Form I-290B Notice of Appeal or Motion

Notice of Appeal or Motion

USCIS
Form I-290B

Department of Homeland Security
U.S. Citizenship and Immigration Services
Returned

For
USCIS
Use
Only

Reloc Sent

OMB No. 1615-0095
Expires 12/31/2023

Receipt

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Remarks

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Resubmitted

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To be completed by an
attorney or accredited
representative (if any).

Select this box if
Form G-28 is
attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

Please visit www.uscis.gov/i-290b/eligibility for information on the immigration benefit types that are eligible for an appeal or
motion using this form.
► START HERE - Type or print in black ink.

If you do not properly complete this form or fail to submit required documents listed in the Instructions, we may dismiss or reject your
appeal or motion.

Part 1. Information About the Applicant or
Petitioner

If a business or organization is filing this appeal or motion, skip
to Item Number 3. and do not complete Item Numbers 1. or 2.

Mailing Address (Safe or Alternate Address,
if applicable)
(USPS ZIP Code Lookup)

6.a. In Care Of Name (if any)

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

6.b. Street Number
and Name

1.c. Middle Name

6.d. City or Town

2.

Date of Birth (mm/dd/yyyy)

6.e. State

3.

Business or Organization Name (if applicable)

6.g. Province

4.

Alien Registration Number (A-Number, if any)

6.c.

► A5.

Apt.

Ste.

6.f.

Flr.

ZIP Code

6.h. Postal Code
6.i.

Country

USCIS Online Account Number (if any)
►

Form I-290B Edition 12/02/21

Page 1 of 5

Part 2. Information About the Appeal or Motion

Part 3. Basis for the Appeal or Motion

Please indicate whether you are filing an appeal to the
Administrative Appeals Office (AAO) or a motion. You cannot
file both an appeal and a motion on a single form. If you select
both an appeal and a motion, we may dismiss or reject your
filing.

You must provide a statement regarding the basis for your
appeal or motion in the space provided on the next page. If
you need additional space to provide your explanation, use Part
7. Additional Information or a separate sheet of paper.

I am filing an appeal to the AAO.
1.a.
1.b.

1.c.

I have attached a brief and/or additional evidence.

I will submit a brief and/or additional evidence
directly to the AAO within 30 calendar days of filing
this appeal.
I will not be submitting any brief or additional
evidence in support of this appeal.

I am filing a motion.
2.a.
2.b.
2.c.

Appeal: Provide a statement that specifically identifies an
erroneous conclusion of law or statement of fact in the decision
you are appealing. You MUST provide this information with
your Form I-290B even if you intend to submit a brief later.

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NOTE: DO NOT use this form to file an appeal with the
Board of Immigration Appeals (BIA). You must instead use
Form EOIR-29.

I am filing a motion to reopen. I have attached a
brief and/or additional evidence.

I am filing a motion to reconsider. I have attached a
brief.
I am filing a motion to reopen and a motion to
reconsider. I have attached a brief and/or additional
evidence.

3.

Immigration Form That is the Subject of This Appeal or
Motion (for example, Form I-140, I-360, I-129, I-485,
I-601, I-730, I-131) (list only one form number)

4.

Receipt Number for the Application, Petition, or Other
Request (list only one Receipt Number)

5.

Requested Immigrant or Nonimmigrant Classification
(for example, H-1B, R-1, O-1, EB-1, EB-2, RE-2, AS-2)
(if applicable)

6.

Date of the Unfavorable Decision (mm/dd/yyyy)

7.

Office That Issued the Unfavorable Decision

Form I-290B Edition 12/02/21

NOTE: Your appeal must address all grounds of
ineligibility identified in the unfavorable decision. If you do
not address an issue in a statement on this form or in a
supporting brief, we may deem it waived for the appeal. A
waived ground of ineligibility may be the sole basis for a
dismissed appeal.

Motion to Reopen: A motion to reopen must state new facts
and must be supported by documentary evidence demonstrating
eligibility for the requested immigration benefit at the time you
filed the application or petition.
Motion to Reconsider: A motion to reconsider must state the
reasons for reconsideration and must be supported by any
pertinent precedent decisions to establish that the decision was
based on an incorrect application of law or service policy, if
applicable. A motion to reconsider must also establish that the
decision was incorrect based on the evidence of record at the
time of the decision.

Page 2 of 5

Part 4. Applicant's or Petitioner's Contact
Information, Certification, and Signature
Applicant's or Petitioner's Contact Information

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

4.

Interpreter's Mobile Telephone Number (if any)

Provide your daytime telephone number, mobile telephone
number (if any), and email address (if any).

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1.

Applicant's or Petitioner's Daytime Telephone Number

2.

Applicant's or Petitioner's Mobile Telephone Number
(if any)

5.

Interpreter's Email Address (if any)

Interpreter's Certification and Signature

I certify, under penalty of perjury, that I am fluent in English

3.

Applicant's or Petitioner's Email Address (if any)

Applicant's or Petitioner's Certification and
Signature

I certify, under penalty of perjury, that I provided or authorized
all of the responses and information contained in and submitted
with my appeal or motion I read and understand or, if
interpreted to me in a language in which I am fluent by the
interpreter listed in Part 5., understood, all of the responses and
information contained in, and submitted with, my appeal/
motion, and that all of the responses and the information are
complete, true, and correct. Furthermore, I authorize the release
of any information from any and all of my records that USCIS
may need to determine my eligibility for an immigration request
and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
4.

Applicant's or Petitioner's Signature

and
,
and I have interpreted every question on the appeal/motion, and
Instructions and interpreted the applicant's answers to the
questions in that language, and the applicant/petitioner informed
me that they understood every instruction, question, and answer
on the appeal/motion.
6.

Date of Signature (mm/dd/yyyy)

Part 6. Contact Information, Declaration, and
Signature of the Person Preparing This Appeal/
Motion, if Other Than the Applicant or
Petitioner
Preparer's Full Name

1.
Date of Signature (mm/dd/yyyy)

Part 5. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name

Form I-290B Edition 12/02/21

Interpreter's Signature

Preparer's Family Name (Last Name)

Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

4.

Preparer's Mobile Telephone Number (if any)

5.

Preparer's Email Address (if any)

Page 3 of 5

Part 6. Contact Information, Declaration, and
Signature of the Person Preparing This Appeal/
Motion, if Other Than the Applicant or
Petitioner (continued)
Preparer's Certification and Signature

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I certify, under penalty of perjury, that I prepared this appeal or
motion for the applicant or petitioner at their request and with
express consent and that all of the responses and information
contained in and submitted with the appeal or motion are
complete, true, and correct and reflects only information
provided by the applicant or petitioner. The applicant or
petitioner reviewed the responses and information and informed
me that they understand the responses and information in or
submitted with the appeal or motion.
6.

Preparer's Signature

Date of Signature (mm/dd/yyyy)

Form I-290B Edition 12/02/21

Page 4 of 5

5.a. Page Number

Part 7. Additional Information
If you need extra space to provide any additional information
within this form, use the space below. If you need more space
than what is provided, you may make copies of this page to
complete and file with this form or attach a separate sheet of
paper. Type or print your name and A-Number at the top of
each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each
sheet.

5.b. Part Number 5.c. Item Number

5.d.

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1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

1.c. Middle Name
2.

A-Number (if any) ► A-

3.a. Page Number

3.d.

4.a. Page Number

3.b. Part Number

3.c. Item Number

6.a. Page Number

6.b. Part Number 6.c. Item Number

6.d.

4.b. Part Number 4.c. Item Number

4.d.

Form I-290B Edition 12/02/21

7.a. Page Number

7.b. Part Number 7.c. Item Number

7.d.

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