I-600 Form TOC

TABLE OF CHANGES – FORM

Form I-600, Petition to Classify Orphan as an Immediate Relative

OMB Number: 1615-0028

11/28/2018

Reason for Revision: Comprehensive revision.

• Black font = Current text

• Red font = Changes

Expires 12/31/2018

Edition Date 12/23/2016

Current Page Number and Section	Current Text	Proposed Text
Page 1, For USCIS Use Only	[Page 1] For USCIS Use Only The petitioner is: Married Unmarried The petition is: Approved Petitioner may adopt orphan ABROAD Orphan will come to the UNITED STATES for adoption. The preadoption requirements have been met. Denied DD Fee Stamp Received Trans In Completed File Number Date of Favorable Determination Remarks District	[Page 1] For U.S. Government Use Only [Column 1] The petitioner is: Married Unmarried [deleted] [] Form I-600A Approval Approval Valid Until (mm/dd/yyyy): The petitioner is approved to adopt an orphan from (if specified): (Name of non-Hague Convention Country) : [] PAIR Letter Issued Date (if applicable) (mm/dd/yyyy) : [Column 2] Action Block Department of State Actions: [] Approved [] Transfer to USCIS as Not Clearly Approvable [] Transfer to USCIS as Consular Return [Column 3] Receipt/Fee Stamp Final Adjudicating Office/Post: Officer Signature and Date: Child’s Legal Name after Adoption: To be Completed By an Attorney or Accredited Representative (if any). Select this box if Form G-28 or Form G-28I is attached. Attorney State Bar Number (if applicable): Attorney or Accredited Representative USCIS Online Account Number (if any)
Page 1, Part 1. Information About You (Petitioner)	[Page 1] START HERE - Type or print legibly in black ink. Complete a separate petition for each child. This petition is made to classify the named orphan as your immediate relative. Part 1. Information About You (Petitioner) 1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Other Names You Have Used (including maiden name, nicknames, and aliases, if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 3. U.S. Mailing Address (if any) In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code 4. Is your current U.S. mailing address the same as your U.S. physical address? Yes/No If you answered "No" to Item Number 4., provide your U.S. physical address in Item Number 5. Or your address abroad in Item Number 6., as appropriate. 5. U.S. Physical Address (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code [Page 2] 6. Address Abroad (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State Province Postal Code Country 7. Date of Birth (mm/dd/yyyy) 8. City/Town/Village of Birth 9. State or Province of Birth 10. Country of Birth 11. Information About Your U.S. Citizenship A. Are you a citizen of the United States? Yes/No NOTE: If you answered “No,” you may NOT file Form I-600. See the What Are the Eligibility Requirements? Section of the Form I-600 instructions for more information. B. How did you acquire your U.S. citizenship? Birth Parents Naturalization C. If you acquired your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes/No If "Yes," provide the following information about your Certificate of Citizenship: Name Under Which the Certificate of Citizenship Was Issued Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number Date of Issuance (mm/dd/yyyy) Place of Issuance D. If you acquired your citizenship through naturalization, provide the following information about your Certificate of Naturalization: Name Under Which the Certificate of Naturalization Was Issued Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) A-Number (if any) Certificate of Naturalization Number Date of Naturalization (mm/dd/yyyy) Place of Naturalization [Page 3] 12. Have you, or any person through whom you claimed citizenship, EVER lost U.S. citizenship? Yes/No NOTE: If you answered "Yes," attach a detailed explanation on a separate sheet of paper; type or print your 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. 13. What is your marital status? Married Widowed Divorced Single 14. How many times have you been married (including your current marriage, if applicable)? 15. Date of Current Marriage (if applicable) (mm/dd/yyyy) 16. Place Where Current Marriage Occurred (if applicable) 17. Information About Your Current Spouse (if applicable) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Other Names Your Current Spouse Has Used (including maiden name, nicknames, and aliases, if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Date of Birth (mm/dd/yyyy) A-Number (if any) City/Town/Village of Birth State or Province of Birth Country of Birth Spouse’s Immigration Status 18. How many times has your current spouse been married (including your current marriage, if applicable)? 19. Does your current spouse reside with you? Yes/No If you answered “No,” provide your current spouse’s physical address in Item Number 20. 20. Your Current Spouse's Physical Address Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 21. How many persons 18 years of age or older, other than your spouse (if married), reside with you? If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person. [Page 4] 22. Have you ever previously filed Form I-600, Form I-600A, Application for Advance Processing of an Orphan Petition, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative? Yes/No If “Yes,” provide the following: A. Type of Petition/Application Filed B. Result - Check the box that best describes the action taken by USCIS and/or U.S. Department of State on your petition and/or application. Approved - Approval Date (mm/dd/yyyy) Denied - Denial Date (mm/dd/yyyy) NOTE: A copy of the denial notice must accompany this petition. Other - Explain [Fillable field] C. A detailed description of any previous Form I-600 or Form I-800 filing that resulted in a disruption prior to finalization of the adoption or that resulted in a completed adoption that was later dissolved either in the United States or abroad. [Fillable field] NOTE: If you need extra space to complete this question, attach a separate sheet of paper; type or print your A-Number (if any) at the top of each sheet; include the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. Duty of Disclosure You and your spouse (if married) must answer the following questions. See the Duty of Disclosure section in the Form I-600 instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any of the questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances about each arrest, signed by you and/or your spouse (if married) under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in light of this history on a separate sheet of paper; type or print your name and A-Number (if any) at the top of each sheet; include the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 23. Have you EVER, whether in or outside the United States: A. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations, but including driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant, even if the record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration? Yes/No B. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes/No C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes/No [Page 5] D. At any time been the subject of any investigation at any time by any child welfare agency, court, or other official authority in any state or foreign country concerning the abuse or neglect of any child, other than an investigation that has been completed and formally closed based on a finding that the allegation of abuse or neglect was unfounded or unsubstantiated? Yes/No 24. Has your spouse EVER, whether in or outside the United States: A. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations, but including driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant, even if the record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration? Yes/No B. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes/No C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes/No D. At any time been the subject of any investigation at any time by any child welfare agency, court, or other official authority in any state or foreign country concerning the abuse or neglect of any child, other than an investigation that has been completed and formally closed based on a finding that the allegation of abuse or neglect was unfounded or unsubstantiated? Yes/No	[Page 1] START HERE - Type or print in black ink. Complete a separate petition for each child. This petition is used to classify an orphan as your immediate relative. You must be a U.S. citizen in order to file this petition. See the What Are the Eligibility Requirements section of the Form I-600 Instructions for more information. Part 1. Information About You (Petitioner) 1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Other Names Used (if any) Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Your Contact Information 3. U.S. Mailing Address (if any) In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code [Page 2] 4. Is your current U.S. mailing address the same as your U.S. physical address? Yes/No If you answered "No,” provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as appropriate. 5. U.S. Physical Address (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code 6. Address Abroad (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State Province Postal Code Country 7. Daytime Telephone Number 8. Mobile Telephone Number (if any) 9. Email Address (if any) Information About Your U.S. Citizenship 10. USCIS Online Account Number (if any) 11. Date of Birth (mm/dd/yyyy) 12. City/Town/Village of Birth 13. State or Province of Birth 14. Country of Birth [deleted] 15. How did you obtain your U.S. citizenship? Birth Parents Naturalization A. If you acquired your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes/No If you answered "Yes," provide the following information about your Certificate of Citizenship: Your Name On the Certificate of Citizenship Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number Date of Issuance (mm/dd/yyyy) Place of Issuance [Page 3] B. If you obtained your citizenship through naturalization, provide the following information about your Certificate of Naturalization: Your Name On the Certificate of Naturalization Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) A-Number (if any) Certificate of Naturalization Number Date of Naturalization (mm/dd/yyyy) Place of Naturalization 16. Have you EVER renounced or lost U.S. citizenship or has anyone you obtained citizenship through (such as your parent or grandparent) EVER lost U.S. citizenship? Yes/No NOTE: If you answered “Yes,” provide a detailed explanation in the space provided in Part 10. Additional Information. 17. What is your marital status? Single Married Separated Divorced Widowed 18. How many times have you been married (including your current marriage, if applicable)? NOTE: If you are not currently married, skip to Item Number 29. Information About Your Current Marriage 19. Date of Current Marriage (mm/dd/yyyy) 20. Place Where Current Marriage Occurred 21. Name of Your Current Spouse Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 22. Other Names Your Current Spouse Has Used (if any) Provide all other names your spouse has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 23. Information About Your Current Spouse Spouse’s Date of Birth (mm/dd/yyyy) Spouse’s A-Number (if any) Spouse’s USCIS Online Account Number (if any) Spouse’s City/Town/Village of Birth Spouse’s State or Province of Birth Spouse’s Country of Birth [Page 4] Is your spouse a U.S. citizen? Yes/No If you answered “Yes,” how did your spouse obtain U.S. citizenship? Birth Naturalization Parents If you answered “No,” provide your spouse’s current U.S. immigration status: 24. How many times has your current spouse been married (including your current marriage, if applicable)? Your Spouse’s Contact Information 25. Does your current spouse reside with you? Yes/No If you answered “No,” provide your current spouse’s physical address in Item Number 26. 