Form I-907 Edition 12/02/19 Page 3 of 7
1. Requestor's Statement Regarding the Interpreter
Requestor's Statement Regarding the Preparer
I can read and understand English, and I have read and understand every question and instruction on this request and
my answer to every question.
The interpreter named in Part 4. read to me every question and instruction on this request and my answer to every
, a language in which I am fluent, and
prepared this request for me based only upon information I provided or authorized.
At my request, the preparer named in Part 5., ,
Part 3. Requestor's Statement, Contact Information, Declaration, Certification, and Signature
NOTE: Read the Penalties section of the Form I-907 Instructions before completing this section.
I understand that U.S. Citizenship and Immigration Services (USCIS) will refund the Premium Processing Service fee to the person
listed in Part 1. of this request if USCIS does not take an action on the related case within 15 calendar days after the appropriate
USCIS office physically receives this request. I understand that case actions include a referral for investigation of suspected fraud,
misrepresentation, or the issuance of an approval notice, a request for evidence, a notice of intent to deny, or a denial notice.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
ZIP CodeStateCity or Town
Province Postal Code Country
Street Number and Name
8. Address of Petitioner, Applicant, Company, or Organization Named in Related Case
Part 2. Information About the Request (continued)
Requestor's Declaration and Certification
I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration and enforcement of U.S. immigration law.
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 understood everything.
Requestor's Contact Information
Requestor's Daytime Telephone Number Requestor's Mobile Telephone Number (if any)3. 4.
Requestor's Email Address (if any)6.Requestor's Fax Number (if any)5.