisional unlawful presence waiver takes effect once you depart
the United States, you appear for your immigrant visa interview, and the DOS consular officer determines you are
otherwise admissible to the United States and eligible for an immigrant visa. Once your waiver takes effect, it is valid
indefinitely for the period of unlawful presence that was waived.

2.

Revocation of an approved waiver. An approved provisional unlawful presence waiver is automatically revoked
and no longer valid if:
A. You enter or attempt to reenter the United States without inspection and admission or parole:
(1) While your application for a provisional unlawful presence waiver is pending with USCIS;
(2) After your provisional unlawful presence waiver is approved; or

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(3) Before your immigrant visa is issued;

B. The DOS consular officer determines at the immigrant visa interview that you are ineligible to receive the
immigrant visa because you are inadmissible on grounds other than the 3-year or 10-year unlawful presence bars;
C. The immediate relative petition approval associated with the provisional unlawful presence waiver is at any time
revoked, withdrawn, or rendered invalid, but not otherwise reinstated for humanitarian reasons or converted to a
widow or widower petition (Form I-360); or
D. DOS terminates your immigrant visa registration in accordance with INA section 203(g).

What Happens If My Provisional Unlawful Presence Waiver is Denied or Revoked or If I Withdraw My
Pending Application?
If your provisional unlawful presence waiver is denied or is approved, but subsequently revoked, or you withdraw your
pending application:
1.

You may depart the United States to attend your immigrant visa interview and apply for a waiver abroad. At
your immigrant visa interview at the U.S. Embassy or U.S. Consulate abroad, DOS will make an admissibility
determination. If DOS determines you are inadmissible, based on unlawful presence or other grounds, you may file
Form I-601, Application for Waiver of Grounds of Inadmissibility, with USCIS from abroad, if a waiver is available
to you.

2.

You may file a new Form I-601A along with the required filing fee and biometric services fee. You must still
meet all the eligibility requirements for the provisional unlawful presence waiver at the time of filing, including
requirements to be physically present in the United States and to appear for your biometric services appointment at a
USCIS Application Support Center (ASC).

3.

USCIS may initiate removal proceedings. Denial of your provisional unlawful presence application does not
automatically trigger initiation of removal proceedings. USCIS will follow its current guidelines for initiation of
removal proceedings. For more information on USCIS guidance for referral of cases and issuance of Notices to
Appear (NTAs) in cases involving inadmissible and removable aliens, visit the USCIS Web site at www.uscis.gov/
provisionalwaiver.

How Does a Pending or Approved Provisional Unlawful Presence Waiver Affect My Immigration Status?
The filing or approval of an application for a provisional unlawful presence waiver does not affect your current
immigration status in the United States. A pending or approved provisional unlawful presence waiver:
1.

Does NOT provide interim benefits. Filing this application does not give you interim benefits such as employment
authorization or eligibility to apply for advance parole to return to the United States. A pending or approved waiver
also does not give you any interim benefits while your immigrant visa application is pending with DOS;

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2.

Does NOT provide lawful status. If you are not otherwise maintaining lawful status in the United States, the filing
or approval of this waiver application alone does not give you lawful immigration status in the United States;

3.

Does NOT stop the accrual of unlawful presence or provide protection from removal. A pending or approved
waiver will not prevent the Department of Homeland Security (DHS) from initiating removal proceedings against you
or actually removing you from the United States. A pending or approved waiver also does not protect you from
accruing additional unlawful presence while still in the United States;

4.

Does NOT remove the requirement to depart the United States and seek an immigrant visa. If your provisional
unlawful presence waiver is approved, you must still depart the United States to process your immigrant visa at a U.S.
Embassy or U.S. Consulate abroad. The approval of a provisional unlawful presence waiver does not make you
eligible for adjustment of status in the United States. For more information on adjustment of status, visit the USCIS
Web site at www.uscis.gov/greencard. ;

5.

Does NOT guarantee immigrant visa issuance. A DOS consular officer will determine if you are eligible for an
immigrant visa. There are many reasons why individuals are ineligible for an immigrant visa, and this provisional
unlawful presence waiver only provisionally covers one ground of inadmissibility resulting from unlawful presence in
the United States. For more information about immigrant visa requirements, consult the DOS Web site at
www.immigrantvisas.state.gov; and

6.

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Does NOT guarantee admission to the United States. Having an approved waiver or immigrant visa does not
guarantee your admission to the United States. A U.S. Customs and Border Protection (CBP) officer will make a
determination when you apply for admission at a U.S. Port-of-Entry.

What Happens If I Depart the United States While My Form I-601A Is Pending or If I Enter or Attempt
to Reenter Without Inspection and Admission or Parole?
All applicants for a provisional unlawful presence waiver must be in the United States at the time of filing Form I-601A
and appear for biometrics capture at a USCIS ASC.
USCIS may consider your case abandoned and deny it pursuant to 8 CFR 103.2(b)(13) if you do not appear for biometrics
capture, if you do not respond to a request for evidence (RFE), or if you do not appear for an interview when requested by
USCIS.
If you depart the United States, and at any time before or after filing Form I-601A, enter or attempt to reenter the United
States without inspection and admission or parole, you may be placed in removal proceedings, may be subject to
additional grounds of inadmissibility that would render you ineligible for a provisional unlawful presence waiver, and any
approval of Form I-601A would be automatically revoked.
.

