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I-698fillable I-698 (ILW.COM)

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Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-698, Application to Adjust Status
From Temporary to Permanent Resident
(Under Section 245A of the INA)
Do not write in this block - For USCIS use only.
Action Block
Remarks
Fee Stamp
1. Name
4. Telephone Number (include area code)
START HERE - Type or print in black ink. If you need more space, see Page 3 of the instructions.
OMB No. 1615-0035; Expires 12/31/10
Form I-698 (Rev. 12/29/09)N
2. Gender
13. Marital Status
Family Name (in capital letters)
5. Reason for difference in name, if any. (marriage, divorce, etc.)
3. Name as it appears on Form I-688, Temporary
Resident Card
Given Name
Middle Name
A-Number
Work
Home
In care of
Street Number and Name
Apt. #
Street Number and Name
Apt. #
City
Zip Code
State
7. Mailing Address in the United States (if different from address in Number 6 above)
In care of
City
Zip Code
State
8. Place of Birth (City or Town)
Country
Country of Citizenship/Nationality
County, Province, or State
9. Date of Birth (mm/dd/yyyy)
11. Your Father's First Name
12. Your U.S. Social Security #
10. Your Mother's First Name
Male
Female
Married
Never Married
Separated
Divorced
Widowed
16. Concerning the requirement of minimal understanding of ordinary English and a knowledge and understanding of the history and
Government of the United States (check appropriate block under Section A or B):
A. I will satisfy these requirements by:
B. I have satisfied these requirements by:
Form I-698 (Rev. 12/29/09)N Page 2
17. 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?
14. Absences from the United States since becoming a temporary resident alien. List most recent absence first. If you have a single
absence in excess of 30 days or if the total of all your absences exceeds 90 days, explain and attach any relevant information.
15. When applying for temporary resident status, I did did not submit a Form I-693, Medical Examination of Aliens Seeking
Adjustment of Status, with my application that included a serologic (blood) test for human immunodeficiency virus (HIV)
infection. (If you did not, submit Form I-693 that includes a serologic test for HIV.)
Country
Purpose of Trip
From
(mm/dd/yyyy)
To
(mm/dd/yyyy)
Total Days
Absent
18. Have you ever been treated for a mental disorder, drug addiction, or alcoholism?
19. Have you ever committed a crime or offense for which you were not arrested?
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?
Satisfactorily pursuing a course of study recognized by the Secretary of Homeland Security.
Examination at the time of interview for permanent residence.
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.)
Having satisfactorily pursued a course of study recognized by the Secretary of Homeland Security. (Attach appropriate
documentation.)
Yes
No
Yes
No
Yes
No
Yes
No
If you answer "Yes" to any of the questions numbered 17 through 37, explain your answer on a separate sheet of paper.
20. 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? If
"Yes" provide the names(s) of the recipients(s) and U.S. Social Security Number(s).
21. Have you ever:
Form I-698 (Rev. 12/29/09)N Page 3
Name of Recipient (Family Name, Given Name, Middle Name)
U.S. Social Security Number
a. Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in
such activities in the future?
b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?
c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States
illegally?
d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit
trafficking of any controlled substance?
22. Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever
solicited membership or funds for, or have you through any means ever 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?
23. Do you intend to engage in the United States in:
a. Espionage?
b. 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?
c. Any activity to violate or evade any law prohibiting the export from the United States of goods,
technology, or sensitive information?
Have you ever been convicted of a crime or offense?
Have you ever been in jail or prison?
Have you ever been placed in an alternative sentencing or a rehabilitative program (for example:
diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Have you ever received a suspended sentence, been placed on probation, or been paroled?
Have you ever been charged with committing any crime or offense?
24. Have you ever been a member of, or in any way affiliated with, a Communist Party or any other
totalitarian party?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Form I-698 (Rev. 12/29/09)N Page 4
30. 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?
31. Are you now withholding custody of a U.S. citizen child outside the United States from a person granted
custody of the child?
