Application for Relief under Former Section 212(c) of the Immigration and Nationality Act

Application for Relief Under Former
Section 212(c) of the Immigration and
Nationality Act (INA)
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-191

OMB No. 1615-0016
Expires 02/28/2021

What Is the Purpose of Form I-191?
You may be eligible to file Form I-191, Application for Relief Under Former Section 212(c) of the Immigration and
Nationality Act (INA), if you:

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1. Were lawfully admitted for permanent residence; and

2. Are subject to removal from the United States because you were convicted before April 1, 1997, of a crime that makes
you inadmissible or deportable.
NOTE: This version of Form I-191 meets the requirement of 8 CFR 1212.3 to file the Form I-191 previously titled,
“Application for Advance Permission to Return to Unrelinquished Domicile”.
If you are in deportation, exclusion, or removal proceedings, you CANNOT file Form I-191 with USCIS. You must seek
relief under former INA section 212(c) before an immigration judge.
Congress repealed former INA section 212(c), effective April 1, 1997. However, the U.S. Supreme Court decided in 2001
that the repeal does not apply to lawful permanent residents (LPRs) who pled guilty to a crime before April 1, 1997 (INS
v. St. Cyr, 533 U.S. 289). In Matter of Abdelghany, 26 I&N Dec. 254 (BIA 2014), the Board of Immigration Appeals
stated that relief under former INA section 212(c) is also available to otherwise eligible LPRs, even if they were convicted
following a trial before April 1, 1997.
Therefore, you are eligible for relief under former INA section 212(c) if you pled guilty or were convicted in a trial before
April 1, 1997, provided you meet all other requirements.

Am I Eligible To File For Relief Under Former INA Section 212(c)?

You may apply for relief under former INA section 212(c) if you meet all of the requirements below:

1. Lawful Permanent Residence (LPR). You were lawfully admitted to the United States for permanent residence and
you continue to be an LPR.
Under 8 Code of Federal Regulation 1.2, your status as an LPR ends once the court issues a final administrative
exclusion, deportation, or removal order. If you became subject to a final administrative removal order before you
lived in the United States for seven consecutive years of unrelinquished domicile, you are no longer eligible for relief
under former INA section 212(c). A final administrative removal order includes an order granting voluntary departure.
If you do not leave before the end of the voluntary departure period, the order will become a final removal order.
Also, your becoming an LPR must have been fully lawful. If you obtained LPR status by fraud or material
misrepresentation, or if you were ineligible for LPR status for any other reason, you cannot obtain relief under former
INA section 212(c).
2. Lawful Unrelinquished Domicile for Seven Years. You must have had your “domicile” in the United States for at
least seven consecutive years immediately before you file Form I-191 in the United States.
The period that makes up the unrelinquished domicile for seven years started when you became either an LPR or
a lawful temporary resident under INA section 210 or 245A. Time that you spent in the United States in any other
status does not count.
USCIS acknowledges that “domicile” is a legal term that may be unfamiliar. This means that you must have had your
permanent home in the United States, and you must have intended to keep your permanent home in the United States.

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3. Criminal Convictions. You were convicted before April 1, 1997, of any crime that makes you deportable or
removable.
4. Eligibility. You were eligible for relief under the version of former INA section 212(c) that was in effect on the day
you were convicted. See the section of these Instructions entitled What Version of Former INA Section 212(c) Will
Apply to My Case, and What Makes Me Ineligible for Relief Under Former INA Section 212(c).

What Version of Former INA Section 212(c) Will Apply to My Case and What Makes Me Ineligible for
Relief Under Former INA Section 212(c)?

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USCIS (or an immigration judge if you are in deportation, exclusion, or removal proceedings) will decide your application
under the version of former INA section 212(c) that was in effect on the date you pled guilty or were convicted.
Congress amended former INA section 212(c) several times before finally repealing the provision. First, section 511
of the Immigration Act of 1990 (“IMMACT90”), Public Law 101-649, made relief under former INA section 212(c)
unavailable to certain aggravated felons. Then, section 440(d) of the Antiterrorism and Effective Death Penalty Act of
1996 (AEDPA), Public Law 104-132, expanded the offenses for which relief under former INA section 212(c) is not
available.
If you pled guilty or were convicted before November 29, 1990.

