Current Page Number and
Section
|
Current Text
|
Proposed
Text
|
Page 1, For USCIS Use
Only
|
[Page
1]
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)
START
HERE - Type or print in black ink.
NOTE: The applicant on this
form is the child’s parent, grandparent, or legal guardian.
|
[Page
1]
To
be completed by an Attorney or Accredited Representative (if
any).
[
] Select this box if Form G-28 or
G-28I
is
attached.
Attorney
State Bar Number (if
applicable)
Attorney
or Accredited Representative USCIS Online Account Number (if
any)
START
HERE - Type or print in black ink.
NOTE: The applicant on this
form is the child’s parent, grandparent, or legal guardian.
|
Page 1, Part 1.
Information About the Child’s Eligibility
|
[Page 1]
Part
1. Information About the Child’s Eligibility
1.
The
application is being filed for a child. The child is under 18
years of age and
(select
only
one box):
The
BIOLOGICAL child of a qualifying U.S. citizen (USC) parent filing
this application.
The
ADOPTED child of a qualifying USC parent filing this application.
The
grandchild of a qualifying USC grandparent or the child ward of a
USC legal guardian filing this application within five years of
the death of the USC parent.
[new]
|
[Page 1]
Part
1. Information About the Child’s Eligibility
[deleted]
1.
Is
the child under 18 years of age?
Yes
No
2.
Is the child residing outside the United States?
Yes
No
3.
Does the child
regularly reside in the legal and physical custody of a U.S.
citizen parent (or, if the U.S. citizen parent is deceased, an
individual who does not object to the application)?
Yes
No
NOTE:
If you answered “No” to any of the questions in Item
Numbers 1. - 3., do
not file Form N-600K. The
child is not eligible to obtain citizenship via Form N-600K.
4.
Is the child a lawful permanent resident?
Yes
No
5.
Are either of the child’s parents (or the spouse of either
of the child’s parents) currently a member of the U.S. armed
forces stationed outside the United States?
Yes
(answer Item
Numbers 6. and
7.)
No
(go to Item
Number 8.)
6.
Does
the member of the U.S. armed forces have official orders that
authorize the child to accompany and reside with the member of the
U.S. armed forces?
Yes
No
7.
If the child’s U.S. citizen parent is the spouse of the
member of the U.S. armed forces, is the U.S. citizen parent
authorized to accompany and reside with the U.S. armed forces
member as provided by the member’s official orders?
Yes
No
8.
Are either of the child’s parents (or the spouse of either
of the child’s parents) currently a U.S. Government employee
stationed outside the United States?
Yes
No
NOTE:
If you answered “Yes” to Item
Numbers 4. - 7.,
or if you answered “Yes” to Item
Numbers 4. and
8.,
the child may not be eligible to obtain citizenship via Form
N-600K. See “Who
Should Not File Form N-600K?” in the Instructions for more
information.
|
|
[new]
|
[Page
2]
Part
2. Person Filing this Application
1.
I
am the child’s:
[]
U.S. Citizen Parent
[]
U.S. Citizen Grandparent
[]
U.S. Citizen Legal Guardian
NOTE:
In order for a grandparent or a legal guardian to file this
application, the child’s U.S. citizen parent must have died
during the last five years.
|
Page 1, Part 2.
Information About the Child
|
[Page 1]
Part
2. Information About the Child
(for whom this application being filed)
[new]
1.
Current
Legal Name (do
not
provide a nickname)
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Name
Exactly As It Appears on the Permanent Resident Card (if
applicable)
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
3.
Other
Names Used (if applicable)
Provide
all other names ever used, including nicknames, maiden name, and
aliases.
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
4.
U.S.
Social Security Number
(if
applicable)
5.
USCIS
Online Account Number (if any)
6.
Date of Birth (mm/dd/yyyy)
7.
Country of Birth
[Page
2]
8.
Country of Citizenship or Nationality
9.
Gender Male/Female
10.
Height Feet/Inches
[moved
up from below]
[new]
11.
Mailing
Address
In
Care Of Name (if any)
Street
Number and Name
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
12.
Physical
Address (Do not
provide
a PO Box in this space unless it is the ONLY
address.)
Street
Number and Name
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
13.
