Form I-698 Application to Adjust Status from Temporary to Permanent

Application to Adjust Status From Temporary
to Permanent Resident (Under Section 245A of the INA)
Department of Homeland Security
U.S. Citizenship and Immigration Services
Receipt

Applicant Interviewed
Date:
For
USCIS
Date of Adjustment
Use
Only

USCIS
Form I-698

OMB No. 1615-0035
Expires 04/30/2021

Action Block

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Remarks

Date:

► START HERE - Type or print in black ink.

Part 1. Information About You
1.

Full Legal Name

Family Name (Last Name)
2.

Given Name (First Name)

Middle Name

Name as it Appears on Your Employment Authorization Document (Form I-766)
A. Family Name (Last Name)

Given Name (First Name)

Middle Name

B. Provide the reason for a difference in the names, if any (marriage, divorce, etc.)
3.

4.

Any Other Names Used

A. Family Name (Last Name)

Given Name (First Name)

Middle Name

B. Family Name (Last Name)

Given Name (First Name)

Middle Name

A. If your native alphabet does not use Roman letters, type or print your name in your native alphabet.
Family Name (Last Name)

Given Name (First Name)

Middle Name

B. Language of Your Native Alphabet
5.

U.S. Mailing Address

(USPS ZIP Code Lookup)

In Care Of Name
Street Number and Name
City or Town
6.

Is your current U.S. mailing address the same as your U.S. physical address?

Apt. Ste. Flr. Number
State

ZIP Code
Yes

No

If you answered "No," provide your U.S. physical address in Item Number 7.
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Part 1. Information About You (continued)
7.

A-

U.S. Physical Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town
8.

State

ZIP Code

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Alien Registration Number (A-Number) (if any)
► A-

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

9.

U.S. Social Security Number (if any)
►

11. Gender

Female

Male

12. Place of Birth
City or Town

Province or Foreign State

13. Country of Citizenship or Nationality
16. Marital Status

Country

14. Mother's First Name

Single (Never Married)

Married

15. Father's First Name

Divorced or Separated

Widowed

17. List absences from the United States since becoming a temporary resident. List the most recent absence first. If you have a single
absence that exceeded 30 days or if the total of all of your absences exceeds 90 days, explain using the space provided in Part 8.
Additional Information or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of the
sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
Country

From
(mm/dd/yyyy)

Purpose of Trip

To
(mm/dd/yyyy)

Total Days
Absent

Part 2. Biographic Information
1.

Ethnicity (Select only one box)

2.

Race (Select all applicable boxes)
White

Asian

Black or African
American

3.

Height

5.

Eye Color (Select only one box)

6.

4.

Inches

Feet

Black

Hispanic or Latino

Blue

Brown

American Indian or
Alaska Native

Weight

Gray

Not Hispanic or Latino
Native Hawaiian or
Other Pacific Islander

Pounds

Green

Hazel

Maroon

Pink

Unknown/Other

Hair Color (Select only one box)
Bald
(No Hair)

Form I-698 04/28/19

Black

Blond

Brown

Gray

Red

Sandy

White

Unknown/
Other

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Part 3. Eligibility Standards
1.

A-

You are required to have a minimal understanding of standard English and a knowledge and understanding of the history and
Government of the United States. Select the appropriate box in Item A. or B. below.
A. I will satisfy these requirements through:
An examination at the time of interview for lawful permanent residence; or
Satisfactory pursuit of a course of study recognized by the Secretary of Homeland Security (Secretary).
B. I have satisfied these requirements by:

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Satisfactory pursuit of a course of study recognized by the Secretary (attach appropriate documentation); or
An exemption because I am 65 years of age or older, under 16 years of age, or I am physically unable to comply. (If you
are physically unable to comply, explain and attach relevant documentation.)
Answer Item Numbers 2. - 29. If you answer "Yes" to any of the questions, provide a complete explanation using the space provided
in Part 8. Additional Information or attach a separate sheet of paper. Type or print your 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.
Answering "Yes" does not necessarily mean that you are not entitled to adjust status or register for lawful permanent residence.
2.

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

3.

Have you EVER been treated for a mental disorder, drug addiction, or alcoholism?

Yes

No

4.

Have you EVER committed a crime or offense for which you were not arrested?

Yes

No

5.

Have you EVER been arrested, cited, or detained by any law enforcement officer (including Immigration
and Customs Enforcement (ICE), Customs and Border Protection (CBP), former Immigration and
Naturalization Service (INS), and/or military officers) for any reason?

Yes

No

6.

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

Yes

No

7.

Have you EVER been convicted of a crime or offense?

Yes

No

8.

Have you EVER been in jail or prison?

Yes

No

9.

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

Yes

No

10. Have you EVER received a suspended sentence, been placed on probation, or been paroled?

Yes

No

11. A. 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?

Yes

No

B. If "Yes," provide the names of the recipients and their U.S. Social Security Numbers below.
Full Name of Recipient (Family Name, Given Name, Middle Name)

U.S. Social Security Number

12. Have you EVER:
A. Within the past 10 years been a prostitute, procured anyone for prostitution, or intend to engage in such
activities in the future?

Yes

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 any controlled substance?

Yes

No

Form I-698 04/28/19

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Part 3. Eligibility Standards (continued)

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13. Have you EVER engaged in, conspired to engage in, do you intend to engage in, or have you EVER
solicited membership or funds for, or have you EVER through any means 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?

Yes

No

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

15. Have you EVER been a member of, or in any way affiliated with, a Communist Party or any other
totalitarian party?

Yes

No

16. Did you EVER, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi
Government of Germany or any organization or government associated or allied with the Nazi Government
of Germany, order, incite, assist, or otherwise participate in the persecution of any person because of race,
religion, national origin, or political opinion?

Yes

No

17. Have you EVER claimed to be a United States citizen in writing or any other way?

Yes

No

18. Have you EVER been deported from the United States, 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 rescission proceedings?

Yes

No

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

Yes

No

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

Yes

No

21. Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence
requirement and have not yet complied with that requirement or obtained a waiver?

Yes

No

22. Are you NOW withholding custody of a U.S. citizen child outside the United States from a person granted
custody of the child?

Yes

No

23. Do you plan to practice polygamy in the United States?

Yes

No

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

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24. Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:
A. Acts involving torture or genocide?

Yes

No

B. Killing any person?

Yes

No

C. Intentionally and severely injuring any person?

Yes

No

D. Engaging in any kind of sexual contact or relations with any person who was being forced or
threatened?

Yes

No

E. Limiting or denying any person's ability to exercise religious beliefs?

Yes

No

A. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police
unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization?

Yes

No

B. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that
involved detaining persons?

Yes

No

25. Have you EVER:

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Part 3. Eligibility Standards (continued)

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26. Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of any
kind in which you or other persons used any type of weapon against any person or threatened to do so?

Yes

No

27. Have you EVER assisted or participated in selling, providing, or transporting weapons to any person who,
to your knowledge, used them against another person?

Yes

No

28. Have you EVER received any type of military, paramilitary or weapons training?

Yes

No

A. Recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed
force or group?

Yes

No

B. Used any person under 15 years of age to take part in hostilities, or to help or provide services to
people in combat?

Yes

No

29. Have you EVER:

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Part 4. Accommodations for Individuals With Disabilities and Impairments (Read the information in the
Form I-698 instructions before completing this part.)
1.

Are you requesting an accommodation because of your disabilities and/or impairments?

Yes

No

If you answered "Yes," Select all applicable boxes.
A.

I am deaf or hard of hearing and request the following accommodations (if you are requesting a sign-language interpreter,
indicate for which language (e.g., American Sign Language)):

B.

I am blind or have low vision and request the following accommodations:

C.

I have another type of disability and/or impairment (describe the nature of your disabilities and/or impairments and the
accommodations you are requesting):

Part 5. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-698 Instructions before completing this section.

Applicant's Statement

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Applicant's Statement Regarding the Interpreter
A.

I can read and understand English, and I have read and understand every question and instruction on this application and
my answer to every question.

B.

The interpreter named in Part 6. read to me every question and instruction on this application and my answer to every
question, in
I am fluent, and I understood everything.

2.

, a language in which

Applicant's Statement Regarding the Preparer
At my request, the preparer named in Part 7.,
prepared this application for me based only upon information I provided or authorized.

Form I-698 04/28/19

,

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Part 5. Applicant's Statement, Contact Information, ASC Acknowledgement, ACertification, and Signature (continued)
Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

5.

Applicant's Email Address (if any)

4.

Applicant's Mobile Telephone Number (if any)

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Applicant's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the
information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.

Applicant's Signature
6.

Applicant's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.

Part 6. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Given Name (First Name)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town
Province

Form I-698 04/28/19

State
Postal Code

ZIP Code

Country

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Part 6. Interpreter's Contact Information, Certification, and Signature
(continued)

A-

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

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Interpreter's Certification

I certify, under penalty of perjury, that:

, which is the same language
I am fluent in English and
specified in Part 5., Item B. in Item Number 1.; and I have read to this applicant in the identified language every question and
instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every
instruction, question, and answer on the application, including the Applicant's Certification, and has verified the accuracy of every
answer.

Interpreter's Signature
7.

Date of Signature (mm/dd/yyyy)

Interpreter's Signature

Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if
Other Than the Applicant
Provide the following information about the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization (if any)

Preparer's Given Name (First Name)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town
Province

Form I-698 04/28/19

State
Postal Code

ZIP Code

Country

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Part 7. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant (continued)

A-

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (if any)

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Preparer's Statement
7.

A.

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant
and with the applicant's consent.

B.

I am an attorney or accredited representative and my representation of the applicant in this case
extends
does not extend beyond the preparation of this application.

NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this application.

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then
reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted
with, his or her application, including the Applicant's Certification, and that all of this information is complete, true, and correct. I
completed this application based only on information that the applicant provided to me or authorized me to obtain or use.

Preparer's Signature
8.

Preparer's Signature

Form I-698 04/28/19

Date of Signature (mm/dd/yyyy)

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Part 8. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space
than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.
Include your 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.
1.

Family Name (Last Name)

2.

A-Number (if any)

3.

A. Page Number
D.

4.

5.

A. Page Number
D.

6.

Middle Name

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A. Page Number
D.

Given Name (First Name)

A. Page Number

► A-

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

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