Form G-1450 USCIS Electronic Payment Processing

Authorization for Credit Card Transactions

USCIS
Form G-1450

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

OMB No. 1615-0131
Expires 08/31/2018

What Is the Purpose of Form G-1450?
Use Form G-1450, Authorization for Credit Card Transactions, to pay the filing fee and biometric services fee (if applicable) by credit
card for an application, petition, or request that you are filing with a U.S. Citizenship and Immigration Services (USCIS) Lockbox.

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NOT FOR
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General Instructions

USCIS provides forms free of charge through the USCIS website. 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 Form G-1450 must be properly signed and filed. For all signatures on this form, USCIS will not accept a stamped or
typewritten name in place of a signature.
How To Fill Out Form G-1450
1.

Type or print legibly in black ink.

2.

Complete the "Applicant's/Petitioner's/Requester's Information," "Credit Card Billing Information," and "Credit Card
Information" sections and sign the authorization.

3.

Place your Form G-1450 ON TOP of your application, petition, or request package.

NOTE: Failure to provide the requested information may result in USCIS and your financial institution not accepting the payment.
USCIS cannot process credit card payments without an authorized signature.
NOTE: Form G-1450 may only be used with a form being submitted to a USCIS Lockbox. Do not submit this form to a USCIS
Field Office. They will not accept it.

Applicant's/Petitioner's/Requester's Information (Full Legal Name)
Given Name (First Name)

Middle Name (if any)

Family Name (Last Name)

Credit Card Billing Information (Credit Card Holder's Name as it Appears on the Card)
Given Name (First Name)

Middle Name (if any)

Family Name (Last Name)

Credit Card Holder's Billing Address:
Street Number and Name

Apt. Ste. Flr.

Number

State

ZIP Code

City or Town

Credit Card Holder's Signature and Contact Information:
Credit Card Holder's Signature
Credit Card Holder's Daytime Telephone Number

Credit Card Holder's Email Address

Credit Card Information
Credit Card Number

Credit Card Expiration Date
(mm/yyyy)
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Credit Card Type:

Visa

Authorized Payment Amount

MasterCard

$

.00

American Express
Discover
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We recommend that you print or save a copy of your completed Form G-1450 to review in the future and for your records.
Notice to Those Making Payment by Credit Card
If you submit Form G-1450, USCIS will use the information you provide to process a credit card payment through the U.S.
Department of Treasury Pay.gov Trusted Collections Service (TCS). TCS is a web-based application that allows Government
agencies to process payments by credit or debit cards.
After USCIS processes your Form G-1450, we will destroy your authorization, regardless if USCIS approves or denies your
application, petition, or request. USCIS will reject your application, petition, or request for lack of payment if your credit card is
declined. USCIS will not attempt to process your credit card payment a second time.

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NOT FOR
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DHS Privacy Notice

AUTHORITIES: The information requested on this form is collected pursuant to Section 286(m) of the Immigration and Nationality
Act, 8 U.S.C. 1356(m).
PURPOSE: The primary purpose for providing the requested information is to authorize the USCIS Lockbox to make an electronic
credit card payment in Pay.gov, which is owned and operated by the Department of Treasury, for the filing fee and biometric services
fee associated with a benefit request form. DHS processes your case when the payment is received in full.
DISCLOSURE: The information you provide is voluntary. However, failure to make a payment towards the associated benefit
request filing fee and biometric services fee may delay or prevent USCIS from accepting your benefit request form.
ROUTINE USES: DHS may share the information you provide on this form to USCIS personnel and contractors or other agents who
need the information to assist in activities related to processing associated fees. Additionally, USCIS may disclose the information to
other Federal, state, local and authorized organizations. DHS follows approved routine uses described in the associated published
system of records notices [DHS/USCIS/ICE/CBP-001 - Alien File, Index, and National File Tracking, DHS-USCIS-007 - Benefits
Information System] and published privacy impact assessments [DHS/USCIS/PIA-061 Benefit Request Intake Process], available at
www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national
security.

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 Office of Management and Budget (OMB) control number. The public reporting
burden for this collection of information is estimated at 7 minutes per response, including the time for reviewing instructions and
completing and submitting the authorization. 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 No. 1615-0131. Do not
mail your completed Form G-1450 to this address.

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