I-600 Form TOC

TABLE OF CHANGES – FORM

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

OMB Number: 1615-0028

05/12/2020

Reason for Revision: Bio Rule

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 12/31/2021

Edition Date 12/21/2019

Current Page Number and Section	Current Text	Proposed Text
Pages 1-6, Part 1. Information About You (Petitioner)	[Page 1] Part 1. Information About You (Petitioner) 1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Other Names Used (if any) Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Your Contact Information 3. U.S. Mailing Address (if any) In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code [Page 2] 4. Is your current U.S. mailing address the same as your U.S. physical address? Yes/No If you answered "No,” provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as appropriate. 5. U.S. Physical Address (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code 6. Address Abroad (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State Province Postal Code Country 7. Daytime Telephone Number 8. Mobile Telephone Number (if any) 9. Email Address (if any) Information About Your U.S. Citizenship 10. USCIS Online Account Number (if any) 11. Date of Birth (mm/dd/yyyy) 12. City/Town/Village of Birth 13. State or Province of Birth 14. Country of Birth 15. How did you obtain your U.S. citizenship? Birth Parents Naturalization A. If you obtained your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes/No If you answered "Yes," provide the following information about your Certificate of Citizenship: Your Name On the Certificate of Citizenship Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number Date of Issuance (mm/dd/yyyy) Place of Issuance [Page 3] B. If you obtained your citizenship through naturalization, provide the following information about your Certificate of Naturalization: Your Name On the Certificate of Naturalization Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) A-Number (if any) Certificate of Naturalization Number Date of Naturalization (mm/dd/yyyy) Place of Naturalization 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 10. Additional Information. [New] 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 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 22. Other Names Your Current Spouse Has Used (if any) 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 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 23. Information About Your Current Spouse Spouse’s Date of Birth (mm/dd/yyyy) Spouse’s A-Number (if any) Spouse’s USCIS Online Account Number (if any) Spouse’s City/Town/Village of Birth Spouse’s State or Province of Birth Spouse’s Country of Birth [Page 4] Is your spouse a U.S. citizen? Yes/No If you answered “Yes,” how did your spouse obtain U.S. 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)? Your Spouse’s Contact Information 25. Does your current spouse reside with you? Yes/No If you answered “No,” provide your current spouse’s physical address in Item Number 26. 26. Your Current Spouse's Physical Address (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 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 10. 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 [Page 5] Information About Prior Filings or Adoptions If you need extra space to complete Item Numbers 32. - 37., use the space provided in Part 10. Additional Information. 32. Have you ever previously filed Form I-600, Form I-600A, Application for Advance Processing of an Orphan Petition, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative, or Form I-130, Petition for Alien Relative, for an adopted child? Yes/No 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 County 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] [Page 6] Duty of Disclosure You and your spouse (if married) must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your ongoing duty to disclose information in response to these questions. If you 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 10. 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 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	[No change] 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)  White  Asian  Black or African American Indian or Alaska Native  Native Hawaiian or Other Pacific Islander  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 Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 28. Other Names Your Current Spouse Has Used (if any) 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 10. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 29. Information About Your Current Spouse Spouse’s Date of Birth (mm/dd/yyyy) Spouse’s A-Number (if any) Spouse’s USCIS Online Account Number (if any) Spouse’s City/Town/Village of Birth Spouse’s State or Province of Birth Spouse’s Country of Birth [Page 4] Is your spouse a U.S. citizen? Yes/No If you answered “Yes,” how did your spouse obtain U.S. 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)? Your Spouse’s Contact Information 31. Does your current spouse reside with you? Yes/No If you answered “No,” provide your current spouse’s physical address in Item Number 32. 32. Your Current Spouse's Physical Address (if applicable) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 33. Your Spouse’s Daytime Telephone Number 34 Your Spouse’s Mobile Telephone Number (if any) 35. Your Spouse’s Email Address (if any) 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 10. 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 [Page 5] Information About Prior Filings or Adoptions If you need extra space to complete Item Numbers 38. - 43., use the space provided in Part 10. Additional Information. 38. Have you ever previously filed Form I-600, Form I-600A, Application for Advance Processing of an Orphan Petition, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative, or Form I-130, Petition for Alien Relative, for an adopted child? Yes/No 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 County Where Adoption Was Finalized Date Adoption Was Finalized (mm/dd/yyyy) 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] [Page 6] Duty of Disclosure You and your spouse (if married) must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your ongoing duty to disclose information in response to these questions. If you 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 10. 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 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 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