General Instructions

USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you
do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that
we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not
accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal
guardian may sign the application on your behalf. A legal guardian may also sign for a mentally incompetent person.
Filing Fee. Each application must be accompanied by the appropriate filing fee and biometric services fee (if applicable).
(See the What Is the Filing Fee section of these Instructions.)
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the What Evidence
Should I Submit With This Application section of these Instructions.

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Biometric Service Appointment. USCIS may require that you appear for an interview or provide fingerprints, photograph,
and/or signature at any time to verify your identity, obtain additional information, and conduct background and security
checks, including a check of criminal history records maintained by the Federal Bureau of Investigation (FBI), before making
a decision on your application. After USCIS receives your application and ensures it is complete, we will inform you in
writing if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you
the location of your local or designated USCIS Application Support Center (ASC) and the date and time of your
appointment. If you fail to attend your biometric services appointment, USCIS may deny your application.
Acknowledgement of Appointment at USCIS Application Support Center. Review the ASC Acknowledgement that
appears in Part 6. of the application. The purpose of this ASC Acknowledgement is to confirm that you have completed
your application, reviewed your responses, and affirmed that the information was provided by you and is complete, true,
and correct. If someone helped you fill out your application, that person must review the ASC Acknowledgement with
you to make sure you understand it.
Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application. If you submit original documents when not required, the documents may remain a part of
the record, and USCIS will not automatically return them to you.

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Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and
that he or she is competent to translate from the foreign language into English.
How to Fill Out Form I-601A
1.

Type or print legibly in black ink.

2. If you need extra space to complete any item within this application, use the space provided in Part 9. 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.
3.

Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks "Provide the name of your current spouse"), type or print "N/A," unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, "How many
children do you have" or "How many times have you departed the United States"), type or print "None," unless
otherwise directed.

Specific Instructions

Approved Immediate Relative Petition

To apply for a provisional unlawful presence waiver, you must be the beneficiary of an approved immigrant visa petition
that classifies you as an immediate relative of a U.S. citizen. An immediate relative is:
1.

The spouse or child (unmarried and under 21 years of age) of a U.S. citizen;

2.

The parent of a U.S. citizen son or daughter who is at least 21 years of age; or

3.

In certain cases, the widows/widowers of deceased U.S. citizens and the children of such widows/widowers.

The Child Status Protection Act (CSPA) permits certain beneficiaries of immigrant visa petitions to retain classification as
a child and immediate relative even if they have reached 21 years of age. Visit the USCIS Web site at www.uscis.gov/
green-card/green-card-processes-and-procedures/child-status-protection-act/child-status-protection-act-cspa for
more information.

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Immigrant Visa Processing
DOS processes immigrant visas for individuals seeking to immigrate permanently to the United States from abroad.
USCIS sends the approved immediate relative petition to the DOS National Visa Center (NVC) for consular processing of
the immigrant visa if Form I-130, Petition for Alien Relative, or Form I-360, Petition for Amerasian, Widow(er) or
Special Immigrant, indicates that the beneficiary will seek an immigrant visa through the consular process abroad. Once
the NVC receives this approved petition, the NVC sends the beneficiary instructions on how to initiate the immigrant visa
application process and pay the immigrant visa application processing fee.
You must have already paid the DOS immigrant visa processing application fee and must provide USCIS with a copy of
your DOS issued immigrant visa fee receipt when you submit your provisional unlawful presence waiver application.
You must submit the DOS immigrant visa application fee receipt for the NVC case associated with the approved
immigrant visa petition classifying you as an immediate relative. Contact the NVC if you need another copy of your
DOS-issued immigrant visa application fee receipt.

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Immigrant Visa Interviews

You can file a provisional unlawful presence waiver if DOS initially acted on or after January 3, 2013, to schedule your
immigrant visa interview for the approved immediate relative petition upon which your Form I-601A is based.
NOTE: You CANNOT file an application for a provisional unlawful presence waiver if DOS initially acted BEFORE
January 3, 2013, to schedule your immigrant visa interview. Instead, you must file Form 1-601, Application for Waiver
of Grounds of Inadmissibility, from outside the United States after you are interviewed for the immigrant visa, and the
DOS consular officer finds you are inadmissible on a waivable ground. USCIS will use the date that DOS initially acted
to schedule your interview to determine if you are eligible to file Form I-601A and not the date you are scheduled to
appear for your immigrant visa interview.
Extreme Hardship to a Qualifying Relative

