Form DS-4298 REQUEST BY NON-PIDDED PERSONS FOR NON-ELIGIBILITY LETTER

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INSTRUCTIONS FOR COMPLETEING FORM DS-4298,
REQUEST FOR NON-ELIGIBILITY LETTER BY NON-ACCREDITED
OR TERMINATED PERSONNEL
Please read all instructions before completing this form.
This form is to be completed for all non-accredited or terminated foreign missions personnel requesting a non-eligibility
letter. Only personnel holding a US Visa in A or G status may apply for a non-eligibility letter. All questions on this form
should be answered completely and accurately.
NON-ACCREDITED PERSONNEL
All non-eligibility letter requests must be submitted by the individual's US sponsoring organization, not by the individual.
In addition to this form, all such requests must include the following:
• An endorsement letter from the United States Government organization, agency, military division, or
sponsoring entity to which the individual is assigned. This endorsement letter should be on the
organization's official letterhead and include the applicant's full name, date and place of birth, citizenship,
complete residential address, beginning and end tour of duty dates in MM/DD/YYYY format, his/her
personal email address, and visa foil number.
• A scanned copy of the applicant's US Visa. Only visas in A or G status are accepted.
• A scanned copy of the applicant's most recent Customs and Border Protection Form I-94.
TERMINATED PERSONNEL
In addition to this form, any individual requesting a non-eligibility letter who is in a terminated status must provide the
following:
• If adjusting within the A or G visa categories - a copy of a Department of State-endorsed I-566.
• If adjusting to any other status - a copy of DHS Form I-797C "Notice of Action" indicating that the
Department of Homeland Security has accepted and is processing the visa change request.
• A scanned copy of the applicant's US Visa. Only visas in A or G status are accepted.
• A scanned copy of the applicant's most recent Customs and Border Protection Form I-94.
NOTE: It is important that all information provided to the Office of Foreign Missions be consistent. Discrepancies, such
as the spelling of the name, residential address, date of birth, etc., may delay processing a non-eligibility letter request.
The instructions below are numbered to correspond to the numbered items on the form. All dates should be in
MM/DD/YYYY format. Please type all answers.
1. Enter the applicant's full name as it appears on the US Visa: (a) surname; (b) given name.
2. Enter the applicant's date of birth.
3. Enter the applicant's personal email address. If the applicant is a dependent, the email address may
belong to the principal.
4. Select male or female from the drop down list to indicate the applicant's gender.
5. Enter the US residential address where the applicant currently resides.
6. (a) Enter the visa foil number exactly as it appears on the US visa. This 8-digit alphanumeric
number is located on the right side of the US visa written in red. (b) Enter the visa expiration date.
7. Select applicant's present nationality from the drop down list.
8. (a) Select the type of US visa held in the applicant's passport from the drop down list. (b) Enter the
I-94 Admission Record Number. (c) Enter the arrival date listed on the most recent I-94 form.
(d) Enter the I-94 Admit Until Date; if the I-94 notes D/S next to this date, please leave this field blank.
9. Enter beginning and end tour of duty dates.

Submit Form DS-4298 and all supporting documents to [email protected].
DS-4298
03-2018

Instruction page 1 of 1

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OMB APPROVAL NO. 1405-XXXX
EXPIRATION DATE: XX-XX-20XX
ESTIMATED BURDEN: 5 Minutes

U.S. Department of State

REQUEST BY NON-PIDDED PERSONS FOR NON-ELIGIBILITY LETTER
1a. Surname

2. Date of Birth (MM/DD/YYYY)

1b. Given Name

3. Email Address

4. Gender

5a. Street Number 5b. Street Name

5c. Street Type

5g. City

5h. State

6a. Visa Foil Number

8a. I-94 Classification Type

9a. Duty Start Date

5d. Quadrant

6b. Visa Expiration Date

8b. I-94 Number

5e. Unit Type

5f. Unit Number

5i. Zip Code

7. Citizenship

8c. I-94 Arrival Date

8d. I-94 Admit Until Date (leave blank for (D/S))

9b. Duty End Date

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 5 minutes per
response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or
documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB
control number. If you have comments on the accuracy of this burden estimate and/or recommendation for reducing it, please send them to: The
Office of Foreign Missions, 3507 International Pl. NW Washington, DC 20008
DS-4298
03-2018