Immigration Intake Form

Personal Details

Select Forms

Case Details

Form Details & Verification

Personal Details

Tell us who needs help and how to reach you. This creates your intake record and helps us match you with the right U.S.-licensed attorney.

Full Name

Email Address

Phone Number

State Where You Need Legal Help

County / City

Preferred Contact Method

Best Time to Reach You

Password

Select USCIS Forms

Choose the immigration forms you want help preparing first. The next steps will collect your case details and the supporting information attorneys usually need for these filings.

Important

Important Legal Notice

Justice Immigration SaaS is a technology platform and is not a law firm.

We do not provide legal advice, legal opinions, legal representation, or attorney services.

Use of this platform does not create an attorney-client relationship.

Immigration decisions, eligibility determinations, and legal strategy should be discussed with a licensed immigration attorney.

Fees

Pricing Notice

Software service fees are separate from all government filing fees.

Your purchase includes access to our technology platform and AI-assisted document preparation tools. It does not include:

USCIS filing fees
Government fees
Attorney fees
Legal consultation fees
Translation fees
Mailing or courier fees

Select one form to start with. If you are not fully sure yet, choose the most likely form and add the uncertainty in your notes during the final step.

Immigration Matter Details

These questions follow common USCIS and removal-defense intake patterns: current status, immigration objective, filings, deadlines, and whether there is any hearing, detention, or urgent relief issue.

Important

Important Legal Notice

Justice Immigration SaaS is a technology platform and is not a law firm.

We do not provide legal advice, legal opinions, legal representation, or attorney services.

Use of this platform does not create an attorney-client relationship.

Immigration decisions, eligibility determinations, and legal strategy should be discussed with a licensed immigration attorney.

Fees

Pricing Notice

Software service fees are separate from all government filing fees.

Your purchase includes access to our technology platform and AI-assisted document preparation tools. It does not include:

USCIS filing fees
Government fees
Attorney fees
Legal consultation fees
Translation fees
Mailing or courier fees

Legal First Name

Legal Last Name

Middle Name

Date of Birth

Gender

Marital Status

Immigration Matter Type

Current U.S. Immigration Status

Country of Citizenship

Currently in the United States?

City of Birth

Country of Birth

Mailing Street Address

Apartment / Suite / Floor

ZIP Code

Country of Mailing Address

I-539 Mailing Address Same as Physical?

A-Number / USCIS Number

Passport / I-94 Expiration or Key Date

Passport Number

Passport Issuing Country

Most Recent I-94 Number

Current Nonimmigrant Status Code

Last Arrival Date to the U.S.

Last Arrival City / Port

Last Arrival State

Any Prior USCIS or Consular Filing?

Any USCIS Interview, Biometrics, or Hearing Scheduled?

Detained or in Removal Proceedings?

Primary Language

For Family-Based Cases: Are You the Petitioner or Beneficiary?

Family Relationship

Petitioner / Sponsor Full Name

Petitioner Date of Birth

Petitioner Country of Birth

Petitioner Status

Petitioner Street Address

Petitioner Unit Type

Petitioner Unit Number

Petitioner Legacy Unit Text

Petitioner City

Petitioner Country

Petitioner State

Petitioner ZIP Code

What Immigration Goal Are You Trying to Achieve?

USCIS Online Account Number

Main USCIS Receipt Number

Family Petition

I-130 Relationship to Beneficiary

I-130 Child / Parent Relationship Detail

I-130 Sibling Relationship by Adoption?

I-130 Petitioner Gained Status Through Adoption?

I-130 Petitioner Status Basis

I-130 Petitioner SSN

I-130 Petitioner Middle Name

Part 2. Petitioner Other Names Used

I-130 Petitioner Other Names Summary

I-130 Petitioner Other Names Family Name

I-130 Petitioner Other Names Given Name

I-130 Petitioner Other Names Middle Name

I-130 Petitioner A-Number

I-130 Petitioner USCIS Online Account Number

I-130 Petitioner Gender

I-130 Petitioner Current Marital Status

I-130 Petitioner City/Town/Village of Birth

I-130 Petitioner Number of Marriages

I-130 Mailing Address Same as Physical?

I-130 Date of Current Marriage

I-130 Place of Current Marriage Summary

I-130 Current Marriage City/Town

I-130 Current Marriage State

I-130 Current Marriage Province

I-130 Current Marriage Country

Petitioner Spouse History

I-130 Spouse 1 Family Name

I-130 Spouse 1 Given Name

I-130 Spouse 1 Middle Name

I-130 Spouse 1 Marriage End Date

I-130 Spouse 2 Family Name

I-130 Spouse 2 Given Name

I-130 Spouse 2 Middle Name

I-130 Spouse 2 Marriage End Date

I-130 Certificate Number

I-130 Certificate Issuance Place

I-130 Certificate Issuance Date

I-130 LPR Class of Admission

I-130 LPR Admission Date

I-130 LPR Place of Admission

I-130 LPR Place of Admission State

I-130 LPR Status Obtained Through Marriage?

I-130 Mailing In Care Of Name

I-130 Petitioner Mailing Street Address

I-130 Petitioner Mailing Apartment / Suite / Floor

I-130 Petitioner Mailing City

I-130 Petitioner Mailing State

I-130 Petitioner Mailing ZIP Code

I-130 Petitioner Mailing Postal Code

I-130 Petitioner Mailing Province

I-130 Petitioner Mailing Country

I-130 Petitioner Physical Address 1

I-130 Petitioner Physical Address 1 Unit

I-130 Petitioner Physical Address 1 City

I-130 Petitioner Physical Address 1 State

I-130 Petitioner Physical Address 1 ZIP Code

I-130 Petitioner Physical Address 1 Postal Code

I-130 Petitioner Physical Address 1 Province

I-130 Petitioner Physical Address 1 Country

I-130 Petitioner Physical Address 1 From Date

I-130 Petitioner Physical Address 1 To Date

I-130 Petitioner Physical Address 2

I-130 Petitioner Physical Address 2 Unit

I-130 Petitioner Physical Address 2 City

I-130 Petitioner Physical Address 2 State

I-130 Petitioner Physical Address 2 ZIP Code

I-130 Petitioner Physical Address 2 Postal Code

I-130 Petitioner Physical Address 2 Province

I-130 Petitioner Physical Address 2 Country

I-130 Petitioner Physical Address 2 From Date

I-130 Petitioner Physical Address 2 To Date

Petitioner Parents

I-130 Petitioner Parent 1 Full Name

I-130 Petitioner Parent 1 Middle Name

I-130 Petitioner Parent 1 Date of Birth

I-130 Petitioner Parent 1 Sex

I-130 Petitioner Parent 1 City of Birth

I-130 Petitioner Parent 1 State / Province of Birth

I-130 Petitioner Parent 1 Country of Birth

I-130 Petitioner Parent 1 Country of Residence

I-130 Petitioner Parent 1 City / Town of Residence

I-130 Petitioner Parent 2 Full Name

I-130 Petitioner Parent 2 Middle Name

I-130 Petitioner Parent 2 Date of Birth

I-130 Petitioner Parent 2 Sex

I-130 Petitioner Parent 2 City of Birth

I-130 Petitioner Parent 2 State / Province of Birth

I-130 Petitioner Parent 2 Country of Birth

I-130 Petitioner Parent 2 Country of Residence

I-130 Petitioner Parent 2 City / Town of Residence

Petitioner Employment History

I-130 Employer 1 Name

I-130 Employer 1 Occupation

I-130 Employer 1 Street

I-130 Employer 1 Unit

I-130 Employer 1 City

I-130 Employer 1 State

I-130 Employer 1 ZIP Code

I-130 Employer 1 Postal Code

I-130 Employer 1 Country

I-130 Employer 1 Province

I-130 Employer 1 Start Date

I-130 Employer 1 End Date

I-130 Employer 2 Name

I-130 Employer 2 Occupation

I-130 Employer 2 Street

I-130 Employer 2 Unit

I-130 Employer 2 City

I-130 Employer 2 State

I-130 Employer 2 ZIP Code

I-130 Employer 2 Postal Code

I-130 Employer 2 Country

I-130 Employer 2 Province

I-130 Employer 2 Start Date

I-130 Employer 2 End Date

Petitioner Biographic Information

I-130 Petitioner Ethnicity

I-130 Petitioner Eye Color

I-130 Petitioner Height Feet

I-130 Petitioner Height Inches

I-130 Petitioner Weight (lbs)

I-130 Petitioner Hair Color

I-130 Petitioner Race

White Asian Black or African American American Indian or Alaska Native Native Hawaiian or Other Pacific Islander

Beneficiary Information

I-130 Beneficiary Full Name

I-130 Beneficiary Other Names Used

I-130 Beneficiary Middle Name

I-130 Beneficiary Other Names Middle Name

I-130 Beneficiary A-Number

I-130 Beneficiary USCIS Online Account Number

I-130 Beneficiary SSN

I-130 Beneficiary Gender

I-130 Beneficiary Date of Birth

I-130 Beneficiary City of Birth

I-130 Beneficiary Country of Birth

I-130 Beneficiary Country of Citizenship

I-130 Has Anyone Else Filed for This Beneficiary?

I-130 Beneficiary Physical Street Address

I-130 Beneficiary Physical Apartment / Suite / Floor

I-130 Beneficiary Physical City

I-130 Beneficiary Physical State

I-130 Beneficiary Physical ZIP Code

I-130 Beneficiary Physical Province

I-130 Beneficiary Physical Postal Code

I-130 Beneficiary Physical Country

I-130 Intended U.S. Address

I-130 Intended U.S. Address Unit

I-130 Intended U.S. City

I-130 Intended U.S. State

I-130 Intended U.S. ZIP Code

I-130 Beneficiary Daytime Phone

I-130 Beneficiary Mobile Phone

I-130 Beneficiary Email Address

I-130 Beneficiary Marital Status

I-130 Beneficiary Number of Marriages

I-130 Beneficiary Current Spouse Full Name

I-130 Beneficiary Prior Spouse Full Name

I-130 Beneficiary Current Spouse Middle Name

I-130 Beneficiary Prior Spouse Middle Name

I-130 Beneficiary Current Marriage Date

I-130 Beneficiary Prior Marriage End Date

I-130 Place of Beneficiary's Current Marriage Summary

I-130 Beneficiary Currently in the U.S.?

I-130 Beneficiary Current Marriage City/Town

I-130 Beneficiary Current Marriage State

I-130 Beneficiary Current Marriage Province

I-130 Beneficiary Current Marriage Country

I-130 Class of Admission

I-130 I-94 Number

I-130 Date of Arrival

I-130 Authorized Stay Expiration

I-130 Passport Number

I-130 Travel Document Number

I-130 Passport / Travel Document Country of Issuance

I-130 Passport / Travel Document Expiration

I-130 Current Employer or Company

I-130 Employer Street Address

I-130 Employer Unit

I-130 Employer City

I-130 Employer State

I-130 Employer ZIP Code

I-130 Employer Province

I-130 Employer Postal Code

I-130 Employer Country

I-130 Employment Start Date

I-130 In Removal Proceedings?