You must show that you have a U.S. citizen spouse or parent (qualifying relative) who would experience extreme
hardship if you are refused admission to the United States. The qualifying relative does not need to be the relative who
filed the immigrant visa petition to classify you as an immediate relative, but he or she must be your U.S. citizen spouse or
parent. For information about how you can show extreme hardship to your qualifying relative, see Extreme Hardship in
the What Evidence Should I Submit With This Application section of these instructions.
NOTE to parents of a U.S. citizen child: A U.S. citizen child is not a qualifying relative for the purpose of showing
extreme hardship in this application. USCIS will not consider extreme hardship experienced by your U.S. citizen children
except to the extent that it affects the extreme hardship your U.S. citizen spouse or parent would experience if your U.S.
citizen spouse or parent chooses to remain in the United States without you or chooses to relocate abroad to reside with
you outside of the United States.
NOTE to surviving immediate relatives: If your U.S. citizen spouse or parent filed your immediate relative petition, but
died after filing the petition on your behalf, USCIS will consider the U.S. citizen spouse's or parent's death the functional
equivalent of extreme hardship to the petitioner, if you resided in the United States at the time of the death and you
continue to reside in the United States.
You must still complete Part 3. Information About Your Immediate Relative Petition and the Processing of Your
Immigrant Visa Applications and Part 4. Information About Your Qualifying Relative with information about the
Form I-130 petitioner. In Part 5. Statement from Applicant, you must explain why you believe USCIS should approve
your application for a provisional unlawful presence waiver as a matter of discretion. You must also provide a copy of the
U.S. citizen spouse or parent's death certificate with your application.

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This application is divided into nine parts. See below for greater detail.
Part 1. Information About You
In this section, provide the requested information about yourself.
Item Number 1. Alien Registration Number (A-Number) (if any). Provide your A-Number. Your A-Number is the
number used to identify your immigration records. You can find this number on documents you received from USCIS,
U.S. Immigration and Customs Enforcement (ICE), or DOJ Executive Office of Immigration Review (EOIR) during
immigration proceedings in court.
Item Number 2. U.S. Social Security Number (if any). Provide your U.S. Social Security Number, if you have one.
Item Number 3. USCIS ELIS Account Number (if any). If you have previously filed an application using the USCIS
Electronic Immigration System (USCIS ELIS), provide the USCIS ELIS Account Number you were issued by the system.
The USCIS ELIS Account Number is not the same as an A-Number. If you were issued a USCIS ELIS Account Number,
enter it in the space provided.

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Item Numbers 4.a. - 4.c. Your Full Name. Provide your full legal name in the spaces provided.

Item Numbers 5.a. - 6.c. Other Names Used (if any). Provide all the names you have used, including maiden names,
married names, and nicknames in the space provided.
Item Numbers 7.a. - 7.f. Your U.S. Mailing Address. Provide the address where you would like to receive written
correspondence regarding your application.
Item Numbers 8. - 9.e. Your U.S. Physical Address. If your current mailing address is not the same as your physical
address, provide your physical street address. You must include a street number and name or a rural route number. Do
not provide a post office box (P.O. Box) number here.
Item Number 10. Date of Birth (mm/dd/yyyy). Provide your date of birth in month/day/year format.
Item Number 11. Gender. Indicate whether you are male or female.

Item Numbers 12. - 13. Place of Birth. Provide the city or town and country where you were born in the spaces provided.
Item Number 14. Country of Citizenship or Nationality. Provide the name of the country of which you are a citizen
or your country of nationality. This is not necessarily the country where you were born. If you do not have citizenship in
any country, type or print "stateless" and provide an explanation in Part 9. Additional Information.
Item Numbers 15.a. - 16.b. Your Mother's and Father's Full Legal Name. Provide the full legal name for your
parents in the spaces provided.

Item Numbers 17. - 19. Your Last Entry Into the United States. In the appropriate fields, provide the date and place
where you last entered the United States and your immigration status, if any, at the time of entry. If you entered without
inspection and admission or parole, type or print "EWI" as your immigration status.
Item Numbers 20.a. - 26. Your Previous Entries Into the United States (if applicable). In the appropriate fields,
provide the date and place where you previously entered the United States and your immigration status at the time of
entry. If you entered without inspection and admission or parole, type or print ''EWI" as your immigration status. If you
need extra space to complete this section, use the space provided in Part 9. Additional Information.
Item Numbers 27. - 42. Your Immigration or Criminal History. Provide information about any and all immigration
or criminal history.

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1. Immigration Proceedings (Item Numbers 27. - 28.e.)
If you answer "Yes" to Item Number 27., provide information in Item Numbers 28.a. - 28.e. about the status of
your removal, exclusion, or deportation proceedings. You should include a copy of the charging document (Notice
to Appear or Order to Show Cause), a copy of your administrative closure order from EOIR, or any other documents
that show the outcome of your removal, exclusion, or deportation proceedings.
NOTE: Even if your removal, exclusion, or deportation proceedings are administratively closed, you are still "in
removal proceedings" until EOIR terminates or dismisses your case. However, you can apply for a provisional
unlawful presence waiver as long as EOIR has not placed your removal, exclusion, or deportation proceedings back
on its calendar to continue your removal, exclusion, or deportation proceedings before USCIS receives your
application for a provisional unlawful presence waiver.
You are not eligible for a provisional unlawful presence waiver if you are subject to a final removal, exclusion, or
deportation order and have not left the United States since the order became final or if you are subject to reinstatement
of a prior final removal, exclusion, or deportation order.

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2. Criminal History (Item Numbers 29. - 42.)

