Form I-600A Application for advance processing of orphan petition

Application for
Advance Processing of an Orphan Petition

USCIS
Form I-600A

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0028
Expires 02/28/2017

For USCIS Use Only
The applicant is:
Married
Unmarried
The applicant:
WILL provide proper
care to a child if admitted
to the United States.
WILL NOT provide
proper care to a child if
admitted to the United
States.
Received

The state of the child's
proposed residence:
HAS preadoptive
requirements.
DOES NOT HAVE
preadoptive requirements.
Describe preadoption
requirements (if any).

Trans In

Fee Stamp

The preadoption
requirements:
WERE met.
HAVE NOT
BEEN met.
File Number

DD

Date of Favorable
Determination

District

Remarks

Completed

► START HERE - Type or print legibly in black ink. This application is made by a prospective adoptive parent for advance
processing of an orphan petition.

Part 1. Information About You (Applicant)
1.

Family Name (Last Name)

2.

Other Names You Have Used (including maiden name, nicknames, and aliases, if any)
Family Name (Last Name)
Given Name (First Name)

3.

4.

Given Name (First Name)

Middle Name (if applicable)

Middle Name (if applicable)

U.S. Mailing Address (if any)
In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Is your current U.S. mailing address the same as your U.S. physical address?

Yes

No

If you answered "No" to Item Number 4., provide your U.S. physical address in Item Number 5. or your address abroad in Item
Number 6., as appropriate.
5.

U.S. Physical Address (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-600A 02/01/15 N

ZIP Code

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Part 1. Information About You (Applicant) (continued)
6.

Address Abroad (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

7.

Date of Birth (mm/dd/yyyy)

Postal Code

8.

Country

City/Town/Village of Birth

►
9.

State or Province of Birth

10. Country of Birth

11. Information About U.S. Citizenship
A. Are you a citizen of the United States?

Yes

No

NOTE: If you answered "No," you may NOT file Form I-600A. See the What Are the Eligibility Requirements? section
of the Form I-600A instructions for more information.
B. How did you acquire your U.S. citizenship?

Birth

Parents

Naturalization

C. If you acquired your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name?
Yes
No
If "Yes," provide the following information about your Certificate of Citizenship:
Name Under Which the Certificate of Citizenship Was Issued
Family Name (Last Name)

Alien Registration Number (A-Number) (if any)

Given Name (First Name)

Middle Name (if applicable)

Certificate of Citizenship Number

► ADate of Issuance

Place of Issuance

(mm/dd/yyyy) ►
D. If you acquired your citizenship through naturalization, provide the following information about your Certificate of
Naturalization:
Name Under Which the Certificate of Naturalization Was Issued
Family Name (Last Name)

A-Number (if any)

Given Name (First Name)

Middle Name (if applicable)

Certificate of Naturalization Number

► ADate of Naturalization

Place of Naturalization

(mm/dd/yyyy) ►

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Part 1. Information About You (Applicant) (continued)
Yes

12. Have you, or any person through whom you claimed citizenship, EVER lost U.S. citizenship?

No

NOTE: If you answered "Yes," attach a detailed explanation on a separate sheet of paper; type or print 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.
13. What is your marital status?

Married

Widowed

Divorced

Single

14. How many times have you been married (including your current marriage, if applicable)?
16. Place Where Current Marriage Occurred (if applicable)

15. Date of Current Marriage (if applicable)
(mm/dd/yyyy) ►

17. Information About Your Current Spouse (if applicable)
Family Name (Last Name)
Given Name (First Name)

Middle Name (if applicable)

Other Names Your Current Spouse Has Used (including maiden name, nicknames, and aliases, if any)
Given Name (First Name)
Family Name (Last Name)
Middle Name (if applicable)

Date of Birth

A-Number (if any)

(mm/dd/yyyy) ►

► A-

State or Province of Birth

City/Town/Village of Birth

Country of Birth

Spouse's Immigration Status

18. How many times has your current spouse been married (including your current marriage, if applicable)?
19. Does your current spouse reside with you?

Yes

No

If you answered "No," provide your current spouse's physical address in Item Number 20.
20. Your Current Spouse's Physical Address
Street Number and Name

Apt. Ste. Flr. Number

State

City or Town

Province

Postal Code

ZIP Code

Country

21. How many persons 18 years of age or older, other than your current spouse (if married), reside with you?
If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household,
for each person.

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Part 1. Information About You (Applicant) (continued)
22. Have you ever previously filed Form I-600A, Form I-600, Petition to Classify Orphan as an Immediate
Relative, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention
Country, or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative?

Yes

No

If "Yes," provide the following:
A. Type of Application/Petition Filed

B. Result - Check the box that best describes the action taken by USCIS and/or U.S. Department of State on your application
and/or petition.
Approved - Approval Date (mm/dd/yyyy) ►
Denied - Denial Date

(mm/dd/yyyy) ►

NOTE: A copy of the denial notice must accompany this application.
Other - Explain

C. A detailed description of any previous Form I-600 or Form I-800 filing that resulted in a disruption prior to finalization of the
adoption or that resulted in a completed adoption that was later dissolved either in the United States or abroad.

NOTE: If you need extra space to complete this question, attach a separate sheet of paper; type or print your A-Number (if any)
at the top of each sheet; include the Page Number, Part Number, and Item Number to which your answer refers; and sign and
date each sheet.

Duty of Disclosure
You and your spouse (if married), must answer the following questions. See the Duty of Disclosure section in the instructions to Form
I-600A concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any
of these questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest,
indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating
circumstances about each arrest, signed by you and/or your spouse (if married) under penalty of perjury under U.S. law. The written
statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or
other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a
description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in
light of this history on a separate sheet of paper; type or print 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.
23. Have you EVER, whether in or outside the United States:
A. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any
law or ordinance, excluding traffic violations, but including driving or operating a vehicle while
intoxicated or while impaired by or under the influence of alcohol or other intoxicant, even if the
record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or
the subject of any other amelioration?

Yes

No

B. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?

Yes

No

C. Received a suspended sentence, been placed on probation or parole, or in an alternative sentencing or
rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or
expungement of a criminal charge?

Yes

No

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Part 1. Information About You (Applicant) (continued)
D. At any time been the subject of any investigation by any child welfare agency, court, or other official
authority in any state or foreign country concerning the abuse or neglect of any child, other than an
investigation that has been completed and formally closed based on a finding that the allegation of
abuse or neglect was unfounded or unsubstantiated?

Yes

No

A. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any
law or ordinance, excluding traffic violations, but including driving or operating a vehicle while
intoxicated or while impaired by or under the influence of alcohol or other intoxicant, even if the
record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or
the subject of any other amelioration?

Yes

No

B. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?

Yes

No

C. Received a suspended sentence, been placed on probation or parole, or in an alternative sentencing or
rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or
expungement of a criminal charge?

Yes

No

D. At any time been the subject of any investigation by any child welfare agency, court, or other official
authority in any state or foreign country concerning the abuse or neglect of any child, other than an
investigation that has been completed and formally closed based on a finding that the allegation of
abuse or neglect was unfounded or unsubstantiated?

Yes

No

24. Has your spouse EVER, whether in or outside the United States:

Part 2. Information About Your Home Study Preparer and/or Adoption Service Provider
1.

2.

3.

Your home study:
A.

IS attached to this Form I-600A.

B.

IS NOT attached to this Form I-600A because of state requirements necessitating review and documentation. The
appropriate state authority has indicated that it will submit the home study directly to U.S. Citizenship and Immigration
Services (USCIS). (Do not submit your Form I-600A to USCIS until the state authority is ready to send your home
study to USCIS.)

C.

Will be submitted within one year from the date of this Form I-600A filing. (If your home study is not received within
one year, your Form I-600A application will be denied under 8 CFR 204.3(c)(2) and (h)(5).)

Select one of the following options for which you will provide a name, address, and contact information in Item Number 3.:
A.

The adoption service provider that is responsible for your home study (i.e., the accredited agency as defined in 22 CFR 96.2,
that prepared your home study or reviewed and approved your home study after it was prepared by another authorized home
study preparer, or the public domestic authority, as defined in 22 CFR 96.2, that prepared your home study); or

B.

The primary adoption service provider who is responsible in your case, if you have already identified a primary adoption
service provider. (A primary adoption service provider is an accredited agency or approved person who is responsible
under 22 CFR 96.14 for ensuring the six adoption services defined in 22 CFR 96.2 are provided, supervising and being
responsible for supervised providers where used, and developing and implementing a service plan in accordance with 22
CFR 96.44.)

Provide the name and contact information of your adoption service provider.
A. Name of Adoption Service Provider

B. Point of Contact Within the Organization
Family Name (Last Name)

Form I-600A 02/01/15 N

Given Name (First Name)

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Part 2. Information About Your Home Study Preparer and/or Adoption Service Provider (continued)
C. Provider's Mailing Address
Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

Postal Code

D. Provider's Daytime Telephone Number

Country

E. Provider's Fax Number (if any)

F. Provider's Email Address (if any)

Part 3. General Information
1.

Do you or your spouse (if married) plan to travel abroad to locate or adopt a child?

2.

