Form DHS-7001 Case Assistance Form

DEPARTMENT OF HOMELAND SECURITY
Office of the Citizenship and Immigration Services Ombudsman

Ombudsman DHS Form 7001
OMB Control Number: 1601-0004
Expiration Date: xx/xx/xxxx

Request for Case Assistance
PLEASE READ THESE INSTRUCTIONS FIRST
Background
Congress established the Office of the Citizenship and Immigration Services Ombudsman (CIS Ombudsman) as an
external ombudsman to assist individuals and employers unable to resolve issues directly with U.S. Citizenship and
Immigration Services (USCIS). The CIS Ombudsman is an independent office within the U.S. Department of Homeland
Security (DHS), and not part of USCIS.
To receive assistance with an issue regarding an application or petition with USCIS, submit this form to the CIS
Ombudsman using the instructions below.
Seek Help from USCIS First
You must try to resolve your issue directly with USCIS first before filing DHS Form 7001. Go to www.dhs.gov/caseassistance for ways to seek help from USCIS. If you have tried to address your issue directly with USCIS and still need to
request case assistance from the CIS Ombudsman, you may submit DHS Form 7001 and describe in the first section
below what actions you have taken to resolve your issue with USCIS. The CIS Ombudsman will allow exceptions to this
requirement only in very limited circumstances.
Please review the CIS Ombudsman web pages for current information on when we can and cannot help. For
example, with few exceptions, the CIS Ombudsman cannot help if:
• Your case is within published processing times (https://egov.uscis.gov/processing-times), unless there is a statutory or

regulatory processing time requirement.
• There is no published processing time for the form type, and you have not waited at least six months since filing.
• USCIS has denied an expedite request (www.uscis.gov/forms/filing-guidance/how-to-make-an-expedite-request).
• You are seeking legal advice.
• You are seeking assistance with an issue that does not involve USCIS.
• You are seeking to change a decision by USCIS, unless the decision is based on a clear error.
• It has been less than 30 calendar days since your congressional representative made an inquiry to USCIS.

Who May Prepare and Submit a Request for Case Assistance?
• Applicants and petitioners, as well as attorneys and accredited representatives, may submit a request.
• Applicant is the individual who signs and applies for an immigration benefit.
• Petitioner is an employer or individual who files a petition on behalf of a non-U.S. citizen.
• Beneficiary is the non-U.S. citizen for whom a petition is submitted by an individual or employer.
• Attorney is an individual authorized to practice law and is a member of the bar in good standing.
• Accredited Representative is a member of a qualified nonprofit religious, charitable, social service, or similar

organization.
• We cannot assist the beneficiary of a petition unless the petitioner's consent is provided. There are some

circumstances where an applicant also needs a petitioner's consent, such as with multiple applications/petitions filed
together where the underlying petition has not yet been approved. This is true for both USCIS and the CIS
Ombudsman.
• For example, if an underlying immigrant visa petition (e.g., Form I-130 or I-140) is not yet approved, the

petitioner's consent is required to request information about the immigrant visa petition filed together with it
(e.g., Form I-485, Application to Register Permanent Residence or Adjust Status).
• If you are a family member, congressional representative, or advocate, you must include written consent with a

signature from the applicant or petitioner authorizing the CIS Ombudsman to communicate with you about the status of
their case.
• If you are seeking our help with a T/U/VAWA related matter without the assistance of a legal representative, the CIS

Ombudsman cannot communicate with you by phone or email. We will send correspondence only to the address listed
in the USCIS database as required by law, even if you provide a different address on your DHS Form 7001.
• The CIS Ombudsman requires consent from each applicant and petitioner.
DHS Form 7001 (XX/XX/XX) Draft

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
Required Information/Documents
Please have the following information available to complete this form, if applicable:
• A-Number;
• USCIS form and receipt number(s) for each application or petition for which you seek our assistance;
• Correspondence with USCIS (e.g., Form I-797, Notice of Action);
• USCIS response(s) to inquiry; and
• Any other information or documentation that is important to the case.

Form G-28: If you are a legal representative, you must submit the Notice of Entry of Appearance (Form G-28) that you
have already submitted to USCIS for the application/petition for which you seek our assistance.
For expedite requests: If you are requesting expedited assistance, you must submit documentary evidence of the
urgency or hardship (e.g., medical records, financial documents, letter from employer, etc.) that demonstrates how the
individual or employer will be unable to withstand the hardship. Please do not include private or personally identifiable
information that is not relevant to assessing your request.
How to Submit This Form
Please submit your completed, signed, and dated DHS Form 7001, including supporting documentation, by one of the
following methods:
• Online: Submit your request for case assistance online at: www.dhs.gov/topic/cis-ombudsman/forms/7001. If you are

unable to upload all documents, you may submit documents by email to cisombudsman@hq.dhs.gov. Please include
the CIS Ombudsman request number received via email after submitting DHS Form 7001 online.
• Email: If you are outside the United States and unable to access our online case assistance portal, email DHS Form

7001 and all supporting documents to cisombudsman@hq.dhs.gov.
Only mail or fax documents if you do not have computer access.
• Fax: (202) 357-0042
• U.S. Mail:

Office of the Citizenship and Immigration Services Ombudsman
Department of Homeland Security
Mailstop 0180
Washington, D.C. 20528
What Happens After Submitting a Request?
• Online submissions will receive an automated confirmation email that includes a CIS Ombudsman request number in

the subject line.
• If you submit a paper DHS Form 7001, you will receive a CIS Ombudsman request number by email or mail after we

input your information into our system.
• All requests for case assistance are reviewed to determine if it is appropriate for the CIS Ombudsman to inquire with

USCIS. You will be notified if the CIS Ombudsman is unable to make an inquiry or help.
• We will contact you after our office receives a response from USCIS. There is no need to contact us unless your

circumstances have changed. For example, email us if:
• Your case is resolved by USCIS after you submit a request for case assistance (include your CIS Ombudsman

request number); or
• Your address changes. (Also inform USCIS at: https://egov.uscis.gov/coa/displayCOAForm.do).

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
1A. Actions Taken with USCIS for Resolution

1.

Requested assistance from USCIS using its
e-Request (https://egov.uscis.gov/e-request/Intro.do) or other
online tools, e.g., to request an appointment or interview,
correct typographic errors, inquire about delayed delivery of
documents, notices or cards by mail, or if a case is beyond
the published processing times (https://egov.uscis.gov/
processing-times)

2.

Emailed the lockbox

3.

Called the USCIS Contact Center at 1-800-375-5283

4.

For refugee applicants: Emailed USCIS from your registered
email address to seek assistance

Check all that apply and provide the following
information in the box, where applicable:
• The date and email or phone number used to

call the USCIS Contact Center;
• The response from USCIS; and
• The service request or reference/confirmation

number, or the representative's name or
identification number, as well as the call date
and phone number you called from.

Our office will not contact USCIS on your behalf
For T visa, U visa, or Violence Against Women Act (VAWA)
5.
unless you have indicated prior actions taken with
benefits: Contacted the appropriate USCIS service center
USCIS.
Other
6.
See the USCIS Contact Us web page
Please describe the response(s) USCIS provided and attach all
(https://www.uscis.gov/about-us/contact-us) for
relevant correspondence and/or screenshots:*
additional information and addresses.

1.

1B. Other Actions Taken
Check all that apply and submit a copy of any
response received.

Contacted a U.S. government agency
Date Contacted

Our office may defer action until USCIS has ruled
2.
on your appeal/motion or has responded to the
third party.

Response received:
Yes/attached

Contacted a U.S. congressional representative
Date Contacted

Response received:
Yes/attached

3.

Check all that apply and provide a clear and
concise explanation of the issue and how you
would like the CIS Ombudsman to assist.

Yes/attached

No

Filed an appeal or motion challenging a USCIS decision
denying benefits
Response received:

2. Reason(s) for Requesting Case Assistance

No

Submitted an inquiry through a non-governmental organization
or bar/trade association
Response received:

4.

