I-824, Application For Action On An Approved Application
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1OMB No. 1615-0044; Exp. 3/31/04
I-824, Application for Action on an
U.S. Department of Homeland Security
Approved Application or Petition
Bureau of Citizehsip and Immigration Services
START HERE - Please Type or Print
FOR BCIS USE ONLY
Information about the person that filed the original application
Returned
Receipt
Part 1.
or petition.
(Individuals use the top name line. Organizations use the second line.)
Date
Family Name
Given Name
Middle Name
Date
Company or Organization Name
Resubmitted
Address - In care of -
Date
Street Number and Name
Apt./Suite #
Date
Reloc Sent
City
State or Province
Zip/Postal Code
Country
Date
Date of Birth (mm/dd/yyyy)
Country of Birth
Date
Reloc Rec'd
Social Security # (if any)
A # (if any)
IRS Tax # (if any)
Date
Part 2.
Application type.
(check one)
Date
a.
I am applying for a duplicate approval notice.
Applicant
b.
I am requesting that a new U.S. Consulate or Port of Entry be notified of the previous
Interviewed
approval of a petition. Please notify the U.S. Consulate or Port of Entry at:
on
c.
I am requesting that a U.S. Consulate be notified that my status has been adjusted to
permanent resident. Please notify the U.S. Consulate at:
Part 3.
Processing information.
Action Block
Type of Petition/Application (Form #)
Filing Receipt #
Date of Filing (mm/dd/yyyy)
Date of Approval (mm/dd/yyyy)
If petition is filed for another person, give the following information about the
person you filed for:
Family Name
Given Name
Middle Name
To Be Completed By
Attorney or Representative, if any.
Date of Birth (mm/dd/yyyy)
Country of Birth
A # (if any)
Fill in box if G-28 is attached to
represent the applicant.
Signature.
Read the information on penalties in the instructions before completing
Part 4.
ATTY State License #
this section.
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it are all
true and correct. I authorize the release of any information from my records which the Bureau of Citizenship and Immigration Services needs to
determine eligibility for the benefit I am seeking.
Signature
Print or Type Your Name
Daytime Phone # (with A/C)
Date (mm/dd/yyyy)
Part 5.
Signature of person preparing form, if other than above.
(Sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature
Print or Type Your Name
Date (mm/dd/yyyy)
Fax Number (if any)
(with A/C)
Firm Name and Address
Daytime Telephone Number
Form I-824 (Rev. 04/04/031)N (Prior versions may be used until 09/30/03)
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