Fillable Ins-form-i-824 Form I-824

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Ins-form-i-824 Form I-824

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The Ins-form-i-824 Form I-824 form is 7 pages long and contains:

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  • 36 check-boxes
  • 164 other fields

Country of origin: US
File type: PDF

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Select this box if
Form G-28 or G-28I
is attached.
Application for Action on an Approved Application or Petition
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-824
OMB No. 1615-0044
Expires 11/30/2021
START HERE - Type or print in black ink.►
To be completed
by an attorney or
BIA-accredited
representative (if any).
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Relocated
For
USCIS
Use
Only
Date Date
Action Block
Sent
Date Date
Received
Returned
Fee Stamp
Resubmitted
Remarks
Country of Chargeability:
Priority Date:
Date the Previous Visa Petition Was Approved
(Form I-130, I-140 or I-360):
Classification Code:
Date the Previously Approved Visa Petition
Was Filed (Form I-130, I-140 or I-360):
on the previously approved application or petition.
I am the (select only one):
Applicant Petitioner
Part 1. Information About You (Person filing this
Application)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
3. Company or Organization Name (if any)
NOTE: If you are a U.S. citizen, type or print “N/A”
for Item Number 4.
Current/Recent Immigration Status
A-
►
1.
4.
Certificate of Naturalization or Citizenship Number
(if any)
5.
Alien Registration Number (A-Number) (if any)6.
7. Date of Birth (mm/dd/yyyy)
8. Country
of Birth
10. IRS Tax Number (if any)
U.S. Social Security Number (if any)11.
►
USCIS Online Account Number (if any)12.
►
Mailing Address
13.d.
13.e.
13.b.
13.c.
City or Town
13.f.
Street Number
and Name
Apt. Flr.Ste.
13.h.
13.i.
13.g.
9. Country of Citizenship or Nationality
Province
Country
Postal Code
ZIP CodeState
13.a. In Care Of Name
Page 1 of 7Form I-824 Edition 11/08/19
Part 1. Information About You (Person filing this
Application) (continued)
City or Town
14.e.14.d.
Physical Address
14.a. Street Number
and Name
14.b.
14.c.
Apt.
Flr.Ste.
14.h.
14.g.
Part 2. Reason for Request
I am requesting (select only one):
A duplicate approval notice.
U.S. Citizenship and Immigration Services (USCIS)
to notify a new U.S. Consulate, different from the
one that I originally requested, through the U.S.
Department of State's National Visa Center (NVC) or
Kentucky Consular Center. USCIS will notify the
U.S. Consulate about the approval of a nonimmigrant
visa petition or about a new Port-of-Entry (the Port-
of-Entry is different from what I originally requested)
about the approval of a waiver application.
Please notify the U.S. Consulate or Port-of-Entry at:
USCIS to notify a U.S. Consulate through the NVC
about my adjustment of status to permanent resident
in the United States.
Please notify the U.S. Consulate at:
USCIS to notify the U.S. Department of State that
I have become a U.S. citizen through naturalization.
USCIS to send my approved immigrant visa petition
to the NVC.
so that my spouse and/or children may accompany or
follow-to-join me.
1.a.
1.b.
1.c.
1.d.
1.e.
Part 3. Other Information
1.a. Form Number of Previously Approved Application or
Petition
1.b. Receipt Number (On Form I-797, Notice of Action)
1.c. Filing Date of Application or Petition (mm/dd/yyyy)
1.d. Approval Date (mm/dd/yyyy)
Provide the following information about the principal
beneficiary of the previous application or petition, if other
than you.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
Country of Birth2.e.
2.d. Date of Birth (mm/dd/yyyy)
A-
►
Alien Registration Number (A-Number) (if any)2.f.
Daytime Telephone Number2.g.
14.f.
Province
Country
Postal Code
ZIP CodeState
City or Town3.d.
Mailing Address
3.a. In Care Of Name
Street Number
and Name
3.b.
3.c. Apt. Flr.Ste.
ZIP Code
3.f.
State3.e
Province3.g.
3.h.
3.i. Country
Postal Code
Page 2 of 7Form I-824 Edition 11/08/19
Part 3. Other Information (continued)
If you selected Part 2., Item Number 1.c., provide the
following information about the dependents for whom you are
requesting follow-to-join benefits. If you need additional space
for your dependents, use the space provided in Part 7.
Additional Information, and include all the information
collected in Item Numbers 5.a. - 11.
Dependents
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c. Middle Name
Country of Birth
7.
Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality8.
9. Relationship to Principal Applicant
12.a. Family Name
(Last Name)
12.b. Given Name
(First Name)
12.c. Middle Name
Country of Birth14.
Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality15.
19.a. Family Name
(Last Name)
19.b. Given Name
(First Name)
19.c. Middle Name
Country of Birth21.
20. Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality22.
23. Relationship to Principal Applicant
16. Relationship to Principal Applicant
Dependent's Daytime Telephone Number
10
.
11
.
Dependent's Email Address (if any)
17. Dependent's Email Address (if any)
Dependent's Daytime Telephone Number18.
Dependent's Daytime Telephone Number25.
24. Dependent's Email Address (if any)
13.
6.
Physical Address
4.c.
4.a.
4.b.
City or Town
Street Number
and Name
Apt.
Flr.Ste.
ZIP Code
4.e.
State4.d.
4.g.
Province
4.h. Country
Postal Code
4.f.
Page 3 of 7Form I-824 Edition 11/08/19
Part 3. Other Information (continued)
Contact Information of Dependents
Foreign Telephone Number34.
Part 4. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature
NOTE: Read the Penalties section of the Form I-824
Instructions before completing this part.
NOTE: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.
1.a.
I can read and understand English, and I have read and
understand every question and instruction on this
application and my answer to every question.
Applicant's Statement
The interpreter named in Part 5. read to me every
question and instruction on this application and my
answer to every question in
1.b.
a language in which I am fluent, and I understood
everything.
,
At my request, the preparer named in Part 6.,
2.
prepared this application for me based only upon
information I provided or authorized.
,
5.
Applicant's Email Address (if any)
Applicant's Mobile Telephone Number (if any)4.
Applicant's Daytime Telephone Number3.
Applicant's Contact Information
City or Town33.d.
Foreign Address of Dependents
33.a. In Care Of Name
Street Number
and Name
33.b.
Apt. Flr.Ste.
33.f.
Province
33.g. Country
Postal Code
33.e.
26.a. Family Name
(Last Name)
26.b. Given Name
(First Name)
26.c. Middle Name
Country of Birth28.
27. Date of Birth (mm/dd/yyyy)
Country of Citizenship or Nationality29.
30. Relationship to Principal Applicant
Dependent's Email Address (if any)
Dependent's Daytime Telephone Number32.
31.
Applicant's Declaration and Certification
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 certify, under penalty of perjury, that all of the information in
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
application and that all of this information is complete, true, and
correct.
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 law.
33.c.
Page 4 of 7Form I-824 Edition 11/08/19
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b.
Apt. Flr.Ste.
Interpreter's Daytime Telephone Number
6.
4.
Interpreter's Email Address (if any)
Interpreter's Contact Information
Interpreter's Certification
I certify, under penalty of perjury, that:
which is the same language provided in Part 4., Item Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and
Certification, and has verified the accuracy of every answer.
Interpreter's Signature7.a.
7.b.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 5. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
Interpreter's Business or Organization Name (if any)2.
Provide the following information about the interpreter.
Applicant's Signature
Applicant's Signature
6.a.
6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
Part 4. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature (continued)
Part 6. Contact Information, Declaration,
and Signature of the Person Preparing this
Application, if Other Than the Applicant
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
Preparer's Business or Organization Name (if any)2.
Interpreter's Mobile Telephone Number (if any)5.
I am fluent in English and ,
Page 5 of 7Form I-824 Edition 11/08/19
Preparer's Statement
I am an attorney or accredited representative and
my representation of the applicant in this case
I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.
NOTE: If you are an attorney or accredited
representative, you may be obliged to 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 of the Geographical Confines of the
United States, with this application.
7.a.
7.b.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant.
The applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct.
I completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.
Preparer's Signature
Preparer's Signature8.a.
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Contact Information
Preparer's Daytime Telephone Number
6.
4.
Preparer's Email Address (if any)
Preparer's Mobile Telephone Number (if any)5.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b.
Apt. Flr.Ste.
Part 6. Contact Information, Declaration,
and Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
preparation of this application.
does not extend beyond the extends
Page 6 of 7Form I-824 Edition 11/08/19
Part 7. Additional Information
3.d.
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. 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.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
2. A-Number (if any)
3.a.
Page Number
3.b. Part Number 3.c. Item Number
6.a.
Page Number 6.b. Part Number 6.c. Item Number
6.d.
4.d.
4.a.
Page Number 4.b. Part Number 4.c. Item Number
5.d.
5.a.
Page Number 5.b. Part Number 5.c. Item Number
A-
►
7.a.
Page Number 7.b. Part Number 7.c. Item Number
7.d.
Page 7 of 7Form I-824 Edition 11/08/19
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Ins-form-i-824 Form I-824

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Completed 2 July 2020

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