TABLE OF CHANGES – FORM
Form I-601, Application for Waiver of Grounds of Inadmissibility
OMB Number: 1615-0029
01/03/2017
Reason for Revision: Standard language revision, and inclusion of ELIS language. |
Current Page Number and Section |
Current Text |
Proposed Text |
Page 1, To be completed by an Attorney or Accredited
Representative (if any) |
[page 1]
To be completed by an Attorney or
Accredited Representative (if any)
START HERE – Type or print in black ink.
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To be completed by an Attorney or
Accredited Representative (if any).
START HERE – Type or print in black ink.
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Pages 1-2, Part 1. Information About You
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[page 1]
Part 1. Information About You
1. Alien Registration Number (A-Number) (if any)
2. USCIS ELIS Account Number (if any)
Your Full Name
3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name
Other Names Used
List all other names you have ever used, including maiden names, aliases, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name
Mailing Address
NOTE: If you are outside of the United States, provide a U.S. mailing address if available. If a U.S. mailing address is not available, provide your mailing address abroad.
5.a. In Care Of Name 5.b. Street Number and Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.f. ZIP Code 5.g. Province 5.h. Postal Code 5.i. Country
6. Is your mailing address the same address where you currently live (physical address)? Y/N
If your mailing address and the address where you currently live (physical address) are not the same, provide your current physical address in the next section.
[page 2]
Physical Address
7.a. Street Number and Name 7.b. Apt. Ste. Flr. 7.c. City or Town 7.d. State 7.e. ZIP Code 7.f. Province 7.g. Postal Code 7.h. Country
Other Information
8. U.S. Social Security Number (if any)
9. Gender M/F
10. Date of Birth (mm/dd/yyyy)
11. City or Town of Birth
12. Province of Birth (if applicable)
13. Country of Birth
14. Country of Citizenship or Nationality If you seek a visa and you were already interviewed by a U.S. Department of State (DOS) consular officer at a U.S. Embassy or U.S. Consulate, provide the information requested in Item Numbers 15.a. - 15.b.
15.a. DOS Consular Case Number (if available) 15.b. The location of the U.S. Embassy or U.S. Consulate where your visa application is being or will be made
City Country
16.a. Are you filing this application after you have already filed Form I-485, Application to Register Permanent Residence or Adjust Status? Y/N 16.b. If you answered “Yes” to Item Number 16.a., provide the USCIS Receipt Number for your Form I-485.
17.a. Are you filing this application after you have already filed Form I-821, Application for Temporary Protected Status? Y/N 17.b. If you answered “Yes” to Item Number 17.a., provide the USCIS Receipt Number for your Form I-821, if any.
18.a. Have you previously filed Form I-212, Application for Permission to Reapply for Admission into the United States After Deportation or Removal? Y/N 18.b. If you answered “Yes” to Item Number 18.a., provide the USCIS Receipt Number for your Form I-212, if any. 18.c. Where did you file your application (for example, USCIS Office, U.S. Port-of-Entry, Immigration Court)? 18.d. Date Filed (mm/dd/yyyy)
19. Are you submitting Form I-212 along with this application? Y/N
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Part 1. Information About You
1. Alien Registration Number (A-Number) (if any)
2. USCIS Online Account Number (if any)
Your Full Name
3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name
Other Names Used
List all other names you have ever used, including maiden names, aliases, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name
Mailing Address
NOTE: If you are outside of the United States, provide a U.S. mailing address if available. If a U.S. mailing address is not available, provide your mailing address outside the Unites States.
5.a. In Care Of Name 5.b. Street Number and Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.f. ZIP Code 5.g. Province 5.h. Postal Code 5.i. Country
6. Is your current physical address the same as your mailing address? Y/N
If you answered “No” to Item Number 6., provide your physical address in Item Numbers 7.a. – 7.h.
Physical Address
7.a. Street Number and Name 7.b. Apt. Ste. Flr. 7.c. City or Town 7.d. State 7.e. ZIP Code 7.f. Province 7.g. Postal Code 7.h. Country
Other Information
8. U.S. Social Security Number (if any)
9. Gender M/F
10. Date of Birth (mm/dd/yyyy)
11. City or Town of Birth
12. Province of Birth (if applicable)
13. Country of Birth
14. Country of Citizenship or Nationality If you seek a visa and you were already interviewed by a U.S. Department of State (DOS) consular officer at a U.S. Embassy or U.S. Consulate, provide the information requested in Item Numbers 15.a. - 15.b.
15.a. DOS Consular Case Number (if available) 15.b. The Location of the U.S. Embassy or U.S. Consulate Where Your Visa Application is Being or Will be Made
City Country
16.a. Are you filing this application after you have already filed Form I-485, Application to Register Permanent Residence or Adjust Status? Y/N 16.b. If you answered “Yes” to Item Number 16.a., provide the USCIS Receipt Number for your Form I-485.
17.a. Are you filing this application after you have already filed Form I-821, Application for Temporary Protected Status? Y/N 17.b. If you answered “Yes” to Item Number 17.a., provide the USCIS Receipt Number for your Form I-821, if any.
