Request for Fee Waiver

I912-007-INS-FinalFeeRule-G1056-PCINJ-09022020

Request for Fee Waiver

OMB: 1615-0116

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1615-0116 can be found here:

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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 forms and services by certain eligible categories of
applicants and petitioners. In general, you may request a fee waiver if you are applying or currently approved for one of
the eligible categories, and your documented annual household income is at or below 125 percent of the Federal Poverty
Guidelines (FPG).

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If you are applying based on being impacted by an emergent circumstance or major natural disaster declaration posted
to www.uscis.gov providing relief from USCIS filing fees you may request a fee waiver if you have documented annual
household income is at or below 125 percent of the Federal Poverty Guidelines (FPG), and you are not seeking an
immigration benefit for which you are subject to the public charge ground of inadmissibility, the affidavit of support
requirement under INA 212(a)(4)(C) or (D), or you are not already a sponsored immigrant as defined by 8 CFR 213a.1.
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 required supporting documentation. A letter stating
you are unable to pay the filing fees or biometric services fees will not be accepted without a fully completed and properly
executed 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, requesting a fee waiver and
approval of a fee waiver may negatively impact eligibility for any immigration benefit that is subject to the public charge
determination.

Who May Request a Fee Waiver

Categories and Forms Eligible for Fee Waivers
Category

Forms Eligible for Fee Waivers

Violence Against Women Act (VAWA) self-petitioners
and derivatives as defined in INA 101(a)(51) or
individuals otherwise self-petitioning for immigrant
classification or seeking adjustment of status due to
abuse by a qualifying relative:

•

Form I-485, Application to Register Permanent
Residence or Adjust Status

•

Form I-751, Petition to Remove Conditions on
Residence

•

Form I-881, Application for Suspension of Deportation
or Special Rule Cancellation of Removal

•

Form I-131, Application for Travel Document

•

Form I-360 based on battery or extreme cruelty;

•

Applications for a waiver of the joint filing
requirement for Form I-751 based on battery and
extreme cruelty

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Category

Forms Eligible for Fee Waivers

Special Immigrant as an Afghan or Iraqi Translator
or Interpreter, Iraqi National employed by or on
behalf of the U.S. Government, or Afghan National
employed by or on behalf of the U.S. government or
employed by the International Security Assistance
Forces

•

Form I-212, Application for Permission to Reapply for
Admission into the United States After Deportation or
Removal

•

Form I-601, Application for Waiver of Grounds of
Inadmissibility

•

N-400, Application for Naturalization

•

N-600, Application for Certificate of Citizenship

•

N-600K, Application for Citizenship and Issuance of
Certificate Under Section 322

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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. If you
are filing joint forms that have fees (for example, I-485 and I-765), you only need to file one I-912. You do not have to
file a separate Form I-912 for the filing fee and the biometric services fee (if applicable). 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.

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.
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. If you submit original documents when not required or
requested by USCIS, your original documents may be immediately destroyed after we receive them.

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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 or dark blue ink. If a section does not apply to you, type or print “N/A,” which stands
for “not applicable.” Fully and accurately answer all questions that apply to the basis for your request.
2. If you need extra space to complete any item within this request, use the space provided in Part 7. Additional
Information. You may also attach as many separate sheets of paper as needed; type or print your name and Alien
Registration Number (A-Number) at the top of each sheet and indicate the Page Number, Part Number, and Item
Number to which your answer refers.

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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

Item Numbers 1.A - 1.B. Select a basis for your request and provide supporting documentation for any basis you select.
Item Number 2. Provide your current immigration status.

Item Number 3. Provide the form numbers of applications and petitions for which you are requesting a fee waiver.
Part 2. Information About You (Requestor)

Item Number 1. Full 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. Provide all other names you have used, including your maiden name.
Item Number 3. Alien Registration Number (A-Number). 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 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. Provide your U.S. Social Security number.
Item Number 7. Marital Status. Indicate your current marital status.
Part 3. Household Gross Income
To qualify for the fee waiver, your household gross income must be at or below 125 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.

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Special Immigrant Juveniles (SIJ)
If you are filing based on SIJ classification, and you have been placed in out-of-home care under the supervision of a
juvenile court or a state child welfare agency at the time of filing, you do not need to complete Part 3. or provide evidence
of income. However, you must submit the following with the fee waiver request:
•

Evidence that you are approved or filed for SIJ classification (for example, a copy of the submitted 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); and

•

Evidence that you remain in out-of-home care (for example, a juvenile court order indicating that you are
placed in out-of-home care, such as foster care; or a letter from a state agency authorized with overseeing
your care documenting the care you are receiving).

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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.
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 8.
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 your spouse’s gross income in Item Number 7. Indicate whether or not
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 8.
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 this question.
Your Household Size

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.
VAWA, T and U
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 your head of household, the person upon whose
Federal income tax return you are listed as a dependent, or one of your household members is or was your abuser, human
trafficker, or perpetrator, or is or was a member of your abuser, human trafficker, or perpetrator’s household, then do not
list him or her in Item Number 4. or his or her income in Item Numbers 5. - 9. below.
At the end of the table, provide the total number of household members. Include the following people, who are dependent
on your income, your spouse’s income, or the head of household’s income, 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 income tax return for your household (includes
filing as head of household) or earned the majority of the income for your household.
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B. If you are not the head of household, the head of household is the person who filed the most recent Federal
income tax return on which you are listed as a dependent or the person who provides the majority of your
household’s income.
3. Your spouse, if living with you (if you are separated or your spouse is not living with you, do not include your
spouse); 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 over 21 years of age but under 24 years of age, are full-time
students, and who live with you when not at school;

