Uscis I-192, Application For Advance Permission To Enter As Nonimmigrant

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OMB No. 1615-0017; Expires 04/30/2015
I-192, Application for Advance
Permission to Enter as Nonimmigrant
of Homeland Security
[Pursuant to Section 212(d)(3)(A)(ii) of the INA]
U.S. Citizenship and Immigration Services
Fee Stamp
(Read instructions to the form.)
Type or Print in Black Ink
File No. A-
I hereby apply to the Secretary of Homeland Security for permission to enter the United States temporarily under the provisions of
section 212(d)(3)(A)(ii) of the Immigration and Nationality Act (INA).
1. Full Name
2. Date of Birth (mm/dd/yyyy)
4. Present Citizenship/Nationality
3. Place of Birth (City-Town, State/Province, Country)
5. Present Address, Telephone Number, and E-Mail address
6. All addresses at which I have resided during the past 5 years (Use a separate sheet of paper, if necessary.)
7. Desired Port of Entry into the United States
8. Means of Transportation
9. Proposed Date of Entry
10. Approximate Length of Stay in the United States
11. My purpose for entering the United States is: (Explain fully)
12. I believe that I may be inadmissible to the United States for the following reason(s) and no others:
have not previously filed an application for advance permission to enter as a nonimmigrant
, at
If you are an applicant for T and U nonimmigrant status, you do not need to answer questions 14 through 17.
14. Have you ever been in the United States for a period of 6 months or more? If yes, when, for how long, and in what immigration status?
Form I-192 (Rev. 04/15/13) Y


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