Request for Fee Waiver

Request for Fee Waiver
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-912

OMB No. 1615-0116
Expires 03/31/2020

What Is the Purpose of Form I-912?
Form I-912 is used to request a fee waiver for eligible immigration benefit applications and petitions. You may request
a fee waiver if your documented annual household income is at or below 150 percent of the Federal Poverty Guidelines
(FPG) or if you can demonstrate financial hardship including, but not limited to, medical expenses of family members,
unemployment, eviction, victimization, and homelessness.

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You can find the list of applications and petitions that are eligible for a fee waiver at www.uscis.gov/I-912 or refer to
8 CFR 103.7(c)(3). For filing tips and additional information, see www.uscis.gov/I-912.
To request a fee waiver, you must submit Form I-912 and provide the supporting documentation. A letter stating you
are unable to pay the filing fees or biometric services fees will not be accepted without a completed Form I-912 and
supporting documentation.
You do not need to file Form I-912 for applications and petitions that do not require a filing fee. Some USCIS applications
and petitions have fee exemption requirements for certain types of applicants and petitioners. In these cases, the USCIS
form and instructions will outline the fee exemption and submission requirements if a separate Form I-912 is not required.
NOTE: You may be ineligible for certain immigration benefits if you are found inadmissible as a public charge. While
adjudication of the fee waiver request does not consider the requestor’s inadmissibility, filing to request a fee waiver and
receiving an approved fee waiver can negatively impact eligibility for any immigration benefit that is subject to the public
charge determination.

Forms Eligible For Fee Waiver

Below is a list of applications and petitions U.S. Citizenship and Immigration Services (USCIS) will consider for a fee
waiver and the conditions that you must meet to be eligible for a fee waiver. Under current fee waiver regulations, USCIS
can approve fee waivers only for certain forms or certain types of applicants filing a particular form, and only when fee
waiver requirements are met.
You may file Form I-912 to request a fee waiver for any of the following benefit requests or services:
1. Biometric services fee, except for the biometric services fee required for a provisional unlawful presence waiver
application (Form I-601A) filed under 8 CFR 212.7(e);
2. Form I-90, Application to Replace Permanent Resident Card;
3. Form I-129, Petition for a Nonimmigrant Worker, but only if you are an applicant for E-2 CNMI investor
nonimmigrant status under 8 CFR 214.2(e)(23);
4. Form I-131, Application for Travel Document, but only if you are applying for humanitarian parole;
5. Form I-191, Application for Relief Under Former Section 212(c) of the Immigration and Nationality Act (INA);
6. Form I-192, Application for Advance Permission to Enter as a Nonimmigrant, but only if you are an applicant who is
exempt from the public charge grounds of inadmissibility;
7. Form I-193, Application for Waiver of Passport and/or Visa, but only if you are an applicant who is exempt from the
public charge grounds of inadmissibility;
8. Form I-290B, Notice of Appeal or Motion, but only if the application you are appealing or filing a motion for was fee
exempt, had the filing fee waived, or was eligible for a fee waiver;

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9. Form I-485, Application to Register Permanent Residence or Adjust Status, but only if you are applying for lawful
permanent resident status based on:
A. Special Immigrant Status based on an approved Form I-360 as an Afghan or Iraqi Interpreter, or Afghan or Iraqi
National employed by or on behalf of the U.S. Government;
B. An eligibility category that is exempt from the public charge grounds of inadmissibility of the Immigration and
Nationality Act (INA) section 212(a)(4), such as the Cuban Adjustment Act, the Haitian Refugee Immigration
Fairness Act, continuous residence in the United States since before January 1, 1972, (“Registry”), asylum status,
Special Immigrant Juvenile status, or similar categories;
10. Form I-539, Application to Extend/Change Nonimmigrant Status, but only if you are an applicant with any benefit
request as specified by INA section 245(l)(7) or an applicant for E-2 Commonwealth of the Northern Mariana Islands
(CNMI) investor nonimmigrant status under 8 CFR 214.2(e)(23);

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11. Form I-601, Application for Waiver of Grounds of Inadmissibility, but only if you are an applicant who is exempt
from the public charge grounds of inadmissibility of INA section 212(a)(4);
12. Form I-694, Notice of Appeal of Decision Under Sections 245A or 210 of the Immigration and Nationality Act, if you
are appealing an application or petition that was fee exempt, had the filing fee waived, or was eligible for a fee waiver;
13. Form I-751, Petition to Remove Conditions on Residence;

14. Form I-765, Application for Employment Authorization, unless you are filing under category (c)(33), Deferred Action
for Childhood Arrivals (DACA);
15. Form I-817, Application for Family Unity Benefits;

16. Form I-821, Application for Temporary Protected Status;

17. Form I-881, Application for Suspension of Deportation or Special Rule Cancellation of Removal;
18. Form N-300, Application to File Declaration of Intention;

19. Form N-336, Request for a Hearing on a Decision in Naturalization Proceedings;
20. Form N-400, Application for Naturalization;

21. Form N-470, Application to Preserve Residence for Naturalization Purposes;

22. Form N-565, Application for Replacement of Naturalization/Citizenship Document;
23. Form N-600, Application for Certificate of Citizenship; and

24. Form N-600K, Application for Citizenship and Issuance of Certificate under Section 322.
You may also apply for a fee waiver for ANY application or petition that is related to status as or benefits for a:
1. Battered spouse of an A, G, E-3, or H nonimmigrants (such as Forms I-485, I-601 and I-212);
2. Battered spouse or child of a lawful permanent resident or U.S. citizen under INA section 240A(b)(2);
3. T nonimmigrant (such as Forms I-192, I-485, and I-601);
4. Person with Temporary Protected Status (such as Forms I-131, I-821 and I-601);
5. U nonimmigrant (such as Forms I-192, I-485, and I-929); or
6. VAWA self-petitioner (such as Forms I-485, I-601 and I-212).
You may not file Form I-912 if you are requesting consideration of Deferred Action for Childhood Arrivals (DACA).
There are no fee waivers for DACA. Fee exemptions are available in limited circumstances. For information on
DACA fee exemptions, see www.uscis.gov/forms/forms-and-fees/guidance-exemption-fee-form-i-765-filed-requestconsideration-deferred-action-childhood-arrivals.

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If your form is not listed in the Forms Eligible for Fee Waiver section, please see the specific form instructions for
additional information or visit the USCIS Contact Center at www.uscis.gov/contactcenter to get answers to your
questions and connect with a live USCIS representative.

How to File Form I-912
You must file this fee waiver request with all applications and petitions for which you are requesting a fee waiver. You
do not have to file a separate Form I-912 for the filing fee and the biometric services fee. If USCIS approves your Form
I-912, we will waive both the filing fee and biometric services fee. Each person requesting a fee waiver must submit an
individual Form I-912.

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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 get.adobe.com/reader. If you do not
have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS
Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each request must be properly signed and filed. For all signatures on this request, USCIS will not accept a
stamped or typewritten name in place of a signature. A legal guardian may also sign for a mentally incompetent person.
If the request is not signed or if the requisite signature on the request is not valid, USCIS will reject the request. See
8 CFR 103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature,
USCIS will deny the request.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original, handwritten signature
valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten, ink
signature.
Evidence. At the time of filing, you must submit all evidence and supporting documents listed in the Specific
Instructions section of these Instructions.
Copies. You may submit legible photocopies of documents requested, unless the Instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to
you after USCIS determines it no longer needs your original.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and
that he or she is competent to translate from the foreign language into English. The certification must also include the
translator’s signature, printed name, the signature date, and the translator’s contact information.
How To Fill Out Form I-912
1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this request, use the space provided in Part 8. Additional
Information or attach a separate sheet of paper. Type or print your name and Alien Registration Number (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.

