Fillable form i-192 application for advance permission to enter nonimmigrant

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Form I-192 04/09/19 Page 1 of 11
START HERE - Type or print in black ink.►
Attorney State Bar Number
(if applicable)
Select this box if
Form G-28 or
Form G-28I is
attached.
Volag Number
(if any)
To be completed by an attorney or accredited representative (if any).
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Application for Advance Permission to Enter
as a Nonimmigrant
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-192
OMB No. 1615-0017
Expires 04/30/2021
I am applying to the Secretary of Homeland Security for
permission to enter the United States temporarily under the
provisions of the Immigration and Nationality Act (INA)
section 212(d)(3)(A)(ii), section 212(d)(13), or section
212(d)(14).
I am seeking this permission so that I may obtain (select only
one box):
Admission as a nonimmigrant (other than as a T or U
nonimmigrant).
Status as a victim of trafficking (T nonimmigrant
status) or a victim of a crime (U nonimmigrant
status).
1.
2.
Part 1. Application Type Part 2. Information About You
Your Full Name
1.a.
1.b.
1.c.
Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Received Returned Trans. Out
Trans. In Completed
Fee Stamp
Action by the Department of Homeland Security
T Nonimmigrant/Waiver under INA 212(d)(13) and 8 CFR 212.16
U Nonimmigrant/Advance Permission under INA 212(d)(3)(A) and
8 CFR 212.17
U Nonimmigrant/Waiver under INA 212(d)(14) and 8 CFR 212.17
Granted, subject to revocation at any time,
upon the following terms and conditions
Nonimmigrant other than T or U nonimmigrant/Advance Permission
under INA 212(d)(3)(A) and 8 CFR 212.4
INA 212(a)(6)
T Nonimmigrant/Advance Permission under INA 212(d)(3) and
8 CFR 212.16
INA 212(a)(2)
INA 212(a)(1)
Action Stamp
Benefits Category:
INA 212(a)(3)
INA 212(a)(10)
INA 212(a)(4)
Other:
Ground of Inadmissibility
Date of Action (mm/dd/yyyy) DD or OIC Office
INA 212(a)(9)
For DHS Use Only
INA 212(a)(8)
INA 212(a)(9)
Form I-192 04/09/19 Page 2 of 11
3.c. Middle Name
3.b. Given Name
(First Name)
3.a. Family Name
(Last Name)
Alien Registration Number (A-Number) (if any)
USCIS Online Account Number (if any)
Date of Birth (mm/dd/yyyy)
►
A-
4.
5.
6.
►
Other Information
Part 2. Information About You (continued)
8.a.
8.b.
8.c.
Place of Birth
City or Town
State or Province
Country
Country of Citizenship or Nationality9.
7. FemaleGender Male
Safe Mailing Address
If you are a T or U visa applicant, and do not want U.S.
Citizenship and Immigration Services (USCIS) to send notices
about this application to your home, you may provide a safe
mailing address.
11.a. In Care Of Name (if any)
Organization Name (if applicable)11.b.
11.c.
11.d.
11.e.
11.f.
11.h.
11.j.
11.i.
City or Town
Province
Country
Postal Code
ZIP Code11.g.State
Street Number
and Name
Apt. Ste. Flr.
Mailing Address
10.b.
10.c.
10.d.
10.e.
10.g.
10.i.
10.h.
10.a.
City or Town
Province
Country
Postal Code
ZIP Code10.f.State
Street Number
and Name
Apt. Ste. Flr.
In Care Of Name (if any)
Provide all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 8.
Additional Information.
Other Names Used (if any)
Family Name
(Last Name)
2.a.
Given Name
(First Name)
2.b.
Middle Name2.c.
(USPS ZIP Code Lookup)
Form I-192 04/09/19 Page 3 of 11
Part 2. Information About You (continued)
Physical Address 2
14.a.
14.b.
14.c.
14.d.
14.f.
14.h.
14.g.
City or Town
Province
Country
Postal Code
ZIP Code14.e.State
Street Number
and Name
Apt. Ste. Flr.
Dates of Residence
From (mm/dd/yyyy)
15.b.
To (mm/dd/yyyy)
15.a.
18.h.
18.g.
Country
Postal Code
Dates of Residence
From (mm/dd/yyyy)
19.b. To (mm/dd/yyyy)
19.a.
18.c.
18.d.
18.f.
City or Town
Province
ZIP Code18.e.State
Physical Address 4
18.a.
18.b.
Street Number
and Name
Apt. Ste. Flr.
Physical Address 3
16.a.
16.b.
16.c.
16.d.
16.f.
16.h.
16.g.
City or Town
Province
Country
Postal Code
ZIP Code16.e.State
Street Number
and Name
Apt. Ste. Flr.
Dates of Residence
From (mm/dd/yyyy)
17.b.
To (mm/dd/yyyy)
17.a.
Address History
Provide physical addresses for everywhere you have lived
during the last five years, whether inside or outside the United
States. Provide your current address first. If you need extra
space to complete this section, use the space provided in Part 8.
Additional Information.
Physical Address 1 (current address)
12.a.
12.b.
12.c.
12.d.
12.f.
12.h.
12.g.
City or Town
Province
Country
Postal Code
ZIP Code12.e.State
Street Number
and Name
Apt. Ste.
Flr.
Dates of Residence
From (mm/dd/yyyy)
13.b.
To (mm/dd/yyyy)
13.a.
Form I-192 04/09/19 Page 4 of 11
Part 2. Information About You (continued)
Immigration and Criminal History
26.
Have you previously filed an application for advance
permission to enter the United States as a nonimmigrant?
Do you believe that you may be inadmissible to the
United States?
If you answered "Yes" to Item Number 26., explain the
reasons why you believe, according to the best of your
knowledge, that you may be inadmissible in Part 8.
Additional Information. If you were told that you are
inadmissible, provide the reason you were given.
If you answered "Yes" to Item Number 27., provide the
details in Item Numbers 28. - 29.e. If you need extra
space to complete this section, use the space provided in
Part 8. Additional Information.
Yes No
Yes No
27.
If you (or somebody else on your behalf) have filed multiple
applications or petitions for immigration benefits with the U.S.
Government, use the space provided in Part 8. Additional
Information to provide the answers to Item Numbers
32.a. - 32.c. for each of your additional applications or petitions.
32.a.
Location Where You (or the Other Person) Filed the
Application or Petition (for example, USCIS office or
Port-of-Entry);
Outcome of the Application or Petition (for example,
approved, denied, or is pending).
Type of Application or Petition Filed
32.b.
32.c.
28. Date Application Filed (mm/dd/yyyy)
USCIS Office or U.S. Port-of-Entry
Location where you filed your application (for example, USCIS
Office or Port-of-Entry).
29.b.
State or Province
29.d.
Receipt Number (if available)29.e.
Country
29.c.
City or Town
►
29.a.
30. Have you EVER been in the United States for a period of
six months or more?
If you answered "Yes" to Item Number 30., provide the
dates you were in the United States (from and to) and
your immigration status at the time of entry into the
United States in the space provided in Part 8. Additional
Information.
Yes No
31. Have you EVER filed an application or petition for
immigration benefits with the U.S. Government, or has
one ever been filed on your behalf?
Yes No
If you answered "Yes" to Item Number 31., provide the
information requested in Item Numbers 32.a. - 32.c.
Travel Information
20.a.
20.b.
Location at Which you Plan to Enter the United States (desired
Port-of-Entry)
City
State
21. Name of Port-of-Entry
How do you plan to travel to the United States?
(For example, by plane, ship, car)
When do you plan to enter the United States? (mm/dd/yyyy)23.
24. Approximate Length of Stay in the United States
NOTE: If you are applying for T or U nonimmigrant status and
are in the United States, you may skip Item Numbers 20. - 25.
25. What is the purpose of your stay in the United States?
Explain fully below.
22.
Form I-192 04/09/19 Page 5 of 11
Black
Gray Green
Maroon Pink
Hazel
BrownBlue
Eye Color (Select only one box)5.
Unknown/Other
Hair Color (Select only one box)
Black
Brown Red
White
Unknown/OtherSandy
Gray
BlondBald (No hair)
6.