The amendments to former INA section 212(c) by section 511(a) of IMMACT90 and by section 440(d) of AEDPA do not
apply to you if you were convicted:
1. Before November 29, 1990, after a trial; or

2. At any time, if you prove that you were convicted based on a plea agreement made before November 29, 1990.
You may be eligible for relief under former INA section 212(c) unless you:

1. Are inadmissible to the United States under INA section 212(a)(3) (security related grounds) or INA section (10)(C)
(international child abduction); or
2. Failed, after proper notice, to appear for your deportation, exclusion, or removal proceedings; failed to comply with a
voluntary departure order; or otherwise violated immigration laws relating to deportation proceedings.
If you pled guilty or were convicted on or after November 29, 1990, but before April 24, 1996.
The amendment made by section 511(a) of IMMACT90 applies to you if you were convicted:
1. In a trial on or after November 29, 1990, and before April 24, 1996; or
2. Before, on, or after November 29, 1990, and before, on or after April 24, 1996, if you prove you were convicted based
on a plea agreement made before April 24, 1996.
You may be eligible for relief under former INA section 212(c) unless you:
1. Were convicted of one or more aggravated felonies, as defined in INA section 101(a)(43) and you served for this
aggravated felony or these aggravated felonies an aggregate 5-year term of imprisonment;
2. Are inadmissible to the United States under INA section 212(a)(3) (security related grounds) or (10)(C) (international
child abduction); or
3. Failed, after proper notice, to appear for your deportation, exclusion, or removal proceedings; failed to comply with a
voluntary departure order; or otherwise violated immigration laws relating to deportation proceedings.

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If you pled guilty or were convicted on or after April 24, 1996, but before April 1, 1997.
The amendment made by section 440(d) of AEDPA applies to you if you were convicted:
1. On or after November 29, 1990, and before April 24, 1996, after a trial; or
2. Before, on, or after November 29, 1990, and before, on or after April 24, 1996, if you prove you were convicted based
on a plea agreement made before April 24, 1996.
You may be eligible for relief under former INA section 212(c) unless you:
1. Were convicted of one or more aggravated felonies;

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2. Were convicted of an offense involving a controlled substance under 21 U.S.C. 802;
3. Were convicted of certain offenses involving firearms or destructive devices;

4. Were convicted of two or more crimes involving moral turpitude if each crime is an offense for which a sentence of
one year or longer may be imposed;
5. Were convicted of any of the following offenses, including conspiracy or attempt to commit any of them:
A. Sabotage, espionage, treason or sedition, if a sentence of imprisonment for at least five years may be imposed;
B. Any violation of 18 U.S.C. 871 or 18 U.S.C. 960;

C. Any violation of the Military Selective Service Act;

D. Any violation of the Trading with the Enemy Act; or
E. Any violation of INA section 215 or 278.

6. Are inadmissible to the United States under INA section 212(a)(3) (security related grounds) or (10)(C) (international
child abduction); or
7. Failed, after proper notice, to appear for your deportation, exclusion, or removal proceedings; failed to comply with a
voluntary departure order; or otherwise violated immigration laws relating to deportation proceedings.
Even if you meet the eligibility requirements, USCIS (or an immigration judge if you are in deportation, exclusion,
or removal proceedings) has discretion whether to grant relief under former INA section 212(c). You must
establish that your application warrants a favorable exercise of discretion. For more information on discretion, see
Part 8. Discretion.

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 http://get.adobe.com/reader/. If you do not
have Internet access, you may call the USCIS Contact Center at 1-800-375-5283 and ask that we mail a form to you. For
TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not
accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal
guardian may sign the application on your behalf. A legal guardian may also sign for a mentally incompetent person.
Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section
of these Instructions.)

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Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific
Instructions section of these Instructions.
Biometric Services Appointment. USCIS may require that you appear for an interview or provide fingerprints,
photograph, and/or signature at any time to verify your identity, obtain additional information, and conduct background
and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation
(FBI), before making a decision on your application, petition, or request. After USCIS receives your application and
ensures it is complete, we will inform you in writing, if you need to attend a biometric services appointment. If an
appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support
Center (ASC) and the date and time of your appointment or, if you are currently overseas, instruct you to contact a U.S.
Embassy, U.S. Consulate, or USCIS office outside the United States to set up an appointment.

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If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:
1) You provided or authorized all information in the application;

2) You reviewed and understood all of the information contained in, and submitted with, your application; and
3) All of this information was complete, true, and correct at the time of filing.

