TABLE OF CHANGES – INSTRUCTIONS
Form I-912, Request for Fee Waiver
OMB Number: 1615-0116
Reason for Revision: Fee Rule Project Phase: Final Rule
Legend for Proposed Text:
Expires 10/31/2021 Edition Date 10/15/2019 |
Current Page Number and Section |
Current Text |
Proposed Text |
Page 1, What Is the Purpose of Form I-912? |
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What Is the Purpose of Form I-912?
You may request a fee waiver if you are unable to pay the filing fees or biometric services fees for an application or petition that is eligible for a fee waiver. When you request a fee waiver, you must clearly demonstrate that you are unable to pay the fees.
You can find the list of applications and petitions that are eligible for a fee waiver at www.uscis.gov/I-912 or refer to 8 CFR 103.7(c)(3). For filing tips and additional information, see www.uscis.gov/feewaiver.
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You do not need to submit Form I-912 for an application or petition that does not require a filing fee or if you qualify for a fee exemption based on your immigration status. Refer to the Instructions for each application or petition to see whether you are exempt from paying the fees.
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, filing to request a fee waiver and receiving an approved fee waiver can negatively impact eligibility for any immigration benefit that is subject to the public charge determination.
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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).
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.
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Page 1-2, Forms Eligible for Fee Waiver |
[Page 1] Forms Eligible for Fee Waiver Below is a list of applications and petitions U.S. Citizenship and Immigration Services (USCIS) will consider for a fee waiver and the conditions that must be met to be eligible for a fee waiver. Under current fee waiver regulations, USCIS can only approve fee waivers for certain forms or certain filings of a particular form type, when fee waiver requirements are met. You may file this form to request a fee waiver for any of the following benefit requests or services: 1. Biometric services fee, except for the biometric services fee required for a provisional unlawful presence waiver application (Form I-601A) filed under 8 CFR 212.7(e); 2. Form EOIR-29, Notice of Appeal to the Board of Immigration Appeals from a Decision of an Immigration Officer; 3. Form I-90, Application to Replace Permanent Resident Card; 4. Form I-129, Petition for a Nonimmigrant Worker, but only if you are an applicant for E-2 CNMI investor nonimmigrant status under 8 CFR 214.2(e)(23); 5. Form I-131, Application for Travel Document, but only if you are applying for humanitarian parole; 6. Form I-191, Application for Advance Permission to Return to Unrelinquished Domicile; 7. Form I-192, Application for Advance Permission to Enter as Nonimmigrant, but only if you are an applicant who is exempt from the public charge grounds of inadmissibility; 8. Form I-193, Application for Waiver for Passport and/or Visa, but only if you are an applicant who is exempt from the public charge grounds of inadmissibility; 9. Form I-290B, Notice of Appeal or Motion, but only if your underlying application was fee exempt, the filing fee was waived, or it was eligible for a fee waiver; 10. Form I-485, Application to Register Permanent Residence or Adjust Status. A fee waiver is only available if you are applying for lawful permanent resident status based on: A. Special Immigrant Status based on an approved Form I-360 as an Afghan or Iraqi Interpreter, or Afghan or Iraqi National employed by or on behalf of the U.S. Government;
[Page 2] B. An adjustment provision that is exempt from the public charge grounds of inadmissibility of the Immigration and Nationality Act (INA) section 212(a)(4), such as the Cuban Adjustment Act, the Haitian Refugee Immigration Fairness Act, continuous residence in the United States since before January 1, 1972, (“Registry”), Asylum Status, Special Immigrant Juvenile Status, or similar provisions; 11. Form I-539, Application to Extend/Change Nonimmigrant Status, but only if you are an applicant with any benefit request as specified by INA section 245(l)(7) or an applicant for E-2 Commonwealth of the Northern Mariana Islands (CNMI) investor nonimmigrant status under 8 CFR 214.2(e)(23); 12. Form I-601, Application for Waiver of Grounds of Inadmissibility, but only if you are an applicant who is exempt from the public charge grounds of inadmissibility of INA section 212(a)(4); 13. Form I-694, Notice of Appeal of Decision Under Sections 245A or 210 of the Immigration and Nationality Act, if your underlying application or petition was fee exempt, the filing fee was waived, or was eligible for a fee waiver; 14. Form I-751, Petition to Remove Conditions on Residence; 15. Form I-765, Application for Employment Authorization, unless you are filing under category (c)(33), Deferred Action for Childhood Arrivals (DACA); 16. Form I-817, Application for Family Unity Benefits; 17. Form I-821, Application for Temporary Protected Status; 18. Form I-881, Application for Suspension of Deportation or Special Rule Cancellation of Removal; 19. Form N-300, Application to File Declaration of Intention; 20. Form N-336, Request for a Hearing on a Decision in Naturalization Proceedings; 21. Form N-400, Application for Naturalization; 22. Form N-470, Application to Preserve Residence for Naturalization Purposes; 23. Form N-565, Application for Replacement of Naturalization/Citizenship Document; 24. Form N-600, Application for Certification of Citizenship; and 25. Form N-600K, Application for Citizenship and Issuance of Certificate under Section 322. You may also apply for a fee waiver for ANY application or petition that is related to status as a: 1. Battered spouses of A, G, E-3, or H nonimmigrants (such as Forms I-485, I-601 and I-212); 2. Battered spouse or child of a lawful permanent resident or U.S. citizen under INA section 240A(b)(2); 3. T nonimmigrant (such as Forms I-192, I-485, and I-601); 4. Temporary Protected Status (such as Forms I-131, I-821 and I-601); 5. U nonimmigrant (such as Forms I-192, I-485, and I-929); or 6. VAWA self–petitioner (such as Forms I-485, I-601 and I-212). You may not file Form I-912 if you are requesting consideration DACA. There are no fee waivers for DACA. Fee exemptions will be available in limited circumstances. See the Deferred Action for Childhood Arrivals Fee exemption at www.uscis.gov/forms/forms-and-fees/guidance-exemption-fee-form-i-765-filed-request-consideration-deferredaction-childhood-arrivals for more details. You do not need to file Form I-912 for applications and petitions that do not require a filing fee. Other 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 if a separate Form I-912 is not required. If your form is not listed, please see the specific form instructions for additional information or call the USCIS National Customer Service Center at 1-800-375-5283.
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[Table, 2 columns, 7 rows] Categories and Forms Eligible for Fee Waiver
[Row 1]
[Left Column header] Category
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
[Right Column header]
Forms Eligible for Fee Waivers
[Row 2]
Victims of Severe Form of Trafficking (T visas)
[Row 3]
Victims of Criminal Activity (U nonimmigrants)
[Row 4]
Battered spouses or children of a lawful permanent resident or U.S. citizen and derivatives under INA 240A(b)(2)
NOTE: This category is included in any reference to “VAWA” used throughout this form
[Row 5]
Temporary Protected Status
[Row 6]
Special Immigrant Juveniles (SIJs) who 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.
[Row 7]
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
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Page 3, How to File Form I-192 |
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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. You do not have to file a separate Form I-912 for the filing fee and the biometric services fee. If USCIS approves your Form I-912, we will waive both the filing fee and biometric services fee.
You may file one Form I-912 for all family-related applications or petitions filed at the same time. For example, if you file Form I-765, Application for Employment Authorization, and your spouse and children are filing separate Form I-765s at the same time, you only need to file one Form I-912 for all Form I-765s. You must send all forms together.
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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.
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Page 3, General Instructions |
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General Instructions USCIS provides all forms free of charge. The latest versions are available at www.uscis.gov/forms. In order to best 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 or have questions about this request, you may call 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. See 8 CFR 103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature, USCIS will deny 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 documentation required under the Specific Instructions section of these Instructions.
Copies. You should submit legible photocopies of documents requested, unless these 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.
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 11. 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) (if any) 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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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.
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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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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.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None” unless otherwise directed.
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Page 4-10, Specific Instructions |
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Specific Instructions
Part 1. Basis for Your Request
Item Numbers 1. - 3. Select a basis for your request. You are not required to complete the entire section of this request. Rather, select one basis or more for which you may qualify and complete the corresponding section as explained below in Parts 4., 5., and 6.
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 (if any). Provide all other names you have used, including your maiden name.
Item Number 3. Alien Registration Number (A-Number) (if any). 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 USCIS-issued or INS-issued documentation. If the intending immigrants you are sponsoring were not previously in the United States or were only in the United States as tourists, they may not have A-Numbers.
Item Number 4. USCIS ELIS Account Number (if any). If you were issued a USCIS Electronic Immigration System (USCIS ELIS) Account Number, enter it in the space provided. The USCIS ELIS Account Number is not the same as an A-Number.
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 (if any). Provide your U.S. Social Security number.
Item Number 7. Marital Status. Indicate your current marital status.
Part 3. Applications and Petitions for Which You are Requesting a Fee Waiver
Item Number 1. Complete the table for yourself and each person requesting a fee waiver with you. Provide the form numbers and the total number of applications and petitions for which you and any family members are requesting a fee waiver.
