Enter your A-Number if USCIS or another immigration authority assigned one to you.

Enter your U.S. Social Security Number if one has been issued. Do not enter a foreign tax or national identification number.

Provide your USCIS Online Account Number if one has been assigned. This is different from your A-Number and receipt number.

Enter your Family Name, Given Name and Middle Name exactly according to your legal identity records.

List every other name you have used, including maiden names, aliases, former legal names and nicknames.

Provide the U.S. address where you can reliably receive USCIS correspondence, including In Care Of Name where applicable, street number and name, apartment, suite or floor, city, state and ZIP Code.

Provide street number and name, apartment, suite or floor, city, state and ZIP Code for your actual residence.

Provide your date of birth, city or town of birth and country of birth exactly as supported by your legal records.

Provide your current country of citizenship or nationality.

Form I-601A may be used when you believe departure will trigger the three-year unlawful-presence bar under INA section 212(a)(9)(B)(i)(I).

Form I-601A may also address the ten-year unlawful-presence bar under INA section 212(a)(9)(B)(i)(II).

If proceedings were administratively closed, provide the applicable immigration-court documentation and review the current eligibility rules carefully.

Answer the voluntary-departure questions accurately. An unexpired grant of voluntary departure can affect eligibility for I-601A.

Where I-212 approval is required for I-601A eligibility, provide the USCIS receipt information requested by the form and keep the approval notice available.

Disclose applicable arrests or detentions even when no criminal charge was ultimately filed.

If you were charged, provide the complete factual answer and certified court disposition required by the instructions.

Report applicable convictions truthfully, including records that may have been sealed, expunged or treated under a rehabilitation program when USCIS requires disclosure.

Provide the actual outcome of the criminal matter, including sentencing or alternative disposition where applicable.

For any Yes response requiring explanation, use Part 9 to provide the location, date and a concise but complete description of what occurred.

The current I-601A questions require disclosure of specified serious conduct, including certain acts involving torture, genocide, human trafficking, murder, serious injury or forced sexual activity.

Select every applicable race category listed on the form.

Enter your height in feet and inches.

Enter your weight in pounds.

Select the eye-color option that applies.

Select the hair-color option that applies.

Select only one basis for your immigrant visa case.

Provide the Diversity Visa case number assigned by the Department of State Kentucky Consular Center.

If your spouse or parent is the principal DV selectee, provide that person's Family Name, Given Name and Middle Name.

Provide the receipt number for the approved immigrant petition that forms the basis of your immigrant visa case.

Provide the Department of State or National Visa Center case number.

Provide the full name of the family member who filed the petition, or identify the company or organization for an applicable employment-based case.

If the underlying immigration classification permits self-petitioning, provide the petition information exactly as it appears in USCIS records.

Provide the Family Name, Given Name and Middle Name of the spouse or parent who would experience extreme hardship if you were refused admission.

Provide Family Name, Given Name, Middle Name and select whether the additional relative is a U.S. citizen spouse, U.S. citizen parent, LPR spouse, or LPR parent.

Explain the specific hardships your qualifying relative would experience if you were refused admission to the United States. The statement should connect each claimed hardship to actual evidence.

Explain what would happen if your qualifying relative remained in the United States while you remained outside the country.

Explain the hardship if the qualifying relative relocated outside the United States in order to live with you.

Where health issues are relevant, provide medical records, professional evaluations, treatment information and evidence explaining how separation or relocation would affect care.

Use actual financial records to show income, expenses, debts, housing, childcare, medical costs and other relevant obligations.

Describe genuine psychological or emotional consequences and support significant conditions with qualified professional evidence where appropriate.

Explain positive factors that genuinely apply to your case, such as family ties, responsibility, rehabilitation, community involvement, employment history or other relevant circumstances.

Address significant adverse facts honestly, including relevant immigration or criminal history. Explain context, subsequent conduct and rehabilitation when applicable.

Indicate whether you read and understood the application yourself or whether an interpreter read it to you.

Select the applicable box if a preparer completed the application based on information you provided or authorized.

Provide your current daytime telephone number.

Provide your mobile telephone number if applicable.

Provide your current email address if applicable.

Read the declaration carefully before signing. You certify that the information and documents submitted are complete, true and correct.

Provide the interpreter's Family Name and Given Name.

Provide the interpreter's business or organization name where applicable.

Provide the interpreter's complete mailing address.

Provide daytime telephone, mobile telephone and email information where applicable.

Identify the language used to interpret the application for the applicant.

The interpreter certifies that the application was interpreted accurately and signs and dates the section.

Provide the preparer's Family Name and Given Name.

Provide the preparer's business or organization name where applicable.

Provide the preparer's complete mailing address, telephone numbers and email address as requested.

If the preparer is an attorney or accredited representative, complete the applicable representation information and submit Form G-28 where required.

The preparer signs and dates this section when someone other than the applicant prepared the form.

Provide your identifying information at the top of the additional-information section.

For every continuation or explanation, identify the exact page, part and item number.

If Part 9 does not provide enough room, follow USCIS instructions for additional sheets and identify every continued response clearly.

For I-130, I-140 or I-360 cases, include the applicable approval information and a copy of the Form I-797 approval notice when available.

Provide evidence of the qualifying DOS immigrant visa case, including the NVC or KCC case information and required immigrant visa processing evidence where applicable.

Provide civil documents proving the relationship to each qualifying spouse or parent.

Submit evidence showing that each qualifying relative is a U.S. citizen or lawful permanent resident.

Submit evidence supporting every significant hardship claim, which may include financial, medical, psychological, family, educational and country-condition documents.

If you have immigration-court history, provide relevant EOIR orders, administrative-closure documents, voluntary-departure records or final-order records as required.

Provide the I-212 receipt number requested by Form I-601A and/or the USCIS approval notice as applicable.

If you were arrested, detained, charged or convicted, provide the arrest records, charging documents and certified court dispositions required by USCIS.

Provide reliable evidence supporting the favorable factors described in your Part 5 statement.

Any foreign-language document submitted to USCIS must include a complete English translation and the required translator certification.