Marital Status
Single,
Never Married
Married
Divorced
Widowed
Separated
Marriage
Annulled
Other
(Explain): _______
14.
Information
About the Child’s Admission Into the United States and
Current Immigration Status
NOTE:
Do
NOT
complete
this section. The USCIS officer will complete it during the
interview.
A.
Port-of-Entry
[Fillable
Field]
Date
of Entry (mm/dd/yyyy)
Exact
Name Used at Time of Entry
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
B.
Current Immigration Status
15.
Was
there any prior application for citizenship or for a U.S.
passport? Y/N
[Page
3]
16.
Was
the child adopted? Y/N
A.
Date
of Adoption (mm/dd/yyyy)
B.
Date
Legal Custody Began (mm/dd/yyyy)
C.
Date
Physical Custody Began
(mm/dd/yyyy)
17.
Were
the child's parents married to each other when the child was born
(or adopted)? Y/N
|
[Page 2]
Part
3.
Information About the Child for
Whom This Application Is Being Filed
1.
What is the child’s relationship to their U.S. citizen
parent?
[]
The biological child of a U.S. citizen parent. (If the U.S.
citizen parent is the child’s biological father, you will
generally have to establish that the child was born in wedlock or
legitimated).
[]
The child of a non-genetic gestational U.S. citizen parent (person
who carried and gave birth to the child) who is also the child’s
legal parent.
[]
The child of a U.S. citizen parent who was married to the child’s
genetic or gestational parent at the time of their birth (even if
no genetic or gestational relationship exists with the U.S.
citizen parent) and both of the child’s parents are also
their legal parents.
[]
The adopted child of a U.S. citizen parent.
2.
Child’s
Current
Legal Name (Do
not
provide a nickname)
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
(if applicable)
[deleted]
3.
Other
Names Used (if
any)
Provide
all other names the
child has ever
used
since birth,
including aliases,
name at birth, and nicknames.
If
you need extra space to complete this section, use the space
provided in Part
13. Additional Information.
Family
Name (Last Name)
[x2]
Given
Name (First Name)
[x2]
Middle
Name
(if applicable)
[deleted]
4.
USCIS
Online Account Number (if any)
5.
Date
of Birth (mm/dd/yyyy)
6.
Country
of Birth
7.
Country
of Citizenship or Nationality
8.
Gender
Male
Female
Another
Gender Identity
9.
Height
Feet
Inches
10.
Marital
Status
Single,
Never Married
Married
Divorced
Widowed
Separated
Marriage
Annulled
11.
Has
anyone applied for a U.S. passport or a Certificate of Citizenship
for this child before?
Yes
No
[Page
3]
12.
Current
Mailing
Address
In
Care Of Name (if any)
Street
Number and Name
Apt./Ste./Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
13.
Current Physical
Address (if
different from the address above)
Street
Number and Name
(Do not
provide
a PO Box in this space unless it is the ONLY
address.)
Apt./Ste./Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[moved up
to #10]
[deleted]
|
|
|
[Page 3]
Part
4. Information about the Child’s
Adoption
1.
Was the child adopted?
Yes
(answer Item
Numbers
2.
and
3.,
as
applicable).
No
(Go to Part
5.)
2.
Full,
Final and Complete Adoption Information
Place
of Adoption
City
or Town
State
Country
Date
of Adoption (mm/dd/yyyy)
3.
If the child’s adoptive parent did not use the orphan
process (Form I-600) or Hague process (Form I-800), complete the
following items to determine if the child’s adoption meets
the 2-year legal custody and joint residence requirements for an
adopted child.
Date
Legal Custody Began (mm/dd/yyyy)
Dates
of Joint Residence
Table 2
columns, From, To; Three rows mm/dd/yyyy, mm/dd/yyyy
|
Page 3, Part 3.
Information About the Child’s U.S. Citizen Biological or
Adoptive Parent
|
[Page 3]
Part
3. Information About the Child’s U.S. Citizen Biological or
Adoptive Parent
NOTE:
Provide information about the
U.S. citizen father or mother applying on behalf of the eligible
child.
Provide
information about the child's U.S. citizen parent in the sections
noted if
the U.S. citizen grandparent or legal guardian is filing this
form.
1.
Current
Legal Name of U.S. Citizen Parent
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Date of Birth (mm/dd/yyyy)
3.