If you answered "Yes" to Item Number 1., provide the following information (if available):
A. Your intended departure date
(mm/dd/yyyy) ►
B. Place to which you or your spouse (if married) are traveling
City or Town

Yes

No

Yes

No

Your spouse's intended departure date
(mm/dd/yyyy) ►
Province

Country

3.

Will you and your spouse (if married) adopt the child abroad after either you or your spouse (if married)
have personally seen and observed the child?

4.

Provide a written description of the pre-adoption requirements, if any, of the state of the child's proposed residence if you know
that the child will be adopted in the United States. Cite any relevant state statutes and regulations, and describe the steps you have
already taken or will take to comply with these requirements. Note and explain any pre-adoption requirements that you cannot
meet at this time due to operation of state law.

NOTE: If you need extra space to complete this Item Number, 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.
5.

What is the intended country of adoption (if known)?

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Part 3. General Information (continued)
6.

Where do you wish to file your orphan petition? (Complete one of the options below)
A. The USCIS office located at:
OR
B. The U.S. Embassy or U.S. Consulate located at:

7.

Do you plan to adopt more than one child?

8.

If you answered "Yes" to Item Number 7., enter the number of children you plan to adopt.

Yes

No

Yes

No

Part 4. Accommodations for Individuals With Disabilities and/or Impairments
1.

Are you requesting an accommodation because of disabilities and/or impairments?

2.

If you answered "Yes" to Item Number 1., select all applicable boxes below to indicate who has the disabilities and/or impairments.
Applicant

3.

Spouse

Other Household Member

If you answered "Yes" to Item Number 1., select all applicable boxes below. Provide information for each person with the
disabilities and/or impairments.
A.

Deaf or hard of hearing and request the following accommodations (If requesting a sign-language interpreter, indicate for
which language (e.g., American Sign Language):

B.

Blind or have low vision and request the following accommodations:

C.

Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and accommodation
you are requesting):

Part 5. Applicant's Statement, ASC Acknowledgement (if applicable), Certification, Signature, and
Contact Information
Applicant's Statement
Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2.
1.A.

I can read and understand English, and have read and understand each and every question and instruction on this
application, as well as my answer to each question. I have read and understand the Acknowledgement of Appointment at
USCIS Application Support Center (if applicable).

1.B.

The interpreter named in Part 9. has read to me each and every question and instruction on this application, as well as my
answer to each question, in
, a language in which I am fluent.
I understand each and every question and instruction on this application as translated to me by my interpreter, and have
provided complete, true, and correct responses. The interpreter named in Part 9. also has read the Acknowledgement of
Appointment at USCIS Application Support Center (if applicable) to me, in the language in which I am fluent, and I
understand this ASC Acknowledgement as read to me by my interpreter.

Form I-600A 02/01/15 N

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Part 5. Applicant's Statement, ASC Acknowledgement (if applicable), Certification, Signature, and
Contact Information (continued)
2.

I have requested the services of and consented to
,
is not
who is
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 (if applicable) with me and I understand the ASC Acknowledgement.

Acknowledgement of Appointment at USCIS Application Support Center (if applicable)
I,

,

understand that the purpose of a USCIS Application Support Center (ASC) appointment is for me to provide my fingerprints, photograph,
and/or signature and to reverify 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 this application as identified by the
receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with this
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 reverifying
that I willingly submit this application; I have reviewed the contents of this application; all of the information in this application and
all supporting documents submitted with my application 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
(if applicable) with me.

Applicant's Certification
I certify, under penalty of perjury under the laws of the United States of America, that the information in this application and any
document submitted with this application is complete, true, and correct.
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 my
records that USCIS may need to determine my suitability and eligibility as an adoptive parent.
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 of U.S. immigration laws.

Applicant's Signature
3.

Applicant's Signature

Date of Signature
(mm/dd/yyyy) ►

Applicant's Contact Information
4.

Applicant's Daytime Telephone Number

6.

Applicant's Email Address (if any)

Form I-600A 02/01/15 N

5. Applicant's Mobile Telephone Number (if any)

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Part 6. Applicant's Duty of Disclosure
Certification: I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent,
as described in the Form I-600A and/or Form I-600 instructions, and I agree to notify the home study preparer and USCIS of any new
information that I am required to disclose.
Applicant's Signature

Date of Signature
(mm/dd/yyyy) ►

Part 7. Spouse's Statement, ASC Acknowledgement (if applicable), Certification, Signature, and
Contact Information
Spouse's Statement
Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2.
1.A.

I can read and understand English, and have read and understand each and every question and instruction on this application, as
well as my answer to each question. I have read and understand the Acknowledgement of Appointment at USCIS
Application Support Center (if applicable).

1.B.

