Form N-600K Application for Citizenship and Issuance of Certificate

OMB No. 1615-0087; Expires 07/31/2018

Form N-600K, Application for Citizenship and
Issuance of Certificate Under Section 322

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

Print or type the answers fully and accurately in black ink. Write “N/A” if an item is not applicable. Write “None” if the
answer is none. Failure to answer all of the questions may delay the Form N-600K.

Part 1. Information About the Child's Eligibility (check only one box)
The application is being filed for a child. The child is under 18 years of age and:
1.

The BIOLOGICAL child of a qualifying U.S. citizen (USC) parent filing this
form.

2.

The ADOPTED child of a qualifying USC parent filing this form.

3.

The grandchild of a qualifying USC grandparent or the child ward of a USC legal
guardian filing this form within 5 years of the death of the USC parent.

Child's A-Number:

-

A

-

For USCIS Use Only
Bar Code

2016
Fee
Rule
11/17/2016

Date Stamp

Part 2. Information About the Child (for whom this application is
being filed)
1. Current Legal Name (do not provide a nickname)
Family Name (last name)
Given Name (first name)

Middle Name (if applicable)

Remarks

2. Name exactly as it appears on the Permanent Resident Card (if applicable)
Family Name (last name)
Given Name (first name)

Middle Name (if applicable)

3. Other name(s) used since birth (if applicable. Include nicknames.)
Family Name (last name)

Given Name (first name) Middle Name (if applicable)

4. U.S. Social Security Number
(if applicable)
6.

Country of Birth

8. Gender
Male

Action

5. Date of Birth
(mm/dd/yyyy)

7. Country of Citizenship/Nationality
9. Height

Female

Feet

Inches

10. Home Address
Street Number and Name (do not provide a P.O. Box in this space unless it is the ONLY address.)

Apartment Number

City

State

ZIP Code

Province (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)
Form N-600K (Rev. 12/23/16) N

Part 2. Information About the Child (continued)

-

A

-

11. Mailing Address
C/O (in care of name)
Street Number and Name
City

State

12. Daytime Phone Number

)

Mobile Phone Number (if any)

(

)

14. Marital Status

ZIP Code

2016
Fee
Rule
11/17/2016

Province (foreign address only)

(

Apartment Number

Country (foreign address only)

Postal Code (foreign address only)

Work Phone Number (if any)

Evening Phone Number

(

(

)

)

13. E-Mail Address (if any)

Single, Never Married

Married

Marriage Annulled

Other (explain):

Divorced

Widowed

15. Information about the admission into the United States and current immigration status
(Do NOT complete this section. The USCIS officer will complete it during the interview.)
Arrived in the following manner:
Port of Entry (City/State)

Date of Entry (mm/dd/yyyy) Current Immigration Status

Exact Name Used at Time of Entry

16. Was there any prior application for citizenship or for a U.S. passport?

Yes

No

17. Was the child adopted?

Yes

No

Date of Adoption (mm/dd/yyyy)

Date Legal Custody Began (mm/dd/yyyy)

Date Physical Custody Began (mm/dd/yyyy)

18. Were the child's parents married to each other when the child was born (or adopted)?

Yes

No

Part 3. Information About the Child's U.S. Citizen Biological or Adoptive Parent (Provide information
about the U.S. citizen father or mother applying on behalf of the eligible child. Provide information
about the child's U.S. citizen parent in the sections noted if the U.S. citizen grandparent or legal
guardian is filing this form.)
1. Current legal name of U.S. citizen parent
Given Name (first name)
Family Name (last name)

Middle Name (if applicable)

Form N-600K (Rev. 12/23/16) N Page 2

Part 3. Information About the Child's U.S. Citizen Biological or
Adoptive Parent (continued)
2. Date of Birth (mm/dd/yyyy)

-

A

-

4. U.S. Social Security Number (if applicable)

3. Country of Birth

5. Home Address
Street Number and Name (do not provide a P.O. Box in this space)
City

6. Daytime Phone Number

)

Mobile Phone Number (if any)

(

)

State

ZIP Code

Country (foreign address only)

Postal Code (foreign address only)

Work Phone Number (if any)

Evening Phone Number

(

(

2016
Fee
Rule
11/17/2016

Province (foreign address only)

(

Apartment Number

)

7.

)

E-Mail Address (if any)

8. The parent is a U.S. citizen by:
Birth in the United States
Acquisition after birth through naturalization of alien parent(s)
Birth abroad to U.S. citizen parent(s)
Certificate of Citizenship Number
Naturalization

A-Number (if known)

Date of Naturalization (mm/dd/yyyy)

Place of Naturalization (name of court and City/State or USCIS office location)

Certificate of Naturalization Number

A-Number (if known)

9. Has the U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
Yes (provide full explanation on an additional sheet(s) of paper.)

No

10. Marital History
A. How many times has the U.S. citizen father or mother been married (including annulled marriages and marriage(s) to the
same person)?
B. What is the U.S. citizen father or mother's current marital status?
Single, Never Married

Married

Marriage Annulled

Other (explain):

Separated

Divorced

Widowed

C. Information about the U.S. citizen father's or mother's current spouse:
Family Name (last name)

Given Name (first name)

Middle Name (if applicable)

Date of Birth (mm/dd/yyyy)

Country of Birth

Country of Citizenship/Nationality

Form N-600K (Rev. 12/23/16) N Page 3

Part 3. Information About the Child's U.S. Citizen Biological or
Adoptive Parent (continued)

-

A

-

Spouse's Home Address
Street Number and Name (do not provide a P.O. Box in this space)

Apartment Number

City

State

ZIP Code

Province (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

Date of Marriage (mm/dd/yyyy)

Place of Marriage (City/State or Country)

2016
Fee
Rule
11/17/2016

Spouse's Immigration Status
U.S. Citizen

Permanent Resident

Other (explain):

D. Is the U.S. citizen father's or mother's current spouse also the child's biological (or adoptive) parent?

Yes

No

A. Is the sponsoring U.S. citizen parent a member of the U.S. Armed Forces?

Yes

No

B. If the answer is yes, then are there official orders authorizing the child to accompany and reside with
the sponsoring U.S. citizen parent who is a member of the U.S. Armed Forces?

Yes

No

11. Member of U.S. Armed Forces

NOTE: If the U.S. citizen biological or adoptive parent is filing this application AND has the required physical
presence in the United States, skip Part 4 and go directly to Part 5.

Part 4. Information About the Child's Qualifying U.S. Citizen Grandparent (complete this part only if
the U.S. citizen parent (or adoptive parent), grandparent, or legal guardian is applying for citizenship
for the child, and the U.S. citizen parent has not been physically present in the United States for 5
years; 2 years of which were after the age of 14.)
1. Current legal name of U.S. citizen grandparent
Family Name (last name)
Given Name (first name)
2. Date of Birth (mm/dd/yyyy)

3. Country of Birth

Middle Name (if applicable)

4. U.S. Social Security Number (if applicable)

5. Home Address
Street Number and Name (do not provide a P.O. Box in this space)

Apartment Number

City

State

ZIP Code

Province (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)
Form N-600K (Rev. 12/23/16) N Page 4

Part 4. Information About the Child's Qualifying U.S. Citizen
Grandparent (continued)
6. Daytime Phone Number

(

)

Mobile Phone Number (if any)

(

-

A

Work Phone Number (if any)

Evening Phone Number

(

(

7.

)

-

)

E-Mail Address (if any)

)

8. The grandparent is a U.S. citizen by:
Birth in the United States

2016
Fee
Rule
11/17/2016

Acquisition after birth through naturalization of alien parent(s)
Birth abroad to U.S. citizen parent(s)
Certificate of Citizenship Number

A-Number (if known)

Naturalization
Date of Naturalization (mm/dd/yyyy)

Place of Naturalization (name of court and City/State or USCIS office location)

Certificate of Naturalization Number

A-Number (if known)

9. Has the grandparent ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
Yes (provide full explanation on an additional sheet(s) of paper)

No

Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K (Provide the
dates that the U.S. citizen parent or grandparent was present in the United States. If the U.S. citizen
parent has not been physically present in the United States for 5 years, 2 years of which were after
the age of 14, then the child must use the physical presence of the U.S. citizen grandparent.)
U.S. Citizen
Parent

Indicate whether this information relates to the U.S. citizen
parent or to the qualifying grandparent

U.S. Citizen
Grandparent

Physical Presence in the United States (mm/dd/yyyy)

From

Until

From

Until

Until

From

Until

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From

Until

From
From

NOTE: If the U.S. citizen biological/adoptive parent is filing this application, skip Part 6 and go directly to Part 7.

Form N-600K (Rev. 12/23/16) N Page 5

Part 6. Information About the Legal Guardian (complete this part only
if the legal guardian is filing this application in lieu of a
deceased U.S. citizen parent)
1. Current legal name of the legal guardian
Family Name (last name)
Given Name (first name)
2. Date of Birth (mm/dd/yyyy)
5. Home Address

3. Country of Birth

-

A

Middle Name (if applicable)
4. U.S. Social Security Number (if applicable)

2016
Fee
Rule
11/17/2016

Street Number and Name (do not provide a P.O. Box in this space)
City

Province (foreign address only)
6. Daytime Phone Number

(

)

Mobile Phone Number (if any)

(

)

-

Apartment Number

State

ZIP Code

Country (foreign address only)

Postal Code (foreign address only)

Work Phone Number (if any)

Evening Phone Number

(

(

7.

)

)

E-Mail Address (if any)

8. The legal guardian is a U.S. citizen by:

Birth in the United States
Acquisition after birth through naturalization of alien parent(s)
Birth abroad to U.S. citizen parent(s)
Certificate of Citizenship Number
A-Number (if known)
Naturalization
Date of Naturalization (mm/dd/yyyy)

Place of Naturalization (name of court and City/State or USCIS office location)

Certificate of Naturalization Number

A-Number (if known)

9. Date of Legal Guardianship (mm/dd/yyyy)

10. Name of Authority that Granted Legal Guardianship

11. Address of Authority that Granted Legal Guardianship

Part 7. Preferred Location and Date for Interview
1. Location (USCIS Office, City, or State)

2.

Preferred Date (mm/dd/yyyy)

USCIS will attempt to accommodate the requested preferences.
NOTE: Interview date should be at least 90 days after filing Form N-600K and before the child's 18th birthday.
Form N-600K (Rev. 12/23/16) N Page 6

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A

Part 8. Signature (USCIS will reject an unsigned Form N-600K.)

-

I certify, under penalty of perjury under the laws of the United States, that this application, and the evidence submitted with it, is all
true and correct. I authorize the release of any information that USCIS may need to determine eligibility for the benefit being sought.
Signature

Date (mm/dd/yyyy)

Part 9. Signature of Person Who Prepared This Form (if applicable)

2016
Fee
Rule
11/17/2016

I declare that I prepared this application at the request of the above person. The answers provided are based on information of which I
have personal knowledge and/or were provided to me by the above-named person in response to the questions contained on this
application.
Preparer's Signature

Preparer's Printed Name

Date (mm/dd/yyyy)

Preparer's Firm or Organization Name (if applicable)
Preparer's Daytime Phone Number

Preparer's Fax Number

(

(

)

Preparer's Address

Preparer's Email Address

)

Street Number and Name (do not provide a P.O. Box in this space)
City

Province (foreign address only)

State

ZIP Code

Country (foreign address only)

Postal Code (foreign address only)

NOTE: Do not complete the part below until the USCIS officer instructs you to do so at the interview.

Part 10. Affidavit (At the time of Interview)
I, the parent/grandparent/legal guardian,

do swear or affirm, under penalty of perjury under

the laws of the United States, that I know and understand the contents of this application signed by me, and the attached
supplementary pages number (
that corrections number (

) to (
) to (

) inclusive, that the same are true and correct to the best of my knowledge, and

) were made by me or at my request.
Date (mm/dd/yyyy)

Parent, Grandparent or Legal Guardian's Signature

Subscribed and sworn or affirmed before me upon examination of the applicant and U.S. citizen parent/grandparent/legal guardian on
at

Interviewing USCIS Officer's Name and Title

.
Interviewing USCIS Officer's Signature
Form N-600K (Rev. 12/23/16) N Page 7

Part 11. USCIS Officer Report and Recommendation

-

A

-

On the basis of the documents, records and the testimony of person examined, and the identification upon personal appearance of the
underage beneficiary, I find that all the facts and conclusions set forth under oath in this application are:
1.

True and correct;

2.

The applicant derived or acquired U.S. citizenship on

(mm/dd/yyyy)

3. The applicant derived or acquired U.S. citizenship through (check the box next to the appropriate section of law or, if the
section of law is not reflected, write the applicable section of law in the space next to “Other”)

2016
Fee
Rule
11/17/2016

Section 322(a)(2)(A) of the INA (Parent residence);

Section 322(a)(2)(B) of the INA (Grandparent residence); or
Other _________________________________________
I recommend that this Form N-600K be:

Approved

Denied

Issue Certificate of Citizenship in the Name of

USCIS Officer's Name and Title

I do

do not

USCIS Officer's Signature

Date (mm/dd/yyyy)

concur with the USCIS officer's recommendation of the Form N-600K.

USCIS Field Office Director's Signature

Date (mm/dd/yyyy)

Form N-600K (Rev. 12/23/16) N Page 8