Fillable Immigration Assistance Request Form printable pdf download

PID#:_________________________

ATTN:_________________________

(For Staff Use Only)

IMMIGRATION ASSISTANCE REQUEST FORM

U.S. Senator Dianne Feinstein

One Post Street, Suite 2450

San Francisco, CA 94104

Fax: 415-393-0710

PLEASE PRINT CLEARLY OR TYPE

Please complete all sections that apply to your case and review instructions at the end of the form.

Title: □ Mr. □ Mrs. □ Ms. □ Miss □ Dr. □ Other _____

Name: _________________________________________ Date: _________________

Street Address: ______________________________________ Apt. #: ____________

City: ___________________________________ State: ______ Zip Code: __________

Primary Phone #: (____)__________________ Alternate Phone #: (_____)__________________

E-mail Address: ______________________________

NOTE: Attorneys, if you are completing this form for your client, please attach a copy of the G-28.

If you have contacted another Congressional office about this case, please list the office(s) contacted

and the date(s) of contact: _____________________________________________

SECTION 1:

NOTE: The “beneficiary” is the alien who will receive the direct benefit of a filed petition (i.e. visa or green card).

Please see further instructions for waiver applications. Please use one form per beneficiary.

A. Petitioner’s Name: ______________________________________

Alien Registration #: A______________________

Petitioner’s relationship to beneficiary: ______________________

Beneficiary’s Name: _____________________________________

Alien Registration #: A__________________________

Date of Birth (MM/DD/YY): _____________ Country of Birth: _________________

B. Mark an ‘X’ to the right of the forms filed

For I-130, I-140, I-485, waivers and appeals,

see notes below.

G-639

I-131

I-730

I-824

Other:

I-90

I-360

I-751

N-400

I-129

I-539

I-765

N-565

I-129F

I-600/A

I-821

N-600

I-290B

I-601

I-130

I-140

I-485

I-212

I-130/I-140: Be sure to indicate the visa category of your petition and verify that a visa is available by checking the

Department of State Visa Bulletin: OR by phone: 202-663-

1541. Include case priority date(s) from your I-797 Notice of Action below.

For I-485, I-601, I-290B, all appeals or waivers: Include case information on the related petitions (i.e. the I140 or

I130 filed), as well as the visa category and priority date for those petitions.

USCIS case information (from I-797 Notice of Action):

Please list all petitions you need help with, as well as the related visa petitions. Include case priority date for I-140 petitions.

Form filed: ________ Filing date: __________ Case #: __________________________

Version 09/12

Immigration Assistance Request Form

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