Form I-601 - Application For Waiver Of Grounds Of Inadmissibility - U.s. Citizenship And Immigration Services

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Application for Waiver of Grounds of Inadmissibility
USCIS
Form I-601
Department of Homeland Security
OMB No. 1615-0029
U.S. Citizenship and Immigration Services
Expires 03/31/2019
Initial
Resubmitted
Action Block
Fee Stamp
For
Receipt
USCIS
Use
Only
Relocated
Benefits Category
Received
Sent
Immigrant
Adjustment of Status
TPS
V Nonimmigrant
K Nonimmigrant
Inadmissible Under
212(a)(1)
212(a)(3)
212(a)(6)
212(a)(10)
212(a)(2)
212(a)(4)
212(a)(9)
Other
To be completed
Select this box if
Attorney State Bar Number
Attorney or Accredited Representative
by an Attorney
Form G-28 is
(if applicable)
USCIS Online Account Number (if any)
or Accredited
attached or G-28I
Representative (if any).
is attached.
START HERE - Type or print in black ink.
Part 1. Information About You
Mailing Address
1.
Alien Registration Number (A-Number) (if any)
NOTE: If you are outside of the United States, provide a U.S.
mailing address if available. If a U.S. mailing address is not
A-
available, provide your mailing address outside the United States.
2.
USCIS Online Account Number (if any)
5.a. In Care Of Name
5.b.
Street Number
Your Full Name
and Name
3.a.
Family Name
5.c.
Apt.
Ste.
Flr.
(Last Name)
3.b. Given Name
5.d. City or Town
(First Name)
3.c.
Middle Name
5.e. State
5.f.
ZIP Code
5.g. Province
Other Names Used
5.h. Postal Code
List all other names you have ever used, including maiden names,
aliases, and nicknames. If you need extra space to complete this
5.i.
Country
section, use the space provided in Part 10. Additional
Information.
4.a.
Family Name
6.
Is your current physical address the same as your mailing
(Last Name)
address?
Yes
No
4.b.
Given Name
(First Name)
If you answered "No" to Item Number 6., provide your
physical address in Item Numbers 7.a. - 7.h.
4.c.
Middle Name
Form I-601 08/21/17 N
Page 1 of 12

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