If you fail to attend your biometric services appointment, USCIS (or an immigration judge if you are in deportation,
exclusion, or removal proceedings) may deny your application.
Copies. You should 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.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed upon receipt.
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 should also include the date,
the translator’s signature and printed name, and may contain the translator’s contact information.
How To Fill Out the Form I-191

1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this application, use the space provided in Part 12. Additional
Information or attach a separate sheet of paper, type or print your name and Alien Registration Number (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.
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.

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Specific Instructions
Part 1. Information About You
Item Number 1. Your Full Name. Provide your full legal name as shown on your identity documents or legal change of
name document in the spaces provided.
Item Number 2. Other Names Used. Provide other names you have used since birth, including your maiden name, any
nicknames, and any names that appear in your documents. If you need extra space to complete this section, use the space
provided in Part 12. Additional Information.

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Item Number 3. Date of Birth. Provide your date of birth in mm/dd/yyyy format in the space provided.

Item Number 4. Alien Registration Number (A-Number). An Alien Registration Number, otherwise known as an
“A-Number,” is typically issued to persons who apply for, or are granted, certain immigration benefits. If you were issued
an A-Number, type or print it into the spaces provided. If you do not have an A-Number, or if you cannot remember it,
leave this space blank.
Item Number 5. USCIS Online Account Number. If you have previously filed an application, petition, or request 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, petitions, or requests
on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing
you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be found
at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The USCIS
Online Account Number is not the same as an A-Number.
Item Number 6. Place of Birth. Provide the name of the city, town, or village, state or province, and country where you
were born.
Item Number 7. Country of Citizenship or Nationality. Provide the country where you are currently a citizen or
national. If you do not have citizenship in any country, indicate “stateless.”
Item Number 8. Mailing Address. Provide the address where you would like to receive written correspondence
regarding this application. Use a mailing address in the United States if you have one. If you do not have a U.S. mailing
address, provide your mailing address abroad.
Item Number 9. Physical Address. If the place where you live is different from your mailing address, provide the
address where you currently reside.
Item Number 10. Information About When and How You Became a Lawful Permanent Resident (LPR). Provide the
date when you became a Lawful Permanent Resident (LPR). Also select the box that shows how you obtained LPR status.
Select only one box.
Item Numbers 11. - 14. Passport and Travel Document Numbers. If you used a passport or travel document to travel
to the United States, enter either the passport or travel document information in the appropriate space on the application,
even if the passport or travel document is currently expired.
Item Number 15. Information About Your Departures From and Returns To the United States. List all dates you
departed from and returned to the United States since you became a LPR. Also provide a brief description of the means of
transportation that you used for travel, and the purpose of your trips.
If you have multiple trips from the United States, but do not remember the exact dates and/or details for the trip, you must
still list each trip separately and type or print “approximately” next to the information you provide for that trip.

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Part 2. Biographic Information
Provide the biographic information requested in Part 2., Item Numbers 1. - 6. Providing this information as part of
your application may reduce the time you spend at your USCIS ASC appointment as described in the Biometric Services
Appointment section of these Instructions.
Item Numbers 1. - 2. Ethnicity and Race. Select the boxes that best describe your ethnicity and race.
Categories and Definitions for Ethnicity and Race
1. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture
or origin, regardless of race. (NOTE: This category is only included under Ethnicity in Part 2., Item Number 1.)

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2. White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
3. Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
4. Black or African American. A person having origins in any of the black racial groups of Africa.

5. American Indian or Alaska Native. A person having origins in any of the original peoples of North and South
America (including Central America), and who maintains tribal affiliation or community attachment.
6. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
Item Number 3. Height. Select the values that best match your height in feet and inches. For example, if you are five
feet and nine inches, select “5” for feet and “09” for inches. Do not enter your height in meters or centimeters.
Item Number 4. Weight. Enter your weight in pounds. If you do not know your weight, or need to enter a weight under
30 pounds or over 699 pounds, enter “000.” Do not enter your weight in kilograms.
Item Number 5. Eye Color. Select the box that best describes the color of your eyes.

Item Number 6. Hair Color. Select the box that best describes the color of your hair.
Part 3. Information About Your Criminal Convictions

Provide the requested information for each of your criminal convictions. The requested information should be on the
court documents related to each conviction.
The application has space for your three most recent convictions. You must list all of your convictions in the United
States and abroad, and provide the information otherwise requested on the application. If you need extra space to
complete this section, use the space provided in Part 12. Additional Information.
For each conviction, indicate whether you were convicted after a trial or based on a guilty or no contest plea. If you were
convicted based on a plea, enter the date the plea agreement was signed or the date you entered your guilty or no contest
plea in court.
For each conviction, you must include a certified copy of:
1. The indictment, information, complaint, citation or other formal charging document;
2. Any plea agreement, showing the date it was signed; and
3. The court judgment.

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Part 4. Information About Your Residence
Provide information about where have you lived during the last seven years. List your most recent residence first and then
list every other location where you have lived during the last seven years. There should be no gaps in time. If you need
extra space to complete this section, use the space provided in Part 12. Additional Information.
Part 5. Information About Your Employment
List where you have worked full time or part time during the last seven years. If you need extra space to complete this
section, use the space provided in Part 12. Additional Information.

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Part 6. Information About Your Family

Provide the following information about your family members. Your family members are your spouse, your children,
and your parents. If you need extra space to complete this section, use the space provided in Part 12. Additional
Information.
Part 7. Other Grounds of Removal

If you believe you may be subject to removal on any grounds other than based on the criminal convictions listed in Part 3.
Information About Your Convictions, provide a full explanation of why you may be subject to removal.
The other grounds of removal may be any inadmissibility grounds that are listed in section 212(a) of the INA or any
deportability grounds that are listed in section 237(a) of the INA. If you have a criminal history besides the criminal
convictions listed in Part 3. Information About Your Convictions, list these incidents and provide a full explanation. If
you were arrested or detained by any law enforcement officer for any reason, and no charges were filed, include an original
official statement by the arresting or detaining agency or applicable court order confirming that no charges were filed.
If you were arrested or detained by any law enforcement officer for any reason and charges were filed, or if charges
were filed against you without an arrest, submit an original or court-certified copy of the complete arrest record and/or
disposition for each incident (for example, a dismissal order or an acquittal order). If you need extra space to complete
your statement, use the space provided in Part 12. Additional Information or attach a separate letter.
Part 8. Discretion

Even if you meet the eligibility requirements, Form I-191 can only be approved if your application warrants a favorable
exercise of discretion. This means that you have to establish that the favorable factors in your case outweigh the
unfavorable factors.
In the space provided, explain why the favorable factors in your case should outweigh the unfavorable factors. If you
need extra space to complete your statement, use the space provided in Part 12. Additional Information or attach a
separate letter. Indicate in the space that you are including a separate letter. You must submit the separate letter with your
Form I-191 application.
Unfavorable factors are any facts that could give a reasonable person a reasonable basis for deciding that you should not
be allowed to remain in the United States as a LPR. These unfavorable factors include, but are not limited to:
1. Your criminal record, including its nature, and how recent and serious your crimes were;
2. The nature and underlying circumstances of any other ground of removal that may apply to you;
3. Other significant violations of immigrations laws; or
4. Other evidence that supports a finding of bad character or undesirability as an LPR.
NOTE: The criminal history that makes you subject to removal is, by itself, an unfavorable factor that weighs against a
favorable exercise of discretion.

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Favorable factors that USCIS (or an immigration judge if you are in deportation, exclusion, or removal proceedings)
considers include but are not limited to:
1. Family ties in the United States;
2. Length of lawful residence in the United States;
3. Hardship to you or other family members who are living lawfully in the United States;
4. Honorable service in the U.S. Armed Forces;
5. History of lawful employment in the United States;

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6. Property or business ties in the United States;
7. Value or service to the community;

8. Proof of genuine rehabilitation or reform;

9. Absence of other violations of U.S. laws (Federal or State); and
10. Good moral character.

You must submit information or documentary evidence showing that you are eligible for this type of relief and why the
application should be approved because the favorable factors in your case outweigh the unfavorable factors.
Part 9. Applicant’s Statement, Contact Information, Certification, and Signature

Item Numbers 1. - 6. Select the appropriate box to indicate whether you read this application yourself or whether you
had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you
used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile
telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or
parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
Part 10. 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 application 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 application.
Part 11. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
Item Numbers 1. - 8. This section must contain the signature of the person who completed your application, if other than
you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both
Part 10. and Part 11. If the person who completed this application is associated with a business or organization, that
person should complete the business or organization name and address information. Anyone who helped you prepare this
application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable.
If the person who helped you prepare your application is an attorney or accredited representative, he or she may be
obliged to also submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative,
along with your application.
Part 12. Additional Information
Item Numbers 1. - 6.D. If you need extra space to provide any additional information within this application, use the
space provided in Part 12. Additional Information. If you need more space than what is provided in Part 12., you may
make copies of Part 12. to complete and file with your 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.
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We recommend that you print or save a copy of your completed application to review in the future and for
your records. We recommend that you review your copy of your completed application before you come to
your biometric services appointment at a USCIS ASC. At your appointment, USCIS will permit you to
complete the application process only if you are able to confirm, under penalty of perjury, that all of the
information in your application is complete, true, and correct. If you are not able to make that attestation in good
faith at that time, USCIS will require you to return for another appointment.