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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 income tax return or your spouse or head of household’s Federal
income tax returns.
Your Annual Gross Household Income

Item Number 5. Federal Income Tax Return Filing. Identify whether you and your household member(s) listed in
Item Number 4. filed a Federal income tax return last year.
If you and/or your household members have filed the current year’s Federal income tax return, submit a transcript of your
and your household members’ current year’s Federal income tax return from the IRS.
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’ Federal income
tax return, or if you are listed as a dependent on anyone else’s Federal income tax return, list the total income from that
individual’s most recent Federal income tax return within the last tax year and submit that individual’s IRS tax transcripts.
Item Number 6. Your Annual Gross Income. Provide information on your annual gross income. Gross income
includes your wages, dividends, capital gains, business income, retirement distributions as well as other income without
any adjustments. From your filed Federal income tax return, enter the gross income listed 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 income tax return transcript.
To document your annual gross income, provide the following information:
1. A transcript of your most recent Federal income 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 income tax return, and you have recently changed employment or had a change in salary, submit
your Federal income tax return transcript and copies of consecutive pay statements;
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3. If you did not file a Federal income 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;
4. If you are a student and not living with your parents or are not claimed as a dependent on your parents’ Federal
income 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;
5. If you do not have any income, describe your particular situation in detail in Part 3. Item Number 10., and submit
documentation from the IRS that indicates no tax transcripts and no W-2s were found (see IRS Form 4506-T).
6. 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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Item Number 7. Annual Gross Income of All Family Members. Provide the annual gross 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 gross income.
2. If you are married but separated and/or 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 8.
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 or T or U nonimmigrant status, do not provide your spouse’s income.
4. Include your parents’ gross 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 income tax return. You must provide a
transcript of both parents’ Federal income tax return transcripts and your own Federal income tax return transcript, or
provide proof of gross income as supporting documentation.
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, a copy of
Form W-2, or Form 1099 Certain Government Payments from the IRS.
To document your household members’ gross incomes, provide the following:

1. A transcript of each household member’s most recent Federal income tax return;
2. If the household member filed a Federal income tax return and has recently changed employment or had a change in
salary, submit his or her Federal income 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, and income tax transcripts or submit documentation from the IRS that indicates no tax transcripts
and no W-2s were found (see IRS Form 4506-T). 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 10., and submit documentation from IRS that indicates no tax transcripts and no W-2s were found (see IRS
Form 4506-T).

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Item Number 8. Total Additional Income or Financial Support. If you received additional income on a continuing
basis (e.g., monthly or annually) 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 that is not
included in Item Number 6. or 7.
Documentation. You must document additional financial assistance as income. For example, include the following
information:

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1. Documents showing parental support; alimony; child support; educational stipend; pension; Social Security; royalties,
veterans benefit; unemployment benefits; and consistent or regular financial support from an adult child(ren), parent,
dependent, or other person 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. Bank statements or IRS Form W-2, Form SSA-1099 for any pension social security or veteran’s benefit.
4. If you are receiving unemployment benefits, provide IRS Form 1099-MISC, in addition to your IRS Form 1040
transcript.
5. Bank statements or other documentation establishing any additional income provided by an adult child(ren),
dependent, or other person living in the household.
Item Number 9. Total Annual Household Gross Income. Provide the total household gross income. Add the amounts
from Item Numbers 6., 7., and 8. USCIS will compare this amount to the Federal Poverty Guidelines.
Item Number 10. Indicate whether any information (including marital status, income, and list of dependents) in your
Federal income 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, or lack of income, use the space provided
below. If you need extra space, use the space provided in Part 7. Additional Information.
Item Number 11. If you already have or are applying for VAWA benefits or T or U nonimmigrant status, and you do
not have any income or cannot provide proof of income for yourself or your household members as required in Part 3.
Item Numbers 5. - 9. above, describe your situation in sufficient detail in Part 3. Item Number 11. to substantiate that
your income is at or below 125 percent of the federal poverty guidelines and that you are unable to obtain the required
documentation. For example, if you cannot access information required to obtain tax transcripts because your abuser
controls access to your documents, then explain the situation below. 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. 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.

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Part 5. 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 6. Contact Information, Declaration, 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 5. and Part 6. 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.

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Part 7. 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 7. Additional Information. If you need more space than what is provided in Part 7., you may make
copies of Part 7. to complete and file with your request, or attach a separate sheet of paper. Include 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.
We recommend that you print or save a copy of your completed request to review in the future and
for your records.

What Is the Filing Fee?

There is no filing fee for Form I-912.

Where To File?
Mail your Form I-912, along with the completed USCIS applications or petitions, and all supporting documentation
according to the Where to File section in the Instructions of the application or petitions for which you are requesting a fee
waiver.

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. Please review the Instructions
for the application or petition for which you want USCIS to consider a fee waiver to determine when to refile.
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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 Statement
AUTHORITIES: The information requested on this request, and the associated evidence, is collected under the
Immigration and Nationality Act sections 286 and 8 CFR 103.7(c).

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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 in which you are filing. The Department of
Homeland Security (DHS) uses 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,
and any requested evidence, may delay a final decision in your case or result in a rejection or denial of your request and
rejection of your application or petition based on non-payment of the filing fee.
ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you
provide on this request 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-007Benefits Information System and DHS-USCIS-001-Alien File, Index, and National File Tracking System of Records]
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 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 205292140; OMB No. 1615-0116. Do not mail your completed Form I-912 to this address.

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File Type	application/pdf
File Title	Form Instructions v5
Author	FMB
File Modified	2020-09-04
File Created	2020-09-04