I-130 Removal Proceeding Type

I-130 Hearing Location

I-130 Hearing Location State

I-130 Hearing Date

I-130 Last Foreign Residence Street Address

I-130 Last Foreign Residence Unit

I-130 Last Foreign Residence City

I-130 Last Foreign Residence Province

I-130 Last Foreign Residence Country

I-130 Last Foreign Residence Postal Code

I-130 Last Foreign Residence From Date

I-130 Last Foreign Residence To Date

Beneficiary Part 4 Continued

I-130 Beneficiary Native Written Family Name

I-130 Beneficiary Native Written Given Name

I-130 Beneficiary Native Written Middle Name

I-130 Beneficiary Foreign Address Street

I-130 Beneficiary Foreign Address Unit

I-130 Beneficiary Foreign City

I-130 Beneficiary Foreign Province

I-130 Beneficiary Foreign Postal Code

I-130 Beneficiary Foreign Country

I-130 Last Address Lived Together Street

I-130 Last Address Lived Together Unit

I-130 Last Address Lived Together City

I-130 Last Address Lived Together State

I-130 Last Address Lived Together ZIP Code

I-130 Last Address Lived Together Postal Code

I-130 Last Address Lived Together Province

I-130 Last Address Lived Together Country

I-130 Last Address Lived Together From Date

I-130 Last Address Lived Together To Date

I-130 USCIS Office City

I-130 USCIS Office State

I-130 Immigrant Visa Consulate City

I-130 Immigrant Visa Consulate Province

I-130 Immigrant Visa Consulate Country

Beneficiary Family Members

I-130 Beneficiary Family Member 1

I-130 Family Member 1 Relationship

I-130 Family Member 1 Middle Name

I-130 Family Member 1 Date of Birth

I-130 Family Member 1 Country of Birth

I-130 Beneficiary Family Member 2

I-130 Family Member 2 Relationship

I-130 Family Member 2 Middle Name

I-130 Family Member 2 Date of Birth

I-130 Family Member 2 Country of Birth

I-130 Beneficiary Family Member 3

I-130 Family Member 3 Relationship

I-130 Family Member 3 Middle Name

I-130 Family Member 3 Date of Birth

I-130 Family Member 3 Country of Birth

I-130 Beneficiary Family Member 4

I-130 Family Member 4 Relationship

I-130 Family Member 4 Middle Name

I-130 Family Member 4 Date of Birth

I-130 Family Member 4 Country of Birth

I-130 Beneficiary Family Member 5

I-130 Family Member 5 Relationship

I-130 Family Member 5 Middle Name

I-130 Family Member 5 Date of Birth

I-130 Family Member 5 Country of Birth

Prior Petition Filing

I-130 Prior Petition Filed Before?

I-130 Prior Petition Beneficiary Name

I-130 Prior Petition Filing Location

I-130 Prior Petition Filing State

I-130 Prior Petition Beneficiary Middle Name

I-130 Prior Petition Filing Date

I-130 Prior Petition Result

Other Relatives on Separate Petitions

I-130 Relative 1 Family Name

I-130 Relative 1 Given Name

I-130 Relative 1 Middle Name

I-130 Relative 1 Relationship

I-130 Relative 2 Family Name

I-130 Relative 2 Given Name

I-130 Relative 2 Middle Name

I-130 Relative 2 Relationship

Petitioner Contact Information

I-130 Petitioner Daytime Telephone

I-130 Petitioner Mobile Telephone

I-130 Petitioner Email Address

I-130 Petitioner Statement Type

I-130 Petitioner Statement Language

I-130 Petitioner Used a Preparer?

I-130 Petitioner Preparer Name for Statement

I-130 Petitioner Signature Date

Part 7. Interpreter

I-130 Interpreter Family Name

I-130 Interpreter Given Name

I-130 Interpreter Business / Organization Name

I-130 Interpreter Street Address

I-130 Interpreter Apartment / Suite / Floor

I-130 Interpreter City

I-130 Interpreter State

I-130 Interpreter ZIP Code

I-130 Interpreter Province

I-130 Interpreter Country

I-130 Interpreter Postal Code

I-130 Interpreter Daytime Telephone

I-130 Interpreter Mobile Telephone

I-130 Interpreter Email Address

I-130 Interpreter Language

I-130 Interpreter Signature

I-130 Interpreter Signature Date

Part 8. Preparer

I-130 Preparer Family Name

I-130 Preparer Given Name

I-130 Preparer Business / Organization Name

I-130 Preparer Street Address

I-130 Preparer Apartment / Suite / Floor

I-130 Preparer City

I-130 Preparer State

I-130 Preparer ZIP Code

I-130 Preparer Province

I-130 Preparer Country

I-130 Preparer Postal Code

I-130 Preparer Daytime Telephone

I-130 Preparer Mobile Telephone

I-130 Preparer Email Address

I-130 Preparer Statement

I-130 Preparer Representation Scope

I-130 Preparer Signature

I-130 Preparer Signature Date

I-130 Additional Information

I-130 Additional Info 1 Page Number

I-130 Additional Info 1 Part Number

I-130 Additional Info 1 Item Number

I-130 Additional Info 1

I-130 Additional Info 2 Page Number

I-130 Additional Info 2 Part Number

I-130 Additional Info 2 Item Number

I-130 Additional Info 2

I-130 Additional Info 3 Page Number

I-130 Additional Info 3 Part Number

I-130 Additional Info 3 Item Number

I-130 Additional Info 3

I-130 Additional Info 4 Page Number

I-130 Additional Info 4 Part Number

I-130 Additional Info 4 Item Number

I-130 Additional Info 4

I-130 Additional Info 5 Page Number

I-130 Additional Info 5 Part Number

I-130 Additional Info 5 Item Number

I-130 Additional Info 5

Spouse Supplement

I-130A Beneficiary Full Name

I-130A USCIS Online Account Number

I-130A Beneficiary Social Security Number

I-130A Legacy Other Names

I-130A Legacy Place of Birth

I-130A Legacy Last Joint Address

I-130A Legacy Cohabitation Start Date

I-130A Beneficiary Family Name

I-130A Beneficiary Given Name

I-130A Beneficiary Middle Name

Physical Address 1

I-130A Physical Address 1 Street

I-130A Physical Address 1 Apartment / Suite / Floor

I-130A Physical Address 1 City

I-130A Physical Address 1 State

I-130A Physical Address 1 ZIP Code

I-130A Physical Address 1 Country

I-130A Physical Address 1 Province

I-130A Physical Address 1 Postal Code

I-130A Physical Address 1 Date From

I-130A Physical Address 1 Date To

Physical Address 2

I-130A Physical Address 2 Street

I-130A Physical Address 2 Apartment / Suite / Floor

I-130A Physical Address 2 City

I-130A Physical Address 2 State

I-130A Physical Address 2 ZIP Code

I-130A Physical Address 2 Country

I-130A Physical Address 2 Province

I-130A Physical Address 2 Postal Code

I-130A Physical Address 2 Date From

I-130A Physical Address 2 Date To

Last Address Outside the U.S.

I-130A Last Foreign Address Street

I-130A Last Foreign Address Apartment / Suite / Floor

I-130A Last Foreign Address City

I-130A Last Foreign Address Province

I-130A Last Foreign Address Postal Code

I-130A Last Foreign Address Country

I-130A Last Foreign Address Date From

I-130A Last Foreign Address Date To

I-130A Legacy Outside U.S. Address

Parent 1

I-130A Parent 1 Family Name

I-130A Parent 1 Given Name

I-130A Parent 1 Middle Name

I-130A Parent 1 Date of Birth

I-130A Parent 1 Sex

I-130A Parent 1 City of Birth

I-130A Parent 1 Country of Birth

I-130A Parent 1 City of Residence

I-130A Parent 1 Country of Residence

Parent 2

I-130A Parent 2 Family Name

I-130A Parent 2 Given Name

I-130A Parent 2 Middle Name

I-130A Parent 2 Date of Birth

I-130A Parent 2 Sex

I-130A Parent 2 City of Birth

I-130A Parent 2 Country of Birth

I-130A Parent 2 City of Residence

I-130A Parent 2 Country of Residence

Employment History

I-130A Employer 1 Name

I-130A Employer 1 Occupation

I-130A Employer 1 Street

I-130A Employer 1 Apartment / Suite / Floor

I-130A Employer 1 City

I-130A Employer 1 State

I-130A Employer 1 ZIP Code

I-130A Employer 1 Country

I-130A Employer 1 Province

I-130A Employer 1 Postal Code

I-130A Employer 1 Date From

I-130A Employer 1 Date To

I-130A Legacy Current Employer

I-130A Legacy Current Employer Address

I-130A Employer 2 Name

I-130A Employer 2 Occupation

I-130A Employer 2 Street

I-130A Employer 2 Apartment / Suite / Floor

I-130A Employer 2 City

I-130A Employer 2 State

I-130A Employer 2 ZIP Code

I-130A Employer 2 Country

I-130A Employer 2 Province

I-130A Employer 2 Postal Code

I-130A Employer 2 Date From

I-130A Employer 2 Date To

Employment Outside the United States

I-130A Employer Outside U.S. Name

I-130A Employer Outside U.S. Occupation

I-130A Employer Outside U.S. Street

I-130A Employer Outside U.S. Apartment / Suite / Floor

I-130A Employer Outside U.S. City

I-130A Employer Outside U.S. State

I-130A Employer Outside U.S. ZIP Code

I-130A Employer Outside U.S. Country

I-130A Employer Outside U.S. Province

I-130A Employer Outside U.S. Postal Code

I-130A Employer Outside U.S. Date From

I-130A Employer Outside U.S. Date To

Spouse Beneficiary Statement and Contact

I-130A Statement Selection

1.a. I can read and understand English. Use this when the spouse beneficiary personally reads the form in English. 1.b. An interpreter read every question and instruction to me. Use this when someone translated or read the form in another language.

I-130A Statement Language

I-130A Preparer Used?

I-130A Preparer Name for Statement

I-130A Daytime Phone

I-130A Mobile Phone

I-130A Email

I-130A Signature Date

I-130A Signature

Interpreter Information

I-130A Interpreter Family Name

I-130A Interpreter Given Name

I-130A Interpreter Business / Organization

I-130A Interpreter Street

I-130A Interpreter Apartment / Suite / Floor

I-130A Interpreter City

I-130A Interpreter State

I-130A Interpreter ZIP Code

I-130A Interpreter Country

I-130A Interpreter Province

I-130A Interpreter Postal Code

I-130A Interpreter Daytime Phone

I-130A Interpreter Mobile Phone

I-130A Interpreter Email

I-130A Interpreter Language

I-130A Interpreter Signature

I-130A Interpreter Signature Date

Preparer Information

I-130A Preparer Family Name

I-130A Preparer Given Name

I-130A Preparer Business / Organization

I-130A Preparer Street

I-130A Preparer Apartment / Suite / Floor

I-130A Preparer City

I-130A Preparer State

I-130A Preparer ZIP Code

I-130A Preparer Country

I-130A Preparer Province

I-130A Preparer Postal Code

I-130A Preparer Daytime Phone

I-130A Preparer Mobile Phone

I-130A Preparer Email

I-130A Preparer Statement

I-130A Representation Scope

I-130A Preparer Signature Date

I-130A Preparer Signature

Additional Information

I-130A Additional Info 1 Page Number

I-130A Additional Info 1 Part Number

I-130A Additional Info 1 Item Number

I-130A Additional Info 1

I-130A Additional Info 2 Page Number

I-130A Additional Info 2 Part Number

I-130A Additional Info 2 Item Number

I-130A Additional Info 2

I-130A Additional Info 3 Page Number

I-130A Additional Info 3 Part Number

I-130A Additional Info 3 Item Number

I-130A Additional Info 3

I-130A Additional Info 4 Page Number

I-130A Additional Info 4 Part Number

I-130A Additional Info 4 Item Number

I-130A Additional Info 4

I-130A Additional Info 5 Page Number

I-130A Additional Info 5 Part Number

I-130A Additional Info 5 Item Number

I-130A Additional Info 5

Change / Extension of Status

I-539 Requested Action

I-539 Current Status

I-539 Requested New Status

I-539 Current Status Expiration

I-539 Dependents Included?

I-539 Number of Dependents

Part 3 Processing Information

Part 3, Item 1. Date you request your current or requested status be extended until

Part 3, Item 2. Based on extension or change of status already granted to your spouse, child, or parent?

Part 3, Item 3. Is this application based on a separate petition?

Related Form Type

USCIS Receipt Number

Beneficiary or Applicant First Name

Beneficiary or Applicant Last Name

Date Filed

Part 4 Additional Information

Complete these fields if you are preparing Form I-539. The questions below mirror Part 4 of the USCIS form.

Current Passport Information

Only complete this section if your current passport information is different from the passport information already provided earlier in the intake.

Current Passport Number

Country of Passport Issuance

Passport Expiration Date

Physical Address Abroad

Street Number and Name

Unit Type

Unit Number

Address Line 2

City or Town

Province

Postal Code

Country

Eligibility and Background Questions

Part 4, Item 3. Are you an applicant for an immigrant visa?

Explanation if Yes

Part 4, Item 4. Has an immigrant petition ever been filed for you?

Explanation if Yes

Part 4, Item 5. Have you ever filed Form I-485, Application to Register Permanent Residence or Adjust Status?

Explanation if Yes

Part 4, Item 6. Have you been arrested or convicted of any criminal offense since last entering the United States?

Explanation if Yes

Part 4, Item 7.a. Have you ever participated in acts involving torture or genocide?

Explanation if Yes

Part 4, Item 7.b. Have you ever been involved in killing any person?

Explanation if Yes

Part 4, Item 7.c. Have you ever intentionally and severely injured any person?

Explanation if Yes

Part 4, Item 7.d. Have you ever engaged in sexual contact or relations without consent, or when the person was unable to consent, or was being forced or threatened?

Explanation if Yes

Part 4, Item 7.e. Have you ever limited or denied a person's ability to exercise religious beliefs?

Explanation if Yes

Part 4, Item 8.a. Have you ever served in, been a member of, assisted, or participated in a military, paramilitary, police, self-defense, rebel, guerrilla, militia, insurgent, or other armed group?

Explanation if Yes

Part 4, Item 8.b. Have you ever worked, volunteered, or otherwise served in a prison, jail, prison camp, detention facility, labor camp, or any situation involving detaining persons?

Explanation if Yes

Part 4, Item 9. Have you ever been a member of, assisted, or participated in a group where any person used or threatened to use a weapon against another person?

Explanation if Yes

Part 4, Item 10. Have you ever sold, provided, or transported weapons, or assisted any person in doing so, knowing or believing the weapons would be used against another person?

Explanation if Yes

Part 4, Item 11. Have you ever received any weapons training, paramilitary training, or other military-type training?

Explanation if Yes

Part 4, Item 12. Have you ever violated the terms of the nonimmigrant status you now hold?

Explanation if Yes

Part 4, Item 13. Are you now in removal proceedings?

Explanation if Yes

Part 4, Item 14. Have you ever been employed in the United States since last admitted or granted an extension or change of status?

Explanation if Yes

Part 4, Item 14. If No, explain how you are supporting yourself in the United States

Part 4, Item 15. Have you ever held J-1 exchange visitor status or J-2 dependent status?

Explanation if Yes

Naturalization

This section mirrors the current USCIS Form N-400 (edition 01/20/25) and uses the same intake keys as the PDF mapping layer.

Part 1. Eligibility

Eligibility Basis

A-Number

Other Eligibility Explanation

Requested USCIS Interview Office

Part 2. Information About You

Current Legal Last Name

Current Legal First Name

Current Legal Middle Name

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Other Names Used 1

Last Name

First Name

Middle Name

Other Names Used 2

Last Name

First Name

Middle Name

Request Legal Name Change

Requested New Last Name

Requested New First Name

Requested New Middle Name

USCIS Online Account Number

Gender

Date of Birth

Date You Became a Lawful Permanent Resident

Country of Birth

Country of Citizenship / Nationality

Parent Was a U.S. Citizen Before Your 18th Birthday

Request Disability Exception to English / Civics Requirement

Ask SSA to Update Status / Issue Replacement Card

Social Security Number

Consent for SSA Disclosure

Part 3. Residence and Contact Information

Current Physical Address Street Number and Name

Current Physical Address Unit Type

Current Physical Address Unit Number

Current Physical Address City or Town

Current Physical Address State

Current Physical Address ZIP Code

Current Physical Address Country

Current Physical Address Province

Current Physical Address Postal Code

Current Residence Since

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Address History for the Last 5 Years 1

Street Number and Name

City

State

ZIP Code

Country

From Date

To Date

Address History for the Last 5 Years 2

Street Number and Name

City

State

ZIP Code

Country

From Date

To Date

Address History for the Last 5 Years 3

Street Number and Name

City

State

ZIP Code

Country

From Date

To Date

Current Mailing Address Same as Physical Address

Current Mailing Address Street Number and Name

Current Mailing Address Unit Type

Current Mailing Address Unit Number

Current Mailing Address City or Town

Current Mailing Address State

Current Mailing Address ZIP Code

Current Mailing Address Country

Current Mailing Address Province

Current Mailing Address Postal Code

Mailing In Care Of

Part 4. Biographic Information

Ethnicity

Race: American Indian or Alaska Native

Race: Asian

Race: Black or African American

Race: Native Hawaiian or Other Pacific Islander

Race: White

Height (Feet)

Height (Inches)

Weight (Pounds)

Eye Color

Hair Color

Part 5. Employment and School History

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Employment and School History 1

Employer or School Name

City

State

ZIP Code

Country

From Date

To Date

Occupation or Field of Study

Employment and School History 2

Employer or School Name

City

State

ZIP Code

Country

From Date

To Date

Occupation or Field of Study

Employment and School History 3

Employer or School Name

City

State

ZIP Code

Country

From Date

To Date

Current Marital Status

Current Spouse Is in U.S. Armed Forces

Number of Times You Have Been Married

Current Spouse Last Name

Current Spouse First Name

Current Spouse Middle Name

Current Spouse Date of Birth

Date Entered Current Marriage

Current Spouse Address Same as Physical Address

Current Spouse Address Street Number and Name

Current Spouse Address Unit Type

Current Spouse Address Unit Number

Current Spouse Address City or Town

Current Spouse Address State

Current Spouse Address ZIP Code

Current Spouse Address Country

Current Spouse Address Province

Current Spouse Address Postal Code

How Current Spouse Became a U.S. Citizen

Date Current Spouse Became a U.S. Citizen

Current Spouse A-Number

Number of Times Current Spouse Has Been Married

Current Spouse Employer or Company

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Prior Spouse Information 1

Prior Spouse Full Name

Marriage Start Date

Marriage End Date

How Marriage Ended

Part 8. Children

Total Number of Children

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Children Information 1

Child Name

Date of Birth

Residence

Relationship

Providing Support

Address if Child Does Not Reside With You

Children Information 2

Child Name

Date of Birth

Residence

Relationship

Providing Support

Address if Child Does Not Reside With You

Children Information 3

Child Name

Date of Birth

Residence

Relationship

Providing Support

Address if Child Does Not Reside With You

Part 9. Additional Information About You

Have you EVER. 5. A. Been a member of, involved in, or in any way associated with any Communist or totalitarian party anywhere in the world?

Have you EVER. 5. A. Been a member of, involved in, or in any way associated with any Communist or totalitarian party anywhere in the world? Explanation

Have you EVER. 5. B. Been a member of, involved in, or in any way associated with any group anywhere in the world that advocates or teaches any of the following: Opposition to all organized government; World communism; The establishment in the United States of a totalitarian dictatorship; The overthrow by force or violence or other unconstitutional means of the Government of the United States or all forms of law; The unlawful assaulting or killing of any officer or officers of the Government of the United States or of any other organized government because of their official character; The unlawful damage, injury, or destruction of property; or Sabotage?

1. Have you EVER claimed to be a U.S. citizen (in writing or any other way)?

1. Have you EVER claimed to be a U.S. citizen (in writing or any other way)? Explanation

2. Have you EVER registered to vote or voted in any Federal, state, or local election in the United States? If you lawfully voted only in a local election where aliens are eligible to vote, you may answer “No.”

3. Do you currently owe any overdue Federal, state, or local taxes in the United States?

3. Do you currently owe any overdue Federal, state, or local taxes in the United States? Explanation

4. Since you became a lawful permanent resident, have you called yourself a “non-U.S. resident” on a Federal, state, or local tax return or decided not to file a tax return because you considered yourself to be a non-U.S. resident?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. D. Intentionally and severely injuring or trying to injure any person?

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that: 6. A. Used a weapon or explosive with intent to harm another person or cause damage to property?

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that: 6. B. Engaged (participated) in kidnapping, assassination, or hijacking or sabotage of an airplane, ship, vehicle, or other mode of transportation?

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that: 6. B. Engaged (participated) in kidnapping, assassination, or hijacking or sabotage of an airplane, ship, vehicle, or other mode of transportation? Explanation

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that: 6. C. Threatened, attempted (tried), conspired (planned with others), prepared, planned, advocated for, or incited (encouraged) others to commit any of the acts listed in Item Numbers 6.a. or 6.b.?

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that: 6. C. Threatened, attempted (tried), conspired (planned with others), prepared, planned, advocated for, or incited (encouraged) others to commit any of the acts listed in Item Numbers 6.a. or 6.b.? Explanation

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 10. A. Were you EVER a part of any group, or did you EVER help any group, unit, or organization that used a weapon against any person, or threatened to do so?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 10. B. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped this group, did you ever use a weapon against another person?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 10. C. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped this group, did you ever threaten another person that you would use a weapon against that person?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 11. Have you EVER sold, provided, or transported weapons, or assisted any person in selling, providing, or transporting weapons, which you knew or believed would be used against another person?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 12. Have you EVER received any weapons training, paramilitary training, or other military-type training?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 13. Have you EVER recruited (asked), enlisted (signed up), conscripted (required to join), or used any person under 15 years of age to serve in or help an armed group, or attempted or worked with others to do so?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 14. Have you EVER used any person under 15 years of age to take part in hostilities or attempted or worked with others to do so? This could include participating in combat or providing services related to combat (such as serving as a messenger or transporting supplies).

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. B. Genocide?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. B. Genocide? Explanation

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. C. Killing or trying to kill any person?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. C. Killing or trying to kill any person? Explanation

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. E. Any kind of sexual contact or activity with any person who did not consent (did not agree) or was unable to consent (could not agree), or was being forced or threatened by you or by someone else?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. G. Causing harm or suffering to any person because of his or her race, religion, national origin, membership in a particular social group, or political opinion?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. A. Torture?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 7. A. Torture? Explanation

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 8. A. Have you EVER served in, been a member of, assisted (helped), or participated in any armed group (a group that carries weapons), for example: a military unit, paramilitary unit (a group of people who act like a military group but are not part of the official military), police unit, self-defense unit, vigilante unit, rebel group, or guerrilla group?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 8. B. Have you EVER served in, been a member of, assisted (helped), or participated in any armed group (a group that carries weapons), for example: a military unit, paramilitary unit (a group of people who act like a military group but are not part of the official military), police unit, self-defense unit, vigilante unit, rebel group, or guerrilla group?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 9. Have you EVER worked, volunteered, or otherwise served in a place where people were detained (forced to stay), for example, a prison, jail, prison camp (a camp where prisoners of war or political prisoners are kept), detention facility, or labor camp, or have you EVER directed or participated in any other activity that involved detaining people?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:16. If you received a suspended sentence, were placed on probation, or were paroled, have you completed your suspended sentence, probation, or parole?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 15. A. Have you EVER committed, agreed to commit, asked someone else to commit, helped commit, or tried to commit a crime or offense for which you were NOT arrested?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 15. B. Have you EVER been arrested, cited, detained or confined by any law enforcement officer, military official (in the U.S. or elsewhere), or immigration official for any reason, or been charged with a crime or offense, or notified that you were being investigated for a crime?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 17. A. Engaged in prostitution, attempted to procure or import prostitutes or persons for the purpose of prostitution, or received any proceeds or money from prostitution?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 17. B. Manufactured, cultivated, produced, distributed, dispensed, sold, or smuggled (trafficked) any controlled substances, illegal drugs, narcotics, or drug paraphernalia in violation of any law or regulation of a U.S. state, the United States, or a foreign country?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 17. B. Manufactured, cultivated, produced, distributed, dispensed, sold, or smuggled (trafficked) any controlled substances, illegal drugs, narcotics, or drug paraphernalia in violation of any law or regulation of a U.S. state, the United States, or a foreign country? Explanation

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 17. G. Failed to support your dependents (pay child support) or to pay alimony (court-ordered financial support after divorce or separation)?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 17. G. Failed to support your dependents (pay child support) or to pay alimony (court-ordered financial support after divorce or separation)? Explanation

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 18. Have you EVER given any U.S. Government officials any information or documentation that was false, fraudulent, or misleading?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 18. Have you EVER given any U.S. Government officials any information or documentation that was false, fraudulent, or misleading? Explanation

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 19. Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: 19. Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States? Explanation

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 20. Have you EVER been placed in removal, rescission, or deportation proceedings?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 20. Have you EVER been placed in removal, rescission, or deportation proceedings? Explanation

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 21. Have you EVER been removed or deported from the United States?

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14. Additional Information. Submit evidence to support your answers. Have you EVER: If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 21. Have you EVER been removed or deported from the United States? Explanation

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 22. A. Are you a male who lived in the United States, except as a lawful nonimmigrant, at any time between your 18th and 26th birthdays? Explanation

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 26. B. If you answered “Yes” to Item Number 26.a., are you scheduled to deploy outside the United States, including to a vessel, within the next 3 months? (Call the Military Help Line at 877-247-4645 if you transfer to a new duty station after you file your Form N-400, including if you are deployed outside the United States or to a vessel.)

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 26. B. If you answered “Yes” to Item Number 26.a., are you scheduled to deploy outside the United States, including to a vessel, within the next 3 months? (Call the Military Help Line at 877-247-4645 if you transfer to a new duty station after you file your Form N-400, including if you are deployed outside the United States or to a vessel.) Explanation

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 27. Have you EVER been court-martialed or have you received a discharge characterized as other than honorable, bad conduct, or dishonorable, while in the U.S. armed forces?

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 27. Have you EVER been court-martialed or have you received a discharge characterized as other than honorable, bad conduct, or dishonorable, while in the U.S. armed forces? Explanation

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 30. B. If you answered “Yes,” to Item Number 30.a., are you willing to give up any inherited titles or orders of nobility that you have in a foreign country at your naturalization ceremony?

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 30. B. If you answered “Yes,” to Item Number 30.a., are you willing to give up any inherited titles or orders of nobility that you have in a foreign country at your naturalization ceremony? Explanation

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 33. Are you unable to take the Oath of Allegiance because of a physical or developmental disability or mental impairment? If you answer “Yes,” skip Item Numbers 34. - 37. and see the Legal Guardian, Surrogate, or Designated Representative section in the Instructions.

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional Information and provide any evidence to support your answers. 33. Are you unable to take the Oath of Allegiance because of a physical or developmental disability or mental impairment? If you answer “Yes,” skip Item Numbers 34. - 37. and see the Legal Guardian, Surrogate, or Designated Representative section in the Instructions. Explanation

Part 10. Request for a Fee Reduction

Household income is less than or equal to 400% of the Federal Poverty Guidelines

Total household income

My household size is

Total number of household members earning income including yourself

I am the head of household

Name of head of household (if you selected No)

Part 11. Applicant Contact and Signature

Daytime Telephone Number

Mobile Telephone Number

Email Address

Applicant Signature

Signature Date

Part 12. Interpreter

Interpreter Last Name

Interpreter First Name

Interpreter Business / Organization

Interpreter Daytime Telephone

Interpreter Mobile Telephone

Interpreter Email

Language Interpreted

Interpreter Signature

Interpreter Signature Date

Part 13. Preparer and Attorney / G-28

Preparer Last Name

Preparer First Name

Preparer Business / Organization

Preparer Daytime Telephone

Preparer Mobile Telephone

Preparer Email

Preparer Signature

Preparer Signature Date

G-28 Attached

Part 14. Additional Information / Overflow

Capture the rows printed on the official N-400. Extra rows will flow into Additional Information.

Additional Information Entries 1

Page Number

Part Number

Item Number

Explanation / Value

Work Permit

Part 2

Family Name, Last Name

Given Name, First Name

Middle Name

Family Name, Last Name

Given Name, First Name

Middle Name

Given Name, First Name

Family Name, Last Name

Given Name, First Name

Middle Name

, provide your physical address below

Is your current mailing address the same as your physical address? Select Yes

Suite

Designated Floor

Apartment, Suite or Floor number

Apartment

city or town

State from list of States

ZIP Code

Street Number and Name

the Country

9 digit number

Suite

Designated Floor

Apartment, Suite or Floor Number

Apartment

City or Town

state from list of states

Zip Code

Street Number and Name

In Care of Name, if any

9 digit number

12 characaters

Female

Male

Widowed

Divorced

Single

Married

Have you previously filed Form I - 7 65? Select No

Have you previously filed Form I - 7 65? Select Yes

your Travel Document Number

the 2-digit Month, 2-digit Day and 4-digit Year

the 2-digit month, 2 digit-Day and 4-digit Year

Country That Issued Your Passport or Travel Document

Passport Number of Your Most Recently Issued Passport

Immigration Status at Your Last Arrival

Your Current Immigration Status or Category

Student and Exchange Visitor Information System number

your Employer's Name as Listed in E Verify

your Employer's E Verify Company Identification Number or a valid E Verify Client Company Identification Number

, refer to Special Filing Instructions for Those With Pending Asylum Applications in the Required Documentation section of the Form I - 7 65 Instructions for information about providing court dispositions

, have you EVER been arrested for and/or convicted of any crime? Select No

13 Characters

Degree,

11 digit number

the 2- digit Month, 2-digit Day and 4-digit Year

Country of your Birth

City / Town / Village of Birth

State / Province of Birth

first four characters

middle three characters

Last three characters

, in the Who May File Form I - 7 65 section of the Form I - 7 65 Instructions for information about providing court dispositions

, have you EVER been arrested for and/or convicted of any crime? Select No

Place of Last Arrival into the United States

Part 1

Initial Permission to accept employment

Replacement of lost, stolen, or damaged employment authorization document, or correction of my employment authorization document NOT DUE to U

Renewal of my permission to accept employment

Other

this box if Form G-28 is attached

Attorney State Bar Number

12 characters

Part 3

The interpreter named in Part 4

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

the language in which you are fluent

At my request, the preparer named in Part 5

name of Preparer from Part 5

the 2-digit Month, 2-digit Day and 4-digit Year

The name of the applicant can not be typewritten into this space

Applicant's Daytime Telephone Number

Applicant's Mobile Telephone Number,

Applicant's Email Address,

this box if you are a Salvadoran or Guatemalan national eligible for benefits under the

Part 4

Interpreter's Business or Organization Name

Interpreter's Given Name

Interpreter's Family Name

Interpreter's Daytime Telephone Number

Interpreter's Email Address

Interpreter's Mobile Telephone Number,

language) which is the same language specified in Part 3

City or Town

Street Number and Name

Floor

Apartment

the Apartment, Suite or Floor number

Suite

the Postal Code

ZIP Code

state from list of states

the Country

the Province

the 2-digit Month, 2-digit Day and 4-digit Year

The name of the applicant can not be typewritten into this space

Part 5

Preparer's Given Name

Preparer's Business or Organization Name, if any

Preparer's Family Name

the City or Town

Street Number and Name

Floor

Apartment

Apartment, Suite or Floor number

Suite

the Postal Code

the ZIP code

state from list of states

the Country

the Province

Preparer's Mobile Telephone Number

Preparer's Daytime Telephone Number

Preparer's Email Address,

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent

I am an attorney or accredited representative and my representation of the applicant in this case extends or does not extend beyond the preparation of this application

I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application

I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application

Print and sign in ink

the 2-digit Month, 2-digit Day and 4-digit Year

Part 6

Page Number

Part Number

Item Number

Page Number

Part Number

Item Number

additional information

Page Number

Part Number

Item Number

additional information

Page Number

Part Number

Item Number

additional information

Page Number

Part Number

Item Number

additional information

A Family Name

B Given Name

C Middle Name

Alien Number

additional information

Travel Document

I-131 Travel Document Type

I-131 Related Receipt Number

I-131 Refugee Travel Document Basis

I-131 Advance Parole Basis

I-131 Class of Admission / Parole Basis

I-131 FRTF Registration Number

I-131 Request EAD for Re-parole?

I-131 Other Program / Process Explanation

I-131 Travel Purpose

I-131 Intended Departure Date

I-131 Expected Length of Trip (days)

I-131 Countries to Visit

I-131 Number of Trips

I-131 Physical Address Different from Mailing?

I-131 Physical Address In Care Of

I-131 Physical Street

I-131 Physical Unit Type

I-131 Physical Unit Number

I-131 Physical City

I-131 Physical State

I-131 Physical ZIP

I-131 Physical Country

I-131 Physical Province

I-131 Physical Postal Code

Other Names and Biographic Information

I-131 Other Name Used 1

I-131 Other Name Used 2

I-131 Other Name Used 3

I-131 Social Security Number

I-131 Ethnicity

I-131 Height Feet

I-131 Height Inches

I-131 Weight (lbs)

I-131 Eye Color

I-131 Hair Color

I-131 Race White

I-131 Race Asian

I-131 Race Black

I-131 Race American Indian / Alaska Native

I-131 Race Native Hawaiian / Pacific Islander

Prior Documents and Processing

Prior Reentry Permit or Refugee Travel Document?

Prior Reentry / Refugee Document Issue Date

Prior Reentry / Refugee Document Disposition

Prior Advance Parole Document?

Prior Advance Parole Issue Date

Prior Advance Parole Disposition

Requesting Replacement Document?

Replacement / Other Basis Explanation

eMedical U.S. Parolee ID (USPID)

Replacement Reason

Replacement Receipt Number

Correction Needed: Name

Correction Needed: A-Number

Correction Needed: Country of Birth / Citizenship

Correction Needed: Terms and Conditions

Correction Needed: Date of Birth

Correction Needed: Sex

Correction Needed: Validity Date

Correction Needed: Photo

Replacement Correction Explanation

Applying on Behalf of Another Person

Filing For

Other Person Full Name

Other Person Date of Birth

Other Person Country of Birth

Other Person Citizenship / Nationality

Other Person A-Number

Other Person Daytime Phone

Other Person Email

Other Person Class of Admission

Other Person I-94 Number

Other Person Other Name 1

Other Person Other Name 2

Other Person Other Name 3

Other Person Mailing In Care Of

Other Person Mailing Street

Mailing Unit Type

Mailing Unit Number

Other Person Mailing City

Other Person Mailing State

Other Person Mailing ZIP

Other Person Mailing Country

Other Person Mailing Province

Part 4 Processing Information

Complete these I-131 fields when the travel document should be mailed overseas or when USCIS should send pick-up notice to an alternate address for Part 4, Items 7 through 9.

Where Should the Document Be Sent?

Overseas Delivery City

Overseas Delivery Country

Time Spent Outside U.S. as Permanent Resident

Pick-Up Notification Destination

Notification In Care Of

Notification Street

Notification Unit Type

Notification Unit Number

Notification City

Notification State

Notification ZIP

Notification Country

Notification Province

Notification Postal Code

Notification Daytime Phone

Notification Email

Advance Parole Supplemental Details

Advance Parole Explanation

Expected Length of Trip in the U.S.

Intended Arrival Date in the U.S.

Intended Arrival City / Town

Intended Arrival Country

Refugee Travel Document Details

Country of Refugee or Asylee Status

Plan to Travel to That Country?

Returned to That Country Since Refugee / Asylee Status?

Applied for Passport or Entry Permit from That Country?

Received Benefits from That Country?

Reacquired Nationality of That Country?

Acquired a New Nationality?

Granted Refugee or Asylee Status in Another Country?

Filing Before Departing the U.S.?

Currently Outside the U.S.?

Current Location Outside the U.S.

Other Countries Visited Since Leaving the U.S.

Applicant Signature

I-131 Applicant Signature

I-131 Applicant Signature Date

Interpreter Information

Used Interpreter?

I-131 Interpreter Family Name

I-131 Interpreter Given Name

I-131 Interpreter Business or Organization Name

I-131 Interpreter Language

I-131 Interpreter Daytime Telephone

I-131 Interpreter Mobile Telephone

I-131 Interpreter Email

I-131 Interpreter Signature

I-131 Interpreter Signature Date

Preparer Information

Prepared by Other Person?

I-131 Preparer Family Name

I-131 Preparer Given Name

I-131 Preparer Business or Organization Name

I-131 Preparer Email

I-131 Preparer Daytime Telephone

I-131 Preparer Mobile Telephone

I-131 Preparer Signature

I-131 Preparer Signature Date

Family Support / Green Card Maintenance

I-864 Sponsor Role

I-864 Relationship to Immigrant

I-864 Sponsor Full Name

I-864 Sponsor Date of Birth

I-864 Sponsor Citizenship Status

I-864 Sponsor Domiciled in the U.S.?

I-864 Sponsor Street Address

I-864 Sponsor City

I-864 Sponsor State

I-864 Sponsor ZIP Code

I-864 Sponsor Country

I-864 Sponsor Household Size

I-864 Sponsor Employer / Occupation

I-864 Sponsor Annual Income

I-864 Most Recent Tax Return Filed?

I-864 Most Recent Tax Year Total Income

I-864 Using Household Member Income?

I-864 Using Assets to Qualify?

I-864 Household Member / Joint Sponsor Name

I-864 Assets Value

I-864 Complete Official Field Set

All official USCIS I-864 fillable fields are shown below.

I-864 Subform 1

I-864 G28 Checkbox1 0

I-864 Attorneystatebarnumber 0

I-864 Uscisonlineacctnumber 0

I-864 P1 Line1a F Cb 0

I-864 P1 Line1a F Cb 1

I-864 P1 Line1b Relationship 0

I-864 P1 Line1a F Cb 2

I-864 P1 Line1c Interestin 0

I-864 P1 Line1c Relationship 0

I-864 P1 Line1a F Cb 3

I-864 P1 Line1a F Cb 4

I-864 P1 Line1e1 Checkbox 0

I-864 P1 Line1e1 Checkbox 1

I-864 P1 Line1a F Cb 5

I-864 P1 Line1f Relationship 0

I-864 P4 Line1a Familyname 0

I-864 P4 Line1b Givenname 0

I-864 P4 Line1c Middlename 0

I-864 Subform 2

I-864 P4 Line2a Incareof 0

I-864 P4 Line2b Streetnumbername 0

I-864 P4 Line2c Unit 0

I-864 P4 Line2c Unit 1

I-864 P4 Line2c Unit 2

I-864 P4 Line2d Aptsteflrnumber 0

I-864 P4 Line2e Cityortown 0

I-864 P4 Line2f State 0

I-864 P4 Line2g Zipcode 0

I-864 P4 Line2h Province 0

I-864 P4 Line2i Postalcode 0

I-864 P4 Line2j Country 0

I-864 P1 Line3 Checkbox 0

I-864 P1 Line3 Checkbox 1

I-864 P4 Line4a Streetnumbername 0

I-864 P4 Line4b Unit 0

I-864 P4 Line4b Unit 1

I-864 P4 Line4b Unit 2

I-864 P4 Line4c Aptsteflrnumber 0

I-864 P4 Line4d Cityortown 0

I-864 P4 Line4e State 0

I-864 P4 Line4f Zipcode 0

I-864 P4 Line4h Postalcode 0

I-864 P4 Line4g Province 0

I-864 P4 Line4i Country 0

I-864 P4 Line5 Countryofdomicile 0

I-864 P4 Line6 Dateofbirth 0

I-864 P4 Line7 Cityofbirth 0

I-864 P4 Line10 Socialsecuritynumber 0

I-864 P4 Line11a Checkbox 0

I-864 P4 Line11b Checkbox 0

I-864 P4 Line11c Checkbox 0

I-864 P4 Line12 Aliennumber 0

I-864 P4 Line13 Acctidentifier 0

I-864 P4 Line14 Checkboxes 0

I-864 P4 Line14 Checkboxes 1

I-864 Subform 3

I-864 P2 Line1a Familyname 0

I-864 P2 Line1b Givenname 0

I-864 P2 Line1c Middlename 0

I-864 P2 Line2 Incareof 0

I-864 P2 Line2 Streetnumbername 0

I-864 P2 Line2 Unit 0

I-864 P2 Line2 Unit 1

I-864 P2 Line2 Unit 2

I-864 P2 Line2 Aptsteflrnumber 0

I-864 P2 Line2 Cityortown 0

I-864 P2 Line2 State 0

I-864 P2 Line2 Zipcode 0

I-864 P2 Line2 Province 0

I-864 P2 Line2 Postalcode 0

I-864 P2 Line2 Country 0

I-864 P2 Line3 Countrycitizenship 0

I-864 P2 Line4 Dateofbirth 0

I-864 P2 Line5 Aliennumber 0

I-864 Pt2 Line6 Uscisonlineacctnumber 0

I-864 P2 Line7 Daytimephonenumber 0

I-864 P3 Line1 Checkbox 0

I-864 P3 Line1 Checkbox 1

I-864 P3 Line2 Sponsoringfamily 0

I-864 P3 Line2 Sponsoringfamily 1

I-864 P3 Line3a Familyname 0

I-864 P3 Line3b Givenname 0

I-864 P3 Line3c Middlename 0

I-864 P3 Line4 Relationship 0

I-864 P3 Line Dateofbirth 0

I-864 P2 Line5 Aliennumber 1

I-864 P3 Line7 Acctidentifier 0

I-864 Subform 4

I-864 P3 Line8a Familyname 0

I-864 P3 Line8b Givenname 0

I-864 P3 Line8c Middlename 0

I-864 P3 Line9 Relationship 0

I-864 P3 Line10 Dateofbirth 0

I-864 P3 Line11 Aliennumber 0

I-864 P3 Line12 Acctidentifier 0

I-864 P3 Line13a Familyname 0

I-864 P3 Line13b Givenname 0

I-864 P3 Line13c Middlename 0

I-864 P3 Line14 Relationship 0

I-864 P3 Line15 Dateofbirth 0

I-864 P2 Line5 Aliennumber 2

I-864 P3 Line17 Acctidentifier 0

I-864 P3 Line18a Familyname 0

I-864 P3 Line18b Givenname 0

I-864 P3 Line18c Middlename 0

I-864 P3 Line19 Relationship 0

I-864 P3 Line20 Dateofbirth 0

I-864 P3 Line21 Aliennumber 0

I-864 P3 Line22 Acctidentifier 0

I-864 Subform 5

I-864 P3 Line28 Totalnumberofimmigrants 0

I-864 P5 Line2 Yourself 0

I-864 P5 Line3 Married 0

I-864 P5 Line4 Dependentchildren 0

I-864 P5 Line5 Otherdependents 0

I-864 P5 Line6 Sponsors 0

I-864 P5 Line7 Sameresidence 0

I-864 Override 0

I-864 P6 Line1 Checkbox 0

I-864 P6 Line1a Nameofemployer 0

I-864 P6 Line1a1 Nameofemployer 0

I-864 P6 Line1a2 Nameofemployer 0

I-864 P6 Line4 Checkbox 0

I-864 P6 Line4a Selfemployedas 0

I-864 P6 Line5 Checkbox 0

I-864 P6 Line5a Dateretired 0

I-864 P6 Line6 Checkbox 0

I-864 P6 Line6a Dateofunemployment 0

I-864 P6 Line2 Totalincome 0

I-864 Subform 6

I-864 P6 Line3 Name 0

I-864 P6 Line4 Relationship 0

I-864 P6 Line5 Currentincome 0

I-864 P6 Line6 Name 0

I-864 P6 Line7 Relationship 0

I-864 P6 Line8 Currentincome 0

I-864 P6 Line9 Name 0

I-864 P6 Line10 Relationship 0

I-864 P6 Line11 Currentincome 0

I-864 P6 Line12 Name 0

I-864 P6 Line13 Relationship 0

I-864 P6 Line14 Currentincome 0

I-864 P6 Line15 Totalhouseholdincome 0

I-864 P6 Line16 Completedform 0

I-864 P6 Line17 Notneedcomplete 0

I-864 P6 Line17 Name 0

I-864 P6 Line18a Checkbox 0

I-864 P6 Line18a Checkbox 1

I-864 Subform 7

I-864 P6 Line19a Taxyear 0

I-864 P6 Line19a Totalincome 0

I-864 P6 Line19b Taxyear 0

I-864 P6 Line19b Totalincome 0

I-864 P6 Line19c Taxyear 0

I-864 P6 Line19c Totalincome 0

I-864 P6 Line17 Iwasnotreq 0

I-864 P7 Line1 Balanceofaccounts 0

I-864 P7 Line2 Realestate 0

I-864 P7 Line3 Stocksbonds 0

I-864 P7 Line4 Total 0

I-864 P7 Line5 Totalassetshouseholdmembers 0

I-864 Subform 8

I-864 P7 Line6 Balanceofaccounts 0

I-864 P7 Line7 Realestate 0

I-864 P7 Line8 Stocksbonds 0

I-864 P7 Line9 Total 0

I-864 P7 Line10 Totalvalueassets 0

I-864 Subform 10

I-864 P6 Line1 Checkbox 1

I-864 P6 Line1 Checkbox 2

I-864 P8 Line1b Language 0

I-864 P8 Line2 Checkbox 0

I-864 P8 Line2 Attorney 0

I-864 P8 Line3 Daytimetelephonenumber 0

I-864 P8 Line4 Mobiletelephonenumber 0

I-864 P7line7 Emailaddress 0

I-864 P8 Line9a Applicantsignature 0

I-864 P7line9b Dateofsignature 0

I-864 Subform 11

I-864 P9 Line1a Interpretersfamilyname 0

I-864 P9 Line1b Interpretersgivenname 0

I-864 P8line2 Interpretersbusinessname 0

I-864 P9 Line4 Interpretersdaytimephonenumber 0

I-864 P9 Line4 Interpretersdaytimephonenumber 1

I-864 P9 Line5 Interpretersemailaddress 0

I-864 P9 Language 0

I-864 P9 Line6a Interpreterssignature 0

I-864 P9 Line6b Dateofsignature 0

I-864 P10 Line1a Preparersfamilyname 0

I-864 P10 Line1b Preparersgivenname 0

I-864 P10 Line2 Preparersbusinessname 0

I-864 P10 Line4 Preparersdaytimephonenumber 0

I-864 P10 Line5 Preparersfaxnumber 0

I-864 P10 Line6 Preparersemailaddress 0

I-864 P10 Line8a Preparerssignature 0

I-864 P10 Line8b Dateofsignature 0

I-864 Subform 12

I-864 P4 Line1a Familyname 1

I-864 P4 Line1b Givenname 1

I-864 P4 Line1c Middlename 1

I-864 P4 Line12 Aliennumber 1

I-864 P11 Line3a Pagenumber 0

I-864 P11 Line3b Partnumber 0

I-864 P11 Line3c Itemnumber 0

I-864 P11 Line3d Additionalinfo 0

I-864 P11 Line4a Pagenumber 0

I-864 P11 Line4b Partnumber 0

I-864 P11 Line4c Itemnumber 0

I-864 P11 Line4d Additionalinfo 0

I-864 P11 Line5a Pagenumber 0

I-864 P11 Line5b Partnumber 0

I-864 P11 Line5c Itemnumber 0

I-864 P11 Line5d Additionalinfo 0

I-864 P11 Line6a Pagenumber 0

I-864 P11 Line6b Partnumber 0

I-864 P11 Line6c Itemnumber 0

I-864 P11 Line6d Additionalinfo 0

Green Card Replacement / Renewal

Part 1

Family Name

Given Name

Middle Name

No (Proceed to Item Numbers 6

Not Applicable - I never received my previous card

In Care Of Name

Street Number and Name

Apartment / Suite / Floor

City or Town

Postal Code

ZIP Code

State from List of States

Country

Family Name

Given Name

Middle Name

U S C I S Online Account Number, if any

Province

Alien Registration Number

Street Number and Name

City or Town

ZIP Code

Apartment / Suite / Floor

Country

Postal Code

Province

State from List of States

as 2-digit Month, 2-digit Day, and 4-digit Year

City / Town / Village of Birth

Country of Birth

P Ssn

as 2-digit Month, 2-digit Day, and 4-digit Year

Class of Admission

Given Name

Sex

Male Female

Alien Registration Number

Part 2A

My name or other biographic information has been legally changed since issuance of my existing card

My existing card has already expired or will expire within six months

reason 2

My existing card has incorrect data because of Department of Homeland Security error

My previous card has been lost, stolen, or destroyed

My previous card was issued but never received

My existing card has been mutilated

Lawful Permanent Resident

Permanent Resident - In Commuter Status

I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above

I am a commuter who is taking up actual residence in the United States

I have been automatically converted to lawful permanent resident status

I am a permanent resident who is taking up commuter status

City or Town and State

Part 2B

Conditional Permanent Resident

My previous card was issued but never received

My existing card has been mutilated

My existing card has incorrect data because of Department of Homeland Security error

My name or other biographical information has legally changed since the issuance of my existing card

My previous card has been lost, stolen, or destroyed

Part 3

Location where you applied for an immigrant visa or adjustment of status

Location where your immigrant visa was issued or U S C I S office where you were granted adjustment of status

Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States? Select No

Additional Information

Since you were granted permanent residence, have you ever filed Form I-4 07, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status? Select No

Additional Information

Height

Weight - First Digit

Weight - Second Digit

Weight - Third Digit

Not Hispanic or Latino

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

White

Asian

Black or African American

Blue

Green

Hazel

Pink

Maroon

Brown

Black

Unknown / Other

Gray

City or Town and State

Destination in the United States at time of admission

Bald

Blond

Gray

Sandy

Unknown / Other

White

Red

Brown

Black

Part 4

Are you requesting an accommodation because of a disabilities and/or impairments? Select No

Are you requesting an accommodation because of your disabilities and/or impairments? Select Yes

I am deaf or hard of hearing and request the following accommodation (if you are requesting a sign-language interpreter, indicate for which language (e

Language

I am blind or have low vision and request the following accommodation

Accommodation Requested

I have another type of disability and/or impairment

Description of Disability and/or Impairment and the Accommodations Requested

Part 5

The interpreter named in Part 6

Language

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

At my request, the preparer named in Part 7

Name of Preparer

Applicant's Email Address

Applicant's Daytime Telephone Number

Applicant's Mobile Telephone Number

as 2-digit Month, 2-digit Day, and 4-digit Year

Print and sign in ink

Part 6

Interpreter's Given Name

Interpreter's Family Name

Interpreter's Business or Organization Name

City or Town

Street Number and Name

Apartment / Suite / Floor

Province

ZIP Code

State from List of States

Country

Postal Code

Interpreter's Email Address,

Interpreter's Daytime Telephone Number

Interpreter's Mobile Telephone Number

Language

as 2-digit Month, 2-digit Day, and 4-digit Year

Print and sign in ink

Part 7

Preparer's Family Name

Preparer's Given Name

Preparer's Business or Organization Name

City or Town

Street Number and Name

Apartment, Suite, or Floor Number

Province

Zip Code

State from List of States

Country

Postal Code

Apartment

Suite

Floor

Preparer's Email Address

Preparer's Daytime Telephone Number

Preparer's Mobile Telephone Number

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent

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

I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application

I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application

Print and sign in ink

as 2-digit Month, 2-digit Day, and 4-digit Year

Part 8

Additional Information

Page Number

Part Number

Item Number

Additional Information

Page Number

Part Number

Item Number

Page Number

Part Number

Item Number

This field pre-populates from page 1

Page Number

Part Number

Item Number

Additional Information

Page Number

Part Number

Item Number

Additional Information

Remove Conditions on Residence

Attorney and Petitioner

G-28 Attached?

Attorney State Bar Number

Attorney USCIS Online Account Number

Family Name

Given Name

Middle Name

Other Name 1 Family Name

Other Name 1 Given Name

Other Name 1 Middle Name

Other Name 2 Family Name

Other Name 2 Given Name

Other Name 2 Middle Name

Date of Birth

Country of Birth

Country of Citizenship or Nationality

A-Number

USCIS Online Account Number

Social Security Number

Marital Status

Marriage Date

Marriage End Date

Conditional Residence Expires

Place of Marriage

Mailing Address

In Care Of Name

Street Number and Name

Unit Number

Unit Type

City or Town

State

ZIP Code

Province

Postal Code

Country

Physical Address and Background

Physical Address Different?

In Care Of Name

Street Number and Name

Unit Number

Unit Type

City or Town

State

ZIP Code

Province

Postal Code

Country

In Removal Proceedings?

Fee Paid to Non-Attorney?

Criminal History?

Different Marriage Than Conditional Residence Marriage?

Other Addresses Since Permanent Residence?

Spouse / Parent's Spouse Serving Overseas?

Biographic Information

Ethnicity

Height Feet

Height Inches

Weight (lbs)

Race White

Race Asian

Race Black / African American

Race American Indian / Alaska Native

Race Native Hawaiian / Pacific Islander

Eye Color

Hair Color

Basis and Spouse / Stepparent

Filing Basis

Joint filing with spouse Child filing with parent's spouse because parent cannot be included Waiver because spouse is deceased Waiver because marriage was entered in good faith but ended in divorce or annulment Waiver because petitioner was battered or subjected to extreme cruelty Waiver because conditional resident child was battered or subjected to extreme cruelty Waiver because removal would result in extreme hardship

Relationship in Part 4

Spouse / Stepparent Full Name

Spouse Family Name

Spouse Given Name

Spouse Middle Name

Spouse Date of Birth

Spouse SSN

Spouse A-Number

Spouse Address Line 1

Spouse Unit Type

Spouse Unit Number

Spouse City

Spouse State

Spouse ZIP

Spouse Country

Spouse Province

Spouse Postal Code

Children

Do you have any children?

Child 1

Child 1 Family Name

Child 1 Given Name

Child 1 Middle Name

Child 1 Date of Birth

Child 1 A-Number

Child 1 Living With You?

Child 1 Applying With You?

Child 1 Address Line 1

Child 1 Unit Type

Child 1 Unit Number

Child 1 City

Child 1 State

Child 1 ZIP

Child 1 Country

Child 1 Province

Child 1 Postal Code

Child 2

Child 2 Family Name

Child 2 Given Name

Child 2 Middle Name

Child 2 Date of Birth

Child 2 A-Number

Child 2 Living With You?

Child 2 Applying With You?

Child 2 Address Line 1

Child 2 Unit Type

Child 2 Unit Number

Child 2 City

Child 2 State

Child 2 ZIP

Child 2 Country

Child 2 Province

Child 2 Postal Code

Child 3

Child 3 Family Name

Child 3 Given Name

Child 3 Middle Name

Child 3 Date of Birth

Child 3 A-Number

Child 3 Living With You?

Child 3 Applying With You?

Child 3 Address Line 1

Child 3 Unit Type

Child 3 Unit Number

Child 3 City

Child 3 State

Child 3 ZIP

Child 3 Country

Child 3 Province

Child 3 Postal Code

Child 4

Child 4 Family Name

Child 4 Given Name

Child 4 Middle Name

Child 4 Date of Birth

Child 4 A-Number

Child 4 Living With You?

Child 4 Applying With You?

Child 4 Address Line 1

Child 4 Unit Type

Child 4 Unit Number

Child 4 City

Child 4 State

Child 4 ZIP

Child 4 Country

Child 4 Province

Child 4 Postal Code

Child 5

Child 5 Family Name

Child 5 Given Name

Child 5 Middle Name

Child 5 Date of Birth

Child 5 A-Number

Child 5 Living With You?

Child 5 Applying With You?

Child 5 Address Line 1

Child 5 Unit Type

Child 5 Unit Number

Child 5 City

Child 5 State

Child 5 ZIP

Child 5 Country

Child 5 Province

Child 5 Postal Code

Accommodations

Petitioner Accommodation Requested?

Spouse Accommodation Requested?

Children Accommodation Requested?

Deaf / Hard of Hearing?

Blind / Low Vision?

Other Disability or Impairment?

Deaf / Hard of Hearing Explanation

Blind / Low Vision Explanation

Other Disability Explanation

Petitioner Statement

Statement Language

Preparer Used?

Daytime Phone

Mobile Phone

ASC Acknowledgement Name

Signature

Signature Date

Part 8 Spouse or Part 4 Individual

Part 8 Applicable?

Part 8 Statement

Part 8 Language

Part 8 Preparer Used?

Part 8 Daytime Phone

Part 8 Mobile Phone

Part 8 Email

Part 8 ASC Acknowledgement Name

Part 8 Signature

Part 8 Signature Date

Interpreter

Interpreter Family Name

Interpreter Given Name

Interpreter Middle Name

Business / Organization

Interpreter Address Line 1

Interpreter Unit Type

Interpreter Unit Number

Interpreter City

Interpreter State

Interpreter ZIP

Interpreter Country

Interpreter Province

Interpreter Postal Code

Interpreter Daytime Phone

Interpreter Email

Interpreter Language

Interpreter Signature

Interpreter Signature Date

Preparer

Preparer Full Name

Preparer Family Name

Preparer Given Name

Preparer Middle Name

Business / Organization

Daytime Phone

Fax

Preparer Address Line 1

Preparer Unit Type

Preparer Unit Number

Preparer City

Preparer State

Preparer ZIP

Preparer Country

Preparer Province

Preparer Postal Code

Preparer Type

Preparer Signature

Preparer Signature Date

Additional Information

Additional Info 1 Page Number

Additional Info 1 Part Number

Additional Info 1 Item Number

Additional Info 1 Text

Additional Info 2 Page Number

Additional Info 2 Part Number

Additional Info 2 Item Number

Additional Info 2 Text

Additional Info 3 Page Number

Additional Info 3 Part Number

Additional Info 3 Item Number

Additional Info 3 Text

Additional Info 4 Page Number

Additional Info 4 Part Number

Additional Info 4 Item Number

Additional Info 4 Text

Additional Info 5 Page Number

Additional Info 5 Part Number

Additional Info 5 Item Number

Additional Info 5 Text

Certificate of Citizenship

Provide the core N-600 facts here. Any remaining applicant-editable official Part 1 through Part 11 fields that are not already covered in the guided sections appear below automatically.

Eligibility

N-600 Applicant Type

Relationship to U.S. Citizen Parent

A-Number

Name on Permanent Resident Card

Applicant Information

Current Legal Family Name

Current Legal Given Name

Current Legal Middle Name

Date of Birth

Country of Birth

Prior Citizenship or Nationality

Gender

SSN

USCIS Online Account Number

Height Feet

Height Inches

Current Marital Status

U.S. Armed Forces Service

Other Names Used Since Birth

Mailing Address

In Care Of Name

Street Address

Mailing Address Unit Type

Mailing Address Unit Number

City

State

ZIP Code

Postal Code

Country

Province

Physical Address

Physical Street Address

Physical Address Unit Type

Physical Address Unit Number

Physical City

Physical State

Physical ZIP Code

Physical Country

Physical Province

Physical Postal Code

Admission And Status

Port of Entry

Date of Entry

Name Used at Entry

Travel Document Type

Passport Number

Travel Document Number

Document Issuance Country

Document Issue Date

Ever Been an LPR?

Have You Ever Abandoned or Lost Your LPR Status?

Have You Previously Applied for a Certificate of Citizenship?

Have You Previously Applied for a U.S. Passport?

Do You Regularly Reside in the Legal and Physical Custody of Your U.S. Citizen Parent(s)?

Adoption And Custody

Adopted Child?

Have You Been Absent From the United States Since You First Arrived?

U.S. Citizen Parent

Parent is Applicant's

Citizenship Basis

Parent Family Name

Parent Given Name

Parent Middle Name

Parent Date of Birth

Parent Country of Birth

Parent Physical Address

Certificate or Citizenship Number

Parent A-Number

Other Parent

Other Parent Relationship

Is Other Parent a U.S. Citizen?

Other Parent Family Name

Other Parent Given Name

If your U.S. citizen mother or father is married, is his or her current spouse also your other mother or father?

Yes (Go to Part 4.) No (Answer Item Numbers 10.A. - 10.H.)

Legal Guardian

Legal Guardian Family Name

Legal Guardian Given Name

Applicant Statement And Signature

Interpreter Used?

Preparer Used?

Daytime Phone

Mobile Phone

Email Address

Applicant / Parent / Guardian Signature

Signature Date

Additional Information

Additional Info Row 1 Page Number

Additional Info Row 1 Part Number

Additional Info Row 1 Item Number

Additional Info Row 1 Text

Additional Info Row 2 Page Number

Additional Info Row 2 Part Number

Additional Info Row 2 Item Number

Additional Info Row 2 Text

Additional Info Row 3 Page Number

Additional Info Row 3 Part Number

Additional Info Row 3 Item Number

Additional Info Row 3 Text

Additional Info Row 4 Page Number

Additional Info Row 4 Part Number

Additional Info Row 4 Item Number

Additional Info Row 4 Text

Remaining Official Editable Fields

These are the remaining official applicant-editable or attorney-editable N-600 Part 1 through Part 11 fields that are not already covered above. USCIS-only and interview-only fields are excluded.

Additional Official Fields

To be completed by an Attorney or Accredited Representative, if any. Select this box if Form G- 28 is attached

To be completed by an Attorney or Accredited Representative, if any. Enter Attorney State Bar Number, if applicable.

To be completed by an Attorney or Accredited Representative, if any. Enter Attorney or Accredited Representative U S C I S Online Account Number, if any. Enter 12 digits.

Part 1

Part 1. Information About the Your Eligibility. 1. I am a

Part 1., 1. I am a

Part 1., 2. What is your relationship to your U.S. citizen parent? (Read the N-600 Instructions for more information.)

Part 1., 2. What is your relationship to your U.S. citizen parent? (Read the N-600 Instructions for more information.) If selected Other. Enter a Fully Explanation.

Part 2

Part 2., 2. Your Name Exactly As It Appears on Your Permanent Resident Card (if different from above). Enter Family Name (Last Name).

Part 2., 2. Your Name Exactly As It Appears on Your Permanent Resident Card (if different from above). Enter Given Name (First Name).

Part 2., 2. Your Name Exactly As It Appears on Your Permanent Resident Card (if different from above). Enter Middle Name.

Part 2. Information About You (Child of a U.S. Citizen) (continued). 3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Entry one. Enter Family Name (Last Name).

Part 2. (continued)., 3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Entry one. Enter Given Name (First Name).

Part 2. (continued)., 3. Other Names You Have Used Since Birth. Provide all other names you have ever used, include nicknames, maiden name, and aliases. Entry one. Enter Middle Name.

Part 2. (continued)., 3. Other Names You Have Used Since Birth. Entry two. Enter Family Name (Last Name).

Part 2. (continued)., 3. Other Names You Have Used Since Birth. Entry two. Enter Given Name (First Name).

Part 2. (continued)., 3. Other Names You Have Used Since Birth. Entry two. Enter Middle Name.

Part 2. (continued)., 9. Sex

Part 2. (continued)., 13. Current Marital Status

Part 2. (continued)., 14. U.S. Armed Forces. Are you a member or veteran of any branch of the U.S. Armed Forces?

Part 2. (continued)., 15. Information About Your Admission into the United States and Immigration Status. A. I arrived in the following manner. Exact Name Used at Time of Entry. Enter Middle Name.

Part 2. (continued)., 15. Information About Your Admission into the United States and Immigration Status. A. I arrived in the following manner. Exact Name Used at Time of Entry. Enter Given Name (First Name).

Part 2. (continued)., 15. Information About Your Admission into the United States and Immigration Status. B. I used the following travel document to be admitted to the United States

Part 2. (continued).,15. Information About Your Admission into the United States and Immigration Status. C. Have you ever been a lawful permanent resident (L P R)?

Part 2. (continued)., 16. Have you ever abandoned or lost your L P R status?

Part 2. (continued)., 17. Have you previously applied for a Certificate of Citizenship?

Part 2. (continued)., 18. Have you previously applied for a U.S. Passport?

Part 3

Part 3., 3. This Parent is My

Part 3., 5. Current Physical Address. Enter City or Town.

Part 3., 5. Current Physical Address. Select State from a List of States.

Part 3., 5. Current Physical Address. Enter Zip Code.

Part 3., 5. Current Physical Address. Enter Apartment, Suite, or Floor Number.

Part 3., 5. Current Physical Address

Part 3., 5. Current Physical Address. Enter Postal Code (foreign address only).

Part 3., 5. Current Physical Address. Enter Province (foreign address only).

Part 3., 5. Current Physical Address. Enter Country (foreign address only).

Part 3., 6. My mother or father is a U. S. Citizen by Birth abroad to U.S. citizen parents. Enter Certificate of Citizenship Number (if any).

Part 3., 6. My mother or father is a U. S. Citizen by Birth abroad to U.S. citizen parents. Enter Alien Registration Number (A Number) (if any).

Part 3., 6. My mother or father is a U.S. citizen by

Part 3. (continued)., 6. My mother or father is a U. S. Citizen by Naturalization. Enter A- Number.

Part 3. (continued)., 6. My mother or father is a U. S. Citizen by Naturalization. Select State from a List of States.

Part 3. (continued)., 7. Has your mother or father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?

Part 3. (continued)., 8. Marital History. B. What is your U.S. citizen mother's or father's current marital status?

Part 3. (continued)., 8. Marital History. A. How many times has your U.S. citizen mother or father been married (including annulled marriages and marriages to the same person)? Enter Number of Marriages.

Part 3. (continued)., 8. Marital History. B. What is your U.S. citizen mother's or father's current marital status? If you selected "Other," enter an explanation.

Part 4

Part 4., 1. Current Legal Name of Other Mother or Father. Enter Middle Name.

Part 4., 2. Date of Birth (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 4.,. 3. This Parent is My:

Part 4., 3. This Parent is My:

Part 4., 4. Enter Country of Birth.

Part 4., 5. Enter Country of Citizenship or Nationality.

Part 4., 6. Current Physical Address. Enter City or Town.

Part 4., 6. Current Physical Address. Select State from a List of States.

Part 4., 6. Current Physical Address. Enter Zip Code.

Part 4., 6. Current Physical Address. Enter Apartment, Suite, or Floor Number.

Part 4., 6. Current Physical Address

Part 4., 6. Current Physical Address. Enter Street Number and Name (Type or print "Deceased" and the date of death if applicable.)

Part 4., 6. Current Physical Address. Enter Postal Code (foreign address only).

Part 4., 6. Current Physical Address. Enter Province (foreign address only).

Part 4., 6. Current Physical Address. Enter Country (foreign address only).

Part 4., 7. Is your other mother or father a U.S. citizen?

Part 4., 8. My other mother or father is a U. S. Citizen by

Part 4., 8. My other mother or father is a U. S. Citizen by Certificate of Citizenship Number (if any) or Acquisition after birth through naturalization of parent(s). Enter Alien Registration (A Number) (if any).

Part 4., 8. My other mother or father is a U. S. Citizen by Birth abroad to U.S. citizen parent(s). Enter Alien Registration (A Number) (if any).

Part 4., 8. My other mother or father is a U. S. Citizen by Birth abroad to U.S. citizen parent(s). Enter Certificate of Citizenship Number (if any).

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Enter A Number (if any).

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Enter Certificate of Naturalization Number.

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Select State from a List of States.

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Enter City or Town.

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Date of Naturalization (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 4., 8. My other mother or father is a U. S. Citizen by Naturalization. Enter Place of Naturalization (Name of Court or U S C I S Office Location).

Part 4. (continued)., 9. Has your other mother or father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?

Part 4. (continued)., 10. Marital History. A. How many times has your other mother or father been married (including annulled marriages and marriages to the same person)? Enter Number of Marriages.

Part 4. (continued)., 10. Marital History. B. What is your other mother's or father's current marital status?

Part 4. (continued)., 10. Marital History. B. What is your other mother's or father's current marital status? If you selected “Other,” enter an explanation. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.

Part 4. (continued)., 12. Information About Other Mother's or Father's Current Spouse. E. Spouse's Current Physical Address. Select State from a List of States.

Part 4. (continued)., 12. Information About Other Mother's or Father's Current Spouse. G. Place of Marriage. Select State from a List of States.

Part 6

Part 6. Physical Presence in the United States From U.S. Citizen Mother's or Father's Birth Until Child's Birth. NOTE: Only applicants born outside the United States claiming to have been born U.S. citizens are required to provide all the dates when their U.S. citizen mother or father was physically present in the United States. Include all dates from the U.S. citizen parent's birth until the child's birth. 1. Indicate to which U.S. citizen parent this information relates

Part 6., 2. Physical Presence in the United States. A. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. A. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. B. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. B. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. C. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. C. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. D. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. D. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. E. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. E. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. F. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. F. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. G. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. G. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. H. From Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 6., 2. Physical Presence in the United States. H. To Date (m m / d d / y y y y). Enter date as 2-digit Month, 2-digit Day, and 4-digit Year.

Part 5

Part 5., 3. Current Physical Address. Select State from a List of States.

Part 7

Part 7., 1. Has your U.S. citizen parent served in the U.S. Armed Forces?

Part 8

Part 8. Applicant's, Parent's, or Legal Guardian's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form N- 600 Instructions before completing this section. Applicant's, Parent's, or Legal Guardian'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, Parent's, or Legal Guardian's Statement Regarding the Interpreter

Part 8., Applicant's, Parent's, or Legal Guardian's Statement. 2. Applicant's, Parent's, or Legal Guardian's Statement Regarding the Preparer

Part 9

Part 9., Interpreter's Mailing Address. 3. Enter Province.

Part 9., Interpreter's Mailing Address. 3. Enter Postal Code.

Part 9., Interpreter's Mailing Address. 3

Part 9., Interpreter's Mailing Address. 3. Enter Apartment, Suite, or Floor number.

Part 9. Interpreter's Contact Information, Certification, and Signature (continued). Interpreter's Certification. I certify, under penalty of perjury, that I am fluent in English the same language specified in Part 8., Item B. in Item Number 1. Enter language.

Part 10

Part 10., Preparer's Mailing Address. 3. Enter Province.

Part 10., Preparer's Mailing Address. 3. Enter Postal Code.

Part 10., Preparer's Mailing Address. 3

Part 10., Preparer's Mailing Address. 3. Enter the Apartment, Suite, or Floor number.

Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant, Parent, or Legal Guardian (continued). Preparer's Statement. 7

Part 10. (continued)., Preparer's Statement. If selected 7. B.,

Part 11

Part 11., 5. D. Enter Additional Information.

Part 11., 6. A. Enter Page Number.

Part 11., 6. B. Enter Part Number.

Part 11., 6. C. Enter Item Number.

Part 11., 6. D. Enter Additional Information.

Part 11., 5. C. Enter Item Number.

Part 11., 5. B. Enter Part Number.

Part 11., 5. A. Enter Page Number.

Part 11., 3. A. Enter Page Number.

Part 11., 3. B. Enter Part Number.

Part 11., 3. C. Enter Item Number.

Part 11., 3. D. Enter Additional Information.

Part 11., 4. A. Enter Page Number.

Part 11., 4. B. Enter Part Number.

Part 11., 4. C. Enter Item Number.

Part 11., 4. D. Enter Additional Information.

Goals & Verification

Review any form-specific details you added above, then confirm you want a lawyer consultation. This intake does not create an attorney-client relationship and is not legal advice.

Case Pricing

$0.00

This case carries a fixed price of $0.00 for the full consultation and document processing.

Urgency Level

Do You Have Relevant Documents Available?

Consultation Preference

Anything Else the Attorney Should Know?

1. Accuracy Confirmation

I confirm that the information I provide is accurate.

2. Contact Consent

I agree to the commitment about this intake by email, phone number, or text.

Immigration Intake Form

Personal Details

Select USCIS Forms

Important Legal Notice

Pricing Notice

Immigration Matter Details

Important Legal Notice

Pricing Notice

Family Petition

Part 2. Petitioner Other Names Used

Petitioner Spouse History

Petitioner Parents

Petitioner Employment History

Petitioner Biographic Information

Beneficiary Information

Beneficiary Part 4 Continued

Beneficiary Family Members

Prior Petition Filing

Other Relatives on Separate Petitions

Petitioner Contact Information

Part 7. Interpreter

Part 8. Preparer

I-130 Additional Information

Spouse Supplement

Physical Address 1

Physical Address 2

Last Address Outside the U.S.

Parent 1

Parent 2

Employment History

Employment Outside the United States

Spouse Beneficiary Statement and Contact

Interpreter Information

Preparer Information

Additional Information

Form I-485 - Adjustment of Status

Part 1. Information About You

Addresses

Part 2. Filing Category

Part 5. Parents

Part 6. Marital History

Part 7. Children

Part 8. Biographic Information

Part 1. Continued Address History

Part 1. Prior Address Detail

Part 1. Most Recent Foreign Address

Part 1. Social Security Card

Part 3. Affidavit of Support Exemption

Part 4. Prior Visa and Employment History

Part 9. General Eligibility and Inadmissibility Grounds (continued)

Part 9. Public Charge

Part 11. Interpreter's Contact Information, Certification, and Signature

Part 12. Preparer's Contact Information, Certification, and Signature

Part 14. Additional Information

Change / Extension of Status

Part 3 Processing Information

Part 4 Additional Information

Current Passport Information

Physical Address Abroad

Eligibility and Background Questions

Asylum

Quick Screening

Applicant Information

Residence and Mailing Address

Travel, Passport, and Languages

Spouse

Children

Background Information

1. Last Address Before Coming to the United States

2. Residences During the Past 5 Years

3. Education History

4. Employment During the Past 5 Years

5. Parents and Siblings

Part B. Basis for Asylum

Part C. Additional Information

Applicant Signature and Preparer

Naturalization

Part 1. Eligibility

Part 2. Information About You

Other Names Used 1