TABLE OF CHANGES – FORM
Form I-600A, Application for Advance Processing of an Orphan Petition
OMB Number: 1615-0028
Reason for Revision: Biometrics Rule
Legend for Proposed Text:
Expires 12/31/2021 Edition Date 12/21/19 |
Current Page Number and Section |
Current Text |
Proposed Text |
Pages 1-6, Part 1. Information About You (Applicant) |
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16. 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,” provide a detailed explanation in the space provided in Part 9. Additional Information.
17. What is your marital status? Single Married Separated Divorced Widowed
18. How many times have you been married (including your current marriage, if applicable)?
NOTE: If you are not
currently married, skip to Item Number 30. Information About Your Current Marriage
19. Date of Current Marriage
(mm/dd/yyyy) 20. Place Where Current Marriage Occurred
21. Name of Your Current Spouse
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 9. Additional Information.
Family Name (Last Name)
23. Information About Your Current Spouse
Spouse’s USCIS Online Account Number (if any) Spouse’s City/Town/Village of
Birth
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Yes No
If you answered “Yes,” how did your spouse obtain citizenship? Birth Naturalization Parents
If you answered “No,”
provide your spouse’s current U.S. immigration status: 24. How many times has your current spouse been married (including your current marriage, if applicable)?
25. Does your current spouse reside with you? Yes No
26. Your Current Spouse's
Physical Address (if applicable) State
27. Your Spouse’s Daytime Telephone Number 28. Your Spouse’s Mobile Telephone Number (If any) 29. Your Spouse’s Email Address (if any)
Additional Household Members
30. How many persons 18 years of age or older (other than your spouse if married) reside with you?
If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person.
31. 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 9. Additional Information.
[Table 5 entries] Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth A-Number (if any) Relationship to You (if any)
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Information About Prior Filings or Adoptions
If you need extra space to complete Item Numbers 32. - 37., use the space provided in Part 9. Additional Information.
32. Have you ever previously filed Form I-600A, Form I-600, Petition to Classify Orphan as an Immediate Relative, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative? Yes No If you
answered "Yes," provide the following
information for EACH petition and/or application: Type of Petition/Application Filed: Form I-600A Form I-600 Form I-800A Form I-800 Form I-130 (for an adopted child)
Result: Approved Denied Withdrawn Revoked Other (please explain): [fillable field] Date (mm/dd/yyyy)
33. Have you previously completed a domestic adoption of a child within the U.S.? Yes No
If you answered “Yes,” provide the following information for each completed domestic adoption of a child.
State And Country Where Adoption Was Finalized
Date Adoption Was Finalized (mm/dd/yyyy)
34. 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. [Fillable field]
35. 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
If you answered “Yes,” provide a detailed description of the dissolution. [Fillable field]
36. Have you ever previously placed a child in the care of another person with the intent to transfer permanent custody of the child? Yes No
If you answered “Yes,” provide a detailed description of the placement. [Fillable field]
37. 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? Yes No
If you answered “Yes,” provide a detailed description of the custody transfer. [Fillable field]
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You and your spouse (if married), must answer the following questions. See the Duty of Disclosure section in the Form I-600A Instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any of the questions in Item Numbers 38. and 39., 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 and/or your spouse (if married) under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in light of this history in the space provided in Part 9. Additional Information.
38. 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 adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other 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 39. 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 adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant.) Yes No B. Received the beneficiary of 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
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Your Biographic Information
NOTE: If you previously filed Form I-600A and provided biographic information, skip to Item Number 23. Otherwise, provide biographic information about you, the petitioner.
17. Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino
18. Race (Select all applicable boxes) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
19. Height Feet Inches
20. Weight Pounds
21. Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other
22. Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other
Information About Your Marriage(s)
23. What is your marital status? Single Married Separated Divorced Widowed
24. How many times have you been married (including your current marriage, if applicable)?
NOTE: If you are not
currently married, skip to Item Number 36. Information About Your Current Marriage
25.
Date of Current Marriage (mm/dd/yyyy) 26. Place Where Current Marriage Occurred
27. Name of Your Current Spouse
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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 9. Additional Information.
Family Name (Last Name)
29. Information About Your Current Spouse
Spouse’s USCIS Online Account Number (if any) Spouse’s City/Town/Village of
Birth
Yes No
If you answered “Yes,” how did your spouse obtain citizenship? Birth Naturalization Parents
If you answered “No,”
provide your spouse’s current U.S. immigration status: 30. How many times has your current spouse been married (including your current marriage, if applicable)?
31. Does your current spouse reside with you? Yes No
32.
Your Current Spouse's Physical Address (if
applicable) State
33. Your Spouse’s Daytime Telephone Number 34. Your Spouse’s Mobile Telephone Number (If any) 35. Your Spouse’s Email Address (if any)
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Additional Household Members
36. How many persons 18 years of age or older (other than your spouse if married) reside with you?
If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person.
