Form I-824 Application for Action on an Approved Application

Application for Action on an Approved Application or Petition
Department of Homeland Security
U.S. Citizenship and Immigration Services
Returned
Date

USCIS
Form I-824
OMB No. 1615-0044
Expires 12/31/2023

Fee Stamp

Action Block

Date

Resubmitted
Date

For
USCIS
Use
Only

Date

Relocated

DRAFT
NOT FOR
PRODODUCTION
09/05/2023
Received

Sent

Remarks

Date the Previously Approved Visa Petition
Was Filed (Form I-130, I-140 or I-360):
Date the Previous Visa Petition Was Approved
(Form I-130, I-140 or I-360):

Priority Date:

Country of Chargeability:

Classification Code:

To be completed
by an attorney or
BIA-accredited
representative (if any).

Select this box if
Form G-28 or G-28I
is attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.

Part 1. Information About You (Person filing this
Application)

9.

Country of Citizenship or Nationality

1.

10.

IRS Tax Number (if any)

11.

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

12.

USCIS Online Account Number (if any)
►

I am the (select only one):

Applicant

Petitioner

on the previously approved application or petition.

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

2.c. Middle Name
3.

Company or Organization Name (if any)

Mailing Address

13.a. In Care Of Name

4.

Current/Recent Immigration Status
13.b. Street Number
and Name

NOTE: If you are a U.S. citizen, type or print “N/A”
for Item Number 4.

13.c.

5.

13.d. City or Town

Certificate of Naturalization or Citizenship Number
(if any)

Apt.

13.e. State
Alien Registration Number (A-Number) (if any)
► A-

13.g. Province

7.

Date of Birth (mm/dd/yyyy)

13.i. Country

8.

Country of Birth

6.

Form I-824 Edition 12/02/21

Ste.

Flr.

13.f. ZIP Code

13.h. Postal Code

Page 1 of 6

Part 1. Information About You (Person filing this
Application) (continued)

Part 3. Other Information

Physical Address

Provide the following information about the principal
beneficiary of the previous application or petition, if other
than you.

14.a. Street Number
and Name

1.a. Form Number of Previously Approved Application or
Petition

14.b.

Apt.

Ste.

Flr.
1.b. Receipt Number (On Form I-797, Notice of Action)

14.c. City or Town

DRAFT
NOT FOR
PRODODUCTION
09/05/2023

14.d. State

14.e. ZIP Code

1.c. Filing Date of Application or Petition (mm/dd/yyyy)

14.f. Province

14.g. Postal Code

1.d. Approval Date (mm/dd/yyyy)

14.h. Country

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

Part 2. Reason for Request

2.c.

I am requesting (select only one):

2.d. Date of Birth (mm/dd/yyyy)

1.a.
1.b.

A duplicate approval notice.

U.S. Citizenship and Immigration Services (USCIS)
to notify a new U.S. Consulate, different from the
one that I originally requested, through the U.S.
Department of State's National Visa Center (NVC) or
Kentucky Consular Center. USCIS will notify the
U.S. Consulate about the approval of a nonimmigrant
visa petition or about a new Port-of-Entry (the Portof-Entry is different from what I originally requested)
about the approval of a waiver application.
Please notify the U.S. Consulate or Port-of-Entry at:

Middle Name

2.e. Country of Birth

2.f.

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

2.g. Daytime Telephone Number

Mailing Address

3.a. In Care Of Name

1.c.

USCIS to notify a U.S. Consulate through the NVC
about my adjustment of status to permanent resident
in the United States.
Please notify the U.S. Consulate at:

3.b. Street Number
and Name

so that my spouse and/or children may accompany or
follow-to-join me.

3.d. City or Town

1.d.

USCIS to send my approved immigrant visa petition
to the NVC.

3.e

1.e.

USCIS to notify the U.S. Department of State that
I have become a U.S. citizen through naturalization.

3.c.

State

Ste.

Flr.

3.f. ZIP Code

3.g. Province
3.h. Postal Code
3.i.

Form I-824 Edition 12/02/21

Apt.

Country

Page 2 of 6

Part 3. Other Information (continued)
Physical Address
4.a. Street Number
and Name
4.b.

Apt.

12.c. Middle Name

Ste.

Flr.

4.c. City or Town
4.d. State
4.f.

12.a. Family Name
(Last Name)
12.b. Given Name
(First Name)

4.e. ZIP Code

13.

Date of Birth (mm/dd/yyyy)

14.

Country of Birth

DRAFT
NOT FOR
PRODODUCTION
09/05/2023
15.

Country of Citizenship or Nationality

16.

Relationship to Principal Applicant

17.

Dependent's Email Address (if any)

18.

Dependent's Daytime Telephone Number

Province

4.g. Postal Code
4.h. Country

Dependents

If you selected Part 2., Item Number 1.c., provide the
following information about the dependents for whom you are
requesting follow-to-join benefits. If you need additional space
for your dependents, use the space provided in Part 7.
Additional Information, and include all the information
collected in Item Numbers 5.a. - 11.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c.
6.
7.

8.

Middle Name

Date of Birth (mm/dd/yyyy)

19.a. Family Name
(Last Name)
19.b. Given Name
(First Name)

19.c. Middle Name
20.

Date of Birth (mm/dd/yyyy)

21.

Country of Birth

22.

Country of Citizenship or Nationality

23.

Relationship to Principal Applicant

24.

Dependent's Email Address (if any)

25.

Dependent's Daytime Telephone Number

Country of Birth

Country of Citizenship or Nationality

9.

Relationship to Principal Applicant

10.

Dependent's Email Address (if any)

11.

Dependent's Daytime Telephone Number

Form I-824 Edition 12/02/21

Page 3 of 6

Part 3. Other Information (continued)
26.a. Family Name
(Last Name)
26.b. Given Name
(First Name)

Part 4. Applicant's Contact Information,
Certification, and Signature
Applicant's Contact Information

26.c. Middle Name

Provide your daytime telephone number, mobile telephone
number (if any), and email address (if any).

27.

Date of Birth (mm/dd/yyyy)

1.

28.

Country of Birth

29.

30.

Applicant's Daytime Telephone Number

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NOT FOR
PRODODUCTION
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2.

Applicant's Mobile Telephone Number (if any)

3.

Applicant's Email Address (if any)

Country of Citizenship or Nationality

Relationship to Principal Applicant

Applicant's Certification and Signature

31.

32.

Dependent's Email Address (if any)

Dependent's Daytime Telephone Number

Foreign Address of Dependents
33.a. In Care Of Name

33.b. Street Number
and Name
33.c.

Apt.

Ste.

I certify, under penalty of perjury, that I provided or authorized
all of the responses and information contained in and submitted
with my application, I read and understand or, if interpreted to
me in a language in which I am fluent by the interpreter listed in
Part 5., understood, all of the responses and information
contained in, and submitted with, my application, and that all of
the responses and the information are complete, true, and
correct. Furthermore, I authorize the release of any information
from any and all of my records that USCIS may need to
determine my eligibility for an immigration request and to other
entities and persons where necessary for the administration and
enforcement of U.S. immigration law.
4.

Applicant's Signature

Flr.

33.d. City or Town

Date of Signature (mm/dd/yyyy)

33.e. Province

33.f. Postal Code

Part 5. Interpreter's Contact Information,
Certification, and Signature

33.g. Country

Interpreter's Full Name
Contact Information of Dependents
34.

1.

Foreign Telephone Number

Interpreter's Given Name (First Name)

2.

Form I-824 Edition 12/02/21

Interpreter's Family Name (Last Name)

Interpreter's Business or Organization Name

Page 4 of 6

Part 5. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

4.

Interpreter's Mobile Telephone Number (if any)

5.

Preparer's Certification and Statement
I certify, under penalty of perjury, that I prepared this
application for the applicant at their request and with express
consent and that all of the responses and information contained
in and submitted with the application are complete, true, and
correct and reflects only information provided by the applicant.
The applicant reviewed the responses and information and
informed me that they understand the responses and information
in or submitted with the application.

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NOT FOR
PRODODUCTION
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Interpreter's Email Address (if any)

Preparer's Signature

6.

Preparer's Signature

Interpreter's Certification and Signature

I certify, under penalty of perjury, that I am fluent in English

Date of Signature (mm/dd/yyyy)

, and I have interpreted
every question on the [application/petition] and Instructions and
interpreted the applicant's answers to the questions in that
language, and the applicant informed me that they understood
every instruction, question, and answer on the application.

and

6.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 6. Contact Information, Declaration,
and Signature of the Person Preparing this
Application, if Other Than the Applicant
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

4.

Preparer's Mobile Telephone Number (if any)

5.

Preparer's Email Address (if any)

Form I-824 Edition 12/02/21

Page 5 of 6

5.a. Page Number

Part 7. 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. 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.

5.b. Part Number

5.c. Item Number

5.d.

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

DRAFT
NOT FOR
PRODODUCTION
09/05/2023

1.c. Middle Name
2.

A-Number (if any) ► A-

3.a. Page Number

3.d.

4.a. Page Number

3.b. Part Number

3.c. Item Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.d.

Form I-824 Edition 12/02/21

4.c. Item Number

7.a. Page Number

7.d.

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