No

Yes/attached

No

Mailing issues, including non-delivery of correspondence and/or
immigration documents
Beneficiary may “age-out” of eligibility for the requested
immigration benefit. (see Child Status Protection Act web page:
https://www.uscis.gov/green-card/green-card-processes-andprocedures/child-status-protection-act-cspa)
Certain cases involving U.S. military personnel and their families
Applications or petitions that were improperly rejected by USCIS
due to clear errors of fact or obvious misapplication of the relevant
law by USCIS

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
2. Reason(s) for Requesting Case Assistance
(continued)

Typographic error(s) on immigration documents
(https://egov.uscis.gov/e-request/Intro.do)
You are in removal proceedings before the immigration court with
a hearing scheduled within six months and have an application/
petition pending before USCIS that could impact the outcome
Lost files or file transfer issues
Certain cases involving an emergency or a hardship that falls
under USCIS expedite criteria (https://www.uscis.gov/forms/filingguidance/how-to-make-an-expedite-request)
Priority-2 Direct Access Program
Systemic issues, trends, or patterns that should be given higher
level review
Case is at least 30 days past published processing times (e.g.,
at least 30 days past the receipt date for a case inquiry with
USCIS)
Case has no posted processing times, and your case has been
pending for more than 6 months
Other
Provide a concise explanation of the issue and attach all relevant
supporting documents:*

3. Applications or Petitions Filed
List all USCIS application/petitions related to your
issue. Check the box next to the USCIS receipt
number for which you seek assistance.
If you do not have a receipt number, please
provide a USCIS form number and receipt date.

USCIS Form
Number:*

USCIS Receipt Date:

USCIS Receipt Number:

USCIS Form
Number:

USCIS Receipt Date:

USCIS Receipt Number:

USCIS Form
Number:

USCIS Receipt Date:

USCIS Receipt Number:

4. Type of Benefit Sought

Employment (e.g., Forms I-129, I-140, and I-485 based on I-140)

Check the type of immigration benefit that you are
seeking from USCIS. Select only one.

Family (e.g., Forms I-130, I-751, and I-485 based on I-130)
Humanitarian (e.g., Forms I-360 (SIJ, SIV, VAWA), I-589, I-730, I-821D,
and I-918)

Citizenship/Naturalization
Student (e.g., Form I-539 and related Form I-765 OPT)
Military (e.g., Form N-400, MAVNI, and PIP)
Other (specify):

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
First Name*

5. Name of Applicant or Petitioner

Middle Name

Identify the individual or employer encountering
difficulties with USCIS.

Last Name*

or

Please do not list the beneficiary, attorney, or
accredited representative here.

Employer Name:

Complete Section 11 to provide beneficiary
information.

[The employer is the company or organization that submitted the
USCIS petition.]
If you have a family member who also needs assistance, please
check this box and have them submit a separate DHS Form 7001.
Send an email with all related request numbers to
cisombudsman@hq.dhs.gov so we may link your cases together.

6. Contact Information

Street Address:*

Provide contact information for the individual
(applicant/petitioner) or employer encountering
difficulties with USCIS.

Apartment/Suite:

City:*
If you provide a legal representative's contact
information instead of the individual or employer's Country:*
contact information, you must submit Form G-28.
See Section 10.
Email Address:*
NOTE: Keep your address up to date by contacting
USCIS: https://egov.uscis.gov/coa/displayCOAForm.do

7.Identification
Please provide your A-Number, if applicable, to
assist with the review of your request.
NOTE: Most A-Numbers are 9 digits and follow the
following format: A012-345-678. If yours is 8 digits,
please add a zero ("0") before the first number. If
USCIS did not assign an A-Number to you, leave
this section blank. While this is not a required field,
the information provided will assist with our review.

State/Province:
ZIP Code:

Phone Number:*
Date of Birth:* (mm/dd/yyyy)
Country of Birth:*
Country of Citizenship:*
Alien Registration Number (A-Number)
► A-

8. Supporting Documentation

Form I-797, Notice of Action (e.g., Receipt Notice)

Scan and email documents related to the issue
for which you seek assistance.

Decision Notice
Request for Evidence

If you are requesting expedited processing, you
must submit supporting documentation.

Rejection Notice for expedite request

Please label each document.

Notice of Intent to Deny
Notice of Intent to Revoke
Form G-28
Correspondence with USCIS
Screenshot of your USCIS Online Tool request
Mail confirmation tracking
Privacy waiver
Third-party consent (e.g., agent)
Handwritten or "wet" signature (required for unrepresented
confidential cases; see instructions in Section 9.)

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
Beneficiary information for employment-based petitions

8. Supporting Documentation (continued)

Other:
See How to Submit This Form above.
I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct, and that I am the
individual or employer encountering difficulties with USCIS and I
understand that any falsification of this statement is punishable under
the provisions of 18 U.S.C. Section 1001 by a fine of not more than
$10,000 or by imprisonment of not more than five years or both, and
that requesting or obtaining any record(s) under the false pretenses is
punishable under the provisions of 5 U.S.C. Section 552a (i)(3) by a
fine of not more than $5,000. Further, pursuant to 5 U.S.C. Section
522a(b), I authorize the Office of the Citizenship and Immigration
Services Ombudsman to release all information relating to the
individual or employer above mentioned to USCIS.

9. Consent for Applicant/Petitioner
The applicant/petitioner must sign this section. If
they do not, we will treat your request as
incomplete.

Signature*

Date (mm/dd/yyyy)

Full name of applicant or petitioner*

If you are protected by statutory confidentiality provisions (e.g., Forms
I-360, I-918, I-914, or related Forms I-485, I-765, I-589 and I-590),
please submit your “wet” (handwritten, not electronic) signature. The
CIS Ombudsman may communicate via email or telephone with legal
representatives who have a properly completed Form G-28 already on
file with USCIS. If you do not have an attorney or accredited
representative, we will communicate with you only via postal mail to
the address on file with USCIS.
First Name:*

10. Consent for Attorney or Accredited
Representative
Please complete this section if you are an
attorney or an accredited representatve.

Last Name*

Name of law firm or organization:*

Form G-28: If you are a legal representative, you
must submit the Notice of Entry of Appearance
(Form G-28) that you already have submitted to
USCIS for the application/petition for which you
seek our assistance.

Street Address:*
Apartment/Suite:
City:*
ZIP Code:*

State/Province:*
Country:

Email Address:*
Work Number:*
Alternative Number:

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
I am an accredited representative of a religious, charitable, social
service or similar organization established in the United States
and recognized by the Department of Justice's Executive Office of
Immigration Review.

10. Consent for Attorney or Accredited
Representative (continued)

I have submitted to USCIS a Form G-28 as the attorney/
accredited representative regarding applications/petitions for
which I seek assistance. A copy of my Form G-28 is attached.
Other (Explain fully):

Signature of Attorney/Representative

Date (mm/dd/yyyy)

11. Beneficiary Information for Employment-Based Petitions
If you are an employer who submitted a Form I-129 or Form I-140 referenced in Section 3 on behalf of a beneficiary,
please provide the information requested below. If you submitted a petition that included multiple beneficiaries, such as
for H-2A or H-2B visa classifications, list only the workers for whom you need assistance.
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
11. Beneficiary Information (continued)
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*
Full Name:*
Date of Birth:* (mm/dd/yyyy)
Alien Registration Number (A-Number) ►

A-

Country of Birth:*
Country of Citizenship:*
12. How did you learn about the CIS Ombudsman's casework service?
Referred by USCIS

DHS Website

Community-Based Organization

Search Engine

Social Media

Legal Representative

Congressional Staff

Received a Stakeholder Message through GovDelivery

Friend/Other:
Privacy Act Statement
Authority: 6 U.S.C. Section 272 authorizes the collection of this information.
Purpose: The CIS Ombudsman will use the information provided to assist an individual or employer with the request for
case assistance.
Routine Use: The information will be used by and disclosed to DHS personnel and contractors or other agents who need
the information to assist in activities related to your case assistance request. DHS may also share the information
provided in accordance with the routine uses listed in DHS/CISOMB-001 Case Assistance Analytics and Data Integration
System of Records Notice, 86 FR 59408, October 27, 2021.
Disclosure: Providing this information is voluntary. However, failure to provide the requested information may delay or
prevent the CIS Ombudsman from assisting with your case.

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DEPARTMENT OF HOMELAND SECURITY

Request for Case Assistance
Paperwork Reduction Act Notice
The public reporting burden to complete this information collection is estimated at one hour per response, including the
time for reviewing instructions, searching existing data sources, gathering, and maintaining the necessary data, and
completing and reviewing the collected information. An agency may not conduct or sponsor, 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 1601-0004 and expiration date XX/XX/XXXX. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to the CIS Ombudsman at
the email or mailing address listed above.

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