A. If you answer "Yes" to any question in Item Numbers 29. - 35., provide the location, date, and a brief
description of the event in Part 9. Additional Information. If you answer "Yes" to any question in Item
Numbers 36.a. - 42., provide a complete explanation in Part 9. Additional Information. The provisional
unlawful presence waiver only addresses the inadmissibility grounds associated with unlawful presence under
INA section 212(a)(9)(B)(i). USCIS will deny your application if there is reason to believe that you will be
subject to grounds of inadmissibility other than unlawful presence under INA section 212(a)(9)(B)(i)(I) or (II)
at the time of your immigrant visa interview with a DOS consular officer.
B. If you were arrested or detained, you must provide information about the event regardless of the country where
the event occurred.
C. If you were charged with a crime, you must provide certified court dispositions showing the court proceedings'
outcome. You must also provide copies of arrest reports, statements of charges, indictment information, or any other
charging document issued against you. You MUST provide this information even if:
(1) Your records were expunged;

(2) You were placed in an alternative sentencing or rehabilitation program (for example, diversion, deferred
prosecution, withheld adjudication, deferred adjudication);
(3) Your records were sealed or otherwise cleared; or

(4) If anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a criminal
record.

D. If you were arrested but not charged with a crime or offense, you must provide the arrest report as well as
documentation from the arresting authority or prosecutor's office showing that you were not charged.
E. If you have ever engaged in, ordered, incited, assisted, or otherwise participated in any human rights violations (for
example, acts involving torture, genocide, or human trafficking; murder; severely injuring someone; engaging in
sexual activity with anyone made to participate by force or threat), you must provide information about the events,
place, date, and description regardless of the country where the events occurred.
Part 2. Biographic Information
Provide the biographic information requested in Part 2., Item Numbers 1. - 6. Providing this information as part of your
application may reduce the time you spend at your USCIS ASC appointment as described in the Biometric Services
Appointment section of these Instructions.
Item Numbers 1. - 2. Ethnicity and Race. Select the boxes that best describe your ethnicity and race.

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Categories and Definitions for Ethnicity and Race
1.

Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race. (NOTE: This category is only included under Ethnicity in Part 2., Item
Number 1.)

2.

White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

3.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.

4.

Black or African American. A person having origins in any of the black racial groups of Africa.

5.

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South
America (including Central America), and who maintains tribal affiliation or community attachment.

6.

Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.

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Item Number 3. Height. Select the values that best match your height in feet and inches. For example, if you are five
feet and nine inches, select "5" for feet and "09" for inches. Do not enter your height in meters or centimeters.
Item Number 4. Weight. Enter your weight in pounds. If you do not know your weight, or need to enter a weight under
30 pounds or over 699 pounds, enter "000." Do not enter your weight in kilograms.
Item Number 5. Eye Color. Select the box that best describes the color of your eyes.

Item Number 6. Hair Color. Select the box that best describes the color of your hair.

Part 3. Information About Your Immediate Relative Petition and the Processing of Your Immigrant Visa
Application

In this section, provide information about the approved immigrant visa petition that classifies you as the immediate
relative of a U.S. citizen (either Form I-130 or Form I-360), and the status of your immigrant visa application at the NVC.
Item Number 1. USCIS Receipt Number. Provide the receipt number for the approved immigrant visa petition that
classifies you as an immediate relative of a U.S. citizen. Submit a copy (if available) of the petition approval notice
(Form I-797, Notice of Action). This will assist USCIS in processing your application for a provisional unlawful presence
waiver. Failure to provide a copy of the petition approval notice may result in processing delays or in the rejection of
your application.
NOTE: Failure to provide a copy of the petition approval notice will not, by itself, result in the denial of your application.
Item Numbers 2.a. - 2.c. Petitioner's Full Name. Provide the full name of the U.S. citizen petitioner who filed Form
I-130 on your behalf. If you self-petitioned using Form I-360, type or print "Self."
Item Numbers 3.a. - 3.d. Petitioner's Relationship to You. Indicate whether the petitioner is your U.S. citizen spouse,
parent, son, or daughter or if you self-petitioned using Form I-360.
Item Number 4. DOS Consular Case Number (NVC Case Number). Provide your consular case number (also called
the NVC case number). It is located on your receipt for the DOS immigrant visa application processing fee. The NVC
case number must correspond to the approved petition you listed in Part 3., Item Number 1.
Item Number 5. Immigrant Visa Interview. Indicate whether DOS initially acted before January 3, 2013, to schedule
your immigrant visa interview for the approved immediate relative petition upon which your Form I-601A is based.

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NOTE: The actual date and time that you are scheduled to appear for your immigrant visa interview is not the date USCIS
will use to determine if you are eligible to file Form I-601A. USCIS will use the date DOS initially acted to schedule your
immigrant visa interview for the approved immediate relative petition upon which your Form I-601A is based. You can find
information about how to determine when DOS took action to schedule your immigrant visa interview on the DOS Web site
at www.immigrantvisas.state.gov or you can contact the NVC. If DOS initially acted before January 3, 2013 to schedule
your immigrant visa interview, you are not eligible to file Form I-601A, even if you failed to appear for your immigrant visa
interview or you or DOS canceled or rescheduled the interview on or after January 3, 2013.
If you indicate on your Form I-601A that DOS initially acted before January 3, 2013, to schedule you for an immigrant
visa interview, or if you do not answer the question, USCIS will reject your application for a provisional unlawful
presence waiver and return your filing fee, biometric services fee (if applicable), and application package. USCIS may
also deny your application if you indicate that DOS did not initially act before January 3, 2013, to schedule you for an
immigrant visa the interview, but DOS records indicate the opposite.