37. 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 9. Additional Information.
[Table 5 entries] Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth A-Number (if any) Relationship to You (if any)
Information About Prior Filings or Adoptions
If you need extra space to complete Item Numbers 38. - 43., use the space provided in Part 9. Additional Information.
38. Have you ever previously filed Form I-600A, Form I-600, Petition to Classify Orphan as an Immediate Relative, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative? Yes No If you
answered "Yes," provide the following
information for EACH petition and/or application: Type of Petition/Application Filed: Form I-600A Form I-600 Form I-800A Form I-800 Form I-130 (for an adopted child)
Result: Approved Denied Withdrawn Revoked Other (please explain): [fillable field] Date (mm/dd/yyyy)
39. Have you previously completed a domestic adoption of a child within the U.S.? Yes No
If you answered “Yes,” provide the following information for each completed domestic adoption of a child.
State And Country Where Adoption Was Finalized
Date Adoption Was Finalized (mm/dd/yyyy)
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40. 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. [Fillable field]
41. 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
If you answered “Yes,” provide a detailed description of the dissolution. [Fillable field]
42. Have you ever previously placed a child in the care of another person with the intent to transfer permanent custody of the child? Yes No
If you answered “Yes,” provide a detailed description of the placement. [Fillable field]
43. 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? Yes No
If you answered “Yes,” provide a detailed description of the custody transfer. [Fillable field]
You and your spouse (if married), must answer the following questions. See the Duty of Disclosure section in the Form I-600A Instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any of the questions in Item Numbers 44. and 45., 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 and/or your spouse (if married) under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in light of this history in the space provided in Part 9. Additional Information.
44.
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 adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other 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
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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 45.
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 adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant.) Yes No B. Received the beneficiary of 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
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Pages 7-9, Part 2. Information About Your Home Study Preparer and/or Adoption Service Provider |
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Part 2. Information About Your Home Study Preparer and/or Adoption Service Provider
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Part 2. Information About Your Home Study Preparer and/or Primary Adoption Service Provider
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Pages 10-11, Part 5. Applicant's Statement, Certification, Duty of Disclosure, and Signature |
[Page 10]
Part 5. Applicant’s Statement, Certification, Duty of Disclosure, and Signature
NOTE: Read the Penalties section of the Form I-600A Instructions before completing this section.
Applicant’s Statement
1. Applicant’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 application and my answer to every question.
B. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything.
2. Applicant’s Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 8., [Fillable field], prepared this application for me based only upon information I provided or authorized.
Applicant’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 as an adoptive parent.
I furthermore authorize release of information contained in this application, 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.
[Page 11]
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 application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in and submitted with my application, and that all of this information is complete, true, and correct.
Applicant’s Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600A and/or Form I-600 Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose.
Applicant’s Signature
3. Applicant’s
Signature
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.
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I furthermore authorize release of information contained in this application, 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 certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in and submitted with my application, and that all of this information is complete, true, and correct.
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Pages 11-12, Part 6. Your Spouse's Statement, Certification, Duty of Disclosure, and Signature |
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Part 6. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature
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 application and my answer to every question.
B. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable field], 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 8., [Fillable field], prepared this application for me based only upon information I provided or authorized.
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 as an adoptive parent.
I furthermore authorize release of information contained in this application, 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.
[Page 12]
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 application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in and submitted with my application, 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 as an adoptive parent, as described in the Form I-600A and/or Form I-600 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
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I furthermore authorize release of information contained in this application, 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 certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in and submitted with my application, and that all of this information is complete, true, and correct.
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NOTE TO ALL SPOUSES: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your petition.
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Pages 13-14, Part. Contact Information, Declaration, and Signature of the Person Preparing this Application, If Other Than the Applicant and Spouse |
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Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, If Other Than the Applicant and Spouse
If you and/or your spouse (if married) used a preparer to complete this application, provide the following information about the preparer.
Preparer’s Full
Name 1. Preparer’s
Family Name (Last Name)
Preparer’s Mailing Address
3. Street Number and
Name City or Town
Preparer’s Contact Information
4. Preparer’s
Daytime Telephone Number
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Preparer’s
Statement 7. A. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and/or the applicant’s spouse (if married) with the applicant’s and/or the applicant’s spouse’s (if married) consent.
B. I am an attorney or accredited representative and my representation of the applicant and/or the applicant’s spouse (if married) in this case extends/does not extend beyond the preparation of this application.
Preparer’s
Certification By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant and/or the applicant’s spouse (if married). The applicant and the applicant’s spouse (if married) then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
Preparer’s Signature
8. Preparer's Signature
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NOTE: If you are an attorney or accredited representative, you may 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 Geographical Confines of the United States, with this petition.
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Mulvihill, Timothy R |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |