Form EOIR-62

U.S. Department of Justice
Executive Office for Immigration Review

OMB#1125-XXXX
Volunteer Waiver for Gratuitous Services

I, _________________________, AND/OR ______________________________________________,
(Name of Volunteer)
(Authorized Representative of Organization)
declare under penalty of perjury, that I am willing and able to provide gratuitous services to the Executive
Office for Immigration Review as described below:

___________________________________________________________________________________

AF
T

DESCRIPTION OF GRATUITOUS SERVICES TO BE PERFORMED (for example, Friend of the Court services)

I also acknowledge that neither I, nor my organization or law firm, are a party or privy to the matters before the
Executive Office for Immigration Review for which I am providing gratuitous services.
I hereby state that I am able and willing to provide these services without expectation of payment, and waive any
future pay claims against the Government.
I understand that this waiver will remain in effect until such time as either I or the Executive Office for
Immigration Review terminates this waiver. By signing this form, I consent to the publication of my name on
a roster of gratuitous service providers for verification purposes that I have a valid Form EOIR-62 currently
on record with the Executive Office for Immigration Review.
Signed this _________________, by:
(Date)

______________________________________
Signature

_________________________________
Name of Firm/Organization

______________________________________
EOIR and Bar Identification Number, if any

_________________________________
Street Address, Apt/Suite

______________________________________
Phone Number

_________________________________
City, State, Zip Code

______________________________________
Email Address

D

R

_________________________________
Print Name

Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number.
Every effort is made to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you to
provide information. The estimated average time to review and complete the form is 5 minutes. If you have comments regarding the accuracy of this
estimate, or suggestions for making this form simpler, you can write to the Executive Office for Immigration Review, Office of the General Counsel,
5107 Leesburg Pike, Suite 2600, Falls Church, Virginia 22041.

Privacy Act Statement: The collection of this information is authorized by 8 U.S.C. §§ 1158, 1229 and 8 C.F.R. §§ 1003, 1240, 1241. All information
provided in this form is voluntary. The information you provide will be used to maintain official records of volunteers of the EOIR for the purposes of
tort claims, injury compensation, and other volunteer claims allowed by law. While furnishing this information is voluntary, if this form is incomplete,
provision of services cannot be accepted.

Form EOIR-62
Rev. Nov. 2021