18.a. Have you previously filed Form I-212, Application for Permission to Reapply for Admission into the United States After Deportation or Removal? Y/N 18.b. If you answered “Yes” to Item Number 18.a., provide the USCIS Receipt Number for your Form I-212, if any. 18.c. Where did you file your application (for example, USCIS Office, U.S. Port-of-Entry, Immigration Court)? 18.d. Date Filed (mm/dd/yyyy)
19. Are you submitting Form I-212 along with this application? Y/N
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Pages 2-3, Part 2. U.S. Entry Information
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[page 2]
Part 2. U.S. Entry Information
Provide information for your previous periods of stay in the United States, beginning with your most recent arrival date.
NOTE: If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
1.a. Date you entered the U.S. (mm/dd/yyyy) 1.b. Immigration status at the time of your entry into the U.S. 1.c. Location at which you entered the U.S. 1.d. U.S. city or town where you lived
2.a. Date you entered the U.S. (mm/dd/yyyy) 2.b. Date you departed the U.S. (mm/dd/yyyy)
[page 3]
2.c. Immigration status at the time of your reentry into the U.S. 2.d. Location at which you entered the U.S. 2.e. U.S. city or town where you lived
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Part 2. U.S. Entry Information
Provide information for your previous periods of stay in the United States, beginning with your most recent arrival date.
NOTE: If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
1.a. Date You Entered the U.S. (mm/dd/yyyy) 1.b. Immigration Status At the Time of Your Entry Into the U.S. 1.c. Location at Which You Entered the U.S. 1.d. U.S. City or Town Where You Lived
2.a. Date You Entered the U.S. (mm/dd/yyyy) 2.b. Date You Departed the U.S. (mm/dd/yyyy)
2.c. Immigration Status At the Time of Your Reentry Into the U.S. 2.d. Location at Which You Entered the U.S. 2.e. U.S. City or Town Where You Lived
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Page 3, Part 3. Biographic Information (for USCIS Applicants only)
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[page 3]
Part 3. Biographic Information (for USCIS Applicants only)
1. Ethnicity (Select only one box)
2. Race (Select all
applicable boxes)
3. Height Feet Inches
4. Weight Pounds
5. Eye Color (Select only
one
box)
6. Hair Color (Select only
one box)
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Part 3. Biographic Information
1. Ethnicity (Select only one box)
2. Race (Select all
applicable
boxes)
3. Height Feet Inches
4. Weight Pounds
5. Eye Color (Select only
one
box)
6. Hair Color (Select only
one box)
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Pages 3-5, Part 4. Reasons for Inadmissibility
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[page 3]
Part 4. Reasons for Inadmissibility
Mark all of the following grounds that you believe, according to the best of your knowledge, or that you were told, apply to you. Only mark the applicable grounds listed under the immigration benefit you are seeking.
If you were ever arrested or convicted, provide the disposition (outcome) for all arrests or convictions (for example, dismissed from the appropriate authority). You also will be required to provide certified court records or dispositions for all convictions.
If you are seeking a waiver of inadmissibility because you have a Class A Tuberculosis condition (as defined by U.S. Department of Health and Human Services (HHS) regulations), you must complete Part 11. of this application.
If you are seeking a waiver of inadmissibility because you have a history of physical or mental disorders, you must attach the information requested in the instructions.
Section A
I am an applicant for an immigrant visa or adjustment of status (other than based on T nonimmigrant status or based on classification as a Special Immigrant Juvenile, see Section B below), or for K or V nonimmigrant status, and I believe or I was told that I am inadmissible because (review the form instructions for a detailed explanation of the individual grounds of inadmissibility listed below):
Select all grounds that you believe apply to you.
1. I have a communicable disease of public health significance. (A list of communicable diseases of public health significance can be found in the Specific Instructions section of the application instructions.)
2. I seek an exemption from the vaccination requirement because vaccinations are against my religious beliefs or moral convictions.
3. I have or had a physical or mental disorder and behavior (or history of behavior that is likely to recur) associated with the disorder, which has posed or may pose a threat to the property, safety, or welfare of myself or others.
4. I have been involved in a crime of moral turpitude (other than a purely political offense).
5. I have been involved in a controlled substance violation according to the laws and regulations of any state, the United States, or a foreign country related to a single offense of simple possession of 30 grams or less of marijuana.
6. I have been convicted of two or more offenses (other than purely political offenses), for which the combined sentences to confinement were five years or more.
7. I am coming to the U.S. to engage in prostitution or, in the past 10 years, I have engaged in prostitution (including receiving the proceeds of, in full or in part), procurement of prostitution, or I continue to engage in prostitution or procurement of prostitution.
8. In the past 10 years, I have (either directly or indirectly) procured, attempted to procure, or to import prostitutes or persons for the purpose of prostitution.
[page 4]
9. I came to the United States or I am coming to the United States to engage in any other unlawful commercialized vice whether or not it is related to prostitution.
10. I have been involved in serious criminal activity and have asserted immunity from prosecution.
11. I am or I have been a member of or affiliated with the Communist or any other totalitarian party (or subdivision or affiliate of the party), domestic or foreign.
12. I have sought to procure an immigration benefit by fraud or by concealing or misrepresenting a material fact (immigration fraud or misrepresentation).
13. I have been engaged in alien smuggling.
14. I am subject to a civil penalty because I was the subject of a final order for violation of the Immigration and Nationality Act (INA) section 274C.
15. I am subject to the 3-year or the 10-year bar to admissibility because I was previously unlawfully present in the United States in excess of either 180 days or one year or more, respectively, and subsequently departed the United States.
