Form I-600A Supplement I-600A Supplement Form I-600A Supplement 3, Request for Action on Approved

Supplement 3,
Request for Action on Approved Form I-600A/I-600
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-600A/I-600
Supplement 3
OMB No. 1615-0028
Expires 02/28/2026

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Extension Granted to:

For
USCIS
Use
Only

(Date)

Other Change:

(Type of Change)

To be Completed by
an Attorney or
Accredited
Representative

Select this box if
Form G-28 or G-28I
is attached.

Action Block

New Non-Hague country:
(Name of Country)

Duplicate Approval Notice:
(Date)

Attorney State Bar Number
(if applicable)

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

► START HERE - Type or print in black ink.

If you have changed your marital status since filing your Form I-600A or Form I-600, STOP. Do NOT file this supplement.
Please see the Instructions for Form I-600A, Application for Advance Processing of an Orphan Petition, and Form I-600, Petition to
Classify Orphan as an Immediate Relative, for additional information.
See USCIS Form G-1055, Fee Schedule, available at www.uscis.gov/g-1055, for information on filing fees.

Part 1. Information About You (Applicant/Petitioner who has a valid approved Form I-600A/I-600)
1.

Family Name (Last Name)

2.

Other Names Used

Given Name (First Name)

Middle Name

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 7. Additional Information.
Family Name (Last Name)

3.

Date of Birth (mm/dd/yyyy)

4.

City/Town/Village of Birth

Given Name (First Name)

Middle Name

State or Province of Birth

Country of Birth

Form I-600A/I-600 Supp 3 Edition 04/01/24

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Part 1. Information About You (continued)
Your Contact Information
5.

U.S. Mailing Address

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In Care Of Name

6.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Is your current U.S. mailing address the same as your physical residence?

(USPS ZIP Code Lookup)

Yes

No

If you answered “No” to Item Number 6., provide the address of your U.S. residence in Item Number 7. or the address for your
residence abroad in Item Number 8., as appropriate.
7.

8.

Address of U.S. Residence
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Address of Residence Abroad
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

9.

ZIP Code

Postal Code

Country

Which address would you like USCIS to use for mailing notices and decisions to you?
U.S. Mailing Address

Address of Residence Abroad

10. Daytime Telephone Number

11. Mobile Telephone Number

12. Email Address

Information About Current Marriage
If you have a new spouse who was not listed on your prior Form I-600A or Form I-600, this is considered a change in marital status.
You cannot use this supplement to report a change in marital status.
13. Is your spouse's name the same as listed on your previously filed Form I-600A or Form I-600?

Yes

No

If you answered “No,” please explain.

Form I-600A/I-600 Supp 3 Edition 04/01/24

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Part 1. Information About You (continued)
14. Is your spouse's address and contact information the same as listed on your previously filed Form I-600A or Form I-600?
Yes

No

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If you answered “No,” please explain.

Part 2. Action Requested on Your Previously Approved Form I-600A or Form I-600
Provide the following information about your approved Form I-600A or Form I-600.
1.

USCIS Receipt Number

Date of Approval (mm/dd/yyyy) Date Approval Expires (mm/dd/yyyy)

Location of the Office Where You Filed Your Form I-600A and/or Form I-600

USCIS Online Account Number
►
2.

Indicate which of the following items you are requesting. If any changes have occurred, indicate such change(s) in Item Number
3. You must submit an updated home study if there are any changes or you are requesting an extension.
2.a.
2.b.
2.c.

A FIRST or SECOND extension of your Form I-600A.

A THIRD or SUBSEQUENT extension of your Form I-600A.

A new approval notice based on significant change or change in the number of children or characteristics (such as age,
gender, and/or special needs) of the child or children you intend to adopt after your Form I-600A or Form I-600 was
approved.
If you are requesting an extension of your approval period and a new approval notice based on a significant change after
your suitability determination was approved, you must select either Item Number 2.a. or 2.b.

2.d.

A FIRST or SECOND change to a new non-Hague Adoption Convention country for which you were not previously
approved in your suitability determination.
If you are requesting an extension of your approval period and a change of non-Hague Adoption Convention country,
you must select either Item Number 2.a. or 2.b. and indicate the change in Item Number 3.

2.e.

A THIRD or SUBSEQUENT change to a new non-Hague Adoption Convention country for which you were not
previously approved in your suitability determination.
If you are requesting both an extension of your approval period and a second or subsequent change of non-Hague
Adoption Convention country, you must select either Item Number 2.a. or 2.b. and indicate the change in Item
Number 3.

2.f.

A duplicate approval notice.
Select this option if you are not requesting an extension and there have been no significant changes since your suitability
determination, and you are not changing to a new non-Hague Adoption Convention country.

Form I-600A/I-600 Supp 3 Edition 04/01/24

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Part 2. Action Requested on Your Previously Approved Form I-600A or Form I-600 (continued)
3.

Provide information on any significant changes that have occurred since your suitability determination was approved or extended.
Your home study preparer must fully explain and evaluate all significant changes in your required home study update. Select all
boxes that apply.

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There have been no significant changes.

Change to a different non-Hague Adoption Convention country.
Name of new non-Hague Adoption Convention country

Change of residence, including a change in the child's proposed residence.

Significant decrease in financial resources, such as loss of employment, garnishment of wages, etc.

A development of a serious health condition for any household member regardless of age, including but not limited
to: heart attacks, cancer, strokes, conditions requiring extensive therapy, dementia, severe injuries, etc.
Change in history of arrest or criminal history for any household member regardless of age.

Change in history of child abuse or neglect, as an offender, for any household member regardless of age.
Change in history of substance abuse, as an offender, for any household member regardless of age.
Change in history of family violence, as an offender, for any household member regardless of age.
Change in history of sexual abuse, as an offender, for any household member regardless of age.

Change in the number and/or identity of children in your household. If you need extra space to complete this section,
use the space provided in Part 7. Additional Information.
Name (First/Middle/Last)

Date of Birth
(mm/dd/yyyy)

Country of Birth

A-Number

Relationship to
You

Change in the number and/or identity of adult members of your household. If you select this box, you must also submit
a Form I-600A/ I-600, Supplement 1, Listing of Adult Member of the Household for each new adult member of your
household.
Change in the number of children or the characteristics (such as age, gender, and/or special needs) of the child or
children you intend to adopt.
Other significant change in your household. (If you select this box, please explain the significant change(s) below. If you
need extra space to complete this section, use the space provided in Part 7. Additional Information.

Form I-600A/I-600 Supp 3 Edition 04/01/24

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Part 3. Applicant's/Petitioner's Certification, Duty of Disclosure, and Signature
NOTE: Read the Penalties section of the Form I-600A and Form I-600 Instructions before completing this section.

Applicant's/Petitioner's Certification

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I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my supplement, 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 supplement, 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.

Applicant's/Petitioner's Duty of Disclosure

I understand the ongoing duty to disclose information concerning my suitability and eligibility to adopt, as described in the Form
I-600A and/or Form I-600 instructions, and I agree to notify my home study preparer and USCIS of any new information that I am
required to disclose.

Applicant's/Petitioner's Signature
1.

Applicant's/Petitioner's Signature

Date of Signature (mm/dd/yyyy)

Part 4. Your Spouse's Certification, Duty of Disclosure, and Signature

NOTE: Read the Penalties section of the Form I-600A and Form I-600 Instructions before completing this section.

Your Spouse's Certification

I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my petition, 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 petition, 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.

Your Spouse's Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility to adopt, as described in the Form
I-600 and/or 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
1.

Your Spouse's Signature

Form I-600A/I-600 Supp 3 Edition 04/01/24

Date of Signature (mm/dd/yyyy)

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

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

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Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification and Signature

I certify, under penalty of perjury, that I am fluent in English and [Fillable field], and I have interpreted every question on the petition
and Instructions and interpreted the petitioner's and/or petitioner's spouse's (if married) answers to the questions in that language, and
the petitioner and/or the petitioner's spouse informed me that they understood every instruction, question, and answer on the petition.
6.

Date of Signature (mm/dd/yyyy)

Interpreter's Signature

Part 6. 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 supplement, provide the following information about the
preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

Form I-600A/I-600 Supp 3 Edition 04/01/24

4.

Preparer's Mobile Telephone Number (if any)

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Part 6. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner and Spouse (continued)
Preparer's Certification and Signature

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I certify, under penalty of perjury, that I prepared this petition for the petitioner and/or the petitioner's spouse (if married) at their
request and with express consent and that all of the responses and information contained in and submitted with the petition are
complete, true, and correct and reflects only information provided by the petitioner and/or the petitioner's spouse (if married). The
petitioner and/or the petitioner's spouse (if married) reviewed the responses and information and informed me that they understand the
responses and information in or submitted with the petition.

Preparer's Signature
6.

Preparer's Signature

Form I-600A/I-600 Supp 3 Edition 04/01/24

Date of Signature (mm/dd/yyyy)

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Part 7. Additional Information
If you need extra space to provide any additional information within this petition, 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 petition or attach a separate sheet of paper. Type or
print your name and A-Number (if any) 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.

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1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number ► A-

3.

Page Number

Part Number

Item Number

4.

Page Number

Part Number

Item Number

5.

Page Number

Part Number

Item Number

6.

Page Number

Part Number

Item Number

Form I-600A/I-600 Supp 3 Edition 04/01/24

Middle Name (if applicable)

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