Pages 12-13, Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature	[Page 12] Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Petitioner’s Statement 1. Petitioner’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything. 2. Petitioner’s Statement Regarding the Preparer (if applicable) At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 13] [New] Petitioner’s Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my suitability and eligibility as an adoptive parent and whether the child I am petitioning for is eligible to be classified as my immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. I understand that USCIS will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my petition; 2) I understood all of the information contained in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Petitioner’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose. Petitioner’s Signature 3. Petitioner’s Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.	[Page 12] Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Petitioner’s Statement 1. Petitioner’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything. 2. Petitioner’s Statement Regarding the Preparer (if applicable) At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 13] Petitioner’s Contact Information 3. Petitioner’s Daytime Telephone Number 4. Petitioner’s Mobile Telephone Number (if any) 5. Petitioner’s Email Address (if any) Petitioner’s Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my suitability and eligibility as an adoptive parent and whether the child I am petitioning for is eligible to be classified as my immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. [deleted] I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Petitioner’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose. Petitioner’s Signature 6. Petitioner’s Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.
Pages 13-14, Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature	[Page 13] Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Your Spouse’s Statement 1. Spouse’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition 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 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 14] [New] 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 and whether the child my spouse is petitioning for is eligible to be classified as our immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. I understand that USCIS will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my petition; 2) I understood all of the information contained in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Your Spouse’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose. Your Spouse’s Signature 3. Your Spouse’s Signature Date of Signature (mm/dd/yyyy) [New]	Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section. Your Spouse’s Statement 1. Spouse’s Statement Regarding the Interpreter (Select the box for either Item A. or B.) A. I can read and understand English, and have read and understand every question and instruction on this petition and my answer to every question. B. The interpreter named in Part 8. read to me every question and instruction on this petition 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 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized. [Page 14] Spouse’s Contact Information 3. Spouse’s Daytime Telephone Number 4. Spouse’s Mobile Telephone Number (if any) 5. Spouse’s Email Address (if any) 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 and whether the child my spouse is petitioning for is eligible to be classified as our immediate relative. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. [deleted] I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct. Your Spouse’s Duty of Disclosure I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose. Your Spouse’s Signature 6. Your Spouse’s Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL SPOUSES: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.
Pages 15-16, Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse	[Page 15] Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse If you and/or your spouse (if married) used a preparer to complete this petition, provide the following information about the preparer. Preparer’s Full Name 1. Preparer’s Family Name (Last Name) Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) [Page 16] Preparer’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Mobile Telephone Number (if any) 6. Preparer’s Email Address (if any) Preparer’s Statement 7. A. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and/or the petitioner’s spouse (if married) with the petitioner’s and/or the petitioner’s spouse’s consent. B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse (if married) in this case extends/does not extend beyond the preparation of this petition. [New] Preparer’s Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner and/or the petitioner’s spouse (if married). The petitioner and the petitioner’s spouse (if married) then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. Preparer’s Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)	Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse If you and/or your spouse (if married) used a preparer to complete this petition, provide the following information about the preparer. Preparer’s Full Name 1. Preparer’s Family Name (Last Name) Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) [Page 16] Preparer’s Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Mobile Telephone Number (if any) 6. Preparer’s Email Address (if any) Preparer’s Statement 7. A. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and/or the petitioner’s spouse (if married) with the petitioner’s and/or the petitioner’s spouse’s consent. B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse (if married) in this case extends/does not extend beyond the preparation of this petition. 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. Preparer’s Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner and/or the petitioner’s spouse (if married). The petitioner and the petitioner’s spouse (if married) then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. Preparer’s Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)

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