16. I was previously removed from the United States. (See instructions for Nicaraguan Adjustment and Central American Relief Act (NACARA) and Haitian Refugee Immigration Fairness Act (HRIFA) applicants only. All other applicants file Form I-212.)
17. I have been ordered removed or I have been unlawfully present in the United States for more than one year, in the aggregate, and I subsequently reentered or attempted to reenter without being admitted. (See instructions for NACARA, HRIFA, and the instructions for approved Violence Against Women Act (VAWA) self-petitioners only. Other applicants file Form I-212.)
18. Other (specify):
Section B
I am applying for adjustment of status based on a valid T nonimmigrant status or based on classification as a Special Immigrant Juvenile and I believe or I was told that I am inadmissible because:
19. Specify (Review the application instructions for a detailed explanation of the individual grounds of inadmissibility related to your application.)
Section C
I am applying for TPS and I believe or I was told that I am inadmissible because:
Select all grounds that you believe, according to the best of your knowledge, or that you were told apply to you.
20. I have a communicable disease of public health significance. (A list of communicable diseases of public health significance can be found in the Specific Instructions section of the application instructions.)
21. I have or had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder, which has posed or may pose a threat to the property, safety, or welfare of myself or others.
22. I am or have been a drug abuser or drug addict as described in U.S. Department of Health and Human Services (HHS) Regulations. See 42 CFR Part 34.
23. I have been involved in a controlled substance violation according to the laws and regulations of any state, the United States, or a foreign country related to a single offense of simple possession of 30 grams or less of marijuana.
24. I am coming to the U.S. to engage in prostitution or, in the past 10 years, I have engaged in prostitution (including receiving the proceeds of, in full or in part), procurement of prostitution, or I continue to engage in prostitution or procurement of prostitution.
25. In the past 10 years, I have (either directly or indirectly), procured, attempted to procure, or to import prostitutes or persons for the purpose of prostitution.
26. I came to the United States or I am coming to the United States to engage in any other unlawful commercialized vice, whether or not it is related to prostitution.
27. I have been involved in serious criminal activity and have asserted immunity from prosecution.
28. I did not attend or did not remain at a removal proceeding to determine my inadmissibility or deportability.
[page 5]
29. I have sought to procure an immigration benefit by fraud or by concealing or misrepresenting a material fact (immigration fraud or misrepresentation).
30. I falsely represented myself as a U.S. citizen.
31. I have been engaged in alien smuggling.
32. I am subject to a civil penalty because I have been the subject of a final order for violation of INA section 274C.
33. I am ineligible for U.S. citizenship because I departed from or remained outside the United States to avoid or evade training or service in the armed forces in a time of war or national emergency.
34. I have practiced polygamy since I entered the United States or I intend to practice polygamy in the United States.
35. I am accompanying another alien who is inadmissible after being certified to be helpless under INA section 232(c) and I am inadmissible because that other alien requires my protection or guardianship.
36. I have detained, retained, or withheld the custody of a child having a lawful claim to U.S. citizenship, outside the United States, from a person granted custody.
37. I was an unlawful voter who voted in violation of a Federal, state, or local constitutional provision, statute, ordinance, or regulation.
38. I am a former U.S. citizen who renounced my citizenship in order to avoid taxation by the United States.
39. Other (specify):
Your Inadmissibility Statement
In the space provided in Item Number 40., provide a statement and a full explanation of the acts, convictions, and/or medical conditions that you believe make you inadmissible.
Your statement must indicate when you engaged in the acts that you believe make you inadmissible, the date of all convictions, or the date of any medical diagnosis. You must provide this information even if the information is also in the documents that you submit with your application.
If you need extra space to complete your statement, use the space provided in Part 10. Additional Information or attach a separate letter. If you include separate letter, indicate in Item Number 39. that you are attaching a letter.
40. [space]
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Part 4. Reasons for Inadmissibility
Select all of the following grounds that you believe, according to the best of your knowledge, or that you were told, apply to you. Only select the applicable grounds listed under the immigration benefit you are seeking.
If you were ever arrested or convicted, provide the disposition (outcome) for all arrests or convictions (for example, dismissed from the appropriate authority). You also will be required to provide certified court records or dispositions for all convictions.
If you are seeking a waiver of inadmissibility because you have a Class A Tuberculosis condition (as defined by U.S. Department of Health and Human Services (HHS) regulations), you must complete Part 11. of this application.
If you are seeking a waiver of inadmissibility because you have a history of physical or mental disorders, you must attach the information requested in the instructions.
Section A
I am an applicant for an immigrant visa or adjustment of status (other than based on T nonimmigrant status or based on classification as a Special Immigrant Juvenile, see Section B below), or for K or V nonimmigrant status, and I believe or I was told that I am inadmissible because (review Form I-601 Instructions for a detailed explanation of the individual grounds of inadmissibility listed below):
Select all grounds that you believe apply to you.
1. I have a communicable disease of public health significance. (A list of communicable diseases of public health significance can be found in the Specific Instructions section of Form I-601 Instructions.)
2. I seek an exemption from the vaccination requirement because vaccinations are against my religious beliefs or moral convictions.
3. I have or had a physical or mental disorder and behavior (or history of behavior that is likely to recur) associated with the disorder, which has posed or may pose a threat to the property, safety, or welfare of myself or others.
4. I have been involved in a crime of moral turpitude (other than a purely political offense.)
5. I have been involved in a controlled substance violation according to the laws and regulations of any state, the United States, or a foreign country related to a single offense of simple possession of 30 grams or less of marijuana.
6. I have been convicted of two or more offenses (other than purely political offenses,) for which the combined sentences to confinement were five years or more.
7. I am coming to the U.S. to engage in prostitution or, in the past 10 years, I have engaged in prostitution (including receiving the proceeds of, in full or in part,) procurement of prostitution, or I continue to engage in prostitution or procurement of prostitution.
8. In the past 10 years, I have (either directly or indirectly) procured, attempted to procure, or to import prostitutes or persons for the purpose of prostitution.
9. I came to the United States or I am coming to the United States to engage in any other unlawful commercialized vice whether or not it is related to prostitution.
10. I have been involved in serious criminal activity and have asserted immunity from prosecution.
11. I am or I have been a member of or affiliated with the Communist or any other totalitarian party (or subdivision or affiliate of the party,) domestic or foreign.
12. I have sought to procure an immigration benefit by fraud or by concealing or misrepresenting a material fact (immigration fraud or misrepresentation.)
13. I have been engaged in alien smuggling.
14. I am subject to a civil penalty because I was the subject of a final order for violation of the Immigration and Nationality Act (INA) section 274C.
15. I am subject to the 3-year or the 10-year bar to admissibility because I was previously unlawfully present in the United States in excess of either 180 days or one year or more, respectively, and subsequently departed the United States.
16. I was previously removed from the United States. (See instructions for Nicaraguan Adjustment and Central American Relief Act (NACARA) and Haitian Refugee Immigration Fairness Act (HRIFA) applicants only. All other applicants file Form I-212.)
17. I have been ordered removed or I have been unlawfully present in the United States for more than one year, in the aggregate, and I subsequently reentered or attempted to reenter without being admitted. (See instructions for NACARA, HRIFA, and the instructions for approved Violence Against Women Act (VAWA) self-petitioners only. Other applicants file Form I-212.)
18. Other (specify):
Section B
I am applying for adjustment of status based on a valid T nonimmigrant status or based on classification as a Special Immigrant Juvenile and I believe or I was told that I am inadmissible because:
19. Specify (Review Form I-601 Instructions for a detailed explanation of the individual grounds of inadmissibility related to your Form I-601.)
Section C
I am applying for TPS and I believe or I was told that I am inadmissible because:
Select all grounds that you believe, according to the best of your knowledge, or that you were told apply to you.
20. I have a communicable disease of public health significance. (A list of communicable diseases of public health significance can be found in the Specific Instructions section of Form I-601 Instructions.)
21. I have or had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder, which has posed or may pose a threat to the property, safety, or welfare of myself or others.
22. I am or have been a drug abuser or drug addict as described in U.S. Department of Health and Human Services (HHS) Regulations. See 42 CFR Part 34.
23. I have been involved in a controlled substance violation according to the laws and regulations of any state, the United States, or a foreign country related to a single offense of simple possession of 30 grams or less of marijuana.
24. I am coming to the U.S. to engage in prostitution or, in the past 10 years, I have engaged in prostitution (including receiving the proceeds of, in full or in part,) procurement of prostitution, or I continue to engage in prostitution or procurement of prostitution.
25. In the past 10 years, I have (either directly or indirectly,) procured, attempted to procure, or to import prostitutes or persons for the purpose of prostitution.
26. I came to the United States or I am coming to the United States to engage in any other unlawful commercialized vice, whether or not it is related to prostitution.
27. I have been involved in serious criminal activity and have asserted immunity from prosecution.
28. I did not attend or did not remain at a removal proceeding to determine my inadmissibility or deportability.
29. I have sought to procure an immigration benefit by fraud or by concealing or misrepresenting a material fact (immigration fraud or misrepresentation).
30. I falsely represented myself as a U.S. citizen.
31. I have been engaged in alien smuggling.
32. I am subject to a civil penalty because I have been the subject of a final order for violation of INA section 274C.
33. I am ineligible for U.S. citizenship because I departed from or remained outside the United States to avoid or evade training or service in the armed forces in a time of war or national emergency.
34. I have practiced polygamy since I entered the United States or I intend to practice polygamy in the United States.
35. I am accompanying another alien who is inadmissible after being certified to be helpless under INA section 232(c) and I am inadmissible because that other alien requires my protection or guardianship.
36. I have detained, retained, or withheld the custody of a child having a lawful claim to U.S. citizenship, outside the United States, from a person granted custody.
37. I was an unlawful voter who voted in violation of a Federal, state, or local constitutional provision, statute, ordinance, or regulation.
38. I am a former U.S. citizen who renounced my citizenship in order to avoid taxation by the United States.
39. Other (specify):
Your Inadmissibility Statement
In the space provided in Item Number 40., provide a statement and a full explanation of the acts, convictions, and/or medical conditions that you believe make you inadmissible.
Your statement must indicate when you engaged in the acts that you believe make you inadmissible, the date of all convictions, or the date of any medical diagnosis. You must provide this information even if the information is also in the documents that you submit with your application.
If you need extra space to complete your statement, use the space provided in Part 10. Additional Information or attach a separate letter. If you include separate letter, indicate in Item Number 39. that you are attaching a letter.