Part 4. Other Information About You
Employment History
Provide your employment history for the last five years,
whether inside or outside the United States. Provide the most
recent employment first. If you need extra space to complete
this section, use the space provided in Part 8. Additional
Information.
Employer 1 (current or most recent)
Address of Employer or Company
Name of Employer or Company1.
2.a.
2.b.
2.c.
2.d.
2.f.
2.h.
2.g.
City or Town
Province
Country
Postal Code
ZIP Code2.e.State
Street Number
and Name
Apt. Ste. Flr.
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Dates of Employment
4.a.
4.b.
Your Occupation3.
Part 3. Biographic Information
1.
Not Hispanic or Latino
Hispanic or Latino
Ethnicity (Select only one box)
Height3. Feet Inches
Weight Pounds4.
Race (Select all applicable boxes)
Native Hawaiian or Other Pacific Islander
Black or African American
2.
Asian
American Indian or Alaska Native
White
33. Have you EVER been denied or refused an immigration
benefit by the U.S. Government, or had a benefit revoked
or terminated (including but not limited to visas)?
Yes No
If you answered "Yes" to Item Number 33., provide an
explanation the information in the space provided in
Part 8. Additional Information.
34. Have you EVER, in or outside the United States, been
arrested, cited, charged, indicted, fined, convicted, or
imprisoned for breaking or violating any law or
ordinance, excluding minor traffic violations?
If you answered "Yes" to Item Number 34., describe the
incidents in detail and include all offenses where impaired
driving may have been an issue in the space provided in
Part 8. Additional Information.
Yes No
Part 2. Information About You (continued)
Form I-192 04/09/19 Page 6 of 11
Part 4. Other Information About You (continued)
14. Current City or Town of Residence (if living)
Current Country of Residence (if living)
15.
Information About Your Father
Father's Legal Name
16.c. Middle Name
16.b. Given Name
(First Name)
16.a. Family Name
(Last Name)
Father's Name at Birth (if different than above)
17.c. Middle Name
Date of Birth (mm/dd/yyyy)
17.b. Given Name
(First Name)
17.a. Family Name
(Last Name)
18.
19.
20.
City or Town of Birth
Country of Birth
21. Current City or Town of Residence (if living)
Current Country of Residence (if living)22.
Information About Your Marital History
23. What is your current marital status?
How many times have you been married (including
annulled marriages and marriages to the same person)?
24.
Widowed
Marriage Annulled
Legally Separated
DivorcedMarried
Single, Never Married
Other
►
Employer 2
Address of Employer or Company
Name of Employer or Company5.
6.a.
6.b.
6.c.
6.d.
6.f.
6.h.
6.g.
City or Town
Province
Country
Postal Code
ZIP Code6.e.State
Street Number
and Name
Apt. Ste. Flr.
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Dates of Employment
Your Occupation7.
8.a.
8.b.
Information About Your Parents
Information About Your Mother
Mother's Legal Name
9.c. Middle Name
9.b. Given Name
(First Name)
9.a. Family Name
(Last Name)
Mother's Name at Birth (if different than above)
10.c. Middle Name
10.b. Given Name
(First Name)
10.a. Family Name
(Last Name)
Date of Birth (mm/dd/yyyy)11.
12. City or Town of Birth
13.
Country of Birth
Form I-192 04/09/19 Page 7 of 11
Part 4. Other Information About You (continued)
32. Prior Spouse's Date of Birth (mm/dd/yyyy)
Date of Marriage to Prior Spouse (mm/dd/yyyy)33.
Place of Marriage to Prior Spouse
Information About Prior Marriages (if any)
If you have been married before, whether in the United States or
in any other country, provide the information requested in Item
Numbers 31.a. - 36.c. about your prior marriage. If you have
had more than one previous marriage, use the space provided in
Part 8. Additional Information to provide the answers to Item
Numbers 31.a. - 36.c. for each additional marriage.
Prior Spouse's Legal Name (provide family name before
marriage)
31.c. Middle Name
31.b. Given Name
(First Name)
31.a. Family Name
(Last Name)
34.a. City or Town
34.b. State or Province
Country34.c.
Date Marriage with Prior Spouse Legally Ended
(mm/dd/yyyy)
35.
Place Where Marriage with Prior Spouse Legally Ended
36.a.
City or Town
36.b. State or Province
Country36.c.
Information About Your Current Marriage
(including if you are legally separated)
If you are currently married, provide the following information
about your current spouse.
Current Spouse's Legal Name
25.c. Middle Name
25.b. Given Name
(First Name)
25.a. Family Name
(Last Name)
26.
27.
A-Number (if any)
►
A-
Current Spouse's Date of Birth (mm/dd/yyyy)
Date of Marriage to Current Spouse (mm/dd/yyyy)28.
Current Spouse's Place of Birth
29.a. City or Town
29.b. State or Province
Country29.c.
Place of Marriage to Current Spouse
30.a.
City or Town
30.b. State or Province
Country30.c.
Form I-192 04/09/19 Page 8 of 11
Part 6. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Family Name (Last Name)1.a.
Interpreter's Given Name (First Name)1.b.
2. Interpreter's Business or Organization Name (if any)
Interpreter's Full Name
Provide the following information about the interpreter.
I understand that DHS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information
contained in, and submitted with, my application; and
2) All of this information was complete, true, and correct
at the time of filing.
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.
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.
Date of Signature (mm/dd/yyyy)6.b.
Applicant's Signature6.a.
Applicant's Signature
Part 5. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature
NOTE: Read the Penalties section of the Form I-192
Instructions before completing this section.
The interpreter named in Part 6. read to me every
question and instruction on this application and my
answer to every question in
a language in which I am fluent, and I understood
everything.
,
1.b.
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.
1.a.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
2. At my request, the preparer named in Part 7.,
prepared this application for me based only upon
information I provided or authorized.
,
Applicant's Statement
3. Applicant's Daytime Telephone Number
Applicant's Contact Information
Applicant's Email Address (if any)5.
Applicant's Mobile Telephone Number (if any)4.
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that the U.S. Department of Homeland Security (DHS) may
require that I submit original documents to DHS at a later date.
Furthermore, I authorize the release of any information from
any and all of my records that DHS may need to determine my
eligibility for the immigration benefit that I seek.
Applicant's Declaration and Certification
I furthermore authorize release of information contained in this
application, in supporting documents, and in my DHS records,
to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
Form I-192 04/09/19 Page 9 of 11
2. Preparer's Business or Organization Name (if any)
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
Part 7. 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.
3.d.
State
3.e. ZIP Code
3.f. Province
3.h. Country
Preparer's Mailing Address
3.c. City or Town
Street Number
and Name
3.a.
3.b. Ste. Flr.Apt.
3.g. Postal Code
Preparer's Contact Information
4. Preparer's Daytime Telephone Number
6. Preparer's Email Address (if any)
5. Preparer's Mobile Telephone Number (if any)
Interpreter's Mailing Address
3.h.
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f. Province
Street Number
and Name
3.a.
Country
3.b.
Ste. Flr.Apt.
3.g. Postal Code
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)6.
Interpreter's Mobile Telephone Number (if any)5.
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature7.a.
Interpreter's Signature
Interpreter's Certification
I certify, under penalty of perjury, that:
which is the same language specified in Part 5., 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.
I am fluent in English and
,
Part 6. Interpreter's Contact Information,
Certification, and Signature (continued)
Form I-192 04/09/19 Page 10 of 11
NOTE: If you are an attorney or accredited
representative, you may need 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 the Geographical Confines of the
United States, with this application.
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Signature
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 Certification
7.b.
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.
I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.
7.a.
Preparer's Statement
Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Form I-192 04/09/19 Page 11 of 11
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. 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.
3.d.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
3.a. 3.b. 3.c.Page Number Part Number Item Number
►
A-
A-Number (if any)2.
4.d.
4.a. 4.b. 4.c.Page Number Part Number Item Number
5.d.
5.a. 5.b. 5.c.Page Number Part Number Item Number
Item NumberPart NumberPage Number 7.c.7.b.7.a.
7.d.
6.d.
6.a. 6.b. 6.c.Page Number Part Number Item Number
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form i-192 application for advance permission to enter nonimmigrant

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Completed 18 February 2020

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