Fillable Printable Form I-698

Form I-698

Form I-698 03/03/17 Y

Application to Adjust Status From Temporary

to Permanent Resident (Under Section 245A of the INA)

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-698

OMB No. 1615-0035

Expires 03/31/2019

START HERE - Type or print in black ink.►

Family Name (Last Name) Given Name (First Name)

Middle Name

Part 1. Information About You

Any Other Names Used

In Care Of Name

U.S. Mailing Address

Name as it Appears on Your Employment Authorization Document (Form I-766)

City or Town

State ZIP Code

Street Number and Name Flr.Ste.Apt.

Family Name (Last Name) Given Name (First Name) Middle Name

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

If you answered "No," provide your U.S. physical address in Item Number 7.

NoYes

For

USCIS

Use

Only

Date of Adjustment

Applicant Interviewed

Action BlockReceipt

Date:

Remarks

Date:

Number

Provide the reason for a difference in the names, if any (marriage, divorce, etc.)

Full Legal Name

If your native alphabet does not use Roman letters, type or print your name in your native alphabet.4.

Language of Your Native Alphabet

Family Name (Last Name) Given Name (First Name) Middle Name

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Form I-698 03/03/17 Y

City or Town

Country of Citizenship or Nationality

CountryProvince or Foreign State

11.

12.

Marital Status16. Divorced or SeparatedMarried WidowedSingle (Never Married)

Date of Birth (mm/dd/yyyy)

U.S. Social Security Number (if any)

15. Father's First NameMother's First Name14.

Part 1. Information About You (continued)

A-

Place of Birth

8. Alien Registration Number (A-Number) (if any)

►

A-

Gender

Male

Female

10.

13.

Feet

Race (Select all applicable boxes)

Native Hawaiian or

Other Pacific Islander

Black or African

American

American Indian or

Alaska Native

Height

WeightInches

Pounds

Blue Green Hazel Pink Unknown/OtherMaroonGrayBrown

Eye Color (Select only one box)

Hair Color (Select only one box)

Black Brown Red White

Unknown/

Other

SandyGrayBlond

Bald

(No Hair)

Asian

White

Not Hispanic or LatinoHispanic or Latino

Ethnicity (Select only one box)

Part 2. Biographic Information

List absences from the United States since becoming a temporary resident. List the most recent absence first. If you have a single

absence that exceeded 30 days or if the total of all of your absences exceeds 90 days, explain using the space provided in Part 8.

Additional Information or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of the

sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

From

(mm/dd/yyyy)

Country Purpose of Trip

Total Days

Absent

17.

Black

►

U.S. Physical Address

Street Number and Name

City or Town State ZIP Code

Flr.Ste.Apt.

Number

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Form I-698 03/03/17 Y

Satisfactory pursuit of a course of study recognized by the Secretary (attach appropriate documentation); or

I have satisfied these requirements by:

An exemption because I am 65 years of age or older, under 16 years of age, or I am physically unable to comply. (If you

are physically unable to comply, explain and attach relevant documentation.)

A-

Answer Item Numbers 2. - 29. If you answer "Yes" to any of the questions, provide a complete explanation using the space provided

in Part 8. Additional Information or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of

each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

Answering "Yes" does not necessarily mean that you are not entitled to adjust status or register for lawful permanent residence.

Have you EVER received a suspended sentence, been placed on probation, or been paroled? Yes No

Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example,

diversion, deferred prosecution, withheld adjudication, deferred adjudication)?

Yes No

Have you EVER been in jail or prison?

Yes No

Have you EVER been charged with committing any crime or offense?

Have you EVER been treated for a mental disorder, drug addiction, or alcoholism?

Yes No

Have you EVER committed a crime or offense for which you were not arrested?

NoYes

Have you EVER been arrested, cited, or detained by any law enforcement officer (including Immigration

and Customs Enforcement (ICE), Customs and Border Protection (CBP), former Immigration and

Naturalization Service (INS), and/or military officers) for any reason?

Yes No

Have you EVER been convicted of a crime or offense?

Yes No

Have you EVER assisted in the persecution of any person or persons on account of race, religion, political

opinion, nationality, or membership in a particular social group?

NoYes

Have you, or a dependent member of your immediate family, EVER received public assistance from

any source, including, but not limited to, the U.S. Government, any state, county, city, or municipality?

NoYes

10.

Full Name of Recipient (Family Name, Given Name, Middle Name) U.S. Social Security Number

Illicitly trafficked in any controlled substance or knowingly assisted, abetted, or colluded in the illicit

trafficking of any controlled substance?

Within the past 10 years been a prostitute, procured anyone for prostitution, or intend to engage in such

activities in the future?

11.

Have you EVER:

Yes No

Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States

illegally?

Yes No

Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Yes No

Part 3. Eligibility Standards

12.

If "Yes," provide the names of the recipients and their U.S. Social Security Numbers below.

You are required to have a minimal understanding of standard English and a knowledge and understanding of the history and

Government of the United States. Select the appropriate box in Item A. or B. below.

I will satisfy these requirements through:A.

An examination at the time of interview for lawful permanent residence; or

Satisfactory pursuit of a course of study recognized by the Secretary of Homeland Security (Secretary).

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Form I-698 03/03/17 Y

Part 3. Eligibility Standards (continued)

A-

Do you intend to engage in the United States in:

Espionage? Yes

Any activity to violate or evade any law prohibiting the export from the United States of goods,

technology, or sensitive information?

Yes No

Any activity, a purpose of which, is opposition to, or the control or overthrow of, the Government of

the United States, by force, violence, or other unlawful means?

Yes No

Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that

involved detaining persons?

14.

15. Have you EVER been a member of, or in any way affiliated with, a Communist Party or any other

totalitarian party?

Yes No

Did you EVER, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi

Government of Germany or any organization or government associated or allied with the Nazi Government

of Germany, order, incite, assist, or otherwise participate in the persecution of any person because of race,

religion, national origin, or political opinion?

Yes No

Have you EVER been deported from the United States, removed from the United States at government

expense, excluded within the past year, or are you NOW, or have you EVER been in exclusion,

deportation, removal, or rescission proceedings?

Yes No

17.

Have you EVER claimed to be a United States citizen in writing or any other way?

Yes No

16.

Are you NOW under a final order of civil penalty for violating section 274C of the Immigration and

Nationality Act (INA) for use of fraudulent documents or have you EVER, by fraud or willful

misrepresentation of a material fact, sought to procure or procured a visa, other documentation, entry into

the United States, or any immigration benefit?

18.

Yes No

Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?

22.

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

Yes No

Do you plan to practice polygamy in the United States?

Yes No

Are you NOW withholding custody of a U.S. citizen child outside the United States from a person granted

custody of the child?

Yes

23.

21.

Acts involving torture or genocide?

Killing any person?

Intentionally and severely injuring any person?

Engaging in any kind of sexual contact or relations with any person who was being forced or

threatened?

Limiting or denying any person's ability to exercise religious beliefs?

19.

Yes No20.

Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence

requirement and have not yet complied with that requirement or obtained a waiver?

Yes No

Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police

unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization?

24.

Have you EVER:

Yes No

Yes NoA.

25.

Have you EVER engaged in, conspired to engage in, do you intend to engage in, or have you EVER

solicited membership or funds for, or have you EVER through any means assisted or provided any type of

material support to any person or organization that has EVER engaged or conspired to engage in sabotage,

kidnapping, political assassination, hijacking, or any other form of terrorist activity?

NoYes13.

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Form I-698 03/03/17 Y

is not an attorney or accredited representative, preparing this application for me. This person who assisted me

in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center

with me and I understand the ASC Acknowledgement.

Part 3. Eligibility Standards (continued)

A-

Yes No

Yes NoRecruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed

force or group?

Used any person under 15 years of age to take part in hostilities, or to help or provide services to

people in combat?

Have you EVER:29.

Part 4. Accommodations for Individuals With Disabilities and Impairments (Read the information in the

Form I-698 instructions before completing this part.)

Are you requesting an accommodation because of your disabilities and/or impairments? Yes No1.

If you answered "Yes," Select all applicable boxes.

I am blind or have low vision and request the following accommodations:

I have another type of disability and/or impairment (describe the nature of your disabilities and/or impairments and the

accommodations you are requesting):

I am deaf or hard of hearing and request the following accommodations (if you are requesting a sign-language interpreter,

indicate for which language (e.g., American Sign Language)):

I can read and understand English, and have read and understand every question and instruction on this application, as

well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS

Application Support Center.

Part 5. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS

Application Support Center, Certification, and Signature

The interpreter named in Part 6. has read to me every question and instruction on this application, as well as my

Applicant's Statement Regarding the Interpreter1.

, a language in which I

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, Selectthe box for Item Number 2.

answer to every question, in

am fluent. I understand every question and instruction on this application as translated to me by my interpreter, and have

provided complete, true, and correct responses in the language indicated above. The interpreter named Part 6. has also

read the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I

am fluent, and I understand this ASC Acknowledgement as read to me by my interpreter.

Applicant's Statement Regarding the Preparer2.

Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of any

kind in which you or other persons used any type of weapon against any person or threatened to do so?

Have you EVER assisted or participated in selling, providing, or transporting weapons to any person who,

to your knowledge, used them against another person?

26.

Yes

Yes No

Have you EVER received any type of military, paramilitary or weapons training?

27.

Yes No28.

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I have requested the services of and consented ,

who is

Form I-698 03/03/17 Y

A-

I certify, under penalty of perjury, that the information in my application and any document submitted with my application were

provided by me and are complete, true, and correct.

Applicant's Signature Date of Signature (mm/dd/yyyy)

I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to

other entities and persons where necessary for the administration of U.S. immigration laws.

Applicant's Certification

Part 5. Applicant's Statement, Contact Information, ASC Acknowledgement,

Certification, and Signature (continued)

Acknowledgement of Appointment at USCIS Application Support Center

I, , understand that the purpose of a USCIS Application Support

Center (ASC) appointment is for me to provide fingerprints, photograph, and/or signature and to re-affirm that all of the information in

my application is complete, true, and correct and was provided by me. I understand that I will sign my name to the following

declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC

appointment:

By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request as

identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or

requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS,

and that all of the information in these materials is complete, true, and correct.

I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming

that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all

supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in

completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application

Support Center with me.

Applicant's Signature

Interpreter's Full Name

Provide the following information concerning the interpreter.

Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name)

Part 6. Interpreter's Contact Information, Certification, and Signature

Applicant's Email Address (if any)5.

Applicant's Daytime Telephone Number 3. 4. Applicant's Mobile Telephone Number (if any)

Applicant's Contact Information

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may

require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any

and all of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.

Interpreter's Business or Organization Name (if any)

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Form I-698 03/03/17 Y

A-

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language

provided in Part 5., Item B. in Item Number 1.; and

The applicant has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC

biometric services appointment and providing his or her fingerprints, photographs, and/or signature, he or she is re-affirming that the

contents of this application and all supporting documentation are complete, true, and correct.

Interpreter's Mailing Address

Interpreter's Daytime Telephone Number

City or Town

State ZIP Code

Street Number and Name Flr.Ste.Apt.

Interpreter's Email Address (if any)

Postal Code CountryProvince

Interpreter's Contact Information

Interpreter's Certification

I am fluent in English and

I certify that:

Part 6. Interpreter's Contact Information, Certification, and Signature

(continued)

Interpreter's Signature

Part 7. Contact Information, Statement, Certification, and Signature of the Person Preparing This

Application, If Other Than the Applicant

Provide the following information concerning the preparer.

Preparer's Family Name (Last Name) Preparer's Given Name (First Name)1.

Preparer's Full Name

I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant in the same language

provided in Part 5., Item B. in Item Number 1.

The applicant has informed me that he or she understands every instruction and question on the application, as well as the answer to

every question, and the applicant verified the accuracy of every answer; and

Number

Preparer's Business or Organization (if any)

, which is the same language

provided in Part 5., Item B. in Item Number 1.;

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Form I-698 03/03/17 Y

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.

Preparer's Certification

Preparer's Daytime Telephone Number 4.

Preparer's Email Address (if any)6.

5. Preparer's Fax 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.

Preparer's Signature Date of Signature (mm/dd/yyyy)

Preparer's Contact Information

By my signature, I certify, swear or affirm, under penalty of perjury, that I prepared this application on behalf of, at the request of, and

with the express consent of, the applicant. I completed this application based only on responses the applicant provided to me. After

completing the application, I reviewed it and all of the applicant's responses with the applicant, who agreed with every answer on the

application. If the applicant supplied additional information concerning a question on the application, I recorded it on the application.

I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and the applicant

has informed me that he or she understands the ASC Acknowledgement.

Part 7. Contact Information, Statement, Certification, and Signature of the

Person Preparing This Application, If Other Than the Applicant (continued)

City or Town State ZIP Code

Street Number and Name Flr.Ste.Apt.

Postal Code CountryProvince

Preparer's Mailing Address

A-

Preparer's Statement

Preparer's Signature

Number

NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you

must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.

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Form I-698 03/03/17 Y

Part 8. Additional Information

If you need extra space to provide any additional information within this application, use the space below. If you need more space

than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.

Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to

which your answer refers; and sign and date each sheet.

A-Number (if any) ►

A-

Page Number

Part Number Item Number

Family Name (Last Name) Given Name (First Name) Middle Name1.

B. C.

Page Number

Part Number

Item Number4. B. C.

Page Number

Part Number Item Number

5. B. C.

Page Number

Part Number Item Number

6. B. C.

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