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3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None” unless
otherwise directed.

Specific Instructions
Part 1. Basis for Your Request

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Item Numbers 1. - 2. Select a basis for your request. You are not required to complete the entire section of this request.
Rater, select one basis or more for which you may qualify and complete the corresponding section below.
Part 2. Information About You (Requestor)

Item Number 1. Full Legal Name. Provide your full name. If you have two last names, include both in the Family
Name box and use a hyphen (-) if appropriate. If you do not have a middle name, type or print “N/A.”
Item Number 2. Other Names Used (if any). Provide all other names you have used, including your maiden name.
Item Number 3. Alien Registration Number (A-Number) (if any). An A-Number is a number assigned by USCIS or
the former Immigration and Naturalization Service (INS). People with A-Numbers can locate the number on their USCISissued or INS-issued documentation.
Item Number 4. USCIS Online Account Number (if any). If you have previously filed an application or petition using
the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the
USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by
logging in to your account and going to the profile page. If you previously filed certain applications or petitions on a
paper form through a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing
you a USCIS Online Account Number. You may find your USCIS Online Account Number at the top of the notice. The
USCIS Online Account Number is not the same as an A-Number. If you were issued a USCIS Online Account Number,
enter it in the space provided.
Item Number 5. Date of Birth (mm/dd/yyyy). Provide your date of birth in mm/dd/yyyy format. For example, enter
May 1, 1979, as 05/01/1979.
Item Number 6. U.S. Social Security Number (if any). Provide your U.S. Social Security number.
Item Number 7. Marital Status. Indicate your current marital status.
Item Number 8. Number of Applications and Petitions for Which You are Requesting a Fee Waiver. Provide the
form numbers and the total number of applications and petitions for which you are requesting a fee waiver.
Item Number 9. Certain Statuses. Indicate whether you are applying for or have one of the statuses listed.
Part 3. Household Income
To qualify for the fee waiver, your household income must be at or below 150 percent of the Federal Poverty Guidelines
based on your household size at the time you file your request. The Federal Poverty Guidelines are established by the
Secretary of the Department of Health and Human Services annually. To obtain information on the current Federal
Poverty Guidelines, visit our website at www.uscis.gov/I-912P.
Your Employment Status
Item Number 1. Employment Status. Indicate your current employment status. If you are both employed and a
student, select Other and provide an explanation.

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Item Number 2. Provide the date that you became unemployed and indicate if you are currently receiving unemployment
benefits. Provide the total amount of unemployment benefits you have received in Item Number 10.
Information About Your Spouse
Item Number 3. Indicate whether your spouse is living with you. If your spouse lives with you, list your spouse in the
table provided in Item Number 4. and provide their income in Item Number 9. If applicable, indicate whether your
spouse provides any financial support to your household. If your spouse provides any financial support to your household,
include any contributions that your spouse provides to your household in Item Number 10.
NOTE: If you are applying for any immigration benefits (such as for adjustment of status) based on a pending or
approved petition or application for VAWA benefits or T or U nonimmigrant status, you may skip Item Number 3.
Your Household Size

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Item Number 4. Indicate whether you are providing the primary financial support for your household.
Complete the table with the information requested about the members of your household, including their names, dates of
birth, relationship to you, whether the person is married, whether the person is a full-time student, and whether the person
earns income counted towards household income.
For the last column (Is any income earned by this person counted towards the household income?), select yes if income is
received consistently or regularly as wages or salary from these household members’ employment or business.
At the end of the table, provide the total number of household members who are dependent on your income, your spouse’s
income, or the head of household’s income. Include the following people as part of your household size:
1. You;

2. The head of your household (if not you). If the child is applying individually, provide the information of the primary
custodial parent;
A. You are the head of household if you filed the most recent Federal tax return for your household (includes filing as
head of household) or earned the majority of the income for your household.
B. If you are not the head of household, the head of household is the person who filed the most recent Federal
tax return on which you are listed as a dependent or the person who provides the majority of your household’s
income. If you already have or are applying for Special Immigrant Juvenile (SIJ) classification, do not include
any foster or group home household members.
3. Your spouse, if living with you (do not include your spouse if you are separated, your spouse is not living with you, or
you already have or are applying for VAWA benefits or T or U nonimmigrant status); or
4. Any family members living in your household who are dependent on your income, your spouse’s income, or the head
of household’s income, including:
A. Your children or legal wards who are unmarried and under 21 years of age, and who live with you;
B. Your children or legal wards who are unmarried, are 21 to 23 years of age, are full-time students, and who live
with you when not at school;
C. Your children or legal wards who are unmarried and for whom you are the legal guardian because they are
physically or developmentally disabled or mentally impaired to the extent that they cannot adequately care for
themselves and cannot establish, maintain, or re-establish their own household;
D. Your parents who live with you; and
E. Any other dependents listed on your Federal tax return or your spouse or head of household’s Federal tax returns.
F. If you are applying for any immigration benefits (such as for adjustment of status) based on a pending or approved
petition or application for VAWA benefits or T or U nonimmigrant status and one of your household members is or
was your abuser or human trafficker, do not list him or her as a household member.
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Your Annual Household Income
Item Numbers 5. - 7. Tax Return Filing. Identify whether you and your household member(s) filed a tax return last
year.
If you are filing Form I-912 between January 1 and April 15 of any year, and you and/or your household members have
not yet filed the current year’s federal income tax return, submit IRS transcripts for the most recent tax year. Submit any
tax transcripts that you or your household members filed with any foreign government if you or your household members
were residing outside of the United States during any time within the last tax year and you were not required to file a
federal individual income tax return with the United States government.
If you are a child (under the age of 21 and unmarried) and are listed as a dependent on your parents’ income tax return, or
if you are listed as a dependent on anyone else’s income tax return, list the total income from that individual’s most recent
tax return within the last tax year and submit that individual’s IRS tax transcripts.

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If you are listed as a dependent on an income tax return, and you are applying for any immigration benefits (such as for
adjustment of status) based on a pending or approved petition or application for VAWA benefits or T or U nonimmigrant
status based on abuse from your spouse, parent, or adult child, do not include his/her income.
Item Number 8. Your Annual Income. Provide information on your annual income. From your filed Federal tax
return, enter the amount from Line 37 (adjusted gross income) on Internal Revenue Service (IRS) Form 1040, U.S.
Individual Income Tax Return. If you have not filed a Federal income tax return but you have an IRS Form W-2, Wage
and Tax Statement, that covers the previous 12-month period, take your total wages, tips, and other compensation reported
in Box 1, and enter that amount as your household’s annual wage income.
Documentation. For information on obtaining federal income tax transcripts without a fee, see
www.irs.gov/individuals/get-transcript. You may also use IRS Form 4506-T to request income tax transcripts, or Form
1099 Certain Government Payments from the IRS. If you reside and filed tax returns in a U.S. territory, submit the tax
return transcript from the territory instead of a federal tax return transcript.
To document your annual income, provide the following information:

