Fillable Printable Form I-824
Fillable Printable Form I-824
Form I-824
Form I-824 12/23/16 NPage 1 of 7
Select this box if
Form G-28 is
attached.
Application for Action on an Approved Application or Petition
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-824
OMB No. 1615-0044
Expires 10/31/2017
START HERE - Type or print in black ink.►
To be completed
by an attorney or
BIA-accredited
representative (if any).
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Relocated
For
USCIS
Use
Only
DateDate
Action Block
Sent
DateDate
Received
Returned
Fee Stamp
Resubmitted
Remarks
Country of Chargeability:
Priority Date:
Date the Previous Visa Petition Was Approved
(Form I-130, I-140 or I-360):
Classification Code:
Date the Previously Approved Visa Petition Was
Filed (Form I-130, I-140 or I-360):
on the previously approved application or petition.
I am the (select onlyone):
ApplicantPetitioner
Part 1. Information About You (Person filing this
Application)
2.a.Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c.Middle Name
3.Company or Organization Name (if any)
NOTE: If you are a U.S. citizen, type or print “N/A”
for Item Number 4.
Current/Recent Immigration Status
A-
►
1.
4.
Certificate of Naturalization or Citizenship Number
(if any)
5.
Alien Registration Number (A-Number) (if any)6.
7.Date of Birth (mm/dd/yyyy)
8.Country
of Birth
10.IRS Tax Number (if any)
U.S. Social Security Number (if any)11.
►
USCIS Online Account Number (if any)12.
►
Mailing Address
13.d.
13.e.
13.b.
13.c.
City or Town
13.f.
Street Number
and Name
Apt.Flr.Ste.
13.h.
13.i.
13.g.
9.Country of Citizenship or Nationality
Province
Country
Postal Code
ZIP CodeState
13.a.In Care Of Name
Form I-824 12/23/16 NPage 2 of 7
Part 1. Information About You (Person filing this
Application) (continued)
City or Town
14.e.14.d.
Physical Address
14.a.Street Number
and Name
14.b.
14.c.
Apt.
Flr.Ste.
14.h.
14.g.
Part 2. Reason for Request
I am requesting (select onlyone):
A duplicate approval notice.
U.S. Citizenship and Immigration Services (USCIS)
to notify a new U.S. Consulate, different from the
one that I originally requested, through the U.S.
Department of State's National Visa Center (NVC) or
Kentucky Consular Center. USCIS will notify the
U.S. Consulate about the approval of a nonimmigrant
visa petition or about a new Port-of-Entry (the Port-
of-Entry is different from what I originally requested)
about the approval of a waiver application. Please
notify the U.S. Consulate or Port-of-Entry at:
USCIS to notify a U.S. Consulate through the NVC
about my adjustment of status to permanent resident
in the United States. Please notify the U.S. Consulate
at:
USCIS to notify the U.S. Department of State that I
have become a U.S. citizen through naturalization.
USCIS to send my approved immigrant visa petition
to the NVC.
so that my spouse and/or children may accompany or
follow-to-join me.
1.a.
1.b.
1.c.
1.d.
1.e.
Part 3. Other Information
1.a.Form Number of Previously Approved Application or
Petition
1.b.Receipt Number (On Form I-797, Notice of Action)
1.c.Filing Date of Application or Petition (mm/dd/yyyy)
1.d.Approval Date (mm/dd/yyyy)
Provide the following information about the principal
beneficiary of the previous application or petition
, if other
than you.
2.a.Family Name
(Last Name)
2.b.Given Name
(First Name)
2.c. Middle Name
Country of Birth2.e.
2.d.Date of Birth (mm/dd/yyyy)
A-
►
Alien Registration Number (A-Number) (if any)2.f.
Daytime Telephone Number2.g.
14.f.
Province
Country
Postal Code
ZIP CodeState
City or Town3.d.
Mailing Address
3.a.In Care Of Name
Street Number
and Name
3.b.
3.c.Apt.Flr.Ste.
ZIP Code
3.f.
State3.e
Province3.g.
3.h.
3.i.Country
Postal Code
Form I-824 12/23/16 NPage 3 of 7
Part 3. Other Information (continued)
If you selected Part 2., Item Number 1.c., provide the
following information about the dependents for whom
you are requesting follow-to-join benefits. If you need
additional space for your dependents, use the space
provided in Part 7. Additional Information, and include
all the information collected in Item Numbers 5.a. - 11.
Dependents
5.a.Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c. Middle Name
Country of Birth
7.
Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality8.
9.Relationship to Principal Applicant
12.a.Family Name
(Last Name)
12.b. Given Name
(First Name)
12.c. Middle Name
Country of Birth14.
Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality15.
19.a.Family Name
(Last Name)
19.b. Given Name
(First Name)
19.c. Middle Name
Country of Birth21.
20.Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality22.
23.Relationship to Principal Applicant
16.Relationship to Principal Applicant
Dependent's Daytime Telephone Number
10
.
11
.
Dependent's Email Address (if any)
17.Dependent's Email Address (if any)
Dependent's Daytime Telephone Number18.
Dependent's Daytime Telephone Number25.
24.Dependent's Email Address (if any)
13.
6.
Physical Address
4.c.
4.a.
4.b.
City or Town
Street Number
and Name
Apt.Flr.Ste.
ZIP Code
4.e.
State4.d.
4.g.
Province
4.h.Country
Postal Code
4.f.
Form I-824 12/23/16 NPage 4 of 7
Part 3. Other Information (continued)
Contact Information of Dependents
Foreign Telephone Number34.
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
NOTE: Read the information on penaltiesin the Penalties
section of the Form I-824 Instructions before completing this
part.
NOTE: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.
1.a.
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.
Applicant's Statement
The interpreter named in Part 5. has also read to me
every question and instruction on this application, as
well as my answer to every question, in
1.b.
a language in which I 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.
,
I have requested the services of and consented to
2.
who is is not an attorney or accredited
representative, preparing this application for me.
,
5.
Applicant's Email Address (if any)
Applicant's Mobile Telephone Number (if any)4.
Applicant's Daytime Telephone Number3.
Applicant's Contact Information
City or Town33.d.
Foreign Address of Dependents
33.a.In Care Of Name
Street Number
and Name
33.b.
Apt.Flr.Ste.
33.f.
Province
33.g.Country
Postal Code
33.e.
26.a.Family Name
(Last Name)
26.b. Given Name
(First Name)
26.c. Middle Name
Country of Birth28.
27.Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality29.
30.Relationship to Principal Applicant
Dependent's Email Address (if any)
Dependent's Daytime Telephone Number32.
31.
Applicant's Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any and all of my records that USCIS
may need to determine my eligibility for the immigration
benefit that I seek.
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.
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 and enforcement of U.S. immigration laws.
33.c.
Form I-824 12/23/16 NPage 5 of 7
Interpreter's Mailing Address
3.c.City or Town
3.d.State3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h.Country
Street Number
and Name
3.a.
3.b.
Apt.Flr.Ste.
Interpreter's Daytime Telephone Number
5.
4.
Interpreter's Email Address (if any)
Interpreter's Contact Information
Interpreter's Certification
I certify that:
I am fluent in English and , which
is the same language provided in Part 4., Item Number 1.b.;
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 4., Item Number 1.b.; and
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.
Interpreter's Signature
6.a.
6.b.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 5. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name
1.a.Interpreter's Family Name (Last Name)
1.b.Interpreter's Given Name (First Name)
Interpreter's Business or Organization Name (if any)2.
Provide the following information about the interpreter.
Applicant's Signature
Applicant's Signature
6.a.
6.b.Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
(continued)
Part 6. Contact Information, Statement,
Certification, and Signature of the Person
Preparing This Application, If Other Than the
Applicant
Preparer's Full Name
Provide the following information about the preparer.
1.a.Preparer's Family Name (Last Name)
1.b.Preparer's Given Name (First Name)
Preparer's Business or Organization Name (if any)2.
Form I-824 12/23/16 NPage 6 of 7
Preparer's Statement
I am an attorney or accredited representative and my
representation of the applicant in this case extends
does not extendbeyond the preparation of this
application.
I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.
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 or G-28I,
Notice of Entry of Appearance as Attorney In Matters
Outside of the Geographical Confines of the United
States, with this application.
7.a.
7.b.
Preparer's Certification
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.
Preparer's Signature
Preparer's Signature8.a.
8.b.Date of Signature (mm/dd/yyyy)
Preparer's Contact Information
Preparer's Daytime Telephone Number
6.
4.
Preparer's Email Address (if any)
Preparer's Fax Number 5.
Preparer's Mailing Address
3.c.City or Town
3.d.State3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h.Country
Street Number
and Name
3.a.
3.b.
Apt.Flr.Ste.
Part 6. Contact Information, Statement,
Certification, and Signature of the Person
Preparing This Application, If Other Than the
Applicant (continued)
Form I-824 12/23/16 NPage 7 of 7
Part 7. Additional Information
3.d.
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.
Your Full Name
1.a.Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
2.A-Number (if any)
3.a.
Page Number
3.b.Part Number3.c.Item Number
6.a.
Page Number6.b.Part Number6.c.Item Number
6.d.
4.d.
4.a.
Page Number4.b.Part Number4.c.Item Number
5.d.
5.a.
Page Number5.b.Part Number5.c.Item Number
A-
►
