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Application For Provisional Unlawful Presence Waiver I-601A - Official Federal Forms
| Application For Provisional Unlawful Presence Waiver Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Application for Provisional Unlawful Presence Waiver Department of Homeland Security U.S. Citizenship and Immigration Services Initial Receipt Fee Stamp USCIS Form I-601A OMB No. 1615-0123 Expires 03/31/2015 Action Block For USCIS Use Only Resubmitted Received Relocated Sent To Be Completed by an Attorney or BIA-Accredited Representative, if any. Check box if G-28 is attached to represent the applicant. Attorney State License Number: START HERE - Type or print in black ink. Part 1. Information About Applicant Provide the following information about yourself. 1. Alien Registration Number (A-Number) (if applicable) 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name A2. U.S. Social Security Number (optional) Home Address (where you physically reside) 6.a. Street Number and Name 6.b. Apt. Ste. Flr. Your Full Name 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 6.c. City or Town 6.d. State 6.e. Zip Code Mailing Address (if different from Home Address) 7.a. In Care Of Name Other Names Used (if any) 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 7.b. Street Number and Name 7.c. Apt. Ste. Flr. 7.d. City or Town 7.e. State 7.f. Zip Code Form I-601A 03/04/13 Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About Applicant (continued) Contact Information 21.a. Place or Port of Entry (City or Town) 21.b. State 8. Daytime Phone Number (if any) Extension 22.a. Date From (mm/dd/yyyy) 22.b. Date To 23. (mm/dd/yyyy) ( 9. ) - E-mail Address (if any) Immigration Status (at the time of entry) Birth and Citizenship 10. 11. Date of Birth (mm/dd/yyyy) 24. Are there other previous entries? Yes No City or Town of Birth If "Yes," include the place of entry, dates, and immigration status for previous entries in Part 5, Additional Information, of this form. 12. Province of Birth (if applicable) Immigration or Criminal History 13. Country of Birth 25. Are you currently in removal proceedings (this includes being subject to a final removal order or to a DHS order reinstating a prior removal order)? Yes No Note: If you answered "No," skip to Item Number 27. Note: If your case has been administratively closed, you are still "in removal proceedings" until the Department of Justice, Executive Office for Immigration Review (EOIR) terminates or dismisses your case. However, you are eligible to apply for a provisional unlawful presence waiver if EOIR has not placed your removal proceedings back on EOIR's calendar to continue your removal proceedings. 26. 16.b. State 17. Immigration Status (at the time of entry) If you answered "Yes" to Item Number 25., select the statement below that most accurately describes your current situation: I am in removal proceedings that are administratively closed and have not been placed back on EOIR's calendar to continue my removal proceedings, at the time of filing a Form I-601A. Note: Provide a copy of the administrative closure notice. You should seek termination or dismissal of your removal proceedings before you depart the United States if your application for a provisional unlawful presence waiver is approved. I am now subject to a final order of removal, deportation, or exclusion, or to the reinstatement of a prior removal order. I am subject to a DHS order reinstating a prior removal order. I am currently in removal proceedings that are not administratively closed, or I am currently in removal proceedings that were administratively closed, but my proceedings have been placed back on EOIR's calendar to continue my removal proceedings. Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 14. Country of Citizenship Last Entry Into the United States 15. Date of Entry (mm/dd/yyyy) 16.a. Place or Port of Entry (City or Town) Previous Entries Into the United States Applicant was previously in the United States as follows: 18.a. Place or Port of Entry (City or Town) 18.b. State 19.a. Date From (mm/dd/yyyy) 19.b. Date To 20. (mm/dd/yyyy) Immigration Status (at the time of entry) Form I-601A 03/04/13 27. Have you ever knowingly and willfully given false or misleading information to a U.S. Government official while applying for an immigration benefit or to gain entry or admission into the United States? Yes No Have you ever knowingly assisted or attempted to assist the entry of someone, even a family member, into the United States without the benefit of a valid travel document in violation of U.S. law? No Yes Have you ever been arrested, cited, or detained by a law enforcement officer (including immigration and military officers) in the United States, your home country, and/or any other country for any reason other than traffic violations? No Yes Have you ever been charged, indicted, convicted, imprisoned or jailed in the United States, your home country, and/or any other country for any crime or offense? No Yes Petitioner's Full Name 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 3. Petitioner's Relationship to Applicant (Select only one) U.S. Citizen Spouse U.S. Citizen Parent U.S. Citizen Son or Daughter Self (I-360 petitioner only) Immigrant Visa Processing 4. Consular Case Number (NVC Case Number) 28. 29. 30. Have you ever engaged in, ordered, incited, assisted or otherwise participated in any of the following: 31.a. Acts involving torture, genocide, or human trafficking? 31.b. Killing any person? 31.c. Severely injuring any person? Yes Yes Yes No No No 5. Did the Department of State initially act before January 3, 2013, to schedule you to appear at a U.S. Embassy or consulate for an immigrant visa interview based on the approved immediate relative petition listed in Part 2., Item Number 1.? Yes No Note: USCIS may reject or deny your application if you answer "Yes," do not answer the question, or answer "No" but DOS records indicate that DOS initially acted prior to January 3, 2013, to schedule you for an immigrant visa interview. 31.d. Any kind of sexual contact or relations with any person who was being forced or threatened? Yes No Note: If you answered "Yes" to any item in Item Numbers 27.-31.d., you may be ineligible for a provisional unlawful presence waiver, and your application may be denied. For each "Yes" response, provide the location and date of the event, and a brief description in Part 5., Additional Information, of this form. For Item Number 29., if you were not charged with any crime or offense, provide a statement or other d
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