Fillable Ins-form-i-690 Application for Waiver of Grounds of Inadmissibility

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Ins-form-i-690 Application for Waiver of Grounds of Inadmissibility

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Form I-690 12/23/16 N Page 1 of 8
To be completed by an
attorney or accredited
representative (if any).
Application for Waiver of Grounds of Inadmissibility
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-690
OMB No. 1615-0032
Expires 12/31/2018
Action Block
Fee Receipt Number (This application):
Alien Registration Number (A-Number of This Applicant):
A-
Part 1. Information About You (the Applicant)
APPLICANT: Start here. Type or print in black ink. Read the instructions before completing this application. If you need extra
space to complete any item within this application, use Part 6. Additional Information or attach a separate sheet of paper; type or
print your name and Alien Registration Number (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.
►
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
City or Town State ZIP Code
In Care Of Name (if any)
Street Number and Name
Apt. Flr. NumberSte.
Postal CodeProvince
Country
NoYesIs your current mailing address the same as your physical address?3.
If you answered "No" to Item Number 3., provide your physical address in Item Number 4.
For Government Use Only
2.
Mailing Address
Your Current Legal Name
1.
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Form I-690 12/23/16 N Page 2 of 8
U.S. Social Security Number (if any) 9.
Alien Registration Number (if any)
►
7. 8.
Date of Birth (mm/dd/yyyy)
Part 1. Information About You (the Applicant) (continued)
Part 2. Additional Information About You
1.
Type of Primary Application Permanent Residence (Form I-698) Temporary Residence (Form I-687 or Form I-700)2.
(mm/dd/yyyy) ►Date Primary Application Filed
Relating Receipt Number3.
I am applying for a waiver of (Select all that apply):
INA section (Please see the instructions for more information on these sections)
4.
212 (a) (1)(A)(i), (ii), (iii) or (iv) 212 (a)(2)(A)(i)(II)
212 (a)(6)(A)(i)
212(a)(8)(A) and/or (B)212(a)(6)(D) and/or (E)
212(a)(6)(C)(i) or (ii)
212(a)(9)(A)(i) or (ii)
212(a)(9)(B)(i)(I) or (i)(II) 212(a)(9)(C)(i)(I) or (i)(II)
212 (a)(10)(A), (B), (C), (D) and/or Other Inadmissibility - Specify below
List specific reasons for inadmissibility.5.
►
A-
►
Country of Birth City/Town/Village of Birth5. 6.
Other Information
Street Number and Name Apt. Flr. NumberSte.
City or Town State ZIP Code
Postal CodeProvince
Country
4.
Physical Address
►
USCIS Online Account Number (if any) 10.
Form I-690 12/23/16 N Page 3 of 8
Part 2. Additional Information About You (continued)
C. Your Relative's Information
B. Your Relative's Information
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Street Number and Name
Apt. Flr. NumberSte.
City or Town State ZIP Code
Date of Birth (mm/dd/yyyy) Relationship A-Number (if any)
►
A-
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Street Number and Name
Apt. Flr. NumberSte.
City or Town State ZIP Code
Date of Birth (mm/dd/yyyy)
Relationship
A-Number (if any)
►
A-
6. List all immediate relatives in the United States (Parents, spouse, and children). If you need more space, use Part 6. Additional
Information or attach an additional sheet.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Street Number and Name
Apt. Flr. NumberSte.
City or Town State ZIP Code
A. Your Relative's Information
Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status,
deferred action recipient)
Date of Birth (mm/dd/yyyy) Relationship
A-Number (if any)
►
A-
Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status,
deferred action recipient)
Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status,
deferred action recipient)
Form I-690 12/23/16 N Page 4 of 8
Part 2. Additional Information About You (continued)
I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for
granting a waiver. If you need more space, Part 6. Additional Information or attach a separate sheet of paper; type or print
your name and Alien Registration Number (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.
Part 3. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature
in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center
with me, and I understand the ASC Acknowledgement.
I have requested the services of and consented to
who
2.
NOTE: Select the box for either Item Number A. or B. If applicable, select the box for Item Number 2.
A.
1.
B.
I can read and understand English, and have read and understand every question and instruction on this application, as
well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS
Application Support Center.
I understand every question and instruction on this application as translated to me by my interpreter, and have provided
complete, true, and correct responses in the language indicated above. The interpreter named in Part 4. has also read
the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am
fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter.
answer to every question, in
The interpreter named in Part 4. has also read to me every question and instruction on this application, as well as my
, a language in which I am fluent.
,
is not an attorney or accredited representative, preparing this application for me. This person who assisted me
7.
Applicant's Statement Regarding the Interpreter
Applicant's Statement Regarding the Preparer
D. Your Relative's Information
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Street Number and Name
Apt. Flr. NumberSte.
City or Town State ZIP Code
Date of Birth (mm/dd/yyyy) Relationship
A-Number (if any)
►
A-
NOTE: Read the information on penalties in the Penalties section of the Form I-690 Instructions before completing this part.
Applicant's Statement
is
Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status,
deferred action recipient)
Form I-690 12/23/16 N Page 5 of 8
Part 4. Interpreter's Contact Information, Certification, and Signature
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 3. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature (continued)
Applicant's Signature
Applicant's Certification
Applicant'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 my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
6.
(mm/dd/yyyy)
I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming
that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all
supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in
completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application
Support Center.
Provide the following information concerning the interpreter.
I, ,
Acknowledgement of Appointment at USCIS Application Support Center
understand that the purpose of a USCIS ASC appointment is for me to provide my fingerprints, photograph, and/or signature and to
re-affirm that all of the information in my application is complete, true, and correct and was provided by me. I understand that I will sign
my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature
during my ASC appointment:
Applicant's Contact Information
3. 4.Applicant's Daytime Telephone Number Applicant's Mobile Telephone Number (if any)
5. Applicant's Email Address (if any)
By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request, as
identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or
requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and
that all of the information in these materials is complete, true, and correct.
I certify, under penalty of perjury, that the information in my application and any document submitted with my application were
provided by me and are complete, true, and correct.
Form I-690 12/23/16 N Page 6 of 8
Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Application, If Other Than the Applicant
Preparer's Full Name
Provide the following information concerning the preparer.
Preparer's Given Name (First Name)
Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any)
2.
Part 4. Interpreter's Contact Information, Certification, and Signature (continued)
Date of SignatureInterpreter's Signature
I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant, in the same language
provided in Part 3., Item B., Item Number 1. The applicant has informed me that he or she understands every instruction and
question on the application, as well as the answer to every question, and the applicant verified the accuracy of every answer; and
The applicant has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC
biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the
contents of this application and all supporting documentation are complete, true, and correct.
Interpreter's Certification
Interpreter's Signature
I certify that:
I am fluent in English and
I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language
provided in Part 3., Item B., in Item Number 1.; and
6.
(mm/dd/yyyy)
, which is the same language provided in Part 3.,
Item B., in Item Number 1.
Interpreter's Mailing Address
3.
City or Town
State ZIP Code
Postal CodeProvince
Street Number and Name Apt. Flr. NumberSte.
Country
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number Interpreter's Email Address (if any)5.
Form I-690 12/23/16 N Page 7 of 8
I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the
applicant's consent.
I am an attorney or accredited representative and my representation of the applicant in this case (choose one)
does not extend beyond the preparation of this application.
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 application on behalf of, at the request of,
and with the express consent of the applicant. I completed this application based only on responses the applicant provided to me.
After completing the application, I reviewed it and all of the applicant's responses with the applicant, who agreed with every answer
on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the
application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and
the applicant has informed me that he or she understands the ASC Acknowledgement.
8.
Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Application, If Other Than the Applicant (continued)
Preparer's Statement
NOTE: We recommend that you print a copy of your completed application for your records. If you are required to appear for a
biometric services appointment at a USCIS ASC, you should bring a copy of your completed application with you.
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Fax Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
3. Street Number and Name Apt. Flr. NumberSte.
Preparer's Mailing Address
City or Town State ZIP Code
Postal CodeProvince Country
extends
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application,
you must submit a completed Form G-28, Notice of Attorney or Accredited Representative, with this petition.
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
instructions, your application may be denied.
Form I-690 12/23/16 N Page 8 of 8
Part 6. Additional Information
If you need extra space to provide any additional information within this application, use the space below or attach a separate sheet of
paper. If you need more space than what is provided, you may make copies of this page to complete and file with this application or
attach a separate sheet of paper. Include 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-Number (if any) ►
A-
3.A.
2.
Page Number 3.B. Part Number 3.C. Item Number
3.D.
Page Number
5.A.
Page Number
Part Number Item Number6.C.6.B.
6.D.
6.A.
5.D.
5.B. 5.C.
Item NumberPart NumberPage Number
Part Number Item Number
1. Family Name (Last Name) Given Name (First Name)
Middle Name
4.C.4.B.
4.D.
4.A.
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Ins-form-i-690 Application for Waiver of Grounds of Inadmissibility

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Completed 2 July 2020

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