Form I-590 Registration for Classification as a Refugee

OMB No. 1615-0068; Expires 06/30/2012

Form I-590, Registration for
Classification as Refugee

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

Type or print the following information in black ink. (Read instructions on Page 2.)
A-Number:
1. Name:

(First)

(Last)

(Middle)

2. Present Address: (Street Number and Name/Town or City/State or Province/Country)

3. Date of Birth: (mm/dd/yyyy)

Place of Birth (Town or City/State or Province/Country)

Present Citizenship/Nationality

4. Country from which I fled or was displaced:

On or about (mm/dd/yyyy):

5. Reasons (State in detail):

6. My present immigration status in (Country in which residing)
is:
Evidence of my immigration status is:
(Describe):
7. Name of Spouse:

10. My Spouse:

8. Present Address of Spouse (if different):

will

9. Citizenship/Nationality of Spouse:

will not accompany me to the United States:

Place an (X) in front of name of each child who will accompany you to the United States.
11. Name of Child(ren)
Date of Birth (mm/dd/yyyy)
Place of Birth

Present Address (if different):

12. Schooling or Education
Type

Name and Location of School

Dates Attended

Title of Degree or Diploma

13. Military Service
Country

Branch and Organization

Dates

Serial No.

Rank Attained

Form I-590 (Rev. 06/08/11) Y

14. Political, professional, or social organizations of which I am now or have been a member or with which I am now or have been affiliated since
my 16th birthday. (If you have never been a member of any organization, state "None.")
15. I

have

have not been charged with a violation of law. (If you have ever been charged with a violation of law, give date, place, and
nature of each charge and the final result.)

16. I

have

have not been in the United States. (If you have ever been in the United States, provide the dates of entry and departure and the
purpose of your entry (visitor, lawful permanent resident, student, seaman, etc.).)

File or Alien Registration Number:
17. I have the following close relatives in the United States:
Name

Present Address

Relationship

18. I am being sponsored by (Name and address of sponsor in United States):

Signature of Registrant:

Date:

Do not write below this line. For Government Use Only.
I

, do swear (affirm) that I know the contents of this registration subscribed by me,

including the attached documents, that the same are true to the best of my knowledge, and that corrections numbered (

) to (

)

were made by me or at my request, and that this registration was signed by me with my full, true name:
(Complete and true signature of registrant)
on

Subscribed and sworn to before me by the above-named registrant at

(mm/dd/yyyy)
(Signature and Title of Officer)
Interview

Approved

Date

Date

Action Block

At

Immigration Officer

Officer in Charge

Instructions
Submission of Form -This form should be filled out, signed, and submitted to the District Director or Officer in Charge of the nearest overseas office of U.S.
Citizenship and Immigration Services (USCIS). When USCIS begins processing your form, you will be receive additional instructions.
Registration - A separate Form I-590, Registration for Classification as Refugee, is required for each registrant. Form I-590 on behalf of a child under 14 years of age
shall be submitted by the parent or guardian.
USCIS Privacy Act Statement
Authories: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, section 101, et seq.
Purpose: The primary purpose for providing the requested information on this form is to determine if you have established eligibility for the immigration benefit for
which you are filing. The information you provide will be used to grant or deny the benefit sought.
Disclosure: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay a final decision
or result in denial of your form.
Routine Uses: The information you provide on this form may be shared with other Federal, State, local, and foreign government agencies and authorized organizations
following approved routine uses described in the associated published system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001
- Alien File, Index, and National File Tracking System of Records, which can be found at www.dhs.gov/privacy]. The information may also be made available, as
appropriate, for law enforcement purposes or in the interest of national security.
Public Reporting Burden - A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. This collection
of information is estimated to average 35 minutes per response. If you have comments regarding the accuracy of this estimate or suggestions for simplifying this form,
write to: U.S. Citizenship and Immigration Services, Regulatory Products Division,Office of the Executive Secretariat, 20 Massachusetts Avenue, N.W., Washington,
DC 20529-2020: OMB No. 1615-0068. Do not mail your completed application to this address.
Form I-590 (Rev. 06/08/11) Y Page 2