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Application For Waiver Of Grounds Of Inadmissibility I-601 - Official Federal Forms
| Application For Waiver Of Grounds Of Inadmissibility Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Application for Waiver of Grounds of Inadmissibility Department of Homeland Security U.S. Citizenship and Immigration Services Fee Stamp For USCIS Use Only Benefits Category Immigrant Adjustment of Status TPS V Nonimmigrant K Nonimmigrant USCIS Form I-601 OMB No. 1615-0029 Expires 12/31/2014 Initial Receipt Resubmitted Action Block Relocated Received Sent Inadmissible Under 212(a)(1) 212(a)(2) 212(a)(3) 212(a)(4) 212(a)(6) 212(a)(9) 212(a)(10) Other To Be Completed by an Attorney or Representative, if any. START HERE - Type or print in black ink. Fill in box if G-28 is attached to represent the applicant. Attorney State License Number: Part 1. Information About Applicant 1. Alien Registration Number (A-Number) Contact Information 5. Daytime Phone Number (if any) Extension A2. Applicant's U.S. Social Security Number (optional) ( 6. ) - E-mail Address (if any) Your Full Name 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name Other Information 7. 8. Date of Birth (mm/dd/yyyy) City or Town of Birth Address 4.a. Street Number and Name 4.b. Apt. Ste. Flr. 9. Province of Birth (if applicable) 10. Country of Birth 4.c. City or Town 4.d. State 4.f. Postal Code 4.e. Zip Code 11. Country of Citizenship 4.g. Province 4.h. Country If you are outside the United States and you were already interviewed by a Department of State (DOS) consular officer at a U.S. Embassy or consulate, provide information in item number 12.a. - 12.c. 12.a. Date of Visa Application with DOS (mm/dd/yyyy) Form I-601 12/16/12 N Page 1 of 9 American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About Applicant (continued) 12.b. Location of Visa Application with DOS 17. I have been involved in a crime of moral turpitude (other than a purely political offense) (see instructions). I have been convicted of 2 or more offenses, other than purely political ones, for which the combined sentences to confinement were 5 years or more (see instructions). I have been involved in a controlled substance violation according to the laws and regulations of any country that involved a single offense of simple possession of 30 grams or less of marijuana (see instructions). I have, within the last 10 years, been involved in prostitution, or I am currently involved in prostitution. "Involved in" prostitution means being a prostitute, procuring or attempting to procure others for prostitution, importing other individuals to engage in prostitution, or receiving the proceeds, in full or in part, from prostitution (see instructions). I am coming to the United States to engage in any other unlawful commercialized vice, whether or not related to prostitution (see instructions). I have been involved in serious criminal activity and have asserted immunity from prosecution (see instructions). I have sought to procure an immigration benefit by fraud or by concealing or misrepresenting a material fact (immigration fraud or misrepresentation) (see instructions). I am or I have been a member of or affiliated with the Communist or any other totalitarian party (or subdivision or affiliate of the party), domestic or foreign (see instructions). I have been engaged in alien smuggling (see instructions). I am subject to a civil penalty because I have been the subject of a final order for violation of the Immigration and Nationality Act (INA) section 274C (see instructions). I am subject to the 3-year or the 10-year bar to admissibility because I was previously unlawfully present in the United States in excess of either 180 days or 1 year or more, and subsequently departed the United States (see instructions). I was previously removed from the United States (see instructions for NACARA and HRIFA applicants only. All other applicants, file Form I-212). 12.c. Department of State Consular Case Number 18. 13.a. If in the United States: Did you file this application after you have already filed Form I-485 or Form I-821? Yes 13.b. If "Yes", provide USCIS Receipt # No 19. 20. 13.c. Filing Location 13.d. Date Filed (mm/dd/yyyy) Reason(s) for Inadmissibility Mark all of the following grounds that you believe, according to the best of your knowledge, apply to you. Only mark the applicable ground(s) listed under the immigration benefit you are seeking. In the space provided for item number 51, include a statement explaining the acts, convictions, and medical conditions that you believe make you inadmissible. If you seek a waiver of inadmissibility because you have a Class A Tuberculosis condition (as per HHS regulations), you must complete the last 2 pages of this form. If you seek a waiver of inadmissibility because of a history of physical or mental disorders, you must attach the information requested in the instructions. A. I am an applicant for an immigrant visa or adjustment of status (other than based on T nonimmigrant status), or for K or V nonimmigrant status, and I believe that I am inadmissible because: (See the form instructions for a detailed explanation of the individual grounds.) 21. 22. 23. 24. 25. 26. Check all that apply 14. I have a communicable disease of public health significance, as per HHS regulations (see instructions). I have, or have had in the past, a physical or mental disorder and behavior associated with the disorder that poses, may pose, or has posed, a threat to the property, safety, or welfare of myself or others (see instructions). I seek an exemption from the vaccination requirement because it is against my religious beliefs or moral convictions (see instructions). 27. 15. 28. 16. Form I-601 12/16/12 N Page 2 of 9 American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About Applicant (continued) Reason(s) for Inadmissibility (continued) 29. I have been ordered removed, or I have been unlawfully present in the United States for more than 1 year, in the aggregate, and I subsequently reentered or attempted to reenter without being admitted (see instructions for NACARA, HRIFA, and the instructions for approved VAWA self-petitioners only. Other applicants, file Form I-212). Other (specify) 40. 41. 37. I have committed a serious criminal offense in the United States and asserted immunity from prosecution. I am subject to a final order for violation of INA section 274C (producing/using false documentation to unlawfully satisfy a requirement of the INA). I did not attend or did not remain at a removal proceeding to determine my inadmissibility or deportability. I practice polygamy. I am accompanyin
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