40. [space]
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Page 6, Part 5. Information About Your Qualifying Relatives
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[page 6]
Part 5. Information About Your Qualifying Relatives
Provide information for your U.S. citizen, lawful permanent resident through whom you are eligible to submit this application. In Item Number 9., provide a statement explaining the extreme hardship that you or your qualifying relative (U.S. citizen, lawful permanent resident, or other qualified parent or child) has or will experience if you are refused the immigration benefit you are seeking.
Select here if you are a VAWA self-petitioner and would like to claim extreme hardship to yourself. (If you are only claiming extreme hardship for yourself, you can skip to Item Number 9. If you have additional qualifying relatives to whom you would like to claim extreme hardship, provide their information below.)
Relative’s Full Name
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
Physical Address
2.a. Street Number and Name 2.b. Apt. Ste. Flr. 2.c. City or Town 2.d. State 2.e. ZIP Code 2.f. Province 2.g. Postal Code 2.h. Country
Contact Information
3. Daytime Telephone Number (if any) 4. Email Address (if any)
Other Information
5. What is your relative’s relationship to you?
6. What is your relative’s immigration status?
7. Relative’s A-Number (if any)
8. Date of Birth (mm/dd/yyyy)
Select this box if you have additional relatives through whom you claim eligibility and go to Part 10. Additional Information to provide the same information as requested in Part 5., Item Numbers 1.a. - 8.
Statement from Applicant (Extreme Hardship)
In the space provided below, explain the extreme hardship that your qualifying relative (or yourself if you are a VAWA self-petitioner) would experience if you are refused the immigration benefit you are seeking. For more information on extreme hardship, see the application instructions. If you need extra space to complete you statement, use the space provided in Part 10. Additional Information or attach a separate letter. Indicate in Item Number 9. if you are attaching a separate letter. The letter must be submitted at the same time as your Form I-601 application.
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Part 5. Information About Your Qualifying Relatives
Provide information for your U.S. citizen, lawful permanent resident through whom you are eligible to submit this application. In Item Number 9., provide a statement explaining the extreme hardship that you or your qualifying relative (U.S. citizen, lawful permanent resident, or other qualified parent or child) has or will experience if you are refused the immigration benefit you are seeking. It is not necessary for an SIJ to complete Part 5. of the application.
Select here if you are a VAWA self-petitioner and would like to claim extreme hardship to yourself. (If you are only claiming extreme hardship for yourself, you can skip to Item Number 9. If you have additional qualifying relatives to whom you would like to claim extreme hardship, provide their information below.)
Relative’s Full Name
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
Physical Address
2.a. Street Number and Name 2.b. Apt. Ste. Flr. 2.c. City or Town 2.d. State 2.e. ZIP Code 2.f. Province 2.g. Postal Code 2.h. Country
Contact Information
3. Daytime Telephone Number (if any) 4. Email Address (if any)
Other Information
5. What is your relative’s relationship to you?
6. What is your relative’s immigration status?
7. Relative’s A-Number (if any)
8. Date of Birth (mm/dd/yyyy)
Select this box if you have additional relatives through whom you claim eligibility and use the space provided in Part 10. Additional Information to provide the same information as requested in Part 5., Item Numbers 1.a. - 8.
Statement From Applicant (Extreme Hardship)
In the space provided below, explain the extreme hardship that your qualifying relative (or yourself if you are a VAWA self-petitioner) would experience if you are refused the immigration benefit you are seeking. For more information on extreme hardship, see Form I-601 Instructions. If you need extra space to complete your statement, use the space provided in Part 10. Additional Information or attach a separate letter. Indicate in Item Number 9. if you are attaching a separate letter. The letter must be submitted at the same time as your Form I-601 application.
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Pages 6-7, Part 6. Information About Your Other Relatives with Ties to the United States
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[page 6]
Part 6. Information About Your Other Relatives with Ties to the United States
Provide information for any other U.S. citizen, lawful permanent resident, or any other family members you would like considered in deciding your case. In the space provided in Item Number 9., include a statement explaining why you believe your application should be approved as a matter of discretion, with the favorable factors outweighing the unfavorable factors in your case.
Relative’s Full Name
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
[page 7]
Physical Address
2.a. Street Number and Name 2.b. Apt. Ste. Flr. 2.c. City or Town 2.d. State 2.e. ZIP Code 2.f. Province 2.g. Postal Code 2.h. Country
Contact Information
3. Daytime Telephone Number (if any)
4. Email Address (if any)
Other Information
5. What is your relative’s relationship to you?
6. What is your relative’s immigration status?
7. Relative’s A-Number (if any)
8. Date of Birth (mm/dd/yyyy)
Select this box if you have any other relatives with ties to the United States and go to Part 10. Additional Information to provide the same information as requested in Part 6., Item Numbers 1.a. - 8.
Statement from Applicant (Discretion)
In the space provided below, explain why you believe your application should be approved as a matter of discretion, with the favorable outweighing the unfavorable factors in your case. For more information on discretion, see the application instructions. If you need extra space to complete you statement, use the space provided in Part 10. Additional Information or attach a separate letter. Indicate in Item Number 9. if you are attaching a separate letter. The letter must be submitted at the same time as your Form I-601 application.
9. [space]
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Part 6. Information About Your Other Relatives With Ties to the United States
Provide information for any other U.S. citizen, lawful permanent resident, or any other family members you would like considered in deciding your case. In the space provided in Item Number 9., include a statement explaining why you believe your application should be approved as a matter of discretion, with the favorable factors outweighing the unfavorable factors in your case.
