Current Page Number and
Section
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Current Text
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Proposed
Text
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Page 1
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[Page 1]
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To be completed by an Attorney
or Accredited Representative (if any).
Select this box if Form G-28 is
attached or G-28I is attached.
Attorney State Bar Number (if
applicable)
Attorney or Accredited
Representative USCIS Online Account Number (if any)
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[Page
1]
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To be completed by an Attorney
or Accredited Representative.
Select this box if Form G-28 is
attached or G-28I is attached.
Attorney State Bar Number
Attorney or
Accredited Representative USCIS Online Account Number
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Page 1-2, Part 1.
Information About You
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[Page 1]
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1. Alien Registration Number
(A-Number) (if any)
2. USCIS Online Account
Number (if any)
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8. U.S. Social Security
Number (if any)
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12. Province of Birth (if
applicable)
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17.b. If you answered "Yes"
to Item Number 17.a., provide the USCIS Receipt Number for
your Form I-821, if any.
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18.b. If you answered "Yes"
to Item Number 18.a., provide the USCIS Receipt Number for
your Form I-212, if any.
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[Page 1]
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1. Alien Registration Number
(A-Number)
2. USCIS Online Account
Number
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8. U.S. Social Security
Number
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12. Province of Birth
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17.b. If you answered "Yes"
to Item Number 17.a., provide the USCIS Receipt Number for
your Form I-821.
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18.b. If you answered "Yes"
to Item Number 18.a., provide the USCIS Receipt Number for
your Form I-212.
…
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Page 6, Part 5.
Information About Your Qualifying Relatives
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[Page 6]
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3. Daytime Telephone Number
(if any)
4. Email Address (if any)
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7. Relative's A-Number (if
any)
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[Page 6]
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3. Daytime Telephone Number
4. Email Address
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7. Relative's A-Number
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Page 6-7, Part 6.
Information About Your Other Relatives With Ties to the United
States
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[Page 6]
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3. Daytime Telephone Number
(if any)
4. Email Address (if any)
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7. Relative's A-Number (if
any)
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[Page 6]
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3. Daytime Telephone Number
4. Email Address
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7. Relative's A-Number
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Page 10, Part 10.
Additional Information
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[Page 10]
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If you need extra space to provide
any additional information within this application, 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 application 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.
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2. A-Number (if any)
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[Page 10]
…
If you need extra space to provide
any additional information within this application, 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 application or
attach a separate sheet of paper. Type or print your name and
A-Number 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.
…
2. A-Number
…
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Page 11-12, Part 11.
Statement for Applicants With a Class A Tuberculosis Condition (As
Defined By HHS Regulations)
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[Page 11]
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7. Email Address (if any)
[Page 12]
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13. Email Address (if any)
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[Page 11]
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7. Email Address
[Page 12]
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13. Email Address
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