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Part 4. Information About Your Qualifying Relative

In this section, provide information about the U.S. citizen spouse or parent you believe would experience extreme hardship if
you were refused admission to the United States and your U.S. citizen spouse or parent chooses to remain in the United
States without you or chooses to relocate abroad to reside with you outside of the United States.
Item Numbers l.a. - 2.b. Your Qualifying Relative's Full Name and Relationship to You. Provide the full name of
your qualifying relative and indicate whether the qualifying relative is your U.S. citizen spouse or parent.
Item Number 3. Your Other Qualifying Relative. Indicate whether you have another qualifying relative (U.S. citizen
spouse or parent) who would experience extreme hardship if you were refused admission to the United States. If you
answer "Yes," provide the name, relationship, and evidence of U.S. citizenship of the additional qualifying relative in the
space provided.
Item Numbers 4.a. - 5.b. Additional Qualifying Relative's Full Name and Relationship to You. Provide the full
name of your additional qualifying relative and indicate whether the additional qualifying relative is your U.S. citizen
spouse or parent.
Part 5. Statement from Applicant

In the space provided, describe all the reasons that you believe support your application for a provisional unlawful presence
waiver. If you need extra space to complete your statement, use the space provided in Part 9. Additional Information.
Your statement must explain why you believe your qualifying relative would experience extreme hardship if you are refused
admission to the United States and your U.S. citizen spouse or parent chooses to remain in the United States without you or
chooses to relocate abroad to reside with you outside of the United States. For information about how you can show extreme
hardship, see Extreme Hardship in the What Evidence Should I Submit With This Application section of these
instructions.
Your statement must also explain why you believe USCIS should approve your waiver application as a matter of discretion.
Approval of a provisional unlawful presence waiver is discretionary, and the USCIS officer will weigh favorable and
unfavorable factors presented in your case to determine whether he or she should approve your request. You should explain
why you believe USCIS should approve your application for a provisional unlawful presence waiver because of the favorable
factors, and why the unfavorable factors should not carry as much weight as the favorable ones.
You may provide USCIS with your statement using a separate letter that you submit along with your Form I-601A. If you
choose to submit a statement using a separate letter, type or print into the space provided in Part 5. that you are attaching
a separate letter to your application. 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.

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Part 6. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application
Support Center, Certification, and Signature
Item Numbers 1.a. - 6.b. Select the appropriate box to indicate that you either read this application yourself or someone
interpreted this application for you from English to a language in which you are fluent. If applicable, select the box to
indicate if someone prepared this application for you. You must also affirm that you have read and understand (or that an
interpreter or preparer read to you, and you understand) the Acknowledgement of Appointment at USCIS Application
Support Center in Part 6. Further, you must sign and date your application and provide your daytime telephone number,
mobile telephone number (if any), and email address (if any). Every application MUST contain the signature of the
applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
Part 7. Interpreter's Contact Information, Certification, and Signature
Item Numbers 1.a. - 6.b. If you used anyone as an interpreter to read the instructions and questions on this application to
you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and
address of his or her business or organization (if any), his or her daytime telephone number, and his or her email address
(if any). The interpreter must also certify that he or she has read the Acknowledgement of Appointment at USCIS
Application Support Center in Part 6. to you in the same language in which you are fluent. The interpreter must sign
and date the application.

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Part 8. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If
Other Than the Applicant
Item Numbers 1.a. - 8.b. This section must contain the signature of the person who completed your application, if other
than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete
both Part 7. and Part 8. If the person who completed this application is associated with a business or organization, that
person should complete the business or organization name and address information. Anyone who helped you prepare this
application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable.
Anyone who helped you prepare your application must also certify that he or she has read the Acknowledgement of
Appointment at USCIS Application Support Center in Part 6. to you, and that you informed him or her that you
understood the ASC Acknowledgement. If the person who helped you prepare your application is an attorney or
accredited representative, he or she must also submit a completed Form G-28, Notice of Entry of Appearance as Attorney
or Accredited Representative, along with your application.
Part 9. Additional Information

Item Numbers 1.a. - 7.b. If you need extra space to provide any additional information within this application, use the
space provided in Part 9. Additional Information. If you need more space than what is provided in Part 9., you may
make copies of Part 9. to complete and file with your 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.
We recommend that you print or save a copy of your completed application to review in the future and for your
records. We recommend that you review your copy of your completed application before you come to your
biometric services appointment at a USCIS ASC. At your appointment, USCIS will permit you to complete the
application process only if you are able to confirm, under penalty of perjury, that all of the information in your
application is complete, true, and correct. If you are not able to make that attestation in good faith at that time, USCIS
will require you to return for another appointment.