Part 4. Means-Tested Benefits
Item Number 1. If you, your spouse, or the head of household living with you receives a means-tested benefit, complete the table. You must attach supporting documentation. If you provide sufficient proof that you receive a means-tested benefit, your fee waiver will generally be approved.
A means-tested benefit is a public benefit where a person’s eligibility for the benefit, the amount of the benefit, or both, is based on the person’s income and resources. USCIS will consider means-tested benefits that are Federally, state, or locally funded and granted by the benefit agency.
Examples of means-tested benefit programs are Medicaid, Supplemental Nutrition Assistance Program (known as “SNAP” and formerly called Food Stamps), Temporary Assistance to Needy Families (TANF), and Supplemental Security Income (SSI), among others. Consult with your benefit-granting agency or your legal advisor to determine whether any Federal, state, or local public benefit that you may receive qualifies as a means-tested benefit.
For the purposes of determining an inability to pay the filing fee of the petition or application, the following are not considered means-tested benefits: Medicare; unemployment benefits; Social Security retirement benefits; Social Security Disability Insurance (SSDI); Social Security Retirement, Survivors, and Disability Insurance (RSDI); or student financial aid.
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1. Individual Receipt of a Means-Tested Benefit
A. The individual may demonstrate that he or she is personally receiving a means-tested benefit. B. Is a child is the sole applicant, he or she may provide an individual means-tested benefit or a custodial parent’s means-tested benefit, if living in the same household.
C. If multiple children are filing at the same time, each child must have an individual receipt of a means-tested benefit or be under the parent’s household who is receiving a means-tested benefit.
2. Family Member’ Means-Tested Benefits
D. If you are 21 years of age or older, you cannot use a parent’s means-tested benefits (such as SSI), even if the parent is living with you, as evidence of your eligibility for a fee waiver. However, you may use this information to support a fee waiver request in Part 5. Income at or Below 150 Percent of the Federal Poverty Guidelines or under Part 6. Financial Hardship if the award letter or benefit approval document indicates the total household income and you are otherwise eligible under those criteria.
3. Documentation
B. Documentation must contain:
(1) Your name (or the name of the person receiving the benefit);
(2) The name of the agency granting the public benefit;
(3) The type of benefit; and
(4) An indication that the benefit is currently being received (for example, a recently dated letter or document with effective dates, date of renewal or period the approval ends, if available).
C. If the documentation is more than 12 months old and the benefit is still being received, provide additional evidence that shows the benefit is currently being received.
Part 5. Income at or Below 150 Percent of the Federal Poverty Guidelines
To qualify for the fee waiver, your household income must be at or below 150 percent of the Federal Poverty Guidelines, at the time of filing, based on your household size. 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 Web site at www.uscis.gov/I-912P and review Form I-912P, Poverty Guidelines for Fee Waiver Request.
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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. Indicate if you are currently receiving unemployment benefits. If applicable, provide the date that you became unemployed and include the total amount of unemployment benefits you have received in Item Number 7.
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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. If applicable, indicate whether 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 7.
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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.
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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 tax return for your household (includes filing as head of household) or earned the majority of the income for your household. B. If you are not the head of household, the head of household is the person who filed the most recent Federal tax return on which you are listed as a dependent or the person who provides the majority of your household’s income. If you already have or are applying for Special Immigrant Juvenile (SIJ) classification, do not include any foster or group home household members. 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; 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 tax return or your spouse or head of household’s Federal tax returns.
Your Annual Household Income
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Item Number 5. Your Annual Income. Provide information on your annual income. If you filed a Federal tax return, enter the amount from Line 37 (adjusted gross income) on Internal Revenue Service (IRS) Form 1040, U.S. Individual Income Tax Return. If you have not filed a Federal tax return, take your total household wage income (before any deductions) for the previous 12-month period and enter that amount as your household’s annual income. 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 wage income, deduct Federal, state, and local income taxes withheld, and enter that amount as your household’s annual wage income.
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Documentation.
To document your annual income, provide the following information:
Item Number 6. Annual Income of All Household Members. Provide the annual income from all family members counted as part of your household.
Documentation.
To document your household members’ incomes, provide the following:
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Item Number 7. Total Additional Income or Financial Support. Provide additional income or financial support from a source outside your household. 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 annually that is not included in Item Number 5. or 6.
Documentation. You must document additional financial assistance as income. Include the following information:
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Item Number 8. Total Household Income. Provide the total household income. Add the amounts from Item Numbers 5., 6., and 7. USCIS will compare this amount to the Federal Poverty Guidelines.
If you do not have any income, financial support, or cannot provide evidence of income, describe your particular situation that you believe qualifies you for a fee waiver in Part 5., Item Number 9. If applicable, you may submit affidavits from religious institutions, non-profits, or community-based organizations verifying that you are currently receiving some benefit or support from them.
Item Number 9. Indicate whether any information (including marital status, income, and list of dependents) in your Federal 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, use the space provided in Part 11. Additional Information.
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Part 6. Financial Hardship
Item Number 1. Provide details about your financial hardship. This may include, but is not limited to, medical expenses of family members, unemployment, eviction, and homelessness. You may also complete this section if your income is above 150 percent of the Federal Poverty Guidelines as defined in Part 5. and you believe you have special circumstances that warrant a fee waiver.
Documentation. You must document your income and provide a complete list, description, and an estimate of the value of your assets that you can easily convert into cash and any liabilities. Item Number 2. List the types of assets you have, the dollar value of those assets, and the total dollar value of your assets. Include the following assets:
Do not include your pension plans and Individual Retirement Accounts (IRA). Documentation. Provide documentation of your income and any evidence regarding the types and value of your assets.
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Item Number 3. Total Monthly Expenses and Liabilities. Provide your average monthly costs for all applicable categories provided.
Documentation. Provide evidence, where possible, such as copies of monthly bills and payments, and documentation for monthly expenses and any extenuating circumstances, such as medical bills. If you cannot provide evidence of income, you may submit affidavits from religious institutions, non-profits, or community-based organizations verifying that you are currently receiving some benefit or support from them. Part 7. 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.
Item Numbers 7. - 11. Each person applying for a fee waiver must sign and date Form I-912. This includes family members identified in Part 3. If an individual is under 14 years of age, a parent or legal guardian may sign the request on his or her behalf. USCIS will reject any Form I-912 that is not signed by all individuals requesting a fee waiver. Part 8. Family Member’s Statement, Contact Information, Certification, and Signature NOTE: If the information provided by the requestor in Part 7. is not applicable to a family member identified in Part 3., (for example, the family member used a different interpreter or speaks a different language) that individual should complete Part 8. Make additional copies of Part 8. for each family member to sign, as applicable, and include the pages with your completed Form I-912. USCIS will reject any Form I-912 that is not signed by all individuals requesting a fee waiver. Item Numbers 1. - 6. Select the appropriate box to indicate whether you, the family member, 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. Part 9. Interpreter’s Contact Information, Certification, and Signature
NOTE for Family Members: If you used a different interpreter than the one used by the requestor, make additional copies of Part 9., provide the following information, and include the pages with your completed Form I-912. Item Numbers 1. - 9. 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 10. Contact Information, Declaration, and Signature of the Person Preparing this Request, if Other Than the Requestor
NOTE for Family Members: If you used a different preparer than the one used by the requestor, make additional copies of Part 10., provide the following information, and include the pages with your completed Form I-912.
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Item Numbers 1. - 10. 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 9. and Part 10. 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 be obliged to also 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.
Part 11. 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 11. Additional Information. If you need more space than what is provided in Part 11., you may make copies of Part 11. to complete and file with your request, or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet and 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. |
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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.
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Item Number 3. Provide the form numbers of applications and petitions for which you are requesting a fee waiver.
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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 USCIS-issued or INS-issued documentation.
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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.
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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.
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:
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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.
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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.
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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.
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.
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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;
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;
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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.
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.
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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.
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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 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 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).
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: 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.
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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.
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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
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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
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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 be obliged to also 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.
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 and 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.
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Page 10, What Is the Filling Fee? |
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There is no filing fee for Form I-912. |
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Page 10, Where To File? |
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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. |
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Page 10, Processing Information |
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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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Page 10, Penalties |
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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. |
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Page 11, USCIS Privacy Act Statement |
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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). 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 denial of your request and rejection of your application or petition based on non-payment of the filing fee. ROUTINE USES: DHS may 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-007- Benefits 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. |
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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-007- Benefits 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. |
Page 11, Paperwork Reduction Act |
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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 1 hours and 10 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 20529- 2140; OMB No. 1615-0116. Do not mail your completed Form I-912 to this address.. |
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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 20529- 2140; OMB No. 1615-0116. Do not mail your completed Form I-912 to this address. |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | I-912 |
| Author | Hallstrom, Samantha M |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |