Fillable Immigration Assistance Request Form (Page 2 of 2) in pdf

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

LOCATION OF CASE

Have you been interviewed at a USCIS office for this case?

If so, please list date and location of the USCIS interview: _______________________________

If your case has been sent from USCIS to the National Visa Center, complete Section 2.

If your case has been sent to a U.S. Embassy or U.S. Consulate for processing, complete Section 3.

If none of these apply, please skip to Section 4. Please review all instructions.

SECTION 2:

Complete this section if your case is in process at the Department of State

NATIONAL VISA CENTER

State Department Case Number: _______________________________________

Visa Preference Category: ____________

Case Priority Date: _______________

Foreign State Chargeability: __________________________________________

(Usually the beneficiary’s country of birth)

SECTION 3:

Complete this section if your case is at a U.S. EMBASSY or U.S. CONSULATE

Embassy or Consulate location (City and Country): _____________________________________

Case Number: _________________________ Date of interview(s):_________________________

(For non-immigrant visas, provide the applicant’s passport number)

Has the case been transferred to another office? _______ Where? __________________________

SECTION 4:

FINAL INSTRUCTIONS

FOR ALL CASES: On a separate sheet of paper, please describe briefly what problems you are

experiencing with this case and how you think Senator Feinstein might be able to assist you.

Include copies of the most recent correspondence received from the agency on your case.

For expedite requests, please include evidence that your case meets the agency’s set expedite criteria.

USCIS expedite criteria is available online at uscis.gov.

Due to Privacy Act authorization requirements, we may not be able to open a case for you if proper

authorization is not provided. Please note: ALL CASES require a petitioner’s signature. For non-

immigrant visas where there is no petitioner, U.S. host must sign. Beneficiary signature is required

for I-290B and I-730 cases. For I-212 and I-601 waivers, the beneficiary of the case must sign as the

petitioner for the waiver. You may submit separate forms with each signature if needed.

Mail or fax the form to Senator Feinstein’s San Francisco office.

SIGNATURE

I hereby authorize U.S. Senator Dianne Feinstein and her staff to make inquiries and obtain

information on my case.

Petitioner’s Signature: __________________________________ Date: ________________

Beneficiary’s Signature: __________________________________ Date: _______________

NOTE: The beneficiary’s signature is required for certain cases. See notes above regarding signature.

Attorney of record signature: _________________________________ Date: _______________

NOTE: Please ensure that you provide a signed G-28.

Version 09/12

Immigration Assistance Request Form Page 2