Fillable Ins-form-g-28 Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

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Ins-form-g-28 Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

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Form G-28 05/23/18 Page 1 of 4
Notice of Entry of Appearance
as Attorney or Accredited Representative
Department of Homeland Security
Part 1. Information About Attorney or
Accredited Representative
Name of Attorney or Accredited Representative
4.
5.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
Daytime Telephone Number
DHS
Form G-28
OMB No. 1615-0105
Expires 05/31/2021
1. USCIS Online Account Number (if any)
►
Street Number
and Name
3.a.
3.b. Ste. Flr.Apt.
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f. Province
3.g. Postal Code
3.h. Country
Email Address (if any)
7. Fax Number (if any)
6.
2.b. Name of Recognized Organization
2.c. Date of Accreditation (mm/dd/yyyy)
2.a. I am an accredited representative of the following
qualified nonprofit religious, charitable, social
service, or similar organization established in the
United States and recognized by the Department of
Justice in accordance with 8 CFR part 1292.
1.c. I (select only one box) am not am
subject to any order suspending, enjoining, restraining,
disbarring, or otherwise restricting me in the practice of
law. If you are subject to any orders, use the space
provided in Part 6. Additional Information to provide
an explanation.
1.b. Bar Number (if applicable)
Part 2. Eligibility Information for Attorney or
Accredited Representative
Select all applicable items.
1.a.
I am an attorney eligible to practice law in, and a
member in good standing of, the bar of the highest
courts of the following states, possessions, territories,
commonwealths, or the District of Columbia. If you
need extra space to complete this section, use the
space provided in Part 6. Additional Information.
Contact Information of Attorney or Accredited
Representative
3. I am associated with
the attorney or accredited representative of record
who previously filed Form G-28 in this case, and my
appearance as an attorney or accredited representative
for a limited purpose is at his or her request.
,
4.a. I am a law student or law graduate working under the
direct supervision of the attorney or accredited
representative of record on this form in accordance
with the requirements in 8 CFR 292.1(a)(2).
4.b. Name of Law Student or Law Graduate
Licensing Authority
Mobile Telephone Number (if any)
Address of Attorney or Accredited Representative
1.d. Name of Law Firm or Organization (if applicable)
(USPS ZIP Code Lookup)
Form G-28 05/23/18 Page 2 of 4
I enter my appearance as an attorney or accredited
representative at the request of the (select only one box):
5.
Applicant Petitioner
Requestor
Respondent (ICE, CBP)
2.a. U.S. Immigration and Customs Enforcement (ICE)
List the specific matter in which appearance is entered.2.b.
3.a. U.S. Customs and Border Protection (CBP)
List the specific matter in which appearance is entered.3.b.
1.a. U.S. Citizenship and Immigration Services (USCIS)
List the form numbers or specific matter in which
appearance is entered.
1.b.
Part 3. Notice of Appearance as Attorney or
Accredited Representative
This appearance relates to immigration matters before
(select only one box):
Beneficiary/Derivative
Information About Client (Applicant, Petitioner,
Requestor, Beneficiary or Derivative, Respondent,
or Authorized Signatory for an Entity)
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c. Middle Name
7.a. Name of Entity (if applicable)
11. Mobile Telephone Number (if any)
9. Client's Alien Registration Number (A-Number) (if any)
8. Client's USCIS Online Account Number (if any)
►
Province
13.f.
Postal Code
13.g.
Country 13.h.
13.a. Street Number
and Name
13.c. City or Town
13.d.
State
13.e.
ZIP Code
13.b. Ste. Flr.Apt.
NOTE: Provide the client's mailing address. Do not provide
the business mailing address of the attorney or accredited
representative unless it serves as the safe mailing address on the
application or petition being filed with this Form G-28.
Mailing Address of Client
Email Address (if any)
12.
►
A-
Receipt Number (if any)4.
Daytime Telephone Number
10.
Client's Contact Information
Title of Authorized Signatory for Entity (if applicable)7.b.
►
Part 4. Client's Consent to Representation and
Signature
I have requested the representation of and consented to being
represented by the attorney or accredited representative named
in Part 1. of this form. According to the Privacy Act of 1974
and U.S. Department of Homeland Security (DHS) policy, I
also consent to the disclosure to the named attorney or
accredited representative of any records pertaining to me that
appear in any system of records of USCIS, ICE, or CBP.
Consent to Representation and Release of
Information
If you need extra space to complete this section, use the space
provided in Part 6. Additional Information.
Form G-28 05/23/18 Page 3 of 4
Part 4. Client's Consent to Representation and
Signature (continued)
Part 5. Signature of Attorney or Accredited
Representative
I have read and understand the regulations and conditions
contained in 8 CFR 103.2 and 292 governing appearances and
representation before DHS. I declare under penalty of perjury
under the laws of the United States that the information I have
provided on this form is true and correct.
1. a. Signature of Attorney or Accredited Representative
2.a. Signature of Law Student or Law Graduate
2.b. Date of Signature (mm/dd/yyyy)
I request that USCIS send original notices on an
application or petition to the U.S. business address of
my attorney or accredited representative as listed in
this form.
1.a.
If you want to have notices and/or secure identity documents
sent to your attorney or accredited representative of record rather
than to you, please select all applicable items below. You may
change these elections through written notice to USCIS.
1.b. Date of Signature (mm/dd/yyyy)
USCIS will send notices to both a represented party (the client)
and his, her, or its attorney or accredited representative either
through mail or electronic delivery. USCIS will send all secure
identity documents and Travel Documents to the client's U.S.
mailing address.
Options Regarding Receipt of USCIS Notices and
Documents
I request that USCIS send any secure identity
document (Permanent Resident Card, Employment
Authorization Document, or Travel Document) that I
receive to the U.S. business address of my attorney or
accredited representative (or to a designated military
or diplomatic address in a foreign country (if
permitted)).
1.b.
NOTE: If your notice contains Form I-94,
Arrival-Departure Record, USCIS will send the
notice to the U.S. business address of your attorney
or accredited representative. If you would rather
have your Form I-94 sent directly to you, select
Item Number 1.c.
I request that USCIS send my notice containing Form
I-94 to me at my U.S. mailing address.
1.c.
2.a. Signature of Client or Authorized Signatory for an Entity
2.b. Date of Signature (mm/dd/yyyy)
Signature of Client or Authorized Signatory for an
Entity
Form G-28 05/23/18 Page 4 of 4
Part 6. Additional Information
If you need extra space to provide any additional information
within this form, 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 form or attach a separate sheet of
paper. Type or print your name 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.
2.d.
1.a Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
2.a. 2.b. 2.c.Page Number Part Number
3.d.
3.a. 3.b. 3.c.Page Number Part Number Item Number
Page Number Part Number Item Number
Item NumberPart NumberPage Number
Page Number Part Number Item Number
Item Number
4.c.4.b.
4.d.
4.a.
5.d.
5.c.5.b.5.a.
6.c.6.b.
6.d.
6.a.
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Ins-form-g-28 Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

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Completed 2 July 2020

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