Fillable Ins-form-i-698 Form I-698

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Ins-form-i-698 Form I-698

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Form I-698 04/28/19
Application to Adjust Status From Temporary
to Permanent Resident (Under Section 245A of the INA)
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-698
OMB No. 1615-0035
Expires 04/30/2021
START HERE - Type or print in black ink.►
Family Name (Last Name) Given Name (First Name)
Middle Name
1.
Part 1. Information About You
Any Other Names Used
5.
In Care Of Name
U.S. Mailing Address
2.
3.
Name as it Appears on Your Employment Authorization Document (Form I-766)
City or Town
State ZIP Code
Street Number and Name Flr.Ste.Apt.
Family Name (Last Name) Given Name (First Name) Middle Name
Family Name (Last Name) Given Name (First Name) Middle Name
Family Name (Last Name) Given Name (First Name) Middle Name
B.
A.
Is your current U.S. mailing address the same as your U.S. physical address?
If you answered "No," provide your U.S. physical address in Item Number 7.
6.
NoYes
For
USCIS
Use
Only
Date of Adjustment
Applicant Interviewed
Action BlockReceipt
Date:
Remarks
Date:
Number
A.
Provide the reason for a difference in the names, if any (marriage, divorce, etc.)
B.
Full Legal Name
If your native alphabet does not use Roman letters, type or print your name in your native alphabet.4.
Language of Your Native Alphabet
Family Name (Last Name) Given Name (First Name) Middle Name
A.
B.
Page 1 of 9
(USPS ZIP Code Lookup)
Form I-698 04/28/19
City or Town
Country of Citizenship or Nationality
CountryProvince or Foreign State
11.
12.
Marital Status16. Divorced or SeparatedMarried WidowedSingle (Never Married)
9.
Date of Birth (mm/dd/yyyy)
U.S. Social Security Number (if any)
15. Father's First NameMother's First Name14.
Part 1. Information About You (continued)
A-
Place of Birth
8. Alien Registration Number (A-Number) (if any)
►
A-
Gender
Male
Female
10.
13.
Feet
Race (Select all applicable boxes)
Native Hawaiian or
Other Pacific Islander
Black or African
American
American Indian or
Alaska Native
Height
2.
WeightInches
1.
Pounds
Blue Green Hazel Pink Unknown/OtherMaroonGrayBrown
3.
Eye Color (Select only one box)
Hair Color (Select only one box)
4.
Black Brown Red White
Unknown/
Other
SandyGrayBlond
Bald
(No Hair)
5.
Asian
White
Not Hispanic or LatinoHispanic or Latino
Ethnicity (Select only one box)
6.
Part 2. Biographic Information
List absences from the United States since becoming a temporary resident. List the most recent absence first. If you have a single
absence that exceeded 30 days or if the total of all of your absences exceeds 90 days, explain using the space provided in Part 8.
Additional Information or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of the
sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
From
(mm/dd/yyyy)
To
(mm/dd/yyyy)
Country Purpose of Trip
Total Days
Absent
17.
Black
►
U.S. Physical Address
Street Number and Name
City or Town State ZIP Code
Flr.Ste.Apt.
7.
Number
Page 2 of 9
Form I-698 04/28/19
Satisfactory pursuit of a course of study recognized by the Secretary (attach appropriate documentation); or
I have satisfied these requirements by:
B.
An 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.)
A-
Answer Item Numbers 2. - 29. If you answer "Yes" to any of the questions, provide a complete explanation using the space provided
in Part 8. Additional Information or attach 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.
Answering "Yes" does not necessarily mean that you are not entitled to adjust status or register for lawful permanent residence.
Have you EVER received a suspended sentence, been placed on probation, or been paroled? Yes No
Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example,
diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Yes No
Have you EVER been in jail or prison?
Yes No
Have you EVER been charged with committing any crime or offense?
3.
4.
5.
6.
7.
8.
9.
Have you EVER been treated for a mental disorder, drug addiction, or alcoholism?
Yes No
Have you EVER committed a crime or offense for which you were not arrested?
NoYes
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?
Yes No
2.
Have you EVER been convicted of a crime or offense?
Yes No
Yes No
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?
NoYes
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?
NoYes
10.
Full Name of Recipient (Family Name, Given Name, Middle Name) U.S. Social Security Number
Illicitly trafficked in any controlled substance or knowingly assisted, abetted, or colluded in the illicit
trafficking of any controlled substance?
Within the past 10 years been a prostitute, procured anyone for prostitution, or intend to engage in such
activities in the future?
11.
Have you EVER:
Yes No
Yes No
Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States
illegally?
Yes No
Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Yes No
A.
B.
C.
D.
Part 3. Eligibility Standards
12.
B.
A.
If "Yes," provide the names of the recipients and their U.S. Social Security Numbers below.
You are required to have a minimal understanding of standard English and a knowledge and understanding of the history and
Government of the United States. Select the appropriate box in Item A. or B. below.
1.
I will satisfy these requirements through:A.
An examination at the time of interview for lawful permanent residence; or
Satisfactory pursuit of a course of study recognized by the Secretary of Homeland Security (Secretary).
Page 3 of 9
Form I-698 04/28/19
Part 3. Eligibility Standards (continued)
A-
Do you intend to engage in the United States in:
Espionage? Yes
No
Any activity to violate or evade any law prohibiting the export from the United States of goods,
technology, or sensitive information?
Yes No
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?
Yes No
A.
B.
C.
Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that
involved detaining persons?
14.
15. Have you EVER been a member of, or in any way affiliated with, a Communist Party or any other
totalitarian party?
Yes No
Did you EVER, 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, order, incite, assist, or otherwise participate in the persecution of any person because of race,
religion, national origin, or political opinion?
Yes No
Have you EVER been deported from the United States, 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?
Yes No
17.
Have you EVER claimed to be a United States citizen in writing or any other way?
Yes No
16.
Are you NOW under a final order of civil penalty for violating section 274C of the Immigration and
Nationality Act (INA) for use of fraudulent documents or have you EVER, by fraud or willful
misrepresentation of a material fact, sought to procure or procured a visa, other documentation, entry into
the United States, or any immigration benefit?
18.
Yes No
Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?
22.
Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:
Yes No
Yes No
Yes No
Yes No
Yes No
Do you plan to practice polygamy in the United States?
Yes No
Are you NOW withholding custody of a U.S. citizen child outside the United States from a person granted
custody of the child?
Yes
No
23.
21.
Acts involving torture or genocide?
Killing any person?
Intentionally and severely injuring any person?
Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?
Limiting or denying any person's ability to exercise religious beliefs?
A.
B.
C.
D.
E.
19.
Yes No20.
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?
Yes No
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?
24.
Have you EVER:
Yes No
Yes NoA.
B.
25.
Have you EVER engaged in, conspired to engage in, do you intend to engage in, or have you EVER
solicited membership or funds for, or have you EVER through any means 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?
NoYes13.
Page 4 of 9
Form I-698 04/28/19
is not an attorney or accredited representative, preparing this application for me. This person who assisted me
in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center
with me and I understand the ASC Acknowledgement.
Part 3. Eligibility Standards (continued)
A-
Yes No
Yes NoRecruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed
force or group?
Used any person under 15 years of age to take part in hostilities, or to help or provide services to
people in combat?
A.
B.
Have you EVER:29.
Part 4. Accommodations for Individuals With Disabilities and Impairments (Read the information in the
Form I-698 instructions before completing this part.)
Are you requesting an accommodation because of your disabilities and/or impairments? Yes No1.
If you answered "Yes," Select all applicable boxes.
A.
I am blind or have low vision and request the following accommodations:
C.
I have another type of disability and/or impairment (describe the nature of your disabilities and/or impairments and the
accommodations you are requesting):
B.
I am deaf or hard of hearing and request the following accommodations (if you are requesting a sign-language interpreter,
indicate for which language (e.g., American Sign Language)):
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.
Part 5. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature
The interpreter named in Part 6. has read to me every question and instruction on this application, as well as my
A.
