DHS Form 7001 Citizenship and Immigration Services OMBudsman

12/31/2017

The Office of the Citizenship and Immigration Services Ombudsman (Ombudsman’s Office) assists individuals and employers who are unable to resolve problems directly with U.S. Citizenship
and Immigration Services (USCIS). To receive assistance with a problem regarding an application or petition within USCIS, you may submit this form to the Ombudsman’s Office after trying all
means to resolve the problem with USCIS. Please note the Ombudsman’s Office cannot provide legal advice. It is an independent office within the U.S. Department of Homeland Security (DHS)
and is not part of USCIS.

:
Before asking the Ombudsman’s Office for help with an application or petition, you first should try to resolve the problem with USCIS by using all of the following methods:
Obtain information about the case at myUSCIS Case Status at www.uscis.gov.
Contact the National Customer Service Center (NCSC) for assistance at 1-800-375-5283.
Request assistance from USCIS using their e-Request tool to check on appointment accommodations, typographic errors, delayed delivery of documents, notices or cards by mail or
if a pending application is beyond the normal processing times.
Make an appointment to speak directly with a USCIS Immigration Services Officer at a local office through the InfoPass system. Appointments may be made online at
www.infopass.uscis.gov.

General Instructions
The Ombudsman’s Office does not accept fees.
If a particular item does not apply to your case assistance request, please leave blank.
Please attach scanned copies of any documents you received from or sent to USCIS or any other government entity that is related to your request for assistance. Additionally, you
may submit other information or documentation that will help the Ombudsman’s Office review your request for assistance.
This form is not required. However, a properly completed form ensures that the Ombudsman’s Office receives the necessary information to assist with your case. If you do not
properly complete the form, you may experience a delay in the process of your request for assistance.

DHS Form 7001 – Privacy Act Statement
Authority: 6 U.S.C. Section 272 authorizes the collection of this information.
Purpose: The Ombudsman’s Office will use the information provided to assist an individual or employer with his or her Case Assistance Request.
Routine Use: The information will be used by and disclosed to DHS personnel and contractors or other agents who need the information to assist in activities related to your Case
Assistance Request. DHS may also share the information provided in accordance with the routine uses listed in DHS/CISOMB-001 Virtual Ombudsman System of Records Notice, 75 FR
18857 (April 13, 2010).
Disclosure: Furnishing this information is voluntary. However, failure to provide the requested information may delay or prevent the Ombudsman’s Office from providing assistance with
your case.

email:

your case.

email:

[email:

Please identify the name of the individual or employer (applicant/beneficiary/petitioner) encountering difficulties with USCIS. Do not enter the attorney/law firm’s
name here.

Primary E-mail Address (to receive Ombudsman updates):

(Section 3 and 4)
(Section 5 and 6)

5. Applications/Petitions Filed: List all applications and/or petitions pending with USCIS related to your case inquiry

USCIS
Receipt Date:

6.

USCIS Form Number:

Sought: Please provide the type of immigration benefit sought from USCIS. Check all that apply.

(Section 7 and 8)

7.

/Case Assistance Request: Check all that apply. Provide a description in Section 8 and add documentation in Section 12 related to your inquiry.

I am facing a problem that was not resolved through the normal processes provided by USCIS.

I have received an action or decision that involves clear errors of fact, or gross and obvious misapplication of the relevant law by USCIS.

8.
8.

Description of Your Case Problem: Describe the difficulties experienced with USCIS including all responses USCIS provided. In Section 12, Attach relevant

correspondence concerning actions taken to resolve the issue before submitting with the Ombudsman’s Office including: receipt notices, requests for
evidence; decisions; notices and any other correspondence from USCIS about your case. Limited to 2000 characters.

(Section 9)

9.
Check all that apply and provide the additional information requested for each selection in the Please Describe section provided below. Note that if
selecting the first option “Visited myUSCIS Case Status at www.uscis.gov”, you must indicate what additional actions were taken to remedy the problem before submitting your
inquiry to and
the Ombudsman.
myUSCIS Case Status
and
(provide SRMT Number below)
Provide Referral Number (also referred to as SRMT (provide
Number):InfoPass Number below)
Sent an E-mail to USCIS (provide date sent & USCIS E-mail Address below)

Provide Referral Number (also referred to as SRMT (provide
Number):InfoPass Number below)
Sent an E-mail to USCIS (provide date sent & USCIS E-mail Address below)

Attended an InfoPass Appointment with USCIS. Provide InfoPass Confirmation Number:

Contacted a U.S. Government Department or Agency for assistance (provide name and contact information below)
Sent an email to USCIS. Provide date email sent:
Provide USCIS email address:
Contacted a U.S. Congressional Representative for assistance (provide name and contact information below)
Contacted a U.S. Government Department or Agency for assistance. Provide name and contact information:
Contacted a U.S. Congressional Representative for assistance. Provide name and contact information:
Other. Please describe:

(Section 10)

10.
If you are the beneficiary of a pending petition, the petitioner must provide consent to the release of information relating to your case.

(Section 11)

11.

Please complete this section if you are an attorney or an accredited representative preparing this form on behalf of the
individual or employer encountering difficulties with USCIS. Please attach a copy of your Form G-28.

Law Firm/Organization:

Primary
EmailAddress
Address:
Primary
E-mail
(to receive Ombudsman updates):
Email
*I have submitted a Form G-28 to USCIS as the attorney/accredited representative regarding applications or petitions related to this inquiry. A copy of my Form G-28 is

attached.
I am an accredited representative of a religious, charitable, social service or similar organization established in the United States and recognized by the Board of
Immigration Appeals pursuant to 8 CFR 292.1. The name and address of my organization is provided above.
I am an attorney and a member in good standing of the bar of the highest court of the following State, territory, insular possession, or District of Columbia and am not
under a court or administartive agency order suspending, enjoining, restraining, disbarring, or otherwise restricting me in practicing law. (Provide State of Admission and
Name of Court below)
Other (Explain fully):

under a court or administartive agency order suspending, enjoining, restraining, disbarring, or otherwise restricting me in practicing law. (Provide State of Admission and
Name of Court below)
Other (Explain fully):

(Section 12)

12.

(Section 13)

Please note that if you are the beneficiary of an immigration petition, consent of the individual or employer that submitted the petition on your behalf is required.
13.
The petitioner must sign.

I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct, and that I am the individual or employer encountering
difficulties with USCIS and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C Section 1001 by a fine of not more than $10,000
or by imprisonment of not more than five years or both, and that requesting or obtaining a record(s) under false pretenses is punishable under the provisions of 5 U.S.C
Section 522a(i)(3) by a fine of not more than $5,000. Alternatively, I am the legal representative of record for the person encountering difficulties with USCIS (applicant/
beneficiary/petitioner). I have included a copy of Form G-28 previously filed with USCIS.
Pursuant to 5 U.S.C Section 522a(b), I authorize the Office of the Citizenship and Immigration Services Ombudsman to release any and all information relating to the above
mentioned individual or employer to U.S. Citizenship and Immigration Services.