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. 1615-0005
Expires xx/xx/xxxx

What Is the Purpose of Form I-356?
You should use this form to request cancellation of the public charge bond that was submitted on Form I-945, Public
Charge Bond, on behalf of an alien (someone who is not a citizen of the United States).

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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 (the person who has posted the bond) or by the
obligor’s authorized agent (co-obligor, for surety companies only) who posted the bond on behalf of the alien, or by 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, but 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)) for more than 12 months in the aggregate within any 36 month period (such
that, for instance, receipt of two benefits in one month counts as two months), 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), for more than 12 months in the aggregate within any 36 month period (such that, for instance, receipt of two
benefits in one month counts as two months), 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. We 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?
A public charge bond will be cancelled once the alien has naturalized, permanently departed the United States, or
died. See INA section 213 and 8 CFR 213.1. 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. See INA section 212(a)(4).

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Regardless of the reason an obligor or the alien may seek to cancel the public charge bond, the U.S. Department of
Homeland Security (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; and
2. The alien can establish that he or she has not received public benefits, as defined in 8 CFR 212.21(b), for more than
12 months in the aggregate within any 36 month period (such that, for instance, receipt of two benefits in one month
counts as two months), 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.

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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.

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 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.

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How to Fill Out Form I-356
1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this form, use the space provided in Part 9. 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. For surety bonds, please include
the name of the surety company.
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) (if any). 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 9. 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 9.
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. Reason for Cancellation of the Bond

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 or not you have become a U.S. 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, from
outside the United States 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 that 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 lawful permanent
resident status. These situations include the following:
1. 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 from outside the United States and according to its instructions;

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2. Your lawful permanent resident 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. 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 4. Five Years as a 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. 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 about your (the alien’s) receipt of public benefits, as defined in 8 CFR 212.21(b)
(listed below) for more than 12 months in the aggregate within any 36 month period (such that, for instance, receipt of two
benefits in one month counts as two months), 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.
Receipt means when a benefit-granting agency provides or has provided a public benefit to you whether in the form
of cash, voucher, services, or insurance coverage. NOTE: DHS will only consider the public benefits received by or
attributable to the alien himself or herself. In addition, USCIS does not consider any public benefits received after a
person becomes a U.S. citizen. You do not need to provide information of public benefits received after you became a
citizen, if applicable.
In the space designated, please provide all requested information about each public benefit regardless of the amount or the
duration. USCIS will calculate the relevant public benefit receipt duration to determine whether the alien breached the
bond. If the alien breached the bond, USCIS will not cancel the bond. (Please note that you need to respond even if you
fall within one of categories of individuals for whom receipt of public benefits will not be considered – see the table below
for evidence that must be provided to document that the alien qualifies for the exemption). Please select all that apply. If
you require additional space, please use the space provided in Part 9. Additional Information.
In the space provided, indicate you have received, since your adjustment of status to that of a lawful permanent resident
(for which a bond was submitted on your behalf) any of the following benefits (select all that apply):
1. Any Federal, state, local, or tribal cash assistance for income maintenance;
2. Supplemental Security Income (SSI);
3. Temporary Assistance for Needy Families (TANF);
4. 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);
5. Supplemental Nutrition Assistance Program (SNAP, or formerly called “Food Stamps”);
6. Section 8 Housing Assistance under the Housing Choice Voucher Program;
7. Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation);
8. Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.; or
9. Federally-Funded Medicaid.
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If you have not received any of the public benefits listed above, please select that option.
If you are not currently certified to receive any of the public benefits listed above, please select that option
As part of the determination of whether USCIS can cancel the bond or whether the alien has breached the bond, USCIS
will consider the above listed public benefits except as excluded below.
The following is a list of exclusions from the public benefit(s) considerations listed above. If you have received public
benefits and belong to one of the following categories, submit the evidence listed below for the applicable categories.
Exclusion
U.S. Armed Forces
Service Members

Description

Evidence you must submit to qualify for
exclusion (as applicable)

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At the time the public benefit was
received or at the time you file the request
to cancel the bond, or at time of the
cancelation determination or the bond
breach determination adjudication of this
application, you are:
•

An alien enlisted in the U.S. Armed
Forces, or serving in active duty or in the
Ready Reserve component of the U.S.
Armed Forces;

•

The spouse or child of the service
member (listed in Item Number 1.,
above); or

•

The spouse or child of a U.S. citizen
or U.S. national serving in the U.S.
Armed Forces or in active duty or in
the Ready Reserve component of the
U.S. Armed Forces.