B.
Applicant's Statement Regarding the Interpreter1.
, a language in which I
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, Selectthe box for Item Number 2.
answer to every question, in
am fluent. 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 Part 6. 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 ASC Acknowledgement as read to me by my interpreter.
Applicant's Statement Regarding the Preparer2.
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?
Have you EVER assisted or participated in selling, providing, or transporting weapons to any person who,
to your knowledge, used them against another person?
26.
Yes
No
Yes No
Have you EVER received any type of military, paramilitary or weapons training?
27.
Yes No28.
Page 5 of 9
I have requested the services of and consented ,
who is
Form I-698 04/28/19
A-
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.
Applicant's Signature Date of Signature (mm/dd/yyyy)
6.
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 of U.S. immigration laws.
Applicant's Certification
Part 5. Applicant's Statement, Contact Information, ASC Acknowledgement,
Certification, and Signature (continued)
Acknowledgement of Appointment at USCIS Application Support Center
I, , understand that the purpose of a USCIS Application Support
Center (ASC) appointment is for me to provide 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:
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 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 with me.
Applicant's Signature
Interpreter's Full Name
Provide the following information concerning the interpreter.
Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name)
1.
Part 6. Interpreter's Contact Information, Certification, and Signature
Applicant's Email Address (if any)5.
Applicant's Daytime Telephone Number 3. 4. Applicant's Mobile Telephone Number (if any)
Applicant's Contact Information
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 I seek.
Interpreter's Business or Organization Name (if any)
2.
Page 6 of 9
Form I-698 04/28/19
A-
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
6.
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 5., Item B. in Item Number 1.; 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, photographs, 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 Mailing Address
Interpreter's Daytime Telephone Number
3.
4.
City or Town
State ZIP Code
Street Number and Name Flr.Ste.Apt.
Interpreter's Email Address (if any)
Postal Code CountryProvince
Interpreter's Contact Information
Interpreter's Certification
I am fluent in English and
I certify that:
Part 6. Interpreter's Contact Information, Certification, and Signature
(continued)
Interpreter's Signature
Part 7. Contact Information, Statement, Certification, and Signature of the Person Preparing This
Application, If Other Than the Applicant
Provide the following information concerning the preparer.
Preparer's Family Name (Last Name) Preparer's Given Name (First Name)1.
Preparer's Full Name
I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant in the same language
provided in Part 5., Item B. in 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
Number
Preparer's Business or Organization (if any)
2.
5.
, which is the same language
provided in Part 5., Item B. in Item Number 1.;
Page 7 of 9
Form I-698 04/28/19
I am an attorney or accredited representative and my representation of the applicant in this case
extends does not extend beyond the preparation of this application.
Preparer's Certification
Preparer's Daytime Telephone Number 4.
Preparer's Email Address (if any)6.
5. Preparer's Fax Telephone Number
I am not an attorney or accredited representative but have prepared this application on behalf of the applicant
and with the applicant's consent.
Preparer's Signature Date of Signature (mm/dd/yyyy)
8.
Preparer's Contact Information
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.
7.
Part 7. Contact Information, Statement, Certification, and Signature of the
Person Preparing This Application, If Other Than the Applicant (continued)
3.
City or Town State ZIP Code
Street Number and Name Flr.Ste.Apt.
Postal Code CountryProvince
Preparer's Mailing Address
A-
Preparer's Statement
B.
Preparer's Signature
Number
A.
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 Entry of Appearance as Attorney or Accredited Representative, with this application.
Page 8 of 9
Form I-698 04/28/19
Part 8. Additional Information
If you need extra space to provide any additional information within this application, 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 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-
Page Number
Part Number Item Number
D.
Family Name (Last Name) Given Name (First Name) Middle Name1.
2.
3.
D.
D.
D.
B. C.
Page Number
Part Number
Item Number4. B. C.
Page Number
Part Number Item Number
5. B. C.
Page Number
Part Number Item Number
6. B. C.
A.
A.
A.
A.
Page 9 of 9
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Completed 2 July 2020

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