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What Is the Filing Fee?

The filing fee for Form I-191 is $790.

NOTE: The filing fee is not refundable, regardless of any action USCIS (or an immigration judge if you are in
deportation, exclusion, or removal proceedings) takes on this application. DO NOT MAIL CASH. You must submit all
fees in the exact amount.
Use the following guidelines when you prepare your check or money order for the Form I-191 filing fee:
1. The check or money order must be drawn on a bank or other financial institution located in the United States and must
be payable in U.S. currency; and
2. Make the check or money order payable to U.S. Department of Homeland Security.

NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”
3. If you live outside the United States, contact the nearest U.S. Embassy or U.S. Consulate for instructions on the
method of payment.
Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it into an electronic funds
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your
account for the amount of the check. The debit from your account will usually take 24 hours, and your bank will show it
on your regular account statement.
You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS
cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If your
check is returned as unpayable, we may reject your application.
NOTE: When applying with EOIR during removal proceedings, you must submit the payment as instructed by the
immigration court with jurisdiction over your case. For information about EOIR, visit the EOIR’s website at http://www.
usdoj.gov/eoir.
How to Check If the Fees Are Correct
Form I-191’s filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS fees
change periodically, you can verify that the fees are correct by following one of the steps below.
1. Visit our website at www.uscis.gov, select “FORMS” and check the appropriate fee; or
2. Call the USCIS Contact Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or hard of hearing)
call: 1-800-767-1833.

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Where To File?
Please see our website at www.uscis.gov/I-191 or call our USCIS Contact Center at 1-800-375-5283 for the most current
information about where to file this application. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Address Change
An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his
or her previous residence. For information on filing a change of address, go to the USCIS website at www.uscis.gov/
addresschange or contact the USCIS Contact Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:
1-800-767-1833.

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NOTE: Do not submit a change of address request to USCIS Lockbox facilities because the Lockbox does not process
change of address requests.

Processing Information

Initial Processing. Once your application is accepted, it will be checked for completeness. If you do not completely fill
out this application, you will not establish a basis for your eligibility and your application may be rejected or denied.
Requests for More Information. We may request that you provide more information or evidence to support your
application. We may also request that you provide the originals of any copies you submit. If USCIS requests an original
document from you, it will be returned to you after USCIS determines it no longer needs your original.
Requests for Interview. USCIS may request that you appear at a USCIS office for an interview based on your
application. At the time of any interview or other appearance at a USCIS office, we may require that you provide your
fingerprints, photograph, and/or signature to verify your identity and/or update background and security checks.
Decision. The decision on Form I-191 involves a determination of whether you have established eligibility for the
immigration benefit you are seeking. USCIS (or an immigration judge if you are in deportation, exclusion, or removal
proceedings) will notify you of the decision in writing.

USCIS Forms and Information
To ensure you are using the latest version of this application, 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 “Schedule an appointment online” 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 Form I-191, USCIS
or the U.S. Department of Justice (DOJ) will deny your Form I-191 and may deny any other immigration benefit. In
addition, you will face severe penalties provided by law and may be subject to criminal prosecution.
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DHS Privacy Notice
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the
Immigration and Nationality Act (INA) section 101.
PURPOSE: The primary purpose for providing the requested information on this application is to apply for relief under
the former INA section 212(c). DHS and DOJ will use the information you provide to grant or deny the immigration
benefit you are seeking.
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
a rejection or denial of your application.

Draft
Not for
Reproduction
06/10/2020

ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you
provide on this application 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/ICE/CBP-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-016a
Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems] which you can
find at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law enforcement purposes or in
the interest of national security.

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 90 minutes per response, including the time
for reviewing instructions, gathering the required documentation and information, completing the application, attaching
necessary documentation, and submitting the application. 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 Avenue, NW,
Washington, DC 20529-2140. OMB No. 1615-0016. Do not mail your completed Form I-191 to this address.

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