1. A transcript of your most recent Federal tax return from the IRS. You are not required to have the IRS certify the
transcript or photocopy, but USCIS may later request a certified copy;
2. If you filed a Federal tax return, and you have recently changed employment or had a change in salary, submit
your Federal tax return transcript and copies of consecutive pay statements (stubs) for at least the past month. Pay
statements (stubs) alone are not sufficient evidence;
3. If you are unemployed and receiving unemployment compensation also submit a copy of IRS Form 1099-G. If you
are not receiving unemployment compensation, submit a letter of termination from the employer;
4. If you did not file a Federal tax return, submit a recent Form W-2, Form SSA-1099 (if Social Security is the only
income received), or the most recent Social Security Statement indicating your earning record;
5. If you are a student and not living with your parents or are not claimed as a dependent on your parents’ Federal tax
return, do not include your parents’ incomes. You should only provide proof of your income or documentation that
shows you are not required to file a Federal or state tax return transcript, such as proof that you are a full-time student;
6. If you do not have any income, or cannot provide proof of your income, describe your particular situation in detail in
Part 3. Item Number 12., and submit documentation from the IRS that indicates no tax transcripts and no W-2s were
found (see IRS Form 4506-T).
7. If you are homeless, submit documentation from the IRS that indicates no tax transcripts and no W-2s were found
(see IRS Form 4506-T). If you are homeless and receiving support services, submit an affidavit from a religious
institution, non-profit, or community-based organization verifying that you are currently receiving some benefit or
support from that entity and attesting to your financial situation.

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8. If you are filing Form I-485, Application to Register Permanent Residence or Adjust Status, based on SIJ
classification, you must submit evidence that you were approved or filed for SIJ classification (for example, Form
I-360, Petition for Amerasian, Widow(er), or Special Immigrant; or a copy of Form I-797, Notice of Action, for Form
I-360). If you are applying for adjustment of status or filing related forms based on SIJ classification, you are not
required to complete Part 2. of Form I-912 or to show proof of income to request a fee waiver.
Item Number 9. Annual Income of All Family Household Members. Provide the annual income from all family
members counted as part of your household.
1. If a person lives with you but does not contribute financial support to your household, then you should not include this
person’s income when calculating your household income.

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2. If you are separated or still married but do not live with your spouse, do not include your spouse’s income. However,
you must include any financial support your spouse provides to your household in Item Number 10.
3. If you are applying for any immigration benefits (such as for adjustment of status) based on a pending or approved
petition or application for VAWA benefits or T or U nonimmigrant status, do not provide your spouse’s income.
4. Include your parents’ income if you are a full-time student, 21 to 23 years old, are unmarried, and are living with
your parents, or if you are claimed as a dependent on your parents’ Federal tax return. You must provide a transcript
of both parents’ Federal tax returns and a transcript of your own Federal tax return, or provide proof of income as
supporting documentation.
5. If members of your household are recently unemployed, describe the particular situation in Part 3. Item Number 12.
Documentation. For information on obtaining federal income tax transcripts without a fee, see
www.irs.gov/individuals/get-transcript. You may also use IRS Form 4506-T to request income tax transcripts, or Form
1099 Certain Government Payments from the IRS.
To document your household members’ incomes, provide the following:

1. A transcript of each household member’s most recent Federal tax return;

2. If the household member filed a Federal tax return and has recently changed employment or had a change in salary,
submit his or her Federal tax return transcript and copies of consecutive pay statements (stubs) for at least the past
month. Pay statements (stubs) alone are not sufficient evidence.
If a household member is unemployed and receiving unemployment compensation also submit a copy of his or her
IRS Form 1099-G. If he or she is not receiving unemployment compensation submit, a letter of termination from the
employer.
3. If the household member did not file a Federal tax return, submit a recent Form W-2, Form SSA-1099 (if Social
Security is the only income received), or the most recent Social Security Statement indicating his or her earning
record.
4. If any of the household members do not have any income, describe his or her particular situation in Part 3. Item
Number 12., and submit documentation from IRS that indicates no tax transcripts and no W-2s were found (see IRS
Form 4506-T).
Item Number 10. Total Additional Income or Financial Support. If you received additional income on a continuing
monthly basis for the most recent full year (for example, child support) and it was NOT listed in your tax return, provide
the amount of additional annual income. Type or print “0” if you have no additional income. You must include any
consistent or regular financial support or additional income contributed to your household by any person living with you
or not living with you, even if it is not part of the household for tax purposes.
Select any type of additional income you are receiving, including any amount of money that you receive annually that is
not included in Item Number 8. or 9.
Documentation. You must document additional financial assistance as income. Include the following information:

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1. Documents showing parental support; alimony; child support; educational stipends; pensions; Social Security;
royalties, pensions, veterans benefits; unemployment benefits; and consistent or regular financial support from adult
children, parents, dependents, or other people living in your household.
2. A court order of any child support, or spousal support or documentation that indicates the actual amount of child
support or spousal support being received.
3. Any bank statements or IRS Form W-2, Form SSA-1099 for any pension social security or veteran’s benefits, if
applicable.
4. If you are receiving unemployment benefits, provide IRS Form 1099-MISC, in addition to your IRS Form 1040
transcript.