26. Your Current Spouse's Physical Address (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 27. Your Spouse’s Daytime Telephone Number 28. Your Spouse’s Mobile Telephone Number (if any) 29. Your Spouse’s Email Address (if any) Additional Household Members 30. How many persons 18 years of age or older (other than your spouse, if married) reside with you? If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person. 31. List all of your children who are under 18 years of age. Also include any other children under 18 years of age who reside in your household, regardless of your relationship to those children. If you need extra space to complete this table, use the space provided in Part 10. Additional Information. [Table 5 entries] Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth A-Number (if any) Relationship to You [Page 5] Information About Prior Filings or Adoptions If you need extra space to complete Item Numbers 32. - 37., use the space provided in Part 10. Additional Information. 32. Have you ever previously filed Form I-600, Form I-600A, Application for Advance Processing of an Orphan Petition, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative, or Form I-130, Petition for Alien Relative, for an adopted child? Yes/No If you answered “Yes,” provide the following information for EACH petition and/or application: Type of Petition/Application Filed: Form I-600A Form I-600 Form I-800A Form I-800 Form I-130 (for an adopted child) [deleted] Result: Approved Denied Withdrawn Revoked Other (please explain): [fillable field] Date (mm/dd/yyyy) 33. Have you previously completed a domestic adoption of a child within the U.S.? Yes/No If you answered “Yes,” provide the following information for each completed domestic adoption of a child. State And County Where Adoption Was Finalized Date Adoption Was Finalized (mm/dd/yyyy) 34. Have you ever previously attempted to adopt a child internationally or domestically, but the adoption was disrupted before it was finalized? An adoption is disrupted if you (or a custodian escorting the child on your behalf) are granted legal custody or guardianship of the child, but the adoptive placement is interrupted before the adoption was finalized. Yes No If you answered “Yes,” provide a detailed description of the disruption. [Fillable field] 35. Have you ever previously completed an adoption, either in the United States or abroad, that was later dissolved? An adoption is dissolved if your parental rights over the adopted child are terminated at any time after the adoption was finalized. Yes No If you answered “Yes,” provide a detailed description of the dissolution. [Fillable field] 36. Have you ever previously placed a child in the care of another person with the intent to transfer permanent custody of the child? Yes No If you answered “Yes,” provide a detailed description of the placement. [Fillable field] 37. Have you ever received a child with the intent to gain permanent custody, but without involving the child welfare or other state/local authorities or following the state/local process? Yes No If you answered “Yes,” provide a detailed description of the custody transfer. [Fillable field] [Page 6] Duty of Disclosure You and your spouse (if married) must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any of the questions in Item Numbers 38. and 39., provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances about each arrest, signed by you and/or your spouse (if married) under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in light of this history in the space provided in Part 10. Additional Information. 38. Have you EVER, whether in or outside the United States: A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance? (Answer “Yes,” even if the record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant.) Yes No B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes No D. Been the subject of any investigation at any time even if closed or unsubstantiated, by any child welfare agency, court, or other official authority in any state or foreign country concerning the abuse or neglect of any child? Yes No 39. Has your spouse EVER, whether in or outside the United States: A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance? (Answer “Yes,” even if the record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant.) Yes No B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes No D. Been the subject of any investigation at any time even if closed or unsubstantiated, by any child welfare agency, court, or other official authority in any state or foreign country concerning the abuse or neglect of any child? Yes No
Page 5, Part 2. Information About Orphan Beneficiary	[Page 5] Part 2. Information About Orphan Beneficiary 1. Name at Birth Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Current Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 3. Other Names the Orphan Has Used (including nicknames and aliases, if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 4. Gender Male/Female 5. Date of Birth (mm/dd/yyyy) 6. City/Town/Village of Birth 7. State or Province of Birth 8. Country of Birth 9. The beneficiary is an orphan because (Select only one): A. He or she has no parents due to death or disappearance of, abandonment or desertion by, or separation or loss from both parents. B. He or she has only one sole or surviving parent who is incapable of providing proper care and who has irrevocably released the child for emigration and adoption in writing. [Page 6] 10. If the orphan has only one sole or surviving parent, answer the following: A. What happened to the other birth or previous parent? [Fillable field] B. Is the remaining parent capable of providing proper care for the orphan? Yes/No C. Has the remaining parent irrevocably released the orphan for emigration and adoption, in writing? Yes/No 