Form I-290b - Notice Of Appeal Or Motion - U.s. Citizenship And Immigration Services Page 2
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5Part 3. Basis for Appeal or Motion
Applicant's or Petitioner's Contact Information
3.
Applicant's or Petitioner's Daytime Telephone Number
In Part 7. Additional Information, or on a separate sheet of
paper, you must provide a statement regarding the basis for the
appeal or motion. Type or print your name and A-Number (if
4.
Applicant's or Petitioner's Mobile Telephone Number
any) at the top of each sheet; indicate the Page Number, Part
(if any)
Number, and Item Number to which your answer refers; and
sign and date each sheet.
Appeal: Provide a statement that specifically identifies an
5.
Applicant's or Petitioner's Email Address (if any)
erroneous conclusion of law or fact in the decision being
appealed.
Motion to Reopen: The motion must state new facts and must
Applicant's or Petitioner's Certification
be supported by affidavits and/or documentary evidence that
establish eligibility at the time the underlying application or
Copies of any documents I have submitted are exact
petition was filed.
photocopies of unaltered, original documents, and I understand
Motion to Reconsider: The motion must be supported by
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
citations to appropriate statutes, regulations, or precedent
decisions and must establish that the decision was based on an
any information from any of my records that USCIS may need
incorrect application of law or policy, and that the decision was
to determine my eligibility for the immigration benefit I seek.
incorrect based on the evidence of record at the time of
I further authorize release of information contained in this form,
decision.
in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and
enforcement of U.S. immigration laws.
Part 4. Applicant's or Petitioner's Statement,
Contact Information, Certification, and Signature
I certify, under penalty of perjury, that I provided or authorized
all of the information in my form, I understand all of the
NOTE: Read the Penalties section of the Form I-290B
information contained in, and submitted with, my form, and that
Instructions before completing this part.
all of this information is complete, true, and correct.
Section A
Applicant's or Petitioner's Signature
If you are filing an appeal or motion based on an APPLICATION
6.a.
Applicant's or Petitioner's Signature (sign in ink)
or PETITION FILED BY AN INDIVIDUAL (NOT AN
ENTITY SUCH AS A COMPANY OR BUSINESS), complete
this section:
6.b.
Date of Signature (mm/dd/yyyy)
Applicant's or Petitioner's Statement
Section B
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
If you are filing an appeal or motion for a PETITION FILED
1.a.
I can read and understand English, and I have read
BY AN ENTITY, complete this section:
and understand every question and instruction on this
form and my answer to every question.
Petitioner's Statement
1.b.
The interpreter named in Part 5. has read to me every
NOTE: Select the box for either Item Number 1.a. or 1.b. If
question and instruction on this form, and my answer
applicable, select the box for Item Number 2.
to every question, in
1.a.
I can read and understand English, and I have read
,
and understand every question and instruction on this
a language in which I am fluent. I understood all of
form and my answer to every question.
this information as interpreted.
1.b.
The interpreter named in Part 5. has read to me every
2.
At my request, the preparer named in Part 6. prepared
question and instruction on this form, and my answer
this form for me based only upon information I
to every question, in
provided or authorized.
,
a language in which I am fluent. I understood all of
this information as interpreted.
Form I-290B 04/10/17 N
Page 2 of 5
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