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5. Any bank statements or other documentation establishing any additional income provided by adult children,
dependents, or other people living in the household, if applicable.
Item Number 11. Total Annual Household Income. Provide the total household income. Add the amounts from Item
Numbers 8., 9., and 10. USCIS will compare this amount to the Federal Poverty Guidelines.
Item Number 12. Indicate whether any information (including marital status, income, and list of dependents) in
your Federal tax returns is different from what you indicate in Form I-912. Provide the reasons for any changes in
circumstances and any differences between the tax returns and information in your Form I-912. If you need to explain
anything else about your circumstances that affect the income determination, use the space provided in Part 8. Additional
Information.
NOTE: If you already have or are applying for VAWA benefits or T or U nonimmigrant status, and due to your
victimization, you do not have any income or cannot provide proof of income as required in Part 3. Item Numbers
5. - 12. above, describe your situation in sufficient detail in Part 3. Item Number 12. to substantiate your inability to
pay as well as your inability to obtain the required documentation. Additionally, provide any available documentation
of your and/or your household’s income, such as pay stubs or affidavits from religious institutions, non-profits, or other
community-based organizations verifying that you are currently receiving some benefit or support from that entity and
attesting to your financial situation.
Part 4. Financial Hardship

Item Number 1. Provide details about your financial hardship. This may include, but is not limited to, medical expenses
of family members, unemployment, eviction, victimization, and homelessness. You may also complete this section if your
income is above 150 percent of the Federal Poverty Guidelines as defined in Part 3. and you believe you have special
circumstances that warrant a fee waiver.
Documentation. You must document your income and provide a complete list, description, and an estimate of the value
of your assets that you can easily convert into cash and any liabilities.
Item Number 2. List the types of assets you have, the dollar value of those assets, and the total dollar value of your
assets. Include the following assets:
1. Cash, checking and savings accounts, annuities, stocks, and bonds. These are assets that easily covert into cash; and
2. Other property or assets that you can easily convert into cash without incurring a hardship.
Do not include your pension plans and Individual Retirement Accounts (IRA).
Documentation. Provide documentation of your income and any evidence regarding the types and value of your assets.
Item Number 3. Total Monthly Expenses and Liabilities. Provide your average monthly costs for all applicable
categories provided.

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Documentation. Provide evidence, where possible, such as copies of monthly bills and payments, and documentation
for monthly expenses and any extenuating circumstances, such as medical bills. If you do not have any income, or
cannot provide proof of your income, submit documentation from the IRS that indicates no tax transcripts and no W-2s
were found, see IRS Form 4506-T www.irs.gov/individuals/get-transcript. If you are currently homeless and receiving
support services, submit an affidavit from a religious institution, non-profit, or community-based organization verifying
that you are currently receiving some benefit or support from that entity and that you have no income.
If you already have or are applying for VAWA benefits or T or U nonimmigrant status, and due to your victimization, you
do not have any income or cannot provide proof of income as required in the paragraph above, describe your situation
in sufficient detail in Part 4. Item Number 1. to substantiate your inability to pay as well as your inability to obtain
the required documentation. Additionally, provide any available documentation of your income, such as pay stubs or
affidavits from religious institutions, non-profits, or other community-based organizations verifying that you are currently
receiving some benefit or support from that entity and attesting to your financial situation.

