Fillable I-600asup1 Supplement 1, Listing of Adult Member of the Household

Fill Online, Printable, Fillable, Blank I-600asup1 Supplement 1, Listing of Adult Member of the Household Form

Use Fill to complete blank online USCIS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

I-600asup1 Supplement 1, Listing of Adult Member of the Household

On average this form takes 26 minutes to complete

The I-600asup1 Supplement 1, Listing of Adult Member of the Household form is 6 pages long and contains:

  • 0 signatures
  • 39 check-boxes
  • 84 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your United States Citizenship and Immigration Services documents online.

U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

BROWSE USCIS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Form I-600A/I-600 Supplement 1 12/23/16 N Page 1 of 7
Supplement 1,
Listing of Adult Member of the Household
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-600A/I-600
Supplement 1
OMB No. 1615-0028
Expires 12/31/2018
Part 1. Information About an Adult Member of the Household
You must complete Form I-600A/Form I-600, Supplement 1, for each adult member of your household 18 years of age or older.
Note you do not need to complete one for yourself or your spouse (if married).
Provide the following information about the Adult Member of the Household:
1.
U.S. Mailing Address (if any)
2.
3.
Family Name (Last Name)
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Given Name (First Name) Middle Name (if applicable)
Other Names You Have Used (including maiden name, nicknames, and aliases, if any)
City or Town State ZIP Code
Street Number and Name Apt. Flr. NumberSte.
In Care Of Name
Number
U.S. Physical Address (if any)
Is your current U.S. mailing address the same as your U.S. physical address?
Street Number and Name
City or Town State ZIP Code
Apt. Flr.Ste.
If you answered "No" to Item Number 4., provide your U.S. physical address in Item Number 5. or your address abroad in Item
Number 6., as appropriate.
4.
5.
NoYes
Number
Address Abroad (if any)
Street Number and Name
City or Town State
Apt. Flr.Ste.
Postal CodeProvince Country
6.
7.
Date of Birth (mm/dd/yyyy) City/Town/Village of Birth 8.
Form I-600A/I-600 Supplement 1 12/23/16 N Page 2 of 7
You must answer each of the following questions. See the Duty of Disclosure section in the Form I-600A or Form I-600 instructions,
concerning your ongoing duty to disclose information in response to these questions. If you answer "Yes" to any of these questions,
provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment,
conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating
circumstances about each arrest, signed by the adult member of the household under penalty of perjury under U.S. law. The written
statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department
or other law enforcement administration or other entity involved; and date of incarceration and name of facility, if applicable. Provide
a description of any type of counseling, rehabilitation, or other information that you and the adult member of the household would like
considered in light of this history on 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.
►
A-
Alien Registration Number (A-Number) (if any)11.
State or Province of Birth9. Country of Birth10.
Duty of Disclosure
Received a suspended sentence, been placed on probation or parole, or in an alternative sentencing or
rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or
expungement of a criminal charge?
At any time been the subject of any investigation by any child welfare agency, court, or other official
authority in any State or foreign country concerning the abuse or neglect of any child, other than an
investigation that has been completed and formally closed based on a finding that the allegation of abuse
or neglect was unfounded or unsubstantiated?
Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?B.
C.
D.
Has the adult member of the household EVER, whether in or outside the United States:12.
A. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law
or ordinance, excluding traffic violations, but including driving or operating a vehicle while intoxicated
or while impaired by or under the influence of alcohol or other intoxicant, even if the record of the
arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of
any other amelioration?
Yes No
Yes No
Yes No
Yes No
Part 2. Information About You (Applicant or Petitioner Filing Form I-600A/I-600)
1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
►
A-
Alien Registration Number (A-Number) (if any)6.
2. Date of Birth (mm/dd/yyyy) City/Town/Village of Birth 3.
State or Province of Birth4. Country of Birth5.
Part 1. Information About an Adult Member of the Household (continued)
Form I-600A/I-600 Supplement 1 12/23/16 N Page 3 of 7
Part 3. Adult Member of the Household's Statement, Contact Information, Certification, and Signature
Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2.
1.A.
1.B.
I can read and understand English, and have read and understand every question and instruction on this supplement, as well as
my answer to every question.
The interpreter named in Part 6. has read to me every question and instruction on this supplement, as well as my answer
I understand every question and instruction on this supplement as translated to me by my interpreter, and have provided
complete, true, and correct responses.
to every question, in , a language in which I am fluent.
I have requested the services of and consented to
is not an attorney or accredited representative, preparing this supplement for me.
2. ,
who is
Adult Member of the Household's Certification
Adult Member of the Household's Signature
Adult Member of the Household's Signature Date of Signature
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 the suitability and eligibility of the applicant or petitioner as an adoptive
parent.
I furthermore authorize release of information contained in this supplement, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the administration of U.S. immigration laws.
6.
(mm/dd/yyyy)
Adult Member of the Household's Statement
Part 4. Adult Member of the Household's Duty of Disclosure
Certification: I understand the ongoing duty to disclose information concerning any change of circumstance, as described in the
Form I-600A and/or Form I-600 instructions, and I agree to notify the applicant, petitioner, and/or home study preparer and USCIS of
any new information that I am required to disclose.
Adult Member of the Household's Signature Date of Signature
(mm/dd/yyyy)
Adult Member of the Household's Daytime Telephone Number Adult Member of the Household's Mobile Telephone Number (if any)
Adult Member of the Household's Email Address (if any)
3. 4.
5.
Adult Member of the Household's Contact Information
I certify, under penalty of perjury, that the information in my supplement and any document submitted with my supplement is
complete, true, and correct.
Form I-600A/I-600 Supplement 1 12/23/16 N Page 4 of 7
Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2.
1.A.
1.B.
I can read and understand English, and have read and understand every question and instruction on this supplement, as well as
my answer to every question.
to every question, in
The interpreter named in Part 6. has read to me every question and instruction on this supplement, as well as my answer
, a language in which I am fluent.
I understand every question and instruction on this supplement as translated to me by my interpreter, and have provided
complete, true, and correct responses.
I have requested the services of and consented to
who is not an attorney or accredited representative, preparing this supplement for me.
,
is
2.
Part 5. Applicant's or Petitioner's Statement, Contact Information, Certification, and Signature
Applicant's or Petitioner's Statement
Applicant's or Petitioner's Certification
Applicant's or Petitioner's Signature
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 suitability and eligibility as an adoptive parent.
Applicant's or Petitioner's Signature Date of Signature
I furthermore authorize release of information contained in this supplement, in supporting documents, and in my USCIS records; to
other entities and persons where necessary for the administration of U.S. immigration laws.
6.
(mm/dd/yyyy)
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Interpreter's Full Name
Interpreter's Business or Organization Name (if any)2.
Part 6. Interpreter's Name, Contact Information, Certification, and Signature
If the adult member of the household and/or applicant or petitioner used an interpreter, the interpreter must provide the following
information:
Applicant's or Petitioner's Daytime Telephone Number Applicant's or Petitioner's Mobile Telephone Number (if any)
Applicant's or Petitioner's Email Address (if any)
3. 4.
5.
Applicant's or Petitioner's Contact Information
I certify, under penalty of perjury, that the information in my supplement and any document submitted with my supplement is
complete, true, and correct.
Form I-600A/I-600 Supplement 1 12/23/16 N Page 5 of 7
Interpreter's Mailing Address
3.
City or Town State ZIP Code
Postal CodeProvince Country
Street Number and Name Apt. Flr. NumberSte.
Part 6. Interpreter's Name, Contact Information, Certification, and Signature (continued)
Interpreter's Contact Information
Interpreter's Daytime Telephone Number Interpreter's Email Address (if any)4. 5.
Interpreter's Certification
I certify that:
I am fluent in English and .
I have read to this adult member of the household and/or applicant or petitioner every question and instruction on this supplement, as
well as the answer to every question in the language in which he and/or she is fluent; and
The adult member of the household and/or applicant or petitioner has informed me that he and/or she understands every instruction