What Evidence Should I Submit With This Application?
You must submit all evidence requested in these Instructions with your application. If you fail to submit required
evidence, USCIS may reject or deny your application for failure to submit requested evidence or supporting
documentation in accordance with 8 CFR 103.2(b)(1) and these Instructions.
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Petition Approval Notice
You must submit a copy (if available) of the USCIS approval notice (Form I-797, Notice of Action) for the immigrant
visa petition (Form I-130 or Form I-360) that classifies you as an immediate relative of a U.S. citizen. This will assist
USCIS in processing your application for a provisional unlawful presence waiver.
However, failure to provide a copy of the petition approval notice may result in processing delays or in the rejection of
your application. Failure to provide a copy of the petition approval notice will not, by itself, result in a denial of your
application. See the Specific Instructions section of these instructions for more information.
DOJ EOIR Administrative Closure Order
You must submit a copy (required where applicable) of the administrative closure order issued by EOIR.
DOS Immigrant Visa Application Processing Fee Receipt
You must submit a copy of your fee receipt for your DOS immigrant visa application processing fee. Place this fee
receipt on top of your Form I-601A when you submit your application. See the Specific Instructions section of these
instructions for more information.

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Relationship to a Qualifying Relative

If you claim extreme hardship to a U.S. citizen spouse or parent who is the immigrant visa petitioner, you do not need to
present evidence of your relationship to the petitioner. The immigrant visa petitioner will have already presented this
evidence when he or she filed the immediate relative petition (Form I-130 or Form I-360).
However, if you claim extreme hardship to a qualifying relative who is not the immigrant visa petitioner, you must submit
evidence that shows the qualifying relationship.
You may submit the following evidence to establish the relationship.
1.

To your spouse:

A. A copy of your marriage certificate; and

B. If either you or your spouse were previously married, copies of documents showing that all prior marriages were
legally terminated.
2.

To your mother:

A. A copy of your birth certificate that shows your name and the name of your mother; or

B. If your mother's name has changed since your birth and is different from what is shown on your birth certificate, a
copy of the legal document that authorized the name change.
3.

To your father:

A. A copy of your birth certificate that shows both parents' names;

B. A copy of your parents' marriage certificate or other evidence that shows you were legitimated before reaching 18
years of age;
C. Evidence of legal termination of your parents' prior marriages, if any; or
D. If you were born out of wedlock and were not legitimated before reaching 18 years of age, you must include any
evidence establishing that a bona fide parent-child relationship existed between you and your father while you
were unmarried and under 21 years of age. You may include evidence that your father lived with you, supported
you, or otherwise showed continuing parental interest in your welfare.
4.

To your step-parent:
A. A copy of your birth certificate that shows your parents' names;
B. A copy of the marriage certificate between your natural parent and step-parent that established the relationship
before you reached 18 years of age; or
C. Evidence of legal termination of any prior marriages for your natural parent and step-parent, if applicable.

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5.

To your adoptive parent:
A. A copy of the final adoption decree listing the individual as your adoptive parent; or
B. Evidence that your adoptive parent adopted you before you reached 16 years of age (or reached 18 years of age if
your adoptive parent also adopted your natural sibling) and that your adoptive parent had legal custody of you and
resided with you for at least two years.

Citizenship Status of a Qualifying Relative
If you claim extreme hardship to a U.S. citizen spouse or parent who is the immigrant visa petitioner, you do not need to
present evidence of the petitioner's U.S. citizenship status. The immigrant visa petitioner will have already presented this
evidence when he or she filed the immediate relative petition (Form I-130 or Form I-360).
However, if you claim extreme hardship to a qualifying relative who is not the immigrant visa petitioner, you must submit
evidence showing that your qualifying relative is a U.S. citizen.

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Evidence of U.S. citizenship includes, but is not limited to, any of the following:
1.

If your relative was born in the United States, a copy of his or her birth certificate, issued by a civil registrar, vital
statistics office, or other civil authority of a U.S. state, county, municipal authority, or territory;

2.

A copy of your relative's naturalization certificate or certificate of citizenship issued by USCIS or the former
Immigration and Naturalization Service (INS);

3.

A copy of your relative's unexpired U.S. passport; or

4.

A copy of your relative's DOS-issued Form FS-240, Report of Birth Abroad of a Citizen of the United States.

Extreme Hardship

You may submit any evidence to support your claim that your qualifying relative would experience extreme hardship if
you are refused admission to the United States and your U.S. citizen spouse or parent must remain in the United States
without you or relocate abroad to reside with you outside of the United States. Factors USCIS considers when
determining extreme hardship include, but are not limited to:
1. Health. Examples include: Ongoing or specialized treatment required for a physical or mental condition, availability
or quality of such treatment in the foreign country, anticipated treatment duration, whether the condition is long term,
and whether it is chronic or acute.
2. Financial considerations. Examples include: Future employability, loss due to sale of home or business or
termination of a professional practice, a decline in standard of living, ability to recoup short-term losses, cost of
extraordinary needs (such as special education or training for children with special needs), or the cost of care for
family members such as elderly or sick parents.

3. Education. Examples include: Loss of opportunity for higher education, lower quality or limited scope of education
options, disruption of a current program, requirement to receive education in a foreign language or culture with ensuing
loss of time or grade, and availability of special requirements, such as training programs or internships in specific fields.
4. Personal considerations. Examples include: Close relatives in the United States and country of birth or citizenship,
separation from spouse or children, ages of involved parties, and length of residence and community ties in the
United States.
5. Special factors. Examples include: Cultural, language-related, religious, and ethnic obstacles; valid fears of
persecution, physical harm, or injury; social ostracism or stigma; and lack of access to social institutions or structures
(official or unofficial) that provide support, guidance, or protection.