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Part 5. Requestor’s Statement, Contact Information, Certification, and Signature

Item Numbers 1. - 6. Select the appropriate box to indicate whether you read this request yourself or whether you had
an interpreter assist you. If someone assisted you in completing the request, select the box indicating that you used a
preparer. Further, you must sign and date your request and provide your daytime telephone number, mobile telephone
number (if any), and email address (if any). Every request MUST contain the signature of the requestor (or parent or
legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
Part 6. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1. - 7. If you used anyone as an interpreter to read the Instructions and questions on this request to you in
a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address
of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number
(if any), and his or her email address (if any). The interpreter must sign and date the request.
Part 7. Contact Information and Signature of the Person Preparing this Request, if Other Than the Requestor
Item Numbers 1. - 8. This section must contain the signature of the person who completed your request, if other than
you, the requestor. If the same individual acted as your interpreter and your preparer, that person should complete both
Part 6. and Part 7. If the person who completed this request is associated with a business or organization, that person
should complete the business or organization name and address information. Anyone who helped you complete this
request MUST sign and date the request. A stamped or typewritten name in place of a signature is not acceptable. If the
person who helped you prepare your request is an attorney or accredited representative, he or she may also need to submit
a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or Form G-28I, Notice
of Entry of Appearance as Attorney In Matters Outside the Geographic Confines of the United States, along with your
request.
Part 8. Additional Information
Item Numbers 1. - 6. If you need extra space to provide any additional information within this request, use the space
provided in Part 8. Additional Information. If you need more space than what is provided in Part 8., you may make
copies of Part 8. to complete and file with your request, or attach a separate sheet of paper. Type or print your 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.
We recommend that you print or save a copy of your completed request to review in the future and
for your records.

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What Is the Filing Fee?
There is no filing fee for Form I-912.

Where To File?
Attach your Form I-912 and all supporting documents to the application or petition for which you are requesting a fee
waiver. Mail your completed application or petition, Form I-912, and all supporting documents to the address in the
Where to File section in the Instructions for the specific application or petition you are filing.

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Processing Information

Decision. The decision on Form I-912 involves a determination of whether you have established eligibility for the fee
waiver. USCIS will notify you of the decision in writing. If USCIS denies your fee waiver request, the notice will
include information on resubmitting your application or petition. For certain immigration benefits, you may have only a
limited period of time in which to resubmit your application or petition with the proper filing fee.

USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS website at www.uscis.gov where you can obtain
the latest USCIS forms and immigration-related information. If you do not have internet access, you may order USCIS
forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in
English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at
www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to
set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for
you.

Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-912, USCIS
will deny your fee waiver request and may deny any other immigration benefit. In addition, you may face severe penalties
provided by law and may be subject to criminal prosecution.

USCIS Privacy Act Notice
AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the
Immigration and Nationality Act Section 286(m), 8 U.S.C. 1356, and 8 CFR 103.7(c)(3).
PURPOSE: The primary purpose for providing the requested information on this form is to determine if you have
established eligibility for a fee waiver for the associated immigration benefit that you are filing. DHS uses the information
you provide to grant or deny the request you are making.

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DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in
denial of your fee waiver request and rejection of your application or petition.
ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence with
other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine
uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National
File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments
[DHS/USCIS/PIA-003(a) - Integrated Digitization Document Management Program (IDDMP), DHS/USCIS/PIA-015
Computer Linked Application Information Management System (CLAIMS 4) (and subsequent updates), DHS/USCIS/
PIA-016(a) Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems, and
DHS/USCIS/PIA-056 USCIS Electronic Immigration System (USCIS ELIS)] which you can find at
www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the
interest of national security.

Draft
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Production
09/10/2019

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 2 hours and 20 minutes per response, including the
time for reviewing instructions, gathering the required documentation and information, completing the request, preparing
statements, attaching necessary documentation, and submitting the request. 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. 1615-0116. Do not mail your completed Form I-912 to this
address.

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