Relative’s Full Name
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
Physical Address
2.a. Street Number and Name 2.b. Apt. Ste. Flr. 2.c. City or Town 2.d. State 2.e. ZIP Code 2.f. Province 2.g. Postal Code 2.h. Country
Contact Information
3. Daytime Telephone Number (if any)
4. Email Address (if any)
Other Information
5. What is your relative’s relationship to you?
6. What is your relative’s immigration status?
7. Relative’s A-Number (if any)
8. Date of Birth (mm/dd/yyyy)
Select this box if you have any other relatives with ties to the United States and use the space provided in Part 10. Additional Information to provide the same information as requested in Part 6., Item Numbers 1.a. - 8.
Statement From Applicant (Discretion)
In the space provided below, explain why you believe your application should be approved as a matter of discretion, with the favorable outweighing the unfavorable factors in your case. For more information on discretion, see Form I-601 Instructions. If you need extra space to complete your statement, use the space provided in Part 10. Additional Information or attach a separate letter. Indicate in Item Number 9. if you are attaching a separate letter. The letter must be submitted at the same time as your Form I-601 application.
9. [space]
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Page 7-8, Part 7. Applicant’s Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature
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[page 7]
Part 7. Applicant’s Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature
NOTE: Read the information on penalties in the Penalties section of the Form I-601 Instructions before completing this part.
Applicant’s Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
1.a. I can read and understand English, and have read and understand every question and instruction on this application, as well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS Application Support Center.
1.b. The interpreter named in Part 8. has also read to me every question and instruction on this application, as well as my answer to every question, in [Fillable Field], a language in which I am fluent. I understand every question and instruction on this application as translated to me by my interpreter, and have provided complete, true, and correct responses in the language indicated above. The interpreter named in Part 8. has also read the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter.
[page 8]
2. I have requested the services of and consented to, [Fillable Field], who is/is not an attorney or accredited representative, preparing this application for me. This person who assisted me in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center with me, and I understand the ASC Acknowledgement.
Applicant’s Contact Information
3. Applicant’s Daytime Telephone Number
4. Applicant’s Mobile Telephone Number (if any)
5. Applicant’s Email Address (if any)
Acknowledgement of Appointment at USCIS Application Support Center
I [Auto-populated Field], understand that the purpose of a USCIS ASC appointment is for me to provide fingerprints, photograph, and/or signature and to re-affirm that all of the information in my application is complete, true, and correct and was provided by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC appointment.
By signing here, I declare under penalty of perjury that I have reviewed and understand my application, as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct.
I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center with me.
Applicant’s Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the adjudicating agency may require that I submit original documents to USCIS or the adjudicating agency at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS or the agency adjudicating my application may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that the information in my application and any document submitted with my application were provided by me and are complete, true, and correct.
Applicant’s Signature
6.a. Applicant’s Signature 6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the instructions, USCIS or the adjudicating agency may deny your application.
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Part 7. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
NOTE: Read the Penalties section of the Form I-601 Instructions before completing this part. You must file Form I-601 while in the United States.
Applicant’s Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
1.a. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.
1.b. The interpreter named in Part 8. read to me every question and instruction on this application and my answer to every question, in [Fillable Field], a language in which I am fluent, and I understood everything.
2. At my request, the preparer named in Part 9., [Fillable Filed], prepared this application for me based only upon information I provided or authorized.
Applicant’s Contact Information
3. Applicant’s Daytime Telephone Number
4. Applicant’s Mobile Telephone Number (if any)
5. Applicant’s Email Address (if any)
[deleted]
Applicant’s Declaration and Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information contained in, and submitted with, my application; and 2) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my application and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my application and that all of this information is complete, true, and correct.
Applicant’s Signature
6.a. Applicant’s Signature 6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.
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Pages 8-9, Part 8. Interpreter’s Contact Information , Certification, and Signature
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[page 8]
Part 8. Interpreter’s Contact Information, Certification, and Signature
Provide the following information about the interpreter:
Interpreter’s Full Name
1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name)
2. Interpreter's Business or Organization Name (if any)
[page 9]
Interpreter’s Mailing Address
3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country
Interpreter’s Contact Information
4. Interpreter's Daytime Telephone Number
5. Interpreter’s Email Address (if any)
Interpreter’s Certification
I certify that:
I am fluent in English and [Fillable Field], which is the same language provided in Part 7., Item Number 1.b.; and
I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language provided in Part 7., Item Number 1.b.
I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant in the same language provided in Part 7., Item Number 1.b.;
The applicant has informed me that he or she understands every instruction and question on the application, as well as the answer to every question, and the applicant verified the accuracy of every answer; and
The applicant has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the contents of this application and all supporting documentation are complete, true, and correct.
Interpreter’s Signature
6.a. Interpreter's Signature 6.b. Date of Signature (mm/dd/yyyy)
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Part 8. Interpreter’s Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter’s Full Name
1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name)
2. Interpreter's Business or Organization Name (if any)
Interpreter’s Mailing Address
3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country
Interpreter’s Contact Information
4. Interpreter's Daytime Telephone Number
5. Interpreter’s Mobile Telephone Number (if any)
6. Interpreter’s Email Address (if any)
Interpreter’s Certification
I certify, under penalty of perjury, that:
I am fluent in English and [Fillable Field], which is the same language specified in Part 7., Item Number 1.b., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant’s Declaration and Certification, and has verified the accuracy of every answer.