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Evidence of extreme hardship includes, but is not limited to:
1. Expert opinions;
2. Evidence of employment or business ties (for example, payroll records or tax statements);
3. Evidence of monthly expenditures (for example, receipts from mortgage, rental or bill payments);
4. Other financial records that support any claimed financial hardships;
5. Medical documentation or evaluations by medical professionals that support any claimed medical hardships;
6. Records of membership in community organizations or confirmation of volunteer service, and evidence of cultural
affiliations;
7. Certificates of birth, marriage, or adoption that support any claimed family ties;
8. Affidavits from the qualifying relative or other individuals with personal knowledge of the claimed hardships;
9. Country condition reports; and

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10. Any other evidence you believe supports the claimed extreme hardships.

NOTE: USCIS will consider extreme hardship only to a qualifying relative. If you describe extreme hardship to yourself
or anyone other than a U.S. citizen spouse or parent, you must show how this extreme hardship affects the extreme
hardship your qualifying U.S. citizen spouse or parent would experience if you are refused admission to the United States
and your U.S. citizen spouse or parent must remain in the United States without you or relocate abroad to reside with you
outside of the United States.
Establishing That Your Case Warrants A Favorable Exercise of Discretion

Approval of Form I-601A is discretionary. To determine if your case warrants a favorable exercise of discretion, USCIS
will review the evidence in the records and weigh all favorable and unfavorable factors when deciding whether to approve
your application as a matter of discretion. You should describe the favorable and unfavorable factors in your case and
explain why you think the favorable factors should be given more weight.
Some favorable factors may include, but are not limited to:
1. Close family ties in the United States;

2. Hardship to your relatives who are U.S. citizens or lawful permanent residents, or to yourself, or your employer in the
United States;
3. Evidence of reformation and rehabilitation;

4. Length of lawful presence in the United States and your immigration status while you were lawfully present;

5. Evidence of respect for law and order, good moral character, and family responsibilities or intent to hold family
responsibilities;
6. Absence of significant undesirable or negative factors; and
7. Likelihood that you will become a lawful permanent resident in the near future.
Some unfavorable factors may include, but are not limited to:

1. Evidence of bad moral character, including criminal tendencies reflected by past convictions or an ongoing unlawful
activity or continuing police record;
2. Repeated violations of U.S. immigration laws and a willful disregard for other laws;
3. Absence of close family ties or hardships;
4. Fraudulent marriage to a U.S. citizen for the purpose of gaining an immigration benefit; and
5. Unauthorized employment in the United States.

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What Is the Filing Fee?
The filing fee for Form I-601A is $585. A biometric services fee of $85 is also required for applicants between 14 and 79
years of age. Therefore, the fees you must submit with the application are:
1.

$585 plus $85 for biometric services fee if you are under 79 years of age; or

2.

$585 if you are 79 years of age or older.

3.

You may not request a fee waiver for the Form I-601A filing fee or biometric services fee.

NOTE: The filing fee and biometric services fee are not refundable, regardless of any action USCIS takes on this
application. DO NOT MAIL CASH. You must submit all fees in the exact amounts.
Use the following guidelines when you prepare your checks or money orders for the Form I-601A filing fee and
biometric services fee:

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1.

The check or money order must be drawn on a bank or other financial institution located in the United States and
must be payable in U.S. currency; and

2.

Make the checks or money orders payable to U.S. Department of Homeland Security.

NOTE: Spell out U.S. Department of Homeland Security; do not use the initials "USDHS" or "DHS."

Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it into an electronic funds
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your
account for the amount of the check. The debit from your account will usually take 24 hours and your bank will show it
on your regular account statement.
You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS
cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If
USCIS cannot complete the EFT because of insufficient funds, we may try to make the transfer two additional times.
How to Determine If the Fees Are Correct

Form I-601A filing fee and biometric services fee are current as of the edition date in the lower left corner of this page.
However, because USCIS fees change periodically, you can verify that the fees are correct by following one of the steps
below.
1.

Visit the USCIS Web site at www.uscis.gov, select "FORMS," and check the appropriate fee; or

2.

Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or
hard of hearing) call: 1-800-767-1833.

Where To File?
Please see our Web site at www.uscis.gov/I-601A or call our National Customer Service Center at 1-800-375-5283 for the
most current information about where to file this application. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Address Change
You must notify USCIS of your new address within 10 days of moving from your previous residence. For information on
filing a change of address go to the USCIS Web site at www.uscis.gov/addresschange or contact the USCIS National
Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
NOTE: Do not submit a change of address request to USCIS Lockbox facilities because these facilities do not process
change of address requests.

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Processing Information
USCIS will reject your Form I-601A if it is not signed or accompanied by the correct fees. USCIS will send you a
notice that Form I-601A is deficient. USCIS will also reject Form I-601A if you:
1.

Fail to provide your full name, U.S. physical address, and date of birth;

2.

Are under 17 years of age;

3.

Do not include evidence of an approved immigrant visa petition that classifies you as an immediate relative of a U.S.
citizen;

4.

Do not include a copy of the DOS fee receipt as evidence that you have paid DOS the immigrant visa processing fee;
or

5.