The interpreter named in Part 9. has read to me each and every question and instruction on this application, as well as my
answer to each question, in

, a language in which I am fluent.

I understand each and every question and instruction on this application as translated to me by my interpreter, and have
provided complete, true, and correct responses. The interpreter named in Part 9. also has read the Acknowledgement of
Appointment at USCIS Application Support Center (if applicable) to me, in the language in which I am fluent, and I
understand this ASC Acknowledgement as read to me by my interpreter.
2.

I have requested the services of and consented to
,
is not
who is
an attorney or accredited representative, preparing this application for me. This person who assisted me
in preparing this application has reviewed the Acknowledgement of Appointment at USCIS Application Support
Center (if applicable) with me and I understand the ASC Acknowledgement.

Acknowledgement of Appointment at USCIS Application Support Center (if applicable)
I,

,

understand that the purpose of a USCIS Application Support Center (ASC) appointment is for me to provide my fingerprints, photograph,
and/or signature and to reverify that all of the information in this application is complete, true, and correct and was provided by me or my
spouse. 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 this application as identified by the
receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with this
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 reverifying
that I willingly submit this application; I have reviewed the contents of this application; all of the information in this application and
all supporting documents submitted with my application 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
(if applicable) with me.

Spouse's Certification
I certify, under penalty of perjury under the laws of the United States of America, that the information in this application and any
document submitted with this application is complete, true, and correct.

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Part 7. Spouse's Statement, ASC Acknowledgement (if applicable), Certification, Signature, and
Contact Information (continued)
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 my
records that USCIS may need to determine my suitability and eligibility as an adoptive parent.
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 of U.S. immigration laws.

Spouse's Signature
3.

Spouse's Signature

Date of Signature
(mm/dd/yyyy) ►

Spouse's Contact Information
4.

Spouse's Daytime Telephone Number

6.

Spouse's Email Address (if any)

5. Spouse's Mobile Telephone Number (if any)

Part 8. Spouse's Duty of Disclosure
Certification: I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent,
as described in the Form I-600A and/or Form I-600 instructions, and I agree to notify the home study preparer and USCIS of any new
information that I am required to disclose.
Spouse's Signature

Date of Signature
(mm/dd/yyyy) ►

Part 9. Interpreter's Name, Contact Information, Certification, and Signature
If you and/or your spouse (if married) used an interpreter to read and complete this application, the interpreter must provide the
following information:

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)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

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Postal Code

ZIP Code

Country

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Part 9. Interpreter's Name, Contact Information, Certification, and Signature (continued)
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

.

I have read and accurately translated to this applicant and/or the applicant's spouse (if married) every question and instruction on this
application, as well as the answer to each question, in the language in which he and/or she is fluent.
I have read and accurately translated the Acknowledgement of Appointment at USCIS Application Support Center (ASC) (if
applicable) to the applicant and/or the applicant's spouse, in the language in which he and/or she is fluent.
The applicant and/or the applicant's spouse has informed me that he and/or she understands every instruction and question on the
application, as well as the answer to each question.
The applicant and/or the applicant's spouse also has informed me that he and/or she understands the ASC Acknowledgement and that
by appearing for a USCIS ASC biometric services appointment and providing his and/or her fingerprints, photograph, and/or
signature, he and/or she will be reaffirming 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 10. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing
this Application, If Other Than the Applicant and/or Spouse
If you and/or your spouse (if married) used a preparer to complete this application, the preparer must provide the following information:

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)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-600A 02/01/15 N

Postal Code

ZIP Code

Country

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Part 10. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing
this Application, If Other Than the Applicant and/or Spouse (continued)
Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5. Preparer's Fax Number (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/or the
applicant's spouse (if married) and with the applicant's and/or the applicant's spouse's consent.

7.B.

I am an attorney or accredited representative and my representation of the applicant and/or the applicant's spouse (if married) in
this case (choose one) extends
does not extend
beyond the preparation of this application.

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 and/or the applicant's spouse (if married). I completed this application based only on responses
the applicant and/or the applicant's spouse provided to me. After completing the application, I reviewed it and all of the applicant's and/or
the applicant's spouse's responses with the applicant and/or the applicant's spouse, who agreed with each and every answer on the
application. If the applicant and/or applicant's spouse supplied additional information concerning a question on the application, I recorded
it on the application. I also have read the Acknowledgement of Appointment at USCIS Application Support Center (ASC) (if
applicable) to the applicant and/or the applicant's spouse and the applicant and/or the applicant's spouse has informed me that he and/or
she understands the ASC Acknowledgement.

Preparer's Signature
8.

Preparer's Signature

Date of Signature
(mm/dd/yyyy) ►

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