11. Did you and your spouse (if married) adopt the orphan abroad? Yes/No 12. If you answered "Yes" to Item Number 11., provide the following information: A. Did you or your spouse (if married) personally see and observe the child before or during the adoption proceedings? Yes/No B. Date of Adoption (mm/dd/yyyy) C. Place of Adoption 13. If you answered "No" to either Item Number 11., or 12A., provide the following information: A. Do you and your spouse (if married) intend to adopt the orphan in the United States? Yes/No B. Have any pre-adoption requirements of the orphan's proposed state of residence been met? Yes/No C. If you answered “Yes” to Item B. in Item Number 13., provide a written description of the pre-adoption requirements, if any, of the state of the child’s proposed residence if you know that the child will be adopted in the United States. Cite any relative state statutes and regulations, and describe the steps you have taken or will take to comply with these requirements. Note and explain any pre-adoption requirements that you cannot meet at this time due to operation of state law. [Fillable field] NOTE: If you need extra space to complete this Item Number, attach a separate sheet of paper; type or print you’re A-Number (if any) at the top of each sheet; include the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. D. If you answered "No" to Item B. in Item Number 13., will the pre-adoption requirements be met later? Yes/No 14. To your knowledge: A. Does the orphan have any special need, disability, and/or impairment? Yes/No B. If you answered "Yes" to Item A. in Item Number 14., name or describe the special need, disability, and/or impairment. [Fillable field] 15. Who has legal custody of the orphan? [Page 7] 16. Information About the Attorney Abroad Representing You and/or Your Spouse (if married) in This Case (if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 17. Address in the United States Where the Orphan Will Reside (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code 18. Present Address of the Orphan In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 19. If the orphan resides in an institution, provide the full name of the institution. 20. If the orphan does not reside in an institution, provide the full name of the person with whom the orphan is residing or the name of the orphan's caretaker. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 21. Provide any additional information necessary to locate the orphan, such as the name of a district, section, zone, or locality in which the orphan resides: [Fillable field] [Page 8] 22. Where do you wish to file your visa application? (Complete one of the options below.) A. The USCIS office located at: OR B. The U.S. Embassy or U.S. Consulate located at: [Fillable field]	[Page 6] Part 2. Information About the Orphan Beneficiary 1. Name at Birth Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Current Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) [Page 7] 3. Other Names the Orphan Has Used Provide all other names the orphan has ever used, including aliases and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 4. Gender Male/Female 5. Date of Birth (mm/dd/yyyy) 6. City/Town/Village of Birth 7. State or Province of Birth 8. Country of Birth 9. The beneficiary is an orphan because (select only one box): A. He or she has no parents due to the death or disappearance of, abandonment or desertion by, or separation or loss from both parents. B. He or she has a sole or surviving parent who is incapable of providing proper care and who has in writing irrevocably released the child for emigration and adoption. 10. If the orphan has a sole or surviving parent, answer the following: A. What happened to the other birth or previous parent? [Fillable field] B. Is the remaining parent capable of providing proper care for the orphan? Yes/No C. Has the remaining parent irrevocably released the orphan for emigration and adoption, in writing? Yes/No 11. Did you adopt the orphan abroad? Yes/No 12. Did your spouse (if married) adopt the orphan abroad? Yes/No 13. If you answered “Yes” to Item Number 11. or Item Number 12., provide the following information: A. Did you or your spouse (if married) personally see and observe the child before or during the adoption proceedings? (This does not include the visa interview and issuance.) Yes/No B. Date of Adoption (mm/dd/yyyy) C. Place of Adoption 14. If you answered "No" to either Item Number 11., Item Number 12., or Item A. in Item Number 13., provide the following information: NOTE: If you need extra space to complete Items A. - D., use the space provided in Part 10. Additional Information. A. Do you and your spouse (if married) intend to adopt the orphan in the United States? Yes/No B. Provide a written description of all the pre-adoption requirements of the state of the orphan’s proposed residence and cite any relevant state statutes and regulations. If the state of the orphan’s proposed residence does not have any pre-adoption requirements, indicate “not applicable.” [Fillable field] [Page 8] C. Have any pre-adoption requirements of the orphan's proposed state of residence already been met? Yes/No If you answered “Yes,” provide which requirements have been met. [Fillable field] D. Will any pre-adoption requirements be met at a later time? Yes/No If you answered “Yes,” describe the steps you will take to comply with these requirements. [Fillable field] If you answered “No,” provide each pre-adoption requirement that will not be met and explain why. [Fillable field] [deleted] 15. To your knowledge: A. Does the orphan have any special need, disability, and/or impairment? Yes/No B. If you answered "Yes," name or describe the special need, disability, and/or impairment. [Fillable field] 16. The orphan’s legal custodian is (select only one box): [] An individual or entity other than the orphan’s birth parents. Name of the individual or entity: [Fillable field] [] Both of the orphan’s living birth parents. [] One of the orphan’s living birth parents. The living birth parent is the (select only one box): Mother/Father 17. Information About the Attorney Abroad Representing You and/or Your Spouse (if married) in this Case (if any) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country [Page 9] 18. Address Where the Orphan Will Reside After the Adoption (or after you obtain legal custody) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 19. Current Address of the Orphan In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 20. If the orphan resides in an institution, provide the full name of the institution. 