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,
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.
Part 5. Applicant's Statement, Contact
Information, Declaration, Certification, and
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
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.
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.
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.