G-1580-001-INST-NEW-60Day-09122022

Instructions for Citizen Ambassador Nominee Questionaire
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form G-1580

OMB No. 1615-NEW
Expires Pending

What is the Purpose of Form G-1580?
Form G-1580, Citizenship Ambassador Nominee Questionnaire, is used to determine eligibility for the Citizenship
Ambassador Program.

Draft
Not for
Production
09/12/2022

Who May Use Form G-1580?

Individuals contacted by U.S. Citizenship and Immigration Services (USCIS) who consent to be considered for selection
as an Citizenship Ambassador.

General Instructions

Please submit the form and requested documentation to [email protected]. We recommend that
you encrypt the email before sending.
Accommodations. USCIS is committed to providing disability accommodations to Citizenship Ambassadors and their
guests. To request an accommodation please email [email protected].
Signature. Each questionnaire must be properly signed and filed. For all signatures on this questionnaire, 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 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.

Citizenship Ambassador Program Notification Process
If you are qualified for this program, you will receive confirmation through a notice titled “Confirmation of Eligibility for
the Citizenship Ambassadors Program.”
The role of Citizenship Ambassadors is voluntary and will not be financially or otherwise compensated. Accordingly, all
selected Citizenship Ambassadors will be required to sign a Gratuitous Services Agreement.
Please complete this form and return it to us via Email at [email protected]. For more
information, please refer to the notice.
If you are not selected for this program, you will receive notice through an Email sent to the Email address you provided.

Form G-1580 Instructions Pending

Page 1 of 2

Proof of U.S. Citizenship: (Part 1., Item Numbers 1. - 2.)
We must confirm that you are a U.S. citizen. You may demonstrate evidence of U.S. citizenship by submitting a scanned
copy of your U.S. birth certificate, Certificate of Citizenship, Naturalization Certificate, Consular Report of Birth Abroad,
or a valid unexpired U.S. Passport.
If USCIS has ever issued you a Certificate of Citizenship or a Certificate of Naturalization but you cannot provide any of
the above evidence, USCIS may confirm your U.S. citizenship using our internal database if you answer yes to question 3
and provide the applicable information in question 4.

Draft
Not for
Production
04/12/2022

The scanned copy of your U.S. birth certificate, Certificate of Citizenship, Naturalization Certificate,
Consular Report of Birth Abroad, or your valid unexpired U.S. Passport may be emailed to USCIS at
[email protected]. NOTE: This secure government mailbox is used solely for communication
with Citizenship Ambassador nominees.
For more information about the Citizenship Ambassadors Program, visit www.uscis.gov/citizenshipambassadors.

DHS Privacy Notice

AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the
Immigration and Nationality Act (INA) section 101(a)(42) and 207(c), and 8 CFR part 207.
PURPOSE: The primary purpose for providing the requested information on this questionnaire is to determine if you are
eligible to be a Citizenship Ambassador. DHS uses this information to confirm that you are a U.S. citizen and that you
consent to be participate as a Citizenship Ambassador.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information
may delay your recognition as a Citizenship Ambassador or result in the closing of your nomination as a Citizenship
Ambassador.
ROUTINE USES: The information will be used by and disclosed to Department of Homeland Security personnel and
contractors or other agents who need the information to assist in activities relating to the selection of a nominee as a
Citizenship Ambassador. USCIS may seek information pertaining to your status as a U.S. Citizen to determine eligibility.
Failure to provide may prevent USCIS for determining your status as a U.S. Citizen and being eligible to participate
as a Citizenship Ambassador. The information will be used in accordance with approved routine uses, as described in
the associated published system of records notices [DHS/ALL-011 - Department of Homeland Security Biographies
and Awards, DHS/ALL-024 Department of Homeland Security Facility and Perimeter Access Control and Visitor
Management, and DHS/USCIS-007 Benefits Information System], which can be found at www.dhs.gov/privacy. DHS
may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.

Paperwork Reduction Act
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection
of information, unless it displays a currently valid OMB control number. The public reporting burden for this collection
of information is estimated at 0.5 hours per response, including time for reviewing instructions, gathering the required
documentation and information, completing the form, attaching necessary documentation, and submitting the form. 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, Office of Policy and Strategy, Regulatory
Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No. 16150132. Do not mail your completed Form G-1580 to this address.



Page 2 of 2