Application For Determination Of Suitability To Adopt A Child From A Convention Country {I-800A} | Pdf Fpdf Doc Docx | Official Federal Forms

 Official Federal Forms /  US Citizenship And Immigration Services /
Application For Determination Of Suitability To Adopt A Child From A Convention Country {I-800A} | Pdf Fpdf Doc Docx | Official Federal Forms

Application For Determination Of Suitability To Adopt A Child From A Convention Country {I-800A}

This is a Official Federal Forms form that can be used for US Citizenship And Immigration Services.

Alternate TextLast updated: 3/30/2017

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Department of Homeland Security U.S. Citizenship and Immigration Services Form I-800A, Application for Determination of Suitability to Adopt a Child from a Convention Country For USCIS Use Only Receipt Returned Date Middle Name Date Resubmitted Date START HERE - Type or Print (Use black ink) Part 1. Information About You (Person filing this application) 1. Provide the following information about yourself: Family Name (Last Name) Given Name (First Name) Other Names Used (including maiden name if appropriate) USCIS Account # Date of Birth (mm/dd/yyyy) U.S. Social Security # (if any) Place of Birth (City/Town, State/Province, Country) Date Home Address - Street Number and Name City Zip/Postal Code State or Province Date Country Apt. # Date This application was filed by: Mailing Address (if different from home address) C/O (in care of) City Zip/Postal Code State or Province Country Period of approval valid until: 2. I intend to adopt a child habitually residing in the following Convention country: (Date) Date Reloc Sent Apt. # Date Reloc Rec'd A Married Applicant An Unmarried Applicant This application is approved for a Convention adoptee from: (Name of Convention Country) Action Block Warning: If you are seeking to adopt a child who is habitually residing in a country other than a Convention country, STOP. You cannot file this application. See Pages 1 to 2 of the Form I-800A instructions for additional filing information. 3. I am a habitual resident of the United States as: A person who is domiciled in the United States. A person who is domiciled in the United States, even if temporarily living outside the United States. A person who will establish a domicile in the United States on or before the date of the child's admission to the United States for permanent residence as a Convention adoptee. A person domiciled outside the United States who will bring the child to the United States after adoption and before the child's 18th birthday for naturalization as a U.S. citizen. To Be Completed By Attorney or Representative, if any. Fill in box if G-28 is attached to represent the applicant. ATTY State License # Form I-800A (Rev. 03/10/17) N American LegalNet, Inc. www.FormsWorkFlow.com Part 1. 4. I am: Information About You (Continued) A citizen of the United States. I obtained my U.S. citizenship through: Birth in the United States Parent(s) Naturalization Not a citizen of the United States. STOP. You may not file this application (see Pages 1 to 2 of instructions for eligibility to file). 5. If you derived or acquired citizenship through your parent(s), have you obtained your own certificate of citizenship? If "Yes," provide the following information: Name Under Which Certificate of Citizenship Was Issued Certificate of Citizenship Number Date of Issuance (mm/dd/yyyy) Place of Issuance A# (if known) Yes No 6. If you became a citizen by naturalization, give the following information: Name Under Which Certificate of Naturalization Was Issued Naturalization Certificate Number Date of Naturalization (mm/dd/yyyy) Place of Naturalization A# (if known) 7. Have you, or any person through whom you claimed citizenship, ever lost U.S. citizenship? If "Yes," attach a detailed explanation including date, place, and circumstances on a separate sheet of paper. 8. Provide the following information about your current marital status. a. I am: Single, never married. Single, with all previous marriages terminated. (If you check this box, you must complete 8,c.) Married, with no previous marriages. (If you check this box, you must complete 8,b.) Married, with all previous marriages terminated. (If you check this box, you must complete 8,b, and c.) b. If married, provide the following information: Date of Current Marriage (mm/dd/yyyy) Place of Current Marriage (City/Town, State/Province, Country) Yes No Form I-800A (Rev. 03/10/17) N Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About You (Continued) c. Information on all previous marriages, if applicable. Begin with the most recent termination. 1. Number of Previous Marriages (Do not count current marriage) 2. Provide the following information on each terminated marriage (if applicable): a. Date Marriage Ended Name of (mm/dd/yyyy) Prior Spouse How Marriage Ended Divorce Death Other b. Date Marriage Ended Name of (mm/dd/yyyy) Prior Spouse How Marriage Ended Divorce Death Other NOTE: If you need more space to complete, use a separate sheet of paper. Write your name and USCIS Account Number, if known, at the top of each sheet of paper and indicate the part and number of the item to which the answer refers. 9. My contact information is (all phone numbers must include area code and country code, if applicable): Daytime Phone # (with area/country code) Home Phone # (if different from daytime #) E-Mail Address (if any) 10. Have you ever, whether in or outside the United States: a. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations, but including driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant? b. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? c. Received a suspended sentence, been placed on probation or parole, or in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? d. At any time been the subject of any investigation by any child welfare agency, court, or other official authority in any State or foreign country concerning the abuse or neglect of any child, other than an investigation that has been completed and formally closed based on a finding that the allegation of abuse or neglect was unfounded or unsubstantiated? Yes No Yes Yes No No Yes No Each of the above questions must be answered. See "Duty of Disclosure" on Page 7 of the instructions to Form I-800A concerning your ongoing duty to disclose information in answer to these questions. If the answer is "Yes" to any of the questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances, about each arrest, signed under

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