Have indicated on the application that DOS initially acted before January 3, 2013, to schedule the immigrant visa
interview or have not selected either box in Part 3., Item Number 5.

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If USCIS rejects your Form I-601A, we will return it to you with any fees you submitted with the form. You may correct
the deficiency and resubmit your Form I-601A. An application is not considered properly filed until accepted by USCIS.
If USCIS denies your application after fully adjudicating your Form I-601A, USCIS will not refund the fees
originally submitted with your Form I-601A.
IMPORTANT: You must have a United States address to file this application.

Initial Processing. Once USCIS accepts your application, we will check it for completeness. If you do not completely
fill out this application, you will not establish a basis for your eligibility and USCIS may reject or deny your application.
Requests for More Information. We may request that you provide more information or evidence to support your
application. We may also request that you provide the originals of any copies you submit. USCIS will return any
requested originals when they are no longer needed.

Requests for Interview. We may request that you appear at a USCIS office for an interview based on your application.
At the time of any interview or other appearance at a USCIS office, we may require that you provide your fingerprints,
photograph, and/or signature to verify your identity and/or update background and security checks.
Decision. The decision on Form I-601A involves a determination of whether you have established eligibility for the
immigration benefit you are seeking. USCIS will notify you of the decision in writing.

USCIS Forms and Information

To ensure you are using the latest version of this application, visit the USCIS Web site at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order
USCIS forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling
the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:
1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our
online system, InfoPass, at infopass.uscis.gov. Use the InfoPass appointment scheduler and follow the screen prompts
to set up your appointment. InfoPass generates an electronic appointment notice that appears on the screen.

Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-601A, we
will deny your Form I-601A and may deny any other immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.

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USCIS Privacy Act Statement
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA
section 101, INA section 212(a)(9)(B)(i) and (v), and Title 8 of the Code of Federal Regulation (CFR) section 212.7(e).
PURPOSE: The primary purpose for providing the requested information on this application is to determine if you have
established eligibility for the immigration benefit for which you are filing. DHS will use the information you provide to
grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your application.
ROUTINE USES: DHS may share the information you provide on this application with other Federal, state, local, and
foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated
published system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001 - Alien File,
Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS may also share
the information, as appropriate, for law enforcement purposes or in the interest of national security.

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Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of
information, unless it displays a currently valid OMB control number. The public reporting burden for this collection of
information is estimated at 1 hour and 30 minutes per response, including the time for reviewing instructions, gathering
the required documentation and information, completing the application, preparing statements, attaching necessary
documentation, and submitting the application. The collection of biometrics is estimated to require 1 hour and 10
minutes. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division,
Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB Control No. 1615-0123.
Do not mail your completed Form I-601A to this address.

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Is My Application Complete?
Ensure that you have completed ALL of the following actions before you file your Form I-601A with USCIS.
I placed a copy of my DOS immigrant visa fee receipt on top of my Form I-601A and supporting
documentation.
If I am an alien in removal, exclusion, or deportation proceedings, I included a copy of my administrative
closure order from the U.S. Department of Justice, Executive Office for Immigration Review (EOIR).
I included arrest records and conviction documents for any criminal offenses, if applicable.
I completed every applicable item on my Form I-601A, including my full name, my U.S. mailing and physical
addresses, and my date of birth. I attached documents to support my statements, when requested, on Form
I-601A or in the What Evidence Should I Submit With This Application section of these instructions.

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In Part 3. Information About Your Immediate Relative Petition and the Processing of Your Immigrant
Visa Applications, I provided information about the approved immediate relative petition (Form I-130 or Form
I-360) that was filed on my behalf, and I attached a copy (if available) of the immigrant visa petition approval
notice (Form I-797, Notice of Action).
In Part 3., I provided information about my DOS immigrant visa case.

DOS did not initially act before January 3, 2013, to schedule my immigrant visa interview and I answered the
question in Part 3., Item Number 5.

NOTE: The actual date and time that you are scheduled to appear for your immigrant visa interview is not the date
USCIS will use to determine if you are eligible to file Form I-601A. USCIS will use the date DOS initially acted to
schedule your immigrant visa interview for the approved immediate relative petition upon which your Form I-601A
is based. If DOS initially acted before January 3, 2013, to schedule your immigrant visa interview, you are not
eligible to file Form I-601A, even if you failed to appear for your immigrant visa interview or you or DOS
cancelled or rescheduled the interview on or after January 3, 2013.
USCIS will reject your Form I-60lA and return the filing fee, biometric services fee (if applicable), and
application package to you if you answered "Yes" to the question in Part 3., Item Number 5. USCIS may deny
your application if you indicate on your Form I-601A that you were not scheduled for an immigrant visa
interview before January 3, 2013, but DOS records indicate that you were scheduled prior to this date.

In Part 4. Information About Your Qualifying Relative, I provided information about my qualifying relatives
and I explained the extreme hardship to my qualifying relatives in Part 4. I also explained in Part 4. why USCIS
should approve my application for a provisional unlawful presence waiver as a matter of discretion.

I read the Penalties section of these instructions and I (or a parent or legal guardian, if applicable) signed this
Form I-601A.
I included the required filing fee and biometric services fee in the form of checks or money orders as described
in the What is the Filing Fee section of these instructions.

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