32. Do you plan to practice polygamy in the United States?
33. Have you ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:
a. Acts involving torture or genocide?
b. Killing any person?
c. Intentionally and severely injuring any person?
d. Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?
e. Limiting or denying any person's ability to exercise religious beliefs?
34. Have you ever:
a. 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?
b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that
involved detaining persons?
28. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality
Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact,
ever sought to procure or procured a visa, other documentation, entry into the United States, or any
immigration benefit?
27. Have you ever been deported from the United States or 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?
29. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?
25. Did you, 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, ever order, incite, assist, or otherwise participate in the persecution of any
person because of race, religion, national origin, or political opinion?
26. Have you ever engaged in genocide, or otherwise ordered, incited, assisted, or otherwise participated in
the killing of any person because of race, religion, nationality, ethnic origin, or political opinion?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
I can read and understand English, and I have read and understand each and every question and instruction on this form, as
well as my answer to each question.
Form I-698 (Rev. 12/29/09)N Page 5
38. If your native alphabet is in other than Roman letters, write your name in your native alphabet.
39. Language of your native alphabet.
41. Signature and Certification of Applicant
Each and every question and instruction on this form, as well as my answer to each question, has been read to me in the
language, a language in which I am fluent, by the person named in Interpreter's Statement
and Signature. I understand each and every question and instruction on this form, as well as my answer to each question.
Applicant's Statement and Signature (Check one)
36. Have you ever assisted or participated in selling or providing weapons to any person who to your
knowledge used them against another person, or in transporting weapons to any person who to your
knowledge used them against another person?
37. Have you ever received any type of military, paramilitary, or weapons training?
35. 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?
40. Accommodations for Individuals With Disabilities and/or Impairments (Read the information on Page 4 of the instructions
before completing this section.)
a. I am deaf or hard of hearing and request the following accommodation(s) (if requesting a sign-language interpreter,
indicate which language (e.g., American Sign Language)):
b. I am blind or sight-impaired and request the following accommodation(s):
c. I have another type of disability and/or impairment (describe the nature of your disability(ies) and/or impairment(s) and
accommodation(s) you are requesting):
Are you requesting an accommodation because of your disability(ies) and/or impairment(s)?
If "Yes" check any applicable box:
Yes
No
Yes
No
Yes
No
Yes
No
Form I-698 (Rev. 12/29/09)N Page 6
I hereby consent and authorize U.S. Citizenship and Immigration Services to verify the information provided and to conduct
police, welfare, and other record checks pertinent to this application.
Date (mm/dd/yyyy)
Applicant's Signature
Date (mm/dd/yyyy)
Interpreter's Signature
Date (mm/dd/yyyy)
Signature
I declare under penalty of perjury that I prepared this application at the request of the above person.
The answers provided are based on information of which I have personal knowledge and/or were provided to me by the above
named person in response to the exact questions contained on this form.
43. Signature of Person Preparing Form, If Other Than Applicant
I further certify that I have read each and every question and instruction on this form, as well as the answer to each question, to
this applicant in the above-mentioned language, and the applicant has understood each and every instruction and question on the
form, as well as the answer to each question.
Print Your Full Name
Telephone Number (include area/country code)
Print Your Full Name
Address
Telephone Number (include area/country code)
I certify that I am fluent in English and the below-mentioned language.
Language used (language in which applicant is fluent)
42. Interpreter's Statement and Signature
44. Final Action: Temporary Residence
46. Class of Admission
48. Date of Adjustment
47. Place of Adjustment
49. Final Action By (Print Name and Title)
For U.S. Citizenship and Immigration Services Use Only
Denied
Approved
45. Final Action: Waiver of Inadmissibility under Section 212(a)
Denied
Approved
50. ID Number
51. Date
I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this
application is all true and correct. I certify also that I have not withheld any information that would affect the outcome of this
application.
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Completed 9 January 2021

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