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

Petition to
Classify Orphan as an Immediate Relative

USCIS
Form I-600

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

OMB No. 1615-0028
Expires 12/31/2018

For U.S. Government Use Only
The petitioner is:

Married

Receipt/Fee Stamp

Action Block

Unmarried

Form I-600A Approval
Approval Valid Until (mm/dd/yyyy):

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The petitioner is approved to adopt an
orphan from (if specified):

Department of State Actions:

Final Adjudicating Office/Post:

Approved

(Name of non-Hague Country)

PAIR Letter Issued Date (if applicable)
(mm/dd/yyyy):

To be Completed By
an Attorney or
Accredited
Representative (if any)

Transfer to USCIS as Not Clearly
Approvable

Officer Signature and Date:

Transfer to USCIS as Consular Return

Child's Legal Name after Adoption:

Select this box if
Form G-28 or G-28I
is attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink. Complete a separate petition for each child. This petition is used to determine
if a child is an orphan and eligible to be classified as your immediate relative.
You must be a U.S. citizen 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)

2.

Other Names Used (if any)

Given Name (First Name)

Middle Name (if applicable)

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 13. Additional Information.
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

Your Contact Information
3.

(USPS ZIP Code Lookup)

U.S. Mailing Address (if any)
In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-600 12/23/16

ZIP Code

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Part 1. Information About You (Petitioner) (continued)
4.

Yes

Is your current U.S. mailing address the same address as your U.S. physical residence?

No

If you answered "No" to Item Number 4., provide the address for your U.S. residence in Item Number 5. or the address for your
residence abroad in Item Number 6., as appropriate.
5.

6.

Address of U.S. Residence (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

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Address of Residence Abroad (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

7.

Postal Code

Country

Which address would you like USCIS to use for mailing notices and decisions to you?
U.S. Mailing Address

8.

ZIP Code

Address of Residence Abroad

Daytime Telephone Number

9.

Mobile Telephone Number (if any)

10. Email Address (if any)

Information About Your U.S. Citizenship
11. USCIS Online Account Number (if any)
►

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

13. City/Town/Village of Birth

14. State or Province of Birth

15. Country of Birth

Form I-600 12/23/16

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Part 1. Information About You (Petitioner) (continued)
16. How did you obtain your U.S. citizenship?

Birth

Parents

Naturalization

A. If you obtained 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)

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Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number
►

A-

Date of Issuance

Place of Issuance

(mm/dd/yyyy)

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)

A-Number (if any)
► A-

Date of Naturalization

Given Name (First Name)

Middle Name (if applicable)

Certificate of Naturalization Number

Place of Naturalization

(mm/dd/yyyy)

17. 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” to Item Number 17., provide a detailed explanation in the space provided in Part 13.
Additional Information.

Your Duty of Disclosure

You 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 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 under penalty of perjury under U.S. law. The written statement must show the date of each incident; place each
incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other
entity involved; and date of incarceration and name of facility, if applicable. Provide a description of any type of counseling,
rehabilitation, or other information that you would like considered in light of this history.
18. 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
criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not
include parking or traffic violations, except for violations for driving or operating a vehicle while
intoxicated, or while impaired by, or under the influence of, alcohol or another intoxicant.)

Yes

No

B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?

Yes

No

Form I-600 12/23/16

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Part 1. Information About You (Petitioner) (continued)
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

Information About Your Marital Status

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19. What is your marital status?

Single

Married

Separated

Divorced

Widowed

20. How many times have you been married (including your current marriage, if applicable)?

Part 2. Information About Your Current Spouse
NOTE: If you are not currently married, skip to Part 3.
1.

Date of Current Marriage (mm/dd/yyyy)

3.

Name of Your Current Spouse
Family Name (Last Name)

4.

2.

Place Where Current Marriage Occurred

Given Name (First Name)

Middle Name (if applicable)

Other Names Your Current Spouse Has Used

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 13. Additional Information.
Family Name (Last Name)

Given Name (First Name)

Spouse's Date of Birth (mm/dd/yyyy) Spouse's A-Number (if any)
► A-

Spouse's City/Town/Village of Birth

Middle Name (if applicable)

Spouse's USCIS Online Account Number (if any)
►

Spouse's State or Province of Birth

Spouse's Country of Birth

Is your spouse a U.S. citizen?
If you answered "Yes," how did your spouse obtain U.S. citizenship?

Yes
Birth

Naturalization

No

Parents

If you answered "No," provide your spouse's current U.S. immigration status:

5.

How many times has your current spouse been married (including your current marriage)?

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Part 2. Information About Your Current Spouse (continued)
Your Spouse's Contact Information
6.

Does your current spouse reside with you?
If you answered "No," provide your current spouse's physical address in Item Number 7.

7.

Your Current Spouse's Physical Address (if applicable)
Street Number and Name

8.

No

Apt. Ste. Flr. Number

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State

City or Town

Province

Yes

Postal Code

Your Spouse's Daytime Telephone Number

ZIP Code

Country

9.

