Form I-687 Northwest Immigrant Rights Project (NWIRP) Class Member

OMB No. 1615-0090; Expires 09/30/10

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

Form I-687, NWIRP Class Member Worksheet

Northwest Immigrant Rights Project (NWIRP) Class Member Worksheet
Notice to NWIRP Class Member Applicant
Please complete this Class Member Worksheet if you wish to apply for class member benefits pursuant to the settlement in NWIRP v.
U.S. Citizenship and Immigration Services (USCIS). In order to apply, answer every question on this Class Member Worksheet and
staple it, with any attachments, to the top of the appropriate documents.

Part 1. Information About You (Start Here. Print or type in black ink.)
A. Information About You
Family Name (Last Name)
A # (if any)

Given Name (First Name)

Middle Name

Date of Birth (mm/dd/yyyy)

B. I Am Filing This Worksheet Because:

(Check only one)

1. I have previously filed for legalization and:
I wish to notify USCIS that I meet the NWIRP class definition and my application for legalization on Form I-687,
Application for Temporary Resident Under Section 245A of the INA, or Form I-485, Application to Register Permanent
Residence or Adjust Status (LIFE Act), is still pending.
If this applies to you, you do not need to complete the rest of this Worksheet, but merely sign the bottom of the form and
mail to:
NWIRP WORKSHEET
USCIS - National Benefits Center
P.O. Box 9001
Lee's Summit, MO 64002-9001
OR
I wish to notify USCIS that my application for legalization on Form I-687 or Form I-485 (LIFE Legalization) was denied
because INS/USCIS asserted that I failed to prove that my lawful nonimmigrant status expired or was unlawful prior to
January 1, 1982, or that my unlawful residence after January 1, 1982, was not continuous, and I request that the
application be reopened.
If this applies to you, you do not need to complete the rest of this Worksheet, but merely sign the bottom of the form and
send it with a completed Form I-290B, Notice of Appeal or Motion, and filing fee to:
For U.S. Postal Service (USPS) deliveries:
USCIS - NWIRP
P.O. Box 804727
Chicago, IL 60680-4108
2.

For private couriers (non-USPS) deliveries:
USCIS
Attn: NWIRP
131 South Dearborn - 3rd Floor
Chicago, IL 60603-5517

I attempted to file during the legalization application period, May 5, 1987, to May 4, 1988, and the application was
rejected, and I now wish to file as I qualify for class membership as described below.
If this applies to you, you need to complete the rest of the worksheet, and submit it with a completed Form I-687 and filing
fee to:
For U.S. Postal Service (USPS) deliveries:
USCIS - NWIRP
P.O. Box 804727
Chicago, IL 60680-4108

For private couriers (non-USPS) deliveries:
USCIS
Attn: NWIRP
131 South Dearborn - 3rd Floor
Chicago, IL 60603-5517
Form I-687 NWIRP Class Member Worksheet (09/09/09)

Part 1. Information About You

(Continued)

IMPORTANT: USCIS will accept your I-687 application and Class Member Worksheet for filing so long as the following
requirements are met: (Check all that apply to you)
The boxes checked on Parts 2, 3, and 4 of this Worksheet establish that I am a class member, as explained in the instructions.
I have signed my Class Membership Worksheet.
I have attached evidence available to me about my entry prior to January 1, 1982, with a nonimmigrant visa as described in
the instructions to this Worksheet.
I have signed my Form I-687.
I have included a money order or personal check for the current Form I-687 filing fee.
I have included a money order or personal check for the current biometrics fee.
If your application and Worksheet does not meet the above requirements, USCIS may reject it and return it to you within 30 days
of receipt. If the application is rejected and returned to you as incomplete, you must correct the deficiency and re-file your
application, and do so BEFORE the IAP/NWIRP class member filing period ends. Rejected applications re-submitted after the close of
the filing period will not be accepted. It is very important that you properly submit a complete application within the filing
deadline.

Part 2. General Information
A. I entered the United States before January 1, 1982, on a nonimmigrant visa and then resided in
continuous unlawful status, except for brief absences, from before 1982 until the date I (or my parent or
spouse) was turned away by INS when I (or my parent or spouse) tried to apply for legalization in 1987
- 1988.

Yes

No

B. I was continuously physically present in the United States, except for brief, casual, and innocent
departures from November 6, 1986, until the date I (or my parent or spouse) was turned away by INS
when I (or my parent or spouse) tried to apply for legalization.

Yes

No

C. I have not been convicted in the United States of one felony or three or more misdemeanors, nor have I
ever been convicted of crimes or committed acts which make me inadmissible pursuant to any
provision of the Immigration and Nationality Act (INA), including but not limited to:
a. 212(a)(A)(i)(I) - Crime involving moral turpitude.
b. 212(a)(2)(B) - Multiple criminal convictions.
c. 212(a)(2)(C) - Controlled substance traffickers.
d. 212(a)(2)(A)(i)(II) - Controlled substances (Other than less than 30 grams of marijuana).
e. 212(a)(3) - Security and related grounds.

Yes

No

NOTE: If you answered "Yes" to Questions A, B, and C in Part 2, go to Part 3. If you answered "No" to any of these questions,
STOP. You are not eligible for NWIRP class membership.

Part 3. NWIRP Class Requirements
A. I violated my nonimmigrant status prior to January 1, 1982, and the violation of status is evident based
on a review of government files.

Yes

No

This category includes individuals who worked without authorization before January 1, 1982, and who have social security
records, tax records, or other government records to show income relating to such unauthorized work in their name. It also
includes individuals who failed to file annual and quarterly address reports as required under Section 265 of the INA before
January 1, 1982.
Form I-687 NWIRP Class Member Worksheet (09/09/09) Page 2

Part 3. NWIRP Class Requirements

(Continued)

B. I entered the United States prior to January 1, 1982 as a student (on an F or J visa) or as a temporary
worker (on an H or L visa) and I failed to maintain my status until January 1, 1982.

Yes

No

This category includes individuals who dropped out of school, took less than a full course of study, or transferred schools without
advance INS authorization, or who terminated their authorized employment before January 1, 1982.
C. After January 1, 1982, I obtained reinstatement to nonimmigrant status, or entry into the United States
on a nonimmigrant visa, or a change of nonimmigrant status, or adjustment of status, or some other
immigration benefit that apparently put me in lawful immigration status, even though I did not qualify
for such benefit.

Yes

No

This category includes individuals who did not inform INS that they had previously worked without authorization.
NOTE: If you answered "Yes" to any question in Part 3, go to Part 4. If you answered "No" to all the questions in Part 3, STOP.
You are not eligible for NWIRP class membership.

Part 4. Prior Filing Requirements
A. I (or my parent or spouse) visited an INS office or QDE with a completed application for legalization
(Form I-687) and filing fee between May 5, 1987, and May 4, 1988, and the application and fee were
rejected for filing by either INS or the QDE.

Yes

No

B. I (or my parent or spouse) visited an INS office or QDE in an attempt to apply for legalization between
May 5, 1987, and May 4, 1988, and were refused application forms or were turned away by either the
INS or the QDE.

Yes

No

NOTE: If you answered "Yes" to any question in Part 4, go to Part 5. If you answered "No" to both questions in Part 4, STOP. You
are not eligible for NWIRP class membership

Part 5. Certification
I certify, under penalty of perjury under the laws of the United States of America, that the above statements and evidence submitted
herewith are true and correct. I authorize the release of any information from my records that the Department of Homeland Security
needs to verify the foregoing.
I understand that information I provide in connection with this claim or with the related application Form I-687, I-765, I-131, or
G-639, Freedom of Information/Privacy Act Request, is confidential and may not be used to arrest or remove me or for any purpose
unrelated to the adjudication of this claim, except as provided in 8 U.S.C. Section 1255a(c)(5).
Signature

Date (mm/dd/yyyy)

Mailing Address - Street Number and Name
City

Apt. #
State

Zip Code

Form I-687 NWIRP Class Member Worksheet (09/09/09) Page 3