Interpreter’s Signature
7.a. Interpreter's Signature 7.b. Date of Signature (mm/dd/yyyy)
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Pages 9-10, Part 9. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If Other Than the Applicant
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[page 9]
Part 9. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If Other Than the Applicant
Provide the following information about the preparer:
Preparer’s Full Name
1.a. Preparer’s Family Name (Last Name) 1.b. Preparer’s Given Name (First Name)
2. Preparer’s Business or Organization Name (if any)
Preparer’s Mailing Address
3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country
Preparer’s Contact Information
4. Preparer’s Daytime Telephone Number
5. Preparer’s Fax Number
6. Preparer’s Email Address (if any)
[page 10]
Preparer’s Statement
7.a. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant’s consent.
7.b. I am an attorney or accredited representative and my representation of the applicant in this case extends/does not extend beyond the preparation of this application.
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you must submit a completed Form G-28, Notice of Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance as Attorney in Matters Outside the Geographical Confines of the United States, with 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. I completed this application based only on responses the applicant provided to me. After completing the application, I reviewed it and all of the applicant’s responses with the applicant, who agreed with every answer on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and the applicant has informed me that he or she understands the ASC Acknowledgement.
Preparer’s Signature
8.a. Preparer's Signature 8.b. Date of Signature (mm/dd/yyyy)
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Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant
Provide the following information about the preparer.
Preparer’s Full Name
1.a. Preparer’s Family Name (Last Name) 1.b. Preparer’s Given Name (First Name)
2. Preparer’s Business or Organization Name (if any)
Preparer’s Mailing Address
3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country
Preparer’s Contact Information
4. Preparer’s Daytime Telephone Number
5. Preparer’s Mobile Telephone Number (if any)
6. Preparer’s Email Address (if any)
Preparer’s Statement
7.a. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant’s consent.
7.b. I am an attorney or accredited representative and my representation of the applicant in this case extends/does not extend beyond the preparation of this application.
NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance as Attorney in Matters Outside the Geographical Confines of the United States, with this application.
Preparer’s Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant’s Declaration and Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
Preparer’s Signature
8.a. Preparer's Signature 8.b. Date of Signature (mm/dd/yyyy)
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Page 11, Part 10. Additional Information
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[page 11]
Part 10. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
2. A-Number
3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. [Narrative space]
4.a. Page Number 4.b. Part Number 4.c. Item Number 4.d. [Narrative space]
5.a. Page Number 5.b. Part Number 5.c. Item Number 5.d. [Narrative space]
6.a. Page Number 6.b. Part Number 6.c. Item Number 6.d. [Narrative space]
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Part 10. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. 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.
1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name
2. A-Number (if any)
3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. [Narrative space]
4.a. Page Number 4.b. Part Number 4.c. Item Number 4.d. [Narrative space]
5.a. Page Number 5.b. Part Number 5.c. Item Number 5.d. [Narrative space]
6.a. Page Number 6.b. Part Number 6.c. Item Number 6.d. [Narrative space]
7.a. Page Number 7.b. Part Number 7.c. Item Number 7.d. [Narrative space]
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Pages 12-13, Part 11. Statement for Applicants With a Class A Tuberculosis Condition (As Defined By HHS Regulations)
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[page 12]
Part 11. Statement for Applicants With a Class A Tuberculosis Condition (As Defined By HHS Regulations)
To be completed for applicants with a Class A Tuberculosis Condition (as defined by HHS Regulations).
Statement by Applicant
Upon admission to the United States, I will go directly to the health department named in the section below; present all X-rays used in the visa medical examination to substantiate diagnosis; submit to such examinations, treatment, isolation, and medical regimen as may be required; and remain under the prescribed treatment or observation, whether on an inpatient or outpatient basis, until discharged.
1.a. Signature of Applicant 1.b. Date of Signature (mm/dd/yyyy)
Statement by Local (City or County) Health Department
NOTE: The physician at the local health department in the area where the alien plans to reside should complete this statement.
I agree to supply any treatment or observation necessary for the proper management and continued care of the alien's tuberculosis condition.
Within 30 days of the alien reporting for care, I agree to submit a summary of my initial evaluation of the alien’s condition, indicate presumptive diagnosis, and provide test results and plans for future care of the alien to the State Health Department Official named in the Endorsement of State Health Department Official section and to the Division of Global Migration and Quarantine (E03), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333.
I also agree to report the alien if the alien has not reported within 30 days after receiving notice from the Division of Global Migration and Quarantine, CDC.
Satisfactory financial arrangements have been made. (This statement does not relieve the alien from submitting evidence, as required by a U.S. Consulate, to establish that the alien is not likely to become a public charge.)
I represent (select the appropriate box and give the complete name, address, certification, and contact information of the health department):
2.a. City Health Department 2.b. County Health Department 3. Name of Health Department
Physical Address
4.a. Street Number and Name 4.b. Apt. Ste. Flr. 4.c. City or Town 4.d. State 4.e. ZIP Code
Physician’s Certification
5.a. Signature of Physician 5.b. Date of Signature (mm/dd/yyyy) 5.c. Physician’s Family Name (Last Name) 5.d. Physician’s Given Name (First Name)
Physician’s Contact Information
6. Daytime Telephone Number 7. Email Address (if any)
Arrangement for Medical Care by the Applicant or His or Her Sponsor
Arrange for medical care (of the applicant) and have the appropriate health departments complete Statement by Local (City or County) Health Department and Endorsement of State Health Department Official sections.
