Form I-290B 05/17/18 Page 3 of 6
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 of my records that USCIS may need
to determine my eligibility for the immigration benefit that I
seek.
Applicant's or Petitioner's Certification
I further authorize release of information contained in this form,
in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration and
enforcement of U.S. immigration law.
I certify, under penalty of perjury, that all of the information in
my form and any document submitted with it were provided or
authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my form, and that
all of this information is complete, true, and correct.
Date of Signature (mm/dd/yyyy)6.b.
Applicant's or Petitioner's Signature6.a.
Applicant's or Petitioner's Signature
If you are filing an appeal or motion based on a PETITION
FILED BY A BUSINESS OR ORGANIZATION (NOT AN
INDIVIDUAL), complete this section:
Section B
Part 4. Applicant's or Petitioner's Statement,
Contact Information, Certification, and Signature
(continued)
Petitioner's Statement
I can read and understand English, and I have read
and understand every question and instruction on this
form and my answer to every question.
1.a.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
a language in which I am fluent. I understood all of
this information as interpreted.
The interpreter named in Part 5. has read to me every
question and instruction on this form, and my answer
to every question, in
1.b.
,
2. At my request, the preparer named in Part 6.
prepared this form for me based only upon
information I provided or authorized.
Petitioner's Contact Information
Daytime Telephone Number5.
Email Address (if any)7.
Mobile Telephone Number (if any)6.
Provide the following information about the petitioner's
authorized signatory.
3.b.
3.c.
3.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
4. Title
Copies of any documents submitted are exact photocopies of
unaltered, original documents, and I understand that, as the
petitioner, I may be required to submit original documents to
USCIS at a later date.
Petitioner's Certification
I authorize the release of any information from my records, or
from the petitioning organization's records, to USCIS or other
entities and persons where necessary to determine eligibility for
the immigration benefit sought or where authorized by law. I
recognize the authority of USCIS to conduct audits of this form
using publicly available open source information. I also
recognize that any supporting evidence submitted in support of
this form may be verified by USCIS through any means
determined appropriate by USCIS, including but not limited to,
on-site compliance reviews.
I certify, under penalty of perjury, that I have reviewed this
form, I understand all of the information contained in, and
submitted with, my appeal or motion, and all of this information
is complete, true, and correct.
If filing this form on behalf of an organization, I certify that I
am authorized to do so by the organization.
Date of Signature (mm/dd/yyyy)8.b.
Petitioner's Signature8.a.
Petitioner's Signature
NOTE TO ALL APPLICANTS AND PETITIONERS: If
you do not completely fill out this form or fail to submit
required documents listed in the Instructions, USCIS may
dismiss, deny, or reject your appeal or motion.