and question on the supplement, as well as his and/or her answers to every question, and the adult member of the household and/or
applicant or petitioner verified the accuracy of every answer.
Date of SignatureInterpreter's Signature
6.
(mm/dd/yyyy)
Interpreter's Signature
Preparer's Full Name
Preparer's Given Name (First Name)Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any)2.
Part 7. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing
this Supplement, If Other Than the Adult Member of the Household, and/or Applicant or Petitioner
If the adult member of the household and/or applicant or petitioner used a preparer to complete this supplement, the preparer must
provide the following information:
Form I-600A/I-600 Supplement 1 12/23/16 N Page 6 of 7
Preparer's Mailing Address
Street Number and Name Apt. Flr. NumberSte.
City or Town State ZIP Code
Postal CodeProvince Country
3.
Part 7. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing
this Supplement, If Other Than the Adult Member of the Household, and/or Applicant or Petitioner
(continued)
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Fax Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
Preparer's Statement
I am not an attorney or accredited representative but have prepared this supplement on behalf of the adult member of the
household and/or applicant or petitioner and with the adult member of the household's and/or applicant's or petitioner's
consent.
I am an attorney or accredited representative and my representation of the adult member of the household and/or applicant
extendsor petitioner in this case does not extend beyond the preparation of this supplement.
7.A.
7.B.
Preparer's Signature
Date of Signature
(mm/dd/yyyy)
Preparer's Certification
Preparer's Signature
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this supplement on behalf of, at the request of,
and with the express consent of the adult member of the household and/or applicant or petitioner. I completed this supplement based
only on responses the adult member of the household and/or applicant or petitioner provided to me. After completing the supplement,
I reviewed it and all of the adult member of the household's and/or applicant's or petitioner's responses with the adult member of the
household and/or applicant or petitioner, who agreed with every answer on the supplement. If the adult member of the household and/
or applicant or petitioner supplied additional information concerning a question on the supplement, I recorded it on the supplement.
8.
NOTE: If you are an attorney or accredited representative whose representation extends beyond the preparation of this
supplement, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited
Representative, or Form G-28I, Notice of Entry of Appearance as Attorney in Matters Outside the Geographical Confines of
the United States, with this supplement.
Form I-600A/I-600 Supplement 1 12/23/16 N Page 7 of 7
AUTHORITY: The information requested on this application, petition, and/or supplement, and the associated evidence, is collected
under Section 101(b)(1)(F) of the Immigration and Nationality Act (INA) [8 USC 1101], 8 CFR 204.3, and 8 CFR 204.311.
USCIS Privacy Act Statement
PURPOSE: The purpose of Supplement 1 is to collect information on any adult members of the household.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested
evidence, may delay a final decision or result in denial of your application or petition.
ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, and foreign government
agencies and authorized organizations following approved routine uses described in the associated published system of records notices
[DHS/USCIS-005 - Inter-Country Adoptions Security and DHS/USCIS-001 - Alien File, Index, and National File Tracking System of
Records, which can be found at www.dhs.gov/privacy
]. The information may also be shared, as appropriate, for law enforcement
purposes or in the interest of national security.
This Supplement must be completed for any individual, other than you and your spouse (if married), who has the same principal
residence as you and is 18 years of age or older on or before the date that Form I-600A or Form I-600 is filed. Residence is defined as
the place of general abode or a person's principal, actual dwelling place in fact, without regard to intent. USCIS reserves the right to
request information on any household member who has not yet reached his or her 18th birthday before the date when Form I-600A or
Form I-600 is filed, or who does not actually live at the same residence, but whose presence in the residence is relevant to the issue of
your and your spouse's suitability to adopt.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

I-600asup1 Supplement 1, Listing of Adult Member of the Household

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document