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•

Service Members: Certified evidence of alien’s
enlistment/service issued by the authorizing
official of the executive department in which
service member is serving.

•

Spouses and Children of Service Members:
•

Form DD-1173, United States Uniformed
Services Identification and Privilege Card
(Dependent).

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Exclusion

Description

Evidence you must submit to qualify for
exclusion (as applicable)

Federally-funded
Medicaid

•

Receipt of an alien under 21 years of
age;

•

•

The recipient of Medicaid payment(s)
for an “emergency medical condition”;

A statement with information regarding the
“emergency medical condition” determination
(if applicable);

•

•

The receipt of Medicaid for services
provided under the Individuals with
Disabilities Education Act (IDEA);

Documentation of these payments under the
IDEA or school-based service; or

•

Pregnancy verification letter from medical
professional including estimated duration of
pregnancy.

Children Acquiring
US Citizenship

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•

The receipt of Medicaid for schoolbased non-emergency benefits for
children who are of an age eligible for
secondary education as determined
under state law; or

•

Receipt during pregnancy and during
the 60-day period after the last day of
the pregnancy.

•

Child 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 in the
child’s automatically acquiring U.S.
citizenship upon meeting the eligibility
under INA 320;

•

Child of U.S. citizens whose lawful
admission for permanent residence
will result automatically in the child’s
acquisition of citizenship upon
finalization of adoption (if the child
satisfies the requirements applicable to
adopted children under INA 101(b)(1)),
in the United States by the U.S. citizen
parent(s), upon meeting the eligibility
criteria under INA 320; or

•

Child currently residing abroad who
entered the United States with a
nonimmigrant visa to attend N-600K,
Application for Citizenship and
Issuance of Certificate Under INA
Section 322 interview.

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•

Evidence that you are the child of a United
States citizen, who will be eligible for
acquisition of citizenship under INA 320
and the evidentiary requirements to meet the
qualifications to demonstrate citizenship.
For more information, see Form N-600,
Application for Certificate of Citizenship.

•

A copy of the N-600K interview notice.

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Exclusion

Description

Evidence you must submit to qualify for
exclusion (as applicable)

Public Benefits
While in an
Immigration
Category Exempt
from Public Charge

•

Received public benefits while in a
category that is exempt from public
charge inadmissibility; or

•

•

Received public benefits while
in a category for which you had
received a waiver for public charge
inadmissibility.

Documentation:

Information that evidences your status or that
you received a waiver for the public charge
ground of inadmissibility, such as:
•

Approval notice (Form I-797, Notice of
Action); or

•

Form I-94, Arrival/Departure Record.

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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 public benefit;

4. Date you started receiving the public benefit or if certified, date you will start receiving the public benefit; and
5. Date benefit or coverage ended or expires (mm/dd/yyyy) (if applicable).

If you had applied for a public benefit but withdrew your application, provide proof of the public benefit granting agency
receipt of the withdrawal of the application.
Part 6. 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 7. 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.

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Part 8. 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 7. and Part 8. 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.

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Part 9. Additional Information

Item Number 1. - 7. If you need extra space to provide any additional information within this Form I-356, use the space
provided in Part 9. Additional Information. If you need more space than what is provided in Part 9., you may make
copies of Part 9. 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.

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.

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 USCIS 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.

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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.

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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 USCIS 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.

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.
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.

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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.

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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.

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. 1615-0005. Do not mail your completed Form I-356 to this address.

Form I-356 Instructions xx/xx/xx 

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