I-698 Application to Adjust Status from Temporary to Permanent

OMB No. 1615-0035; Expires 08/31/08

I-698, Application to Adjust Status
From Temporary to Permanent Resident

Department of Homeland Security
U.S. Citizenship and Immigration Services

(Under Section 245A of the INA)

Do not write in this block - For USCIS use only.
Fee Stamp

Action Block

Remarks

START HERE - Please type or print in black ink. If you need more space, use a separate sheet(s) of paper.
1. Name
Family Name (In capital letters)

2. Gender
Male

Female

Given Name

Applicant's A#

Middle Name

3. Name as it appears on
Temporary Resident Card (Form I-688)

4. Telephone Numbers (Include area codes.)
Home:

Work:

5. Reason for difference in name. (For example: marriage, divorce.)

6. Home Address in the United States.
In care of
Number and
Street

Apt. #

City

Zip
Code

State

7. Mailing Address in the U.S. (If different from address in Number 6 above.)
In care of
Number and
Street

Apt. #

City
8. Place of Birth (City or Town)

9. Date of Birth (mm/dd/yyyy)

13. Marital Status

Zip
Code

State

Married

County, Province or State

10. Your Mother's First Name

Never Married

Country of Citizenship/Nationality

Country

11. Your Father's First Name

Separated

Divorced

12. Your U.S. Social Security #

Widowed
Form I-698 (Rev. 05/27/08)Y

14. Absences from the United States since becoming a temporary resident alien. List most recent absence first. If you have a single
absence in excess of 30 days or if the total of all your absences exceeds 90 days, explain and attach any relevant information.
Country

Purpose of Trip

From
(mm/dd/yyyy)

To
(mm/dd/yyyy)

Total Days
Absent

15. When applying for temporary resident status, I

did
did not
submit a medical examination, Form I-693, with my application that included a serologic (blood) test for human immunodeficiency
virus(HIV) infection. (If you did not, submit with this Form I-698 application a medical examination Form I-693 that includes a
serologic test for HIV.)

16. Concerning the requirement of minimal understanding of ordinary English and a knowledge and understanding of the history and
government of the United States: (Check appropriate block under Section A or B).
A. I will satisfy these requirements by:
Examination at the time of interview for permanent residence.
Satisfactorily pursuing a course of study recognized by the Secretary of Homeland Security.
B. I have satisfied these requirements by:
Having satisfactorily pursued a course of study recognized by the Secretary of Homeland Security. (Please attach
appropriate documentation.)
Exemption, in that I am 65 years of age or older, under the age of 16, or I am physically unable to comply. (If you are
physically unable to comply, explain and attach relevant documentation.)
17. Have you ever assisted in the persecution of any person or persons on account of race, religion, political
opinion, nationality, or membership in a particular social group?

Yes

No

18. Have you ever been treated for a mental disorder, drug addiction, or alcoholism?

Yes

No

19. Have you ever committed a crime or offense for which you were not arrested?

Yes

No

Have you ever been arrested, cited or detained by any law enforcement officer
(including USCIS or former INS and military officers) for any reason?

Yes

No

Have you ever been charged with committing any crime or offense?

Yes

No

Have you ever been convicted of a crime or offense?

Yes

No

Have you ever been in jail or prison?

Yes

No

Have you ever been placed in an alternative sentencing or a rehabilitative program
(for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?

Yes

No

Have you ever received a suspended sentence, been placed on probation, or been paroled?

Yes

No

Form I-698 (Rev. 05/27/08)Y Page 2

20. Have you, or a dependent member of your immediate family, ever received public assistance from any
source, including, but not limited to, the U.S. Government, any State, county, city, or municipality? If yes,
provide the names(s) of the recipients(s) and U.S. Social Security number(s).

Yes

No

a. Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities Yes
in the future?

No

b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?

Yes

No

c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally?

Yes

No

d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of Yes
any controlled substance?

No

Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or Yes
funds for, or have you through any means ever assisted or provided any type of material support to any person or
organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or
any other form of terrorist activity?

No

21. Have you ever:

Do you intend to engage in the United States in:
a. Espionage?

Yes

No

b. Any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United
States, by force, violence, or other unlawful means?

Yes

No

c. Any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or
sensitive information?

Yes

No

Yes

No

Did you, during the period from March 23, 1933, to May 8, 1945, in association with either the Nazi Government of
Yes
Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite,
assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political
opinion?
Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any
Yes
person because of race, religion, nationality, ethnic origin, or political opinion?

No

Have you ever been deported from the United States, or removed from the United States at government expense, excluded
within the past year, or are you now, or have you ever been in exclusion, deportation, removal, or recession proceedings?

Yes

No

Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of
fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure or
procured a visa, other documentation, entry into the United States, or any immigration benefit?

Yes

No

Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?

Yes

No

Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement
and have not yet complied with that requirement or obtained a waiver?

Yes

No

Are you now withholding custody of a United States citizen child outside the United States from a person granted
custody of the child?

Yes

No

Do you plan to practice polygamy in the United States?

Yes

No

Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?

No

22. If your native alphabet is in other than Roman letters, write your name in your native alphabet.

23. Language of your native alphabet.
Form I-698 (Rev. 05/27/08)Y Page 3

24. Signature and Certification of applicant.
I CERTIFY, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct. I hereby
consent and authorize U.S. Citizenship and Immigration Services to verify the information provided and to conduct police, welfare, and
other record checks pertinent to this application.
Signature

Date

25. Signature of person preparing form, if other than applicant.
I declare under penalty of perjury that I prepared this application at the request of the above person.
The answers provided are based on information of which I have personal knowledge and/or were provided to me by the above named
person in response to the exact questions contained on this form.

Signature

Date

Print Name
Address

Telephone number with area code
(

)

For U.S. Citizenship and Immigration Services Use Only
26. Final Action: Temporary Residence

Approved

Denied

27. Final Action: Waiver of Inadmissibility under Section 212(a)

Approved

28. Class of Admission

29. Place of Adjustment

30. Date of Adjustment

31. Final Actin By (Print Name and Title)

32. ID Number

33. Date

Denied

Form I-698 (Rev. 05/27/08)Y Page 4