Provide the following information:
Address where you (the sponsor) or the applicant plan to reside in the United States:
8.a. Street Number and Name 8.b. Apt. Ste. Flr. 8.c. City or Town 8.d. State 8.e. ZIP Code
[page 13]
Endorsement of State Health Department Official
NOTE: The State Health Department Official in the area where the applicant plans to reside should complete this statement.
Endorsement signifies recognition of the local health department that completed the Statement by Local (City or County) Health Department section for the purpose of providing care and treatment of the applicant's tuberculosis condition, and that the local health department is within your jurisdiction. Endorsement also signifies recognition that the applicant will be residing within your state's health jurisdiction.
Endorsed by:
9.a. Signature of State Health Department Official 9.b. Date of Signature (mm/dd/yyyy)
10. Name of State Health Department
Physical Address
11.a. Street Number and Name 11.b. Apt. Ste. Flr. 11.c. City or Town 11.d. State 11.e. ZIP Code
Contact Information
12. Daytime Telephone Number
13. Email Address (if any)
NOTE to the Applicant and his or her Sponsor: If you need assistance, contact USCIS at the National Customer Service Center at 1-800-375-5283. You may also schedule an appointment at the local USCIS office through InfoPass (available through the USCIS Web site at www.uscis.gov).
NOTE to the Applicant: If you are approved for a waiver and after admission to the United States, you fail to comply with the terms, conditions, and controls that were imposed with the grant of the waiver, you may be subject to removal under INA section 237(a).
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Part 11. Statement for Applicants With a Class A Tuberculosis Condition (As Defined By HHS Regulations)
To be completed for applicants with a Class A Tuberculosis Condition (as defined by HHS Regulations).
Statement by Applicant
Upon admission to the United States, I will go directly to the health department named in the section below; present all X-rays used in the visa medical examination to substantiate diagnosis; submit to such examinations, treatment, isolation, and medical regimen as may be required; and remain under the prescribed treatment or observation, whether on an inpatient or outpatient basis, until discharged.
1.a. Signature of Applicant 1.b. Date of Signature (mm/dd/yyyy)
Statement by Local (City or County) Health Department
NOTE: The physician at the local health department in the area where the alien plans to reside should complete this statement.
I agree to supply any treatment or observation necessary for the proper management and continued care of the alien's tuberculosis condition.
Within 30 days of the alien reporting for care, I agree to submit a summary of my initial evaluation of the alien’s condition, indicate presumptive diagnosis, and provide test results and plans for future care of the alien to the State Health Department Official named in the Endorsement of State Health Department Official section and to the Division of Global Migration and Quarantine (E03), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333.
I also agree to report the alien if the alien has not reported within 30 days after receiving notice from the Division of Global Migration and Quarantine, CDC.
Satisfactory financial arrangements have been made. (This statement does not relieve the alien from submitting evidence, as required by a U.S. Consulate, to establish that the alien is not likely to become a public charge.)
I represent (select the appropriate box and provide the complete name, address, certification, and contact information of the health department):
2.a. City Health Department 2.b. County Health Department 3. Name of Health Department
Physical Address
4.a. Street Number and Name 4.b. Apt. Ste. Flr. 4.c. City or Town 4.d. State 4.e. ZIP Code
Physician’s Certification
5.a. Signature of Physician 5.b. Date of Signature (mm/dd/yyyy) 5.c. Physician’s Family Name (Last Name) 5.d. Physician’s Given Name (First Name)
Physician’s Contact Information
6. Daytime Telephone Number 7. Email Address (if any)
Arrangement for Medical Care by the Applicant or His or Her Sponsor
Arrange for medical care (of the applicant) and have the appropriate health departments complete Statement by Local (City or County) Health Department and Endorsement of State Health Department Official sections.
Provide the following information:
Address where you (the sponsor) or the applicant plan to reside in the United States:
8.a. Street Number and Name 8.b. Apt. Ste. Flr. 8.c. City or Town 8.d. State 8.e. ZIP Code
Endorsement of State Health Department Official
NOTE: The State Health Department Official in the area where the applicant plans to reside should complete this statement.
Endorsement signifies recognition of the local health department that completed the Statement by Local (City or County) Health Department section for the purpose of providing care and treatment of the applicant's tuberculosis condition, and that the local health department is within your jurisdiction. Endorsement also signifies recognition that the applicant will be residing within your state's health jurisdiction.
Endorsed by:
9.a. Signature of State Health Department Official 9.b. Date of Signature (mm/dd/yyyy)
10. Name of State Health Department
Physical Address
11.a. Street Number and Name 11.b. Apt. Ste. Flr. 11.c. City or Town 11.d. State 11.e. ZIP Code
Contact Information
12. Daytime Telephone Number
13. Email Address (if any)
NOTE to the Applicant and his or her Sponsor: If you need assistance, contact USCIS at the National Customer Service Center at 1-800-375-5283. You may also schedule an online at www.uscis.gov. Select “Schedule an Appointment” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.
NOTE to the Applicant: If you are approved for a waiver and after admission to the United States, you fail to comply with the terms, conditions, and controls that were imposed with the grant of the waiver, you may be subject to removal under INA section 237(a).
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | TABLE OF CHANGE – FORM I-687 |
| Author | jdimpera |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |