Request for Cancellation of Public Charge Bond

Instructions for Request for Cancellation of Public Charge Bond
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-356

OMB No. 1615-xxxx
Expires xx/xx/xxxx

What Is the Purpose of Form I-356?
This form is used to request cancellation of the public charge bond that was submitted on Form I-945, Public Charge
Bond, on behalf of an alien.

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Who Must Complete and File Form I-356?

Form I-356 has several parts that must be completed either by the obligor or the obligor’s authorized agent (co-obligor, for
surety companies only) who posted the bond on behalf of the alien, and the alien. If the alien is deceased, the executor of
the alien’s estate may complete the alien’s part on behalf of the alien.
This form must be submitted according to the instructions provided in this form and the direct filing instructions posted
on www.uscis.gov. Either the obligor (or the agent/co-obligor, if any) or the alien (or the alien’s executor or accredited
representative, if any) may submit this form. The alien (or the alien’s executor, or the alien’s attorney or accredited
representative, if any) may submit Form I-356 (and evidence that the conditions of the bond have been met) without the
obligor or any agent/co-obligor, however, USCIS encourages completion of the entire form.
NOTE: The term “you” in these instructions refers to the person(s) completing this form or parts of this form, including
the alien (or his or her executor or accredited representative, if any) or the obligor (or the obligor’s agent/co-obligor, if
any).

How Is Form I-356 Used?

Public Charge Bonds (Form I-945) are posted as security under the condition that the alien will not receive public benefits
(as defined in 8 CFR 212.21(b)) after the alien’s adjustment to that of a lawful permanent resident and during the bond’s
effective period. If an alien receives public benefits as defined in 8 CFR 212.21(b), the bond is breached and forfeited.
NOTE: This form does not have to be filed if a substitute bond is submitted to release an obligor from the current liability
of a public charge bond posted with USCIS on the alien’s behalf. USCIS will not make any breach or cancellation
assessments as part of a substitution of a public charge bond currently on file with USCIS. For more information about
substitution of a public charge bond, please see Form I-945, Public Charge Bond, and its instructions. Information
addressing substitution of public charge bonds may be found in 8 CFR 213.1.

When Will USCIS Cancel a Public Charge Bond?
Under INA section 213 and 8 CFR 213.1, a public charge bond will be cancelled once the alien has naturalized,
permanently departed the United States, or died. The bond may also be cancelled upon the fifth anniversary of the
alien’s adjustment of status to that of a lawful permanent resident, or if the alien, following the grant of lawful permanent
resident status, obtains another immigration status in the United States that is exempt from the public charge ground of
inadmissibility under INA section 212(a)(4).
Regardless of the reason why an obligor or the alien may seek to cancel the public charge bond, DHS will only cancel the
public charge bond if:
1. The obligor (or agent/co-obligor) or the alien file this form to request cancellation of the public charge bond; or
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2. The alien can establish that he or she has not received public benefits, as defined in 8 CFR 212.21(b), after the alien’s
adjustment of status to that of a lawful permanent resident and until the bond is cancelled, and has otherwise complied
with the conditions of the bond.
When examining whether the bond can be cancelled, USCIS evaluates whether the conditions of the bond are satisfied and
all requirements for cancellation are met. As a spouse, child, or parent of a deceased soldier under the National Defense
Authorization Act (NDAA).
If this application and the evidence does not establish that the bond can be cancelled, the bond will remain in place until
the conditions for cancellation of the bond are met. USCIS will inform the obligor and the alien of the decision. The
obligor, but not the alien (or the alien’s representative, if applicable) may appeal the decision in accordance with 8 CFR
103, Subpart A.

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General Instructions

USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should
use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not
have Internet access, you may call the USCIS National Contact Center at 1-800-375-5283 and ask that we mail a form to
you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each part of the form must be properly signed. For all signatures on this form, USCIS will not accept a
stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may
sign the form on your behalf. A legal guardian may also sign for a mentally incompetent person. If the alien is deceased,
the alien’s executor may sign for the alien. An agent/co-obligor acting as the authorized agent may sign on behalf of the
obligor.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original, handwritten signature
valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten, ink
signature. Executors signing on behalf of a deceased alien must submit a certified copy of the document that establishes
the legal authority to act on behalf of the alien’s estate, such as a small estate affidavit, a will, or a court order.
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Instructions.
Copies. You should submit legible photocopies of the documents requested, unless the Instructions specifically state
that you must submit an original document. USCIS may request an original document at the time of filing or at any time
during processing of an application, petition, or request. If USCIS requests an original document from you, it will be
returned to you after USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS or the Immigration Court, your
original documents may be immediately destroyed after we receive them.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and that
he or she is competent to translate from the foreign language into English. The certification must include the translator’s
signature. DHS recommends the certification contain the translator’s printed name, the signature date, and the translator’s
contact information.
How To Fill Out Form I-356
1. Type or print legibly in black ink.

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2. If you need extra space to complete any item within this form, use the space provided in Part 10. Additional
Information or attach a separate sheet of paper. Type or print the alien’s name and Alien Registration Number
(A-Number) (if any), and the obligor’s name and bond receipt number at the top of each sheet; indicate the Page
Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None” unless
otherwise directed.

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Specific Instructions

Part 1. Obligor and Agent/Co-Obligor Information (To be Completed by the Obligor or Agent/Co-Obligor)
Provide the obligor’s, agent/co-obligor’s, and bond information as requested in the form.

Part 2. Obligor’s or Agent/Co-Obligor’s Statement, Contact Information, Certification, and Signature (To Be
Completed by the Obligor or Agent/Co-Obligor)
Choose the appropriate statement and complete the needed entries. Then sign and date the certification in the appropriate
spaces.
Part 3. Information about the Alien for Whom the Public Charge Bond Was Issued (To Be Completed by the Alien
or the Alien’s Executor)
Provide the information requested in this Part.

Item Number 1. Alien Registration Number (A-Number). An Alien Registration Number, otherwise known as an
“A-Number,” is typically issued to people who apply for, or are granted, certain immigration benefits. Your A-Number
appears on the front of Form I-551, your Permanent Resident Card. If you have more than one A-Number, use the space
provided in Part 10. Additional Information to provide the information. If you do not have the A-Number, leave this
space blank.
Item Number 2. U.S. Social Security Number (SSN) (if any). Provide the U.S. Social Security Number, if you have
one.
Item Number 3. USCIS Online Account Number (if any). If you have previously filed an application or petition using
the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the
USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by
logging in to your account and going to the profile page. If you previously filed certain applications or petitions on a
paper form through a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing
you a USCIS Online Account Number. You may find your USCIS Online Account Number at the top of the notice. If you
were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is not
the same as an A-Number.
Item Number 4. Current Legal Name. Provide your legal name, as shown on your birth certificate or legal name
change document. If you have two last names, include both and use a hyphen (-) between the names, if appropriate. Type
or print your last, first, and middle names in each appropriate field.

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Item Number 5. Other Names you Have Used Since Birth. Provide all the names you have used since birth, including
maiden name, any nicknames, and any names that appear in your documents. If you need extra space, use Part 10.
Additional Information to provide other names used.
Item Number 6. Gender. Select the box that indicates whether you are male or female.
Item Number 7. Date of Birth. Enter your date of birth in mm/dd/yyyy format in the space provided. For example, type
or print October 5, 1967 as 10/05/1967.
Item Number 8. Place of Birth. Enter the name of the city or town, and country where you were born. Type or print
the name of the country as it was named when you were born, even if the country’s name has changed or the country no
longer exists.

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Item Number 9. Country of Citizenship or Nationality. Enter the name of the country where you are a citizen. This
is not necessarily the country where you were born. If you are stateless, type or print the name of the country where you
were last a citizen or national. If you are a citizen or national of more than one country, type or print the name of the
country that issued your last passport.
Item Number 10. Mailing Address. Provide a valid mailing address.

Item Number 11. Physical Address. If the place where you live is different from your mailing address, type or print the
address where you currently live.
Item Number 12. Past Residences. List all your past residences since you became a Lawful Permanent Resident. Start
with the most recent residence.
Part 4. Cancellation of the Bond Because of Alien’s U.S. Citizenship, Permanent Departure, or Death (To Be
Completed By the Alien or the Alien’s Executor, if the Alien is Deceased) or Following the Alien’s 5th Anniversary
After the Alien’s Adjustment of Status to that of a Lawful Permanent Resident (To Be Completed by the Alien)
Answer the questions below and provide the information requested. You should indicate whether any of the circumstances
addressed in the questions have occurred since you adjusted your status to that of a lawful permanent resident (for which a
bond was submitted on your behalf).)
Item Number 1. U.S. Citizenship. Indicate whether you have become a United States citizen. If yes, please provide
proof of your citizenship.
Item Number 2. Permanent Departure. Indicate that you permanently departed the United States. For the specific
purpose of cancelling a bond, evidence of such permanent departure includes:
1. Evidence that you have submitted Form I-407, Record of Abandonment of Lawful Permanent Resident Status and
have actually departed the United States;
2. Evidence that you were placed into removal (or exclusion or deportation proceedings), and were physically removed,
excluded, or deported from the United States; or
3. Evidence that an immigration judge granted you voluntary departure under INA 240B, and you departed while the
voluntary departure order was in effect.
Provide all information that is requested in Item Number 2. and attach the evidence that is requested in each Item
Number.
USCIS will not cancel a bond in certain situations, even if you may have abandoned or lost your LPR status, including:

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1. If you left the United States to live abroad permanently and with the intention to abandon your LPR status but did not
submit Form I-407 according to its instructions;
2. If your LPR status was rescinded or revoked, whether in removal proceedings or not, but you are unable to show that
you have left the United States; or
3. If you have an outstanding voluntary departure order or outstanding removal (or exclusion or deportation) order but
you have not yet departed the United States or have not yet been removed, excluded, or deported.
Item Number 3. Death of the Alien. If the alien for whom the bond was posted has died since the bond was accepted by
DHS, and you are the executor of the alien’s affairs or otherwise acting on behalf of the alien’s estate, please answer the
questions and provide the information requested in Items A. through B. and Item Number 4., including your relationship
to the deceased. Please attach a certified copy of the document that establishes your legal authority to act on behalf of
the alien’s estate, such as a, small estate affidavit, will, or a court order, or your relationship to the deceased. Please also
provide a certified copy of the death certificate.

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Item Number 5. Lawful Permanent Resident. Answer “Yes” if you have been a lawful permanent resident for at least
five years. Provide the date when you became a lawful permanent resident, in mm/dd/yyyy format. Provide a copy of
your lawful permanent resident card.
Part 5. Cancellation of the Bond if Alien Obtains Immigration Status Exempt From Public Charge Inadmissibility
Under INA Section 212(a)(4), Following the Initial Grant of Status as A Lawful Permanent Resident (To Completed
by the Alien)
Answer the questions below and provide the information requested. You should indicate whether any of the circumstances
addressed in the questions have occurred since you adjusted your status to that of a lawful permanent resident (for which a
bond was submitted on your behalf).
Item Number 1. Loss or Relinquishment of Lawful Permanent Resident Status. Indicate when you lost or
relinquished your lawful permanent resident status for which the public charge bond was posted. Please provide any
evidence you may have about your loss or relinquishment of permanent resident status (for which the public charge bond
was posted on your behalf).
Item Number 2. Manner of Loss or Relinquishment. Please provide the information requested about how you lost
your lawful permanent resident status (for which the public charge bond was posted). Please attach any communication
you may have received from immigration authorities, if available.
Item Number 3. Information About Removal, Exclusion, or Deportation Proceedings. Please provide the requested
information about removal, exclusion, or deportation proceedings in which you lost your lawful permanent resident status
(for which the public charge bond was posted on your behalf).
Item Number 4. Information About Current Immigration Status. Please provide the requested information about
your current immigration status and provide documentary evidence that shows your status, (if available).
Part 6. Alien’s Receipt of Public Benefits Since Alien’s Adjustment of Status to That of a Lawful Permanent
Resident (To Be Completed By the Alien or the Alien’s Executor (if the Alien is Deceased))
Please provide the information requested in Item Numbers 1 and 2.
Please provide the information requested about your (the alien’s) receipt of public benefits, as defined in 8 CFR 212.21(b)
(listed below), since your adjustment of status to that of a lawful permanent resident (for which a bond was submitted on
your behalf). If you have terminated the receipt of benefits, provide the documentation that indicates you will no longer
receive the benefits with the applicable termination date.
In the table provided, please provide all requested information about each public benefit regardless of the amount or the
duration. USCIS will calculate the relevant amount to determine whether the bond may be cancelled or whether the bond
has been breached. If you require additional space, please use the space provided in Part 10. Additional Information.

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In the table, indicate whether or not you have ever applied for or received, any of the following monetizable (cash) public
benefits:
1. Any Federal, State, local, or tribal cash assistance for income maintenance including:
A. Supplemental Security Income (SSI).
B. Temporary Assistance for Needy Families (TANF).
C. Federal, State or local cash benefit programs for income maintenance (often called “General Assistance” in the
State context, but which may exist under other names).
2. The following monetizable (non-cash) benefits:

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A. Supplemental Nutrition Assistance Program (SNAP, or formerly called “Food Stamps”).
B. Section 8 Housing Assistance under the Housing Choice Voucher Program.

C. Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation).
3. Any of the following non-monetizable (non-cash) public benefits:
A. Medicaid.

B. Any benefit for institutionalization for long-term care at government expense, for example, Intermediate Care
Facilities for People with Intellectual disability (ICF/ID), Nursing Facility (NF), Preadmission Screening &
Resident Review (PASRR), Inpatient Psychiatric Services for Individuals Under Age 21, and Services for
individuals age 65 or older in an institution for mental diseases.
C. Premium and Cost Sharing Subsidies for Medicare Part D.
D. Public Housing.

Amount and Duration of Benefit

As part of the determination whether the bond can be cancelled or whether the bond had been breached, USCIS will
consider the above listed public benefits as follows:
1. Monetizable (cash or non-cash) benefits: USCIS will consider the benefits when the total receipt of all benefits
cumulatively exceeds 15 percent of the Federal Poverty Guidelines (FPG) for a household of one within any period of
12 consecutive months, based on the per-month average FPG for the months during which the benefits are received.
Note only the amount received by or attributable to the alien will be considered (for example, if the TANF is for a
household of 4, only 25 percent of the total TANF benefit will be considered).
2. Non-monetizable benefits (non-cash): USCIS will generally consider the benefits when the benefit (or benefits)
is received for longer than 12 months in the aggregate within a 36 month period (such that, for instance, receipt of 2
non-monetizable benefits in one month counts as two months). Note only the amount received by or attributable to
the alien will be considered (for example, if the SNAP or housing benefit is for a household of 4, only 25 percent of
the total SNAP or housing benefit will be considered).
3. Combined Monetizable and Non-monetizable Public Benefits: USCIS will generally consider the receipt of a
combination of monetizable benefits, described above, where the cumulative value of such benefits is equal to or less
than 15 percent of the FPG for a household size of one within any period of 12 consecutive based on the per-month
average FPG for the months during which the benefits are received, together with one or more non-monetizable
benefits described above of this section if such non-monetizable benefits are received for more than 9 months in the
aggregate within a 36 month period (such that, for instance, receipt of two non-monetizable benefits in one month
counts as two months).
The following table provides a summary of how USCIS will consider the monetizable and non-monetizable public
benefits.

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Summary of Consideration Monetizable and Non-Monetizable Public Benefit(s)
Monetizable Benefit(s):

Non-Monetizable Benefit(s):

Cumulative value of benefits for a household of one
within any period of 12 consecutive months, based
on the per-month average FPG for the months during
which the benefits are received.

Number of Benefits and Duration (Months) within
36-month period (such that, for instance, receipt of
two non-monetizable benefits in one month counts as
two months)

More than 15% of the FPG

Any benefits for any time period

Equal to or less than 15% of the FPG

1 or more benefits for longer than 9 aggregate months

Any benefits in an percentage of the FPG

1 or more benefit for longer than 12 aggregate months

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Public Benefits Received by U.S. Armed Forces Service Members

When considering receipt of public benefits when determining whether the bond can be cancelled or whether the bond
has been breached, USCIS will not consider any public benefits if you were or are, either at the time of receipt of the
benefit(s), the time of filing your immigration benefits application, or the time of USCIS’ adjudication of the benefit
application:
1. An alien serving in active duty or in the Ready Reserve component of the U.S. Armed Forces; or
2. The spouse or child of the service member (listed in 1, above).

If you answer Item Number 2. in this Part 6. of the form with a “Yes,” you must provide the following documentation:
A. Service Members:

(1) Certified proof, issued by the authorizing official of the executive department in which you are serving.
B. Spouses and Children of Service Members:

(1) Provide copies of marriage certificate for spouse and birth certificates for children; and
(2) DD-1173, United States Uniformed Services Identification and Privilege Card (Dependent).
Medicaid Services Not Considered

In addition, when determining whether the bond can be cancelled and whether the bond had been breached, USCIS will
also not consider any of the Medicaid benefits received by:
A. Children of U.S. citizens whose lawful admission for permanent residence and subsequent residence in the legal
and physical custody of their U.S. citizen parent will result automatically in the child’s acquisition of citizenship
or whose lawful admission for permanent residence will result automatically in the child’s acquisition of
citizenship upon finalization of adoption in the United States by the U.S. citizen parent(s), or once meeting other
eligibility criteria as required under INA 320.
Further, USCIS will not consider Medicaid provided payment for “emergency medical condition,” for services provided
under the Individuals with Disabilities Education Act (IDEA), or for school-based non-emergency benefits provided
to children who are at or below the oldest age of children eligible for secondary education as determined under State
law. Please provide documentation of such payments under those conditions, and, if applicable, provide a statement
and information regarding the “emergency medical condition” determination. USCIS will not consider these specific
Medicaid provisions, the determination whether the bond can be cancelled, or whether the bond has been breached. If
you applied for or received Medicaid under these conditions, please indicate and explain so in Part 10. Additional
Information.

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Documentation of Public Benefit Receipt:
If you have received any of the public benefits listed above, provide evidence in the form of a letter, notice, certification or
other agency documents that contain the following:
1. Your Name;
2. Name and contact information for the public benefit granting agency;
3. Type of Benefit;
4. Amount of benefit(s) received (indicate whether weekly, monthly, or annually. If other, explain);
5. Date Benefit Was Granted;

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6. Date the Benefit Ended or Expires (mm/dd/yyyy) (if applicable); and

7. Number of Household Members Receiving the Benefit (if applicable).

If you have terminated the receipt of benefits, provide the documentation that indicates you will no longer receive the
benefits with the applicable termination date.
Part 7. Alien’s (or Alien’s Executor’s) Contact Information, Certification, and Signature

Item Numbers 1. - 6. Select the appropriate box to indicate whether you read Form I-356 yourself or whether you had an
interpreter assist you. If someone assisted you in completing your parts of Form I-356, select the box indicating that you
used a preparer. Further, you must sign and date your certification and provide your daytime telephone number, mobile
telephone number (if any), and email address (if any). Every Form I-356 MUST contain the signature of the alien (or
parent or legal guardian, or the alien’s executor, if applicable). A stamped or typewritten name in place of a signature is
not acceptable.
Part 8. Interpreter’s Contact Information, Certification, and Signature

Item Numbers 1. - 7. If you (the alien or the alien’s executor) used anyone as an interpreter to read the Instructions and
questions on this form to you in a language in which you are fluent, the interpreter must fill out this section; provide his
or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number,
his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date this
section.
Part 9. Contact Information, Certification, and Signature of the Person Preparing the Alien’s Parts of Form I-356,
if Other Than the Alien (or the Alien’s Executor)
Item Numbers 1. - 8. This section must contain the signature of the person who completed the alien’s parts of Form
I-356, if other than, the alien. If the same individual acted as your interpreter and your preparer, that person should
complete both Part 9. and Part 9. If the person who completed the alien’s parts of Form I-356 is associated with a
business or organization, that person should complete the business or organization name and address information. Anyone
who helped you complete Form I-356 MUST sign and date the form. A stamped or typewritten name in place of a
signature is not acceptable. If the person who helped you prepare your parts of Form I-356 is an attorney or accredited
representative, and you want that person to receive notification on all action taken on this application, he or she must
submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with this
form.
Part 10. Additional Information
If you need extra space to provide any additional information within this Form I-356, use the space provided in Part 10.
Additional Information. If you need more space than what is provided in Part 10., you may make copies of Part 10.
to complete and submit with Form I-356. Type or print the alien’s name and A-Number (if any) at the top of each sheet;
indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
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We recommend that you print or save a copy of your completed declaration to review in the
future and for your records.

What Evidence Must You Submit?
You must submit all evidence requested in these Instructions. If you, the obligor or agent/co-obligor, or the alien, fail
to submit required evidence, USCIS may deny the request to cancel the bond in accordance with 8 CFR 103.2 and these
Instructions.

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What Is the Filing Fee?

The filing fee Form I-356 is $25.

Where To File?

Please see our website at www.uscis.gov/I-356 or call our National Contact Center at 1-800-375-5283 for the most current
information about where to file this form. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Processing Information

USCIS will reject any Form I -356 that is not signed or is incomplete. You may resubmit the Form I-356 once it is
completed and signed.
Requests for More Information. If USCIS cannot make a cancellation determination based on the Form I-356 and
initial evidence submitted, USCIS may request that you provide additional information or evidence. We may also request
that you provide the originals of any copies you submit. If we request an original document from you, it will be returned
to you after USCIS determines it no longer needs your original.
Requests for Interview. We may request that you appear at a USCIS office for an interview. At the time of any interview
or other appearance at a USCIS office, we may require that you provide your biometrics to verify your identity and/or
update background and security checks.

USCIS Forms and Information
To ensure you are using the latest version of this form, please visit the USCIS website at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order
USCIS forms by calling the Forms Request Line at 1-800-870-3676. You may also obtain forms and information by
calling the USCIS National Contact Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at
www.uscis.gov. Select “Make an Appointment” and follow the screen prompts to set up your appointment. Once you
finish scheduling an appointment, the system will generate an appointment notice for you.

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Penalties
If you, the obligor, co-obligor or the alien, knowingly and willfully falsify or conceal a material fact or submit a false
document with your Form I-356, we may deny the request to cancel the bond. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.

USCIS Compliance Review and Monitoring
By signing this form, you, the obligor, co-obligor and alien, have stated under penalty of perjury (28 USC section 1746)
that all information and documentation submitted with this form are complete, true, and correct. You also authorize the
release of any information from your records that USCIS may need to determine your eligibility for the immigration
benefit you are seeking and consent to USCIS verifying such information.

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The Department of Homeland Security (DHS) has the authority to verify any information you submit to establish that
the bond should be cancelled. USCIS’ legal authority to verify this information is in Title 8 USC sections 1103, 1182,
and 1183, and 8 CFR Parts 103 and 213, as well as Title 26 USC 6109, Title 31 U.S.C. 7701 and Executive Order 9397.
To ensure compliance with applicable laws and authorities, USCIS may verify information before or after your case is
decided.
Agency verification methods may include, but are not limited to: review of public records and information; contact
through written correspondence, the Internet, facsimile, other electronic transmission, or telephone; unannounced physical
site inspections of residences and locations of employment; and interviews. USCIS will use information obtained through
verification to assess your compliance with the laws and to determine whether the bond should be cancelled.
Subject to the restrictions under 8 CFR 103.2(b)(16), USCIS will provide you with an opportunity to address any adverse
or derogatory information. USCIS may also provide an opportunity to address any adverse information that may result
from a USCIS compliance review, verification, or site visit after a formal decision is made on your case or after the agency
has initiated an adverse action which may result in revocation of the cancellation of the public charge bond.

DHS Privacy Notice

AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the
Immigration and Nationality Act sections 103 and 212(a)(4) and 213, as well as Title 26 USC 6109, Title 31 USC 7701
and Executive Order 9397.
PURPOSE: The primary purpose for providing the requested information on this form is to determine whether the public
charge bond should be cancelled. USCIS uses the information you provide to grant or deny the request for cancellation of
the public charge bond.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your TIN and Social Security number (if applicable), and any requested evidence, may delay a final decision or
result in denial of your request.
ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence with
other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine
uses described in the associated published system of records notices [DHS-USCIS-001 - Alien File, Index, and National
File Tracking System and DHS-USCIS-007 - Benefits Information System] and the published privacy impact assessments
[DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems,]
which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement
purposes or in the interest of national security.

Form I-356 Instructions xx/xx/xx 

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Paperwork Reduction Act
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection
of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The
public reporting burden for this collection of information is estimated at 45 minutes per response, including the time for
reviewing instructions, gathering the required documentation and information, completing the form, preparing statements,
attaching necessary documentation, and submitting the form. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and
Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW,
Washington, DC 20529-2140; OMB No. 1615-NEW. Do not mail your completed Form I-356 to this address.

Draft
Not for
Production
09/28/2018

Form I-356 Instructions xx/xx/xx 

Page 11 of 11