Country of Birth
4.
U.S.
Social Security Number
(if
applicable)
5.
Physical Address
Street
Number and Name (Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[new]
6.
Daytime
Telephone Number
7.
Work
Telephone Number (if any)
8.
Evening
Telephone Number
9.
Mobile
Telephone Number (if any)
10.
Email
Address (if any)
[Page
4]
11.
The
parent is a U.S. citizen by:
Birth
in the United States
Acquisition
after birth through naturalization of alien parents
[new]
Birth
abroad to U.S. citizen parents
Certificate
of Citizenship Number
Alien
Registration Number (A-Number) (if known)
[moved
down]
Naturalization
Place
of Naturalization
Name
of Court or USCIS Office Location
City
or Town
State
Certificate
of Naturalization Number
A-Number
(if known)
Date
of Naturalization (mm/dd/yyyy)
[new]
12.
Has
the U.S. citizen father or mother ever lost U.S. citizenship or
taken any action that would cause loss of U.S. citizenship? Y/N
If
the
answer
is
“Yes”
to
Item
Number
12.,
provide
a
full
explanation
in
the
space
provided
in
Part
11.
Additional
Information.
13.
Marital
History
A.
How
many times has the U.S. citizen father or mother been married
(including annulled marriages and marriages to the same person)?
B.
What
is the U.S. citizen father or mother's current marital status?
Single,
Never Married
Married
Divorced
Widowed
Separated
Marriage
Annulled
Other
(Explain): _______
C.
Information
About the U.S. Citizen Father's or Mother's Current
Spouse
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
Date
of Birth (mm/dd/yyyy)
Country
of Birth
Country
of Citizenship or Nationality
Spouse's
Physical Address
Street
Number and Name (Do not
provide
a PO Box in this space unless it is your spouse's
ONLY
address.)
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[Page
5]
Date
of Marriage (mm/dd/yyyy)
Place
of Marriage
City
or Town
State
Country
Spouse's
Immigration Status
U.S.
Citizen
Lawful
Permanent Resident
Other
(Explain): ____________
D.
Is
the U.S. citizen father's or mother's current spouse also the
child's biological (or adoptive) parent? Y/N
14.
Member
of U.S. Armed Forces
A.
Is
the sponsoring U.S. citizen parent a member of the U.S. Armed
Forces? Y/N
B.
If
the answer is “Yes,” then are there official orders
authorizing the child to accompany and reside with the sponsoring
U.S. citizen parent who is a member of the U.S. Armed Forces? Y/N
NOTE:
If the U.S. citizen biological or adoptive parent is filing this
application AND has the required physical presence in the United
States, skip Part 4. and go directly to Part 5.
|
[Page
4]
Part
5.
Information About the Child’s U.S. Citizen
Parent
NOTE:
Provide information about yourself
if you are the
U.S. citizen
parent applying
on behalf of your
child.
If
both parents are U.S. citizens, provide information about the
parent filing this form in this Part.
1.
Current
Legal Name of U.S. Citizen Parent
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
(if applicable)
2.
Date of Birth (mm/dd/yyyy)
3.
Country of Birth
[deleted]
4.
Current Physical
Address
Street
Number and Name (Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt./Ste./Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
5.
Were
the child’s parents married to each other when the child was
born (or adopted)?
Yes
No
6.
If the child’s U.S. citizen parent is their father, and
their father was not
married
to the child’s other parent at the time of the child’s
birth, list all the countries and U.S. states where the U.S.
citizen father and/or the child have lived since the child’s
birth. If you need extra space to complete this section, use the
space provided in Part
13. Additional Information.
[fillable
field]
[deleted]
7.
The child’s parent is
a U.S. citizen by:
(see the Instructions for information about evidence you must
provide)
[moved
down]
Birth
in the United States
Birth outside
the United States to U.S. Citizen Parent(s)
[deleted]
Acquisition
after
birth through U.S. Citizen Parent(s)
Naturalization
[deleted]
8.
If you indicated that the child’s parent is a U.S. citizen
through birth outside the United States to U.S. citizen parents,
acquired U.S. citizenship after birth through their U.S. citizen
parent(s), or was naturalized, provide their A-Number.
Alien
Registration Number (A-Number) (if any)
9.
Has
the U.S. citizen
parent
ever lost U.S. citizenship or taken any action that would cause
loss of U.S. citizenship?
Yes
No
If
you
answered “Yes”
to
Item
Number
9.,
provide
a
full
explanation
in
the
space
provided
in
Part
13.
Additional
Information
regardless
of
whether
it
has
since
been
regained.
[deleted]
[moved to
Part 6.]
[deleted]
|
|
[new]
[moved down from section above]
|
[Page
4]
Part
6. Information About the Child’s Other Parent
1.
Other
Parent’s Legal Name
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Date of Birth (mm/dd/yyyy)
3.
Country
of Birth
4.
Country of Citizenship or Nationality
[Page
5]
5.
Other Parent’s Physical
Address (if
different from U.S. Citizen parent’s physical address in
Part
5.)
Street
Number and Name (Do not
provide
a PO Box in this space unless it is the
other parent’s
ONLY
address.)
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
|
Page 5, Part 4.
Information About the Child’s Qualifying U.S. Citizen
Grandparent
|
[Page 5]
Part
4. Information About the Child’s Qualifying U.S. Citizen
Grandparent
NOTE:
Complete
this part only
if
the U.S. citizen parent (or adoptive parent), grandparent, or
legal guardian is applying for citizenship for the child, and the
U.S. citizen parent
has
not been
physically present in the United States for five years; two years
of which were after 14 years of age.)
1.
Current
Legal Name of U.S. Citizen Grandparent
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Date
of Birth (mm/dd/yyyy)
3.
Country
of Birth
4.
U.S.
Social Security Number (if applicable)
5.
Physical
Address
Street
Number
and
Name
(Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt.
Ste.
Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
6.
Daytime
Telephone Number
7.
Work
Telephone Number (if any)
[Page
6]
8.
Evening
Telephone Number
9.
Mobile
Telephone Number (if any)
10.
Email
Address (if any)
11.
The
grandparent is a U.S. citizen by:
Birth
in the United States
Acquisition After Birth Through
Naturalization of Alien Parent(s)
Birth Abroad to U.S. Citizen
Parent(s)
Certificate
of Citizenship Number (if any)
A-Number
(if any)
Naturalization
Place
of Naturalization
Name
of Court or USCIS Office Location
City
or Town
State
Certificate
of Naturalization Number
A-Number
Date of Naturalization (mm/dd/yyyy)
[new]
12.
Has
the grandparent ever lost U.S. citizenship or taken any action
that would cause loss of U.S. citizenship? Y/N
If
you
answered
“Yes”
to
Item
Number
12.,
provide
a
full
explanation
in
the
space
provided
in
Part
11.
Additional
Information.
[new]
|
[Page 5]
Part
7.
Information About the Child’s
U.S. Citizen
Grandparent
or Legal Guardian
If
the child’s U.S. citizen parent is deceased and you are the
child’s U.S. citizen grandparent or the child’s U.S.
citizen legal guardian, provide information about yourself in Part
7. If
you are the U.S. citizen parent, and you will rely on your U.S.
citizen parent’s physical presence in Part
8.,
please provide your U.S. citizen parent’s (the child’s
grandparent’s) information in Part
7.
If neither of these scenarios apply, skip to
Part 8.
1.
Current
Legal Name
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
(if applicable)
2.
Date
of Birth (mm/dd/yyyy)
3.
Country
of Birth
[deleted]
4.
Current
Physical
Address
Street
Number
and
Name
(Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt./Ste./Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[deleted]
5.
The child’s U.S. citizen grandparent or U.S. citizen legal
guardian is a U.S. citizen by:
Birth
in the United States
Acquisition after birth through U.S.
Citizen Parent(s)
Birth outside
the United States to U.S. Citizen Parent(s)
[deleted]
Naturalization
[deleted]
6.
If the child’s U.S. citizen grandparent or U.S. citizen
legal guardian was born outside the United States to U.S. citizen
parents, acquired U.S. citizenship after birth through U.S.
citizen parent(s), or was naturalized, provide your A-Number.
A-Number
7.
Has the child’s U.S.
citizen grandparent or U.S. citizen legal guardian ever
lost U.S. citizenship or taken any action that would cause loss of
U.S. citizenship?
Yes
No
If
you
answered
“Yes”
to
Item
Number
7.,
provide
a
full
explanation
in
the
space
provided
in
Part
13.
Additional
Information
regardless
of
whether
it
has
since
been
regained.
If
you are the child’s legal guardian, provide the information
requested in Item
Numbers 8. - 10.
8.
Date
Legal Guardianship Began (mm/dd/yyyy)
9.
Name
of Authority that Granted Legal Guardianship
[Page
6]
10.
Address
of Authority that Granted Legal Guardianship
Street
Number
and
Name
Apt./Ste./Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
|
Page 6, Part 5. Physical
Presence in the United States From Birth Until Filing of Form
N-600K
|
[Page 6]
Part
5. Physical Presence in the United States From Birth Until Filing
of Form N-600K
NOTE:
Provide the dates that the U.S. citizen parent or grandparent was
present in the United States. If the U.S. citizen parent
has
not been
physically present in the United States for five years, two years
of which were after 14 years of age, then the child must use the
physical presence of the U.S. citizen grandparent.
1.
Indicate
whether this information relates to the U.S. citizen parent or to
the qualifying grandparent.
U.S.
Citizen Parent
U.S.
Citizen Grandparent
2.
Physical
Presence in the United States
A.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
B.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
C.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
D.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
E.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
F.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
G.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
H.
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
NOTE:
If the U.S. citizen biological/adoptive parent is filing this
application, skip Part 6. and go directly to Part 7.
|
[Page 6]
Part
8.
U.S. Citizen Parent’s or U.S. Citizen Grandparent’s
Physical
Presence in the United States From Their
Birth
Until Filing of Form N-600K
Provide
the
dates that the U.S. citizen parent or
U.S. citizen grandparent
was present in the United States. If the U.S. citizen parent
has
not been
physically present in the United States for five years, two years
of which were after 14 years of age,
provide information about the physical
presence of the U.S. citizen grandparent. If
you need extra space to complete this section, use the space
provided in Part
13. Additional Information.
1.
Indicate
whether this information relates to the U.S. citizen parent or to
a
U.S. citizen grandparent.
U.S.
Citizen Parent
U.S.
Citizen Grandparent
2.
Physical
Presence in the United States
From
(mm/dd/yyyy)
Until (mm/dd/yyyy)
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
From
(mm/dd/yyyy) Until (mm/dd/yyyy)
[deleted]
|
Page 7, Part 6.
Information About the Legal Guardian
|
[Page 7]
Part
6. Information About the Legal Guardian
NOTE:
Complete this part only
if
the legal guardian is filing this application on behalf of a
deceased U.S. citizen parent.
1.
Current
Legal Name of Legal Guardian
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Date of Birth (mm/dd/yyyy)
3.
Country of Birth
4.
U.S. Social Security Number (if applicable)
5.
Physical
Address
Street
Number
and
Name
(Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt.
Ste.
Flr.
Number
City
or Town
State
ZIP
Code Province
Postal
Code
Country
6.
Daytime
Telephone Number
7.
Work
Telephone Number (if any)
8.
Evening
Telephone Number
9.
Mobile
Telephone Number (if any)
10.
Email
Address (if any)
11.
The
legal guardian is a U.S. citizen by:
Birth
in the United States
Acquisition After Birth Through
Naturalization of Alien Parent(s)
Birth Abroad to U.S. Citizen
Parent(s)
Certificate
of Citizenship Number (if any)
A-Number
(if any)
Naturalization
Place
of Naturalization
Name
of Court or USCIS Office Location
City
or Town
State
Certificate
of Naturalization Number
A-Number
Date of Naturalization (mm/dd/yyyy)
[Page
8]
12.
Date
of Legal Guardianship (mm/dd/yyyy)
13.
Name
of Authority that Granted Legal Guardianship
14.
Address
of Authority that Granted Legal Guardianship
Street
Number
and
Name
(Do
not
provide
a
PO
Box
in
this
space
unless
it
is
your
ONLY
address.)
Apt.
Ste.
Flr.
Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
|
[deleted]
|
Page 8, Part 7.
Preferred Location and Date for Interview
|
[Page 8]
Part
7. Preferred Location and Date for Interview
[new]
1.
USCIS Office Location
City
or Town
State
2.
Preferred
Date (mm/dd/yyyy)
USCIS
will attempt to accommodate the requested preferences.
NOTE:
The interview date should be at least 90 days after filing Form
N-600K and before the child's 18th birthday.
|
[Page 6]
Part
9.
Preferred Location and Date for Interview
Provide
information about the location where you prefer to have the
interview and a date range when you are available for the
interview. The interview date range should be at least 90 days
after filing Form N-600K and must occur before the child's 18th
birthday.
USCIS will attempt to accommodate the requested preferences.
1.
USCIS Office Location
City
or Town
State
2.
Preferred
Date Range
From
(mm/dd/yyyy)
To
(mm/dd/yyyy)
[deleted]
|
Page 8, Part 8.
Applicant’s Statement, Contact Information, Certification,
and Signature
|
[Page 8]
Part
8. Applicant’s Statement, Certification, and Signature
NOTE:
Read
the Penalties
section
of the Form N-600K Instructions before completing this section.
Applicant’s
Statement
NOTE:
Select
the box for either Item
A. or
B.
in
Item
Number 1. If
applicable, select the box for Item
Number 2.
1.
Applicant's
Statement Regarding the Interpreter
A.
I
can read and understand English, and I have read and understand
every question and instruction on this application and my answer
to every question.
B.
The
interpreter named in Part
9. read
to me every question and instruction on this application and my
answer to every question in__________,
a
language
in
which
I
am
fluent,
and
I understood everything.
2.
Applicant's
Statement Regarding the Preparer
At
my request, the preparer named in Part
10.,
_________, prepared this application for me based only upon
information I provided or authorized.
[new]
[Page 9]
Applicant’s
Certification
Copies
of any documents I have submitted are exact photocopies of
unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date.
Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my
eligibility for the immigration benefit I seek.
I
further authorize release of information contained in this
application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration
and enforcement of U.S. immigration law.
I
certify, under penalty of perjury, that all of the information in
my application, and any document submitted with it were provided
or authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my application, and
that all of this information is complete, true, and correct.
Applicant’s
Signature
3.
Applicant’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
NOTE
TO ALL APPLICANTS: If
you do not completely fill out this application or fail to submit
required documents listed in the Instructions,
USCIS may deny your application.
|
[Page
7]
Part
10.
Applicant’s
Contact
Information, Certification,
and Signature
[deleted]
Applicant’s
Contact Information
Provide your
daytime telephone number, mobile telephone number (if any), and
email address (if any).
1.
Applicant’s Daytime Telephone Number
2.
Applicant’s Mobile Telephone Number (if any)
3.
Applicant’s Email Address (if any)
Applicant’s
Certification and
Signature
[deleted]
I certify, under penalty of perjury,
that I provided or authorized all of the responses
and information contained in
and submitted with my application, I
read and understand or,
if interpreted to me in a language in which I am fluent by the
interpreter listed in Part 11.,
understood, all of the responses and
information contained in, and submitted with, my
application, 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.
[deleted]
4.
Applicant’s
Signature
Date
of Signature (mm/dd/yyyy)
[deleted]
|
Page 9, Part 9.
Interpreter’s Contact Information, Certification, and
Signature
|
[Page 9]
Part
9. Interpreter’s Contact Information, Certification, and
Signature
Provide
the following information about the interpreter.
Interpreter’s
Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's
Given Name (First Name)
2.
Interpreter's
Business or Organization Name (if any)
Interpreter’s
Mailing Address
3.
Street Number and Name
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
Interpreter’s
Contact Information
4.
Interpreter’s Daytime Telephone Number
5.
Interpreter’s
Mobile Telephone Number (if any)
6.
Interpreter’s
Email
Address (if any)
[Page
10]
Interpreter’s
Certification
I
certify, under penalty of perjury, that:
I
am fluent in English and ________, which is the same language
specified in Part
8.,
Item
B. in
Item
Number 1.,
and I have read to this applicant in the identified language every
question and instruction on this application and his or her answer
to every question. The applicant informed me that he or she
understands every instruction, question, and answer on the
application, including the
Applicant's
Certification,
and has verified the accuracy of every answer.
Interpreter’s
Signature
7.
Interpreter’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page 7]
Part
11.
Interpreter’s Contact Information, Certification, and
Signature
[deleted]
Interpreter’s
Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's
Given Name (First Name)
2.
Interpreter's
Business or Organization Name
[deleted]
Interpreter’s
Contact
Information
3.
Interpreter’s
Daytime Telephone Number
4.
Interpreter’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 and [Fillable language field], and
I have interpreted every question on the application and
Instructions and interpreted the applicant’s answers to the
questions in that language, and the applicant informed me that
they understood every instruction, question, and answer on
the application.
[deleted]
6.
Interpreter’s
Signature
Date
of Signature (mm/dd/yyyy)
|
Page 10, Part 10.
Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant
|
[Page 10]
Part
10. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant
Provide
the following information about the preparer.
Preparer’s
Full Name
1.
Preparer’s
Family
Name (Last Name)
Preparer’s
Given
Name (First Name)
2.
Preparer’s
Business
or Organization Name (if any)
Preparer’s
Mailing
Address
3.
Street Number and Name
Apt.
Ste. Flr. Number
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
Preparer’s
Contact
Information
4.
Preparer’s
Daytime
Telephone Number
5.
Preparer’s
Mobile
Telephone Number (if any)
6.
Preparer’s
Email
Address (if any)
[Page
11]
Preparer’s
Statement
7.A.
I
am not an attorney or accredited representative but have prepared
this application on behalf of the applicant and with the
applicant's consent.
B.
I
am an attorney or accredited representative and my representation
of the applicant in this case extends/does not extend beyond the
preparation of this application.
NOTE: If you are an attorney
or accredited representative, you may need to 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 Geographical Confines of the
United States, with this application.
Preparer’s
Certification
By
my signature, I certify, under penalty of perjury, that I prepared
this application at the request of the applicant. The applicant
then reviewed this completed application and informed me that he
or she understands all of the information contained in, and
submitted with, his or her application, including the Applicant's
Certification,
and that all of this information is complete, true, and correct.
I completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.
Preparer’s
Signature
8.
Preparer’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page
8]
Part
12.
Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant
[deleted]
Preparer’s
Full Name
1.
Preparer’s Family Name (Last Name)
Preparer’s
Given Name (First Name)
2.
Preparer’s
Business or Organization Name
[deleted]
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)
[deleted]
Preparer’s
Certification
and Signature
I
certify, under penalty of perjury, that I prepared this
application for the applicant at
their request and
with express consent and that all of the responses and information
contained in and submitted with the application are
complete, true, and correct and reflects
only information provided by the applicant. The applicant
reviewed the responses and information and
informed me that they understand the responses and information in
or submitted with the application.
[deleted]
6.
Preparer’s
Signature
Date
of Signature (mm/dd/yyyy)
|
Page 12, Part 11.
Additional Information
|
[Page 12]
Part
11. Additional Information
If you need extra space to provide
any additional information within this application, use the space
below. If you need more space than what is provided, make copies
of this page to complete and file with this application or attach
a separate sheet of paper. Type or print the child’s name
and A-Number (if any) at the top of each sheet; indicate the
Page Number, Part Number, and Item Number
to which the answer refers; and sign and date each sheet.
1.
Family Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
A-Number
(if any)
3.
A. Page
Number
B.
Part
Number
C.
Item
Number
D.
__________________
4.
A. Page
Number
B.
Part
Number
C.
Item
Number
D.
__________________
5.
A. Page
Number
B.
Part
Number
C.
Item
Number
D.
__________________
6.
A. Page
Number
B.
Part
Number
C.
Item
Number
D.
__________________
7.
A. Page
Number
B.
Part
Number
C.
Item
Number
D.
__________________
[new]
|
[Page
9]
Part
13.
Additional Information
If you need extra space to provide
any additional information within this application, 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
application or attach a separate sheet of paper. Type or print
the child’s name and A-Number (if any) at the top of each
sheet; indicate the Page Number, Part Number, and
Item Number to which the answer refers; and sign and date
each sheet.
1.
Family Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
A-Number
(if any)
3.
Page
Number
Part
Number
Item
Number
[Fillable
field]
4.
Page
Number
Part
Number
Item
Number
[Fillable
field]
5.
Page
Number
Part
Number
Item
Number
[Fillable
field]
6.
Page
Number
Part
Number
Item
Number
[Fillable
field]
7.
Page
Number
Part
Number
Item
Number
[Fillable
field]
Do not
complete
Part 14. This
Part
will
be
completed
at
the
interview.
|
Page 13, Part 12.
Affidavit
|
[Page 13]
Part
12. Affidavit
(At the time of Interview)
I,
the
parent/grandparent/legal guardian, ___________ do swear or affirm,
under penalty
of perjury under the laws of the United States, that I know and
understand the contents of this application signed by me, and the
attached supplementary pages number ___ to ___ inclusive, that the
same are true and correct to the best of my knowledge, and that
corrections number ____ to ____ were made by me or at my request.
Parent’s, Grandparent’s,
or Legal Guardian’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
Subscribed
and sworn or affirmed before me upon examination of the applicant
(U.S. citizen parent, grandparent, or legal guardian) on (Date
(mm/dd/yyyy)) _______ at (Location).
Interviewing
USCIS Officer’s Name
Interviewing
USCIS Officer’s Title
Interviewing
USCIS Officer’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
[new]
|
[Page 10]
Part
14.
Affidavit
I,
the
parent/grandparent/legal guardian, ___________ do swear or affirm,
under penalty
of perjury under the laws of the United States, that I know and
understand the contents of this application signed by me, and the
attached supplementary pages number ___ to ___ inclusive, that the
same are true and correct to the best of my knowledge, and that
corrections number ____ to ____ were made by me or at my request.
Parent’s, Grandparent’s,
or Legal Guardian’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
Subscribed
and sworn or affirmed before me upon examination of the applicant
(U.S. citizen parent, grandparent, or legal guardian) on (Date
(mm/dd/yyyy)) _______ at (Location).
Interviewing
USCIS Officer’s Name
Interviewing
USCIS Officer’s Title
Interviewing
USCIS Officer’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
Do
not complete Part
15.,
as it is for USCIS use only.
|
Page 13, Part 13. USCIS
Officer Report and Recommendation
|
[Page 13]
Part
13. USCIS Officer Report and Recommendation
[new]
On
the
basis of the documents, records and the testimony of person
examined, and the identification upon personal appearance of the
underage beneficiary, I find that all the facts and conclusions
set forth under oath in this application are:
1.
True and correct;
2.
The applicant derived or acquired U.S. citizenship on (Date
(mm/dd/yyyy))
3.
The applicant derived or acquired U.S. citizenship through
(Select the box next to the appropriate section of law or, if the
section of law is not reflected, type or print the applicable
section of law in the space next to “Other.”)
A.
INA Section 322(a)(2)(A) of the (Parent residence);
B.
INA Section 322(a)(2)(B) of the (Grandparent residence); or
C.
Other
[new]
I
recommend that this Form N-600K be: Approved/Denied
Issue
Certificate of Citizenship in the Name of
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
USCIS
Officer's Printed Name
USCIS
Officer’s Title
USCIS
Officer’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
I
do/do not concur with the USCIS officer’s recommendation of
the Form N-600K.
USCIS
Field Office Director’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page 10]
Part
15.
USCIS Officer
Information
About the Child’s Admission into the United States and
Current Immigration Status
1.
Port-of-Entry
[Fillable
Field]
Date
of Entry (mm/dd/yyyy)
Exact
Name Used at Time of Entry
Family
Name (Last Name)
Given
Name (First Name)
Middle
Name
2.
Current Immigration Status [Fillable Field]
USCIS
Officer’s Report
On
the
basis of the documents, records and the testimony of person
examined, and the identification upon personal appearance of the
underage beneficiary, I find that all the facts and conclusions
set forth under oath in this application are:
3.
True
and correct;
[deleted]
4.
The
applicant is eligible for U.S. citizenship
through (Select the box next to the appropriate section of law.)
[]
INA
Section 322(a)(2)(A) of the (Parent
physical presence); or
[]
INA
Section 322(a)(2)(B) of the (Grandparent
physical presence).
[deleted]
5.
The applicant is a child of a member of the Armed Forces who is
authorized pursuant to the member’s official orders to
accompany and reside abroad with the member. []yes []no
[deleted]
|