21. If the orphan does not reside in an institution, provide the full name of the person with whom the orphan is residing or the name of the orphan's caretaker. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 22. Provide any additional information necessary to locate the orphan, such as the name of a district, section, zone, or locality in which the orphan resides: [Fillable field] 23. After you obtain an adoption or legal custody of the orphan, do you intend to: A. Seek an immigrant visa because the child will reside with you in the United States? Y/N B. Seek a non-immigrant visa for the child to travel to the United States temporarily for the purpose of naturalization, because you will continue to reside abroad with the child immediately following the adoption? Y/N 24. Where do you wish to file your visa application (if applicable)? [deleted] The U.S. Embassy or U.S. Consulate located at: [Fillable field]
Page 8, Part 3. Information About Your Home Study and Primary Adoption Service Provider	[Page 8] Part 3. Information About Your Home Study and Primary Adoption Service Provider 1. Your home study: A. Was previously submitted with your approved Form I-600A application B. Was previously submitted with your pending Form I-600A application C. IS attached to this Form I-600. D. IS NOT attached to this Form I-600 because of state requirements necessitating review and documentation. The appropriate state authority has indicated that it will submit the home study directly to U.S. Citizenship and Immigration Services (USCIS). (Do not submit our Form I-600 to USCIS until the state authority is ready to send your home study to USCIS.) 2. Provide the name and address of your primary adoption service provider in the United States. (A primary adoption service provider is the accredited agency or approved person who is responsible under 22 CFR Part 96.14 for ensuring the six adoption services defined in 22 CFR Part 96.2 are provided, supervising and being responsible for supervised providers where used, and developing and implementing a service plan in accordance with 22 CFR 96.44.) A. Name of Primary Adoption Service Provider B. Point of Contact Within the Organization Family Name (Last Name) Given Name (First Name) C. Provider's Mailing Address Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country D. Provider's Daytime Telephone Number E. Provider's Fax Number (if any) F. Provider's Email Address (if any) 3. The primary adoption service provider named above is one of the following: A. An accredited agency in the United States. Yes/No B. An approved person in the United States. Yes/No	[Page 10] Part 3. Information About Your Home Study and Primary Adoption Service Provider 1. Your home study: A. Was previously submitted with your approved Form I-600A application (please attach a copy of your Form I-600A approval notice). B. Was previously submitted with your pending Form I-600A application (please attach a copy of your Form I-600A fee receipt notice). C. IS attached to this Form I-600. D. IS NOT attached to this Form I-600 because of state requirements necessitating review and documentation. The appropriate state authority has indicated that it will submit the home study directly to U.S. Citizenship and Immigration Services (USCIS). (Do not submit your Form I-600 to USCIS until the state authority is ready to send your home study to USCIS.) Information About Your Primary Adoption Service Provider NOTE: A primary adoption service provider is the accredited agency or approved person who is responsible under 22 CFR 96 for ensuring all six adoption services defined in 22 CFR 96.2 are provided according to the law, for supervising and being responsible for supervised providers when used (see 22 CFR 96.14), and for developing and implementing a service plan in accordance with 22 CFR 96.44. 2. Name of Primary Adoption Service Provider 3. Point of Contact Within the Organization Family Name (Last Name) Given Name (First Name) 4. Primary Adoption Service Provider's Mailing Address Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code [deleted] 5. Primary Adoption Service Provider's Daytime Telephone Number 6. Primary Adoption Service Provider's Fax Number (if any) 7. Primary Adoption Service Provider's Email Address (if any) 8. The primary adoption service provider named above is one of the following: A. An accredited agency in the United States. Yes/No B. An approved person in the United States. Yes/No
New		[Page 11] Part 4. Information About Fees, Expenses, and Other Compensation If you need extra space to complete the tables in Item Numbers 1. or 2., use the space provided in Part 10. Additional Information. 1. Information on payments already made. In the following table, provide all payments, including in-kind contributions that you and your spouse (if married) have made in relation to the adoption of the child identified in this Form I-600. The information you provide in this table must include all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you and your spouse, have directly or indirectly made, to any individual, agency, entity, governmental authority, or other payee or recipient. The information below should include all payments made as of the date of your signing this Form I-600. [Table 4 entries] Date (mm/dd/yyyy) Payee Relationship to Child (if any) Purpose of Payment Amount of Payment (or description and value of in kind consideration) 2. Information on anticipated future payments. In the following table, provide all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you and your spouse, reasonably expect to pay or make, either directly or indirectly, to any individual, agency, entity, governmental authority, or other payee or recipient. [Table 4 entries] Anticipated Date of Payment (mm/dd/yyyy) Payee Relationship to Child (if any) Purpose of Payment Amount of Payment (or description and value of in kind consideration) [Page 12] 3. Have you or your spouse (if married) or anyone on behalf of you and your spouse, given or arranged to give money or other consideration either directly or indirectly to the orphan’s parent(s), agent(s), other individual(s), or entity to induce or encourage the release of the orphan? Yes/No If you answered “Yes,” provide a detailed description to explain. [Fillable Field]
Page 9, Part 4. Accommodations for Individuals With Disabilities and/or Impairments	[Page 9] Part 4. Accommodations for Individuals With Disabilities and/or Impairments 1. Are you requesting an accommodation because of your disabilities and/or impairments? Yes/No 2. If you answered “Yes” to Item Number 1., select all applicable boxes below to indicate who has the disabilities and/or impairments. Petitioner Spouse Other Household Member 3. If you answered “Yes” to Item Number 1., select all applicable boxes. Provide information for each person with disabilities and/or impairments. A. Deaf or hard of hearing and request the following accommodations (if requesting a sign-language interpreter, indicate for which language (for example, American Sign Language): [Fillable field] B. Blind or have low vision and request the following accommodations: [Fillable field] C. Another type of disability and/or impairment (Describe the nature of the disability and/or impairment and accommodation you are requesting): [Fillable field]	[Page 12] Part 5. Accommodations for Individuals With Disabilities and/or Impairments NOTE: Read the information in the Form I-600 Instructions before completing this section. 1. Are you requesting an accommodation because of your disabilities and/or impairments? Yes/No 2. If you answered “Yes,” select all applicable boxes below to indicate who has the disabilities and/or impairments. Petitioner Spouse Other Adult Household Member 3. If you answered “Yes” to Item Number 1., select all applicable boxes in Items A. - C. and provide an answer for each person with disabilities and/or impairments. A. Deaf or hard of hearing and request the following accommodation. (If requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).): [Fillable field] B. Blind or have low vision and request the following accommodation: [Fillable field] C. Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and the requested accommodation.): [Fillable field]
Page 9, Part 5. Petitioner’s Statement, ASC Acknowledgement (if applicable), Certification, Signature, and Contact Information	[Page 9] Part 5. Petitioner’s Statement, ASC Acknowledgement (if applicable), Certification, Signature, and Contact Information Petitioner’s Statement Select the box for either Item 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 petition, as well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS Application Support Center (if applicable). 1.B. The interpreter named in Part 9. has read to me every question and instruction on this petition, as well as my answer to every question, in [Fillable field], a language in which I am fluent. I understand each and every question and instruction on this petition as translated to me by my interpreter, and have provided complete, true, and correct responses. The interpreter named in Part 9. has also read the Acknowledgement of Appointment at USCIS Application Support Center (if applicable) to me, in the language in which I am fluent, and I understand this ASC Acknowledgement as read to me by my interpreter. 2. I have requested the services of and consented to [Fillable field], who is/is not an attorney or accredited representative, preparing this petition for me. This person who assisted me in preparing my petition has reviewed the Acknowledgement of Appointment at USCIS Application Support Center (if applicable) with me, and I understand the ASC Acknowledgement. [Page 10] Acknowledgement of Appointment at USCIS Application Support Center (if applicable) I, [Fillable field], understand that the purpose of a USCIS Application Support Center (ASC) appointment is for me to provide my fingerprints, photograph, and/or signature and to reverify that all of the information in my petition 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 this petition as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with this petition 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 reverifying that I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting documents submitted with my petition are complete, true, and correct; and if I was assisted in completing this petition, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center (if applicable) with me. Petitioner’s Certification I certify, under penalty of perjury under the laws of the United States of America, that the information in this petition and any document submitted with this petition is complete, true, and correct. 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 my records that USCIS may need to determine whether the child I am petitioning for is eligible to be classified as my immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration of U.S. immigration laws. Petitioner’s Signature 3. Petitioner’s Signature Date of Signature (mm/dd/yyyy) Petitioner’s Contact Information 4. Petitioner’s Daytime Telephone Number 5. Petitioner’s Mobile Telephone Number (if any) 6. Petitioner’s Email Address (if any)	[Page 12] Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Petitioner’s Statement [deleted] 1. Petitioner’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything. [deleted] 2. Petitioner’s Statement Regarding the Preparer (if applicable) At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 13] Petitioner’s Certification [deleted] 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 suitability and eligibility as an adoptive parent and whether the child I am petitioning for is eligible to be classified as my immediate relative. I furthermore authorize release of information contained in this petition, 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 will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my petition; 2) I understood all of the information contained in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Petitioner’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose. Petitioner’s Signature 3. Petitioner’s Signature Date of Signature (mm/dd/yyyy) [deleted] NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.
Page 10, Part 6. Petitioner’s Duty of Disclosure	[Page 10] Part 6. Petitioner’s Duty of Disclosure Certification: I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose. Petitioner’s Signature Date of Signature (mm/dd/yyyy)	[moved and combined into previous Part]
Page 11, Part 7. Spouse’s Statement, ASC Acknowledgement (if applicable), Certification, Signature, and Contact Information	[Page 11] Part 7. Spouse’s Statement, ASC Acknowledgement (if applicable), Certification, Signature, and Contact Information Spouse’s Statement Select the box for either Item 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 petition, as well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS Application Support Center (if applicable). 1.B. The interpreter named in Part 9. has read to me every question and instruction on this petition, as well as my answer to every question, in [Fillable field], a language in which I am fluent. I understand each and every question and instruction on this petition as translated to me by my interpreter, and have provided complete, true, and correct responses. The interpreter named in Part 9. has also read the Acknowledgement of Appointment at USCIS Application Support Center (if applicable) to me, in the language in which I am fluent, and I understand this ASC Acknowledgement as read to me by my interpreter. 2. I have requested the services of and consented to [Fillable field], who is/is not an attorney or accredited representative, preparing this petition for me. This person who assisted me in preparing my petition has reviewed the Acknowledgement of Appointment at USCIS Application Support Center (if applicable) with me, and I understand the ASC Acknowledgement. [Page 10] Acknowledgement of Appointment at USCIS Application Support Center (if applicable) I, [Fillable field], understand that the purpose of a USCIS Application Support Center (ASC) appointment is for me to provide my fingerprints, photograph, and/or signature and to reverify that all of the information in my petition 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 this petition as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with this petition 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 reverifying that I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting documents submitted with my petition are complete, true, and correct; and if I was assisted in completing this petition, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center (if applicable) with me. Spouse’s Certification I certify, under penalty of perjury under the laws of the United States of America, that the information in this petition and any document submitted with this petition is complete, true, and correct. 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 my records that USCIS may need to determine whether the child my spouse is petitioning for is eligible to be classified as our immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration of U.S. immigration laws. Spouse’s Signature 3. Petitioner’s Signature Date of Signature (mm/dd/yyyy) [Page 12] Spouse’s Contact Information 4. Spouse’s Daytime Telephone Number 5. Spouse’s Mobile Telephone Number (if any) 6. Spouse’s Email Address (if any)	[Page 12] Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Your Spouse’s Statement [deleted] 1. Spouse’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything. [deleted] 2. Spouse’s Statement Regarding the Preparer (if applicable) At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 14] Your Spouse’s Certification [deleted] 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 suitability and eligibility as an adoptive parent and whether the child my spouse is petitioning for is eligible to be classified as our immediate relative. I furthermore authorize release of information contained in this petition, 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 will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my petition; 2) I understood all of the information contained in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Your Spouse’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose. Your Spouse’s Signature 3. Your Spouse’s Signature Date of Signature (mm/dd/yyyy) [deleted]
Page 12, Part 8. Spouse’s Duty of Disclosure	[Page 12] Part 8. Spouse’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose. Petitioner’s Signature Date of Signature (mm/dd/yyyy)	[moved and combined into previous Part]
Page 12, Part 9. Interpreter’s Name, Contact Information, Certification, and Signature	[Page 12] Part 9. Interpreter’s Name, Contact Information, Certification, and Signature If you and/or your spouse (if married) used an interpreter to read and complete this petition, the interpreter must provide the following information: Interpreter’s Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) Interpreter’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Interpreter’s Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter’s Email Address (if any) [Page 13] Interpreter’s Certification I certify that: I am fluent in English and [Fillable field]. I have read and accurately translated to the petitioner and/or the petitioner’s spouse (if married) every question and instruction on this petition, as well as the answer to each question, in the language in which he or she is fluent. I have read the Acknowledgement of Appointment at USCIS Application Support Center (ASC) (if applicable) to the petitioner and/or the petitioner’s spouse in the language in which he or she is fluent. The petitioner and/or the petitioner’s spouse has informed me that he and/or she understands every instruction and question on the petition, as well as the answer to each question. The petitioner and/or the petitioner’s spouse also has informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his and/or her fingerprints, photograph, and/or signature, he and/or she is reaffirming that the contents of this petition and all supporting documentation are complete, true, and correct. Interpreter’s Signature 6. Interpreter's Signature Date of Signature (mm/dd/yyyy)	[Page 14] Part 8. Interpreter’s Contact Information, Certification, and Signature If you and/or your spouse (if married) used an interpreter to read and complete this petition, provide the following information about the interpreter. Interpreter’s Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) [Page 15] Interpreter’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code 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 Parts 6. and 7., Item B in Item Number 1., and I have read to this petitioner and/or the petitioner’s spouse in the identified language every question and instruction on this petition and their answer to every question. The petitioner and/or the petitioner’s spouse informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and has verified the accuracy of every answer. [deleted] Interpreter’s Signature 7. Interpreter's Signature Date of Signature (mm/dd/yyyy)
Page 13, Part 10. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and/or Spouse	[Page 13] Part 10. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and/or Spouse If you and/or your spouse (if married) used a preparer to complete this petition, the preparer must provide the following information: Preparer’s Full Name 1. Preparer’s Family Name (Last Name) Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) Preparer’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country [Page 14] Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Fax 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 petition on behalf of the petitioner and/or the petitioner’s spouse (if married) and with the petitioner’s and/or the petitioner’s spouse’s consent. 7.B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse (if married) in this case extends/does not extend beyond the preparation of this petition. Preparer’s Certification By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this petition on behalf of, at the request of, and with the express consent of the petitioner and/or the petitioner’s spouse (if married). I completed this petition based only on responses the petitioner and/or the petitioner’s spouse provided to me. After completing this petition, I reviewed it and all of the petitioner’s and/or the petitioner’s spouse’s responses with the petitioner and/or the petitioner’s spouse, who agreed with each and every answer on the petition. If the petitioner and/or the petitioner’s spouse supplied additional information concerning a question on the petition, I recorded it on the petition. I have also read the Acknowledgement of Appointment at USCIS Application Support Center (if applicable) to the petitioner and/or the petitioner’s spouse and the petitioner and/or the petitioner’s spouse has informed me that he and/or she understands the ASC Acknowledgement. Preparer’s Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)	[Page 15] Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse If you and/or your spouse (if married) used a preparer to complete this petition, provide the following information about the preparer. Preparer’s Full Name 1. Preparer’s Family Name (Last Name) Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) [Page 16] Preparer’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code 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 petition on behalf of the petitioner and/or the petitioner’s spouse (if married) with the petitioner’s and/or the petitioner’s spouse’s consent. B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse (if married) in this case extends/does not extend beyond the preparation of this petition. Preparer’s Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner and/or the petitioner’s spouse (if married). The petitioner and the petitioner’s spouse (if married) then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. Preparer’s Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)
New		[Page 16] Part 10. Additional Information If you need extra space to provide any additional information within this petition, 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 petition or attach a separate sheet of paper. If you attach a separate sheet of paper, type or print your full 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. Family Name (Last Name) [Auto-populated field] Given Name (First Name) [Auto-populated field] Middle Name [Auto-populated field] 2. A-Number (if any) [Auto-populated field] 3. A. Page Number B. Part Number C. Item Number D. [Fillable field] 4. A. Page Number B. Part Number C. Item Number D. [Fillable field] 5. A. Page Number B. Part Number C. Item Number D. [Fillable field] 6. A. Page Number B. Part Number C. Item Number D. [Fillable field]

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