Your Spouse's Mobile Telephone Number (if any)

10. Your Spouse's Email Address (if any)

Your Spouse's Duty of Disclosure

Your spouse must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your
spouse's ongoing duty to disclose information in response to these questions. If your spouse answers "Yes" to any of these 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 your spouse under penalty of perjury under U.S. law. The written statement must show the
date of each incident; place each incident occurred (city/town, state/province, country); name of police department or other law
enforcement administration or other entity involved; and date of incarceration and name of facility, if applicable. Provide a
description of any type of counseling, rehabilitation, or other information that your spouse would like considered in light of this
history.
11. 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
criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not
include parking or traffic violations, except for violations for driving or operating a vehicle while
intoxicated, or while impaired by, or under the influence of, alcohol or another 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

Form I-600 12/23/16

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Part 3. Information About Additional Household Members
1.

How many persons 18 years of age or older (other than your spouse, if married), reside with you?
If you answered one or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the
Household, for each person.

2.

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 13. Additional Information.
Date of Birth
(mm/dd/yyyy)

Name (First/Middle/Last)

Country of Birth

A-Number (if any)

Relationship to You

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Part 4. Information About Prior Filings or Adoptions

If you need extra space to complete Item Numbers 1. - 6., use the space provided in Part 13. Additional Information.
1.

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

Yes

No

If you answered “Yes,” provide the following information for EACH petition and/or application:
Type of Petition/Application Filed:
Form I-600A
Result:

Form I-600

Approved

Form I-800A

Denied

Form I-130 (for an adopted child)

Withdrawn

Revoked

Other (please explain):
Date (mm/dd/yyyy)

2.

Have you previously completed a domestic adoption of a child within the U.S.?
If you answered “Yes,” provide the following information for each completed domestic adoption.
State And County Where Adoption Was Finalized

Form I-600 12/23/16

Date Adoption Was Finalized (mm/dd/yyyy)

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Part 4. Information About Prior Filings or Adoptions (continued)
3.

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.

4.

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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

Yes

No

Yes

No

If you answered “Yes,” please provide a detailed description of the dissolution.

5.

Have you ever previously placed a child in the care of another person with the intent to transfer permanent
custody of the child?
If you answered “Yes,” please provide a detailed description of the placement.

6.

Have you ever received a child with the intent to gain permanent custody but without involving child welfare
or other state/local authorities or following a state/local process?
If you answered “Yes,” please provide a detailed description of the custody transfer.

Part 5. Information About The Orphan Beneficiary
1.

Name at Birth

Family Name (Last Name)

2.

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

Current Name
Family Name (Last Name)

3.

Given Name (First Name)

Other Names the Child Has Used (if any)
Provide all other names the child has ever used, including aliases and nicknames. If you need extra space to complete this
section, use the space provided in Part 13. Additional Information.
Family Name (Last Name)

4.

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

Gender
Male

Given Name (First Name)

Middle Name (if applicable)

6. City/Town/Village of Birth

Female

Form I-600 12/23/16

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Part 5. Information About The Orphan Beneficiary (continued)
7.

State or Province of Birth

8. Country of Birth

9.

The child 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.

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10. If the child has a sole or surviving parent, answer the following:
A. What happened to the other birth or previous parent?

B. Is the remaining parent capable of providing proper care for the child?

Yes

No

C. Has the remaining parent irrevocably released the child for emigration and adoption, in writing?

Yes

No

11. Did you adopt the child abroad?

Yes

No

12. Did your spouse (if married) adopt the child abroad?

Yes

No

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.)
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 13. Additional Information.
A. Do you and your spouse (if married) intend to adopt the child in the United States?

Yes

No

B. Provide a written description of all the pre-adoption requirements of the state of the child's proposed residence and cite any
relevant state statutes and regulations. If the state of the child's proposed residence does not have any pre-adoption
requirements, indicate “not applicable.”

C. Have any pre-adoption requirements of the child's proposed state of residence already been met?

Yes

No

If you answered “Yes,” provide which requirements have been met.

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Part 5. Information About the Orphan Beneficiary (continued)
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.

If you answered "No," provide each pre-adoption requirement that will not be met and explain why.

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15. To your knowledge:

A. Does the child 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.

16. The child's legal custodian is (select only one box):

An individual or entity other than the child's birth parents.
Name of the individual or entity:
Both of the child's living birth parents.

One of the child's living birth parents. The living birth parent is the (select one):

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)

Middle Name (if applicable)

Given Name (First Name)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

18. Address Where the Child Will Reside After the Adoption (or after you obtain legal custody)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-600 12/23/16

Postal Code

ZIP Code

Country

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Part 5. Information About the Orphan Beneficiary (continued)
19. Current Address of the Child
In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

ZIP Code

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Postal Code

Country

20. If the child resides in an institution, provide the full name of the institution.

21. If the child does not reside in an institution, provide the full name of the person with whom the child is residing or the name of the
child's caretaker.
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

22. Provide any additional information necessary to locate the child, such as the name of a district, section, zone, or locality in which
the child resides:

23. After you obtain an adoption or legal custody of the child, do you intend to:

A. Seek an immigrant visa because the child will reside with you in the United States?

Yes

No

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?

Yes

No

24. Where do you wish to file your visa application (if applicable)?
The U.S. Embassy or U.S. Consulate located at:

Part 6. Information About Your Home Study and Primary Adoption Service Provider
1.

Your home study:
A.

Was previously submitted with your approved and valid 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.

Was previously submitted with a Form I-600A/I-600, Supplement 3 (please attach a copy of your Form I-600A/I-600,
Supplement 3 fee receipt notice).

D.

IS attached to this Form I-600.

E.

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 USCIS. (Do not submit your Form
I-600 to USCIS until the state authority is ready to send your home study to USCIS.)

Form I-600 12/23/16

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Part 6. Information About Your Home Study and Primary Adoption Service Provider (continued)
Information About Your Primary Adoption Service Provider
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

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Family Name (Last Name)

4.

Given Name (First Name)

Primary Adoption Service Provider's Mailing Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Primary Adoption Service Provider's
Fax Number (if any)

5.

Primary Adoption Service Provider's Daytime
Telephone Number

7.

Primary Adoption Service Provider's Email Address (if any)

8.

The primary adoption service provider named above is one of the following:

6.

ZIP Code

A. An accredited agency in the United States.

Yes

No

B. An approved person in the United States.

Yes

No

Form I-600 12/23/16

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Part 7. 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 13. 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 or your spouse (if married) 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.
Date of
Payment
(mm/dd/yyyy)

2.

Relationship to
Child (if any)

Amount of Payment
(or description
and value of in-kind consideration)

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Payee

Purpose of Payment

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 or your spouse (if married) reasonably expect to
pay or make, either directly or indirectly, to any individual, agency, entity, governmental authority, or other payee or recipient.
Anticipated Date
of Payment
(mm/dd/yyyy)

Form I-600 12/23/16

Payee

Relationship to
Child (if any)

Purpose of Payment

Amount of Payment (or
description
and value of in kind consideration)

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Part 7. Information About Fees, Expenses, and Other Compensation (continued)
3.

Have you or your spouse (if married) or anyone on behalf of you or your spouse (if married) given or
arranged to give money or other consideration either directly or indirectly to the child's parent(s),
agent(s), other individual(s), or entity to induce or encourage the release of the child?

Yes

No

If you answered "Yes," provide a detailed description to explain.

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Part 8. 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 disabilities and/or impairments?

2.

If you answered "Yes," select all applicable boxes below to indicate who has the disabilities and/or impairments.
Petitioner

3.

Spouse

Yes

No

Adult Member of the Household

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).):

B.

Blind or have low vision and request the following accommodation:

C.

Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and the requested
accommodation.):

Part 9. 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
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 11. read to me every question and instruction on this petition and my answer to
every question in
, a language in which I am fluent, and
I understood everything.

2.

Petitioner's Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 12.,

,

prepared this application for me based only upon information I provided or authorized.
Form I-600 12/23/16

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Part 9. Petitioner's Statement, Certification, Duty of Disclosure, and Signature (continued)
Petitioner's Certification
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 to adopt and whether the child I am petitioning
for is an orphan and 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.

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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 under the laws of the United States, 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 to adopt, 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)

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.

Part 10. 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
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 11. read to me every question and instruction on this petition and my answer to
every question in
, a language in which I am fluent,
and I understood everything.

2.

Spouse's Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 12.,

,

prepared this petition for me based only upon information I provided or authorized.

Form I-600 12/23/16

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Part 10. Your Spouse's Statement, Certification, Duty of Disclosure, and Signature (continued)
Your Spouse's Certification
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 to adopt and whether the child my spouse is
petitioning for is an orphan and 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.

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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 under the laws of the United States, 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 to adopt, 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)

Part 11. 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)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-600 12/23/16

Postal Code

ZIP Code

Country

Page 15 of 18

Part 11. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

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Interpreter's Certification

I certify, under penalty of perjury under the laws of the United States, that:

, which is the same language specified in

I am fluent in English and

Parts 9. and 10., 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 his or her 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.

Interpreter's Signature
7.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 12. 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)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-600 12/23/16

Postal Code

ZIP Code

Country

Page 16 of 18

Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other
Than the Petitioner and Spouse (continued)
Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (if any)

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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 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 in
extends
this case
does not extend beyond the preparation of this petition.

Preparer's Certification

By my signature, I certify, under penalty of perjury under the laws of the United States, that I prepared this petition at the request of
the petitioner and/or the petitioner's spouse. The petitioner and/or the petitioner's spouse 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 upon information that the petitioner and/or the petitioner's spouse provided to me or authorized me
to obtain or use.

Preparer's Signature
8.

Preparer's Signature

Form I-600 12/23/16

Date of Signature (mm/dd/yyyy)

Page 17 of 18

Part 13. 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)

2.

A-Number (if any) ► A-

3.

A. Page Number

D.

4.

5.

A. Page Number

D.

6.

Middle Name

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A. Page Number

D.

Given Name (First Name)

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

Form I-600 12/23/16

Page 18 of 18