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NOTE: If you are inadmissible under INA section 212(a)(9)(A) or 212(a)(9)(C)(i)(II), you may also need to file

Form I-212, Application for Permission to Reapply for Admission into the United States After Deportation or

Removal.

B. Inadmissible Because of Health-Related Grounds of Inadmissibility Under INA section 212(a)(1)

If you file this application because you are inadmissible because of health-related grounds of inadmissibility, you

must describe the health-related grounds in detail.

If you are seeking admission to the United States for the treatment of a medical condition, you must attach a

written statement establishing:

(1) That satisfactory treatment cannot be obtained outside the United States;

(2) That arrangements for treatment have been made, including where and from whom or what institution

treatment will be received;

(3) What financial arrangements for payment of expenses (incurred in connection with the treatment) have been

made; and

(4) That a bond will be available, if required by the Secretary of Homeland Security.

C. Inadmissible Because of Criminal Convictions and Related Grounds under INA section 212(a)(2)

If the application is made because you have been convicted of one or more crimes anywhere in the world, your

application must include a statement, signed by you under penalty of perjury under U.S. law, specifying the:

(1) Name of the crimes for which you were convicted, and the country in which you were convicted;

(2) Dates and places of the commission of the crimes;

(3) Dates and places of conviction (including the name of the court); and

(4) Sentences you received, or any other judgments from the court related to the crimes.

List each crime separately.

For each conviction, you must submit the official record of each conviction and all court dispositions, as well as

any other documents relating to the commutation of sentence, parole, probation, or pardon. If an official record is

not available then you may submit an official letter from the court of jurisdiction stating the reason why an official

record is not available.

These records must be in English, or an English translation must be included. The translator must certify that he

or she is competent to translate and that the translation is accurate.

D. For All Other Grounds of Inadmissibility under INA section 212(a)

If you are inadmissible under any ground not listed above, you must provide a statement signed by you under

penalty of perjury that specifies the applicable ground of inadmissibility, the factual basis for your inadmissibility,

and reasons for claiming that you should be granted advance permission to enter the United States.

2. Required Additional Information When Filing Form I-192 With CBP

If you file this application with CBP, you must submit the following additional documentation.

A. Proof of citizenship and identity, such as a passport, citizenship card with photograph, naturalization certificate, or

birth certificate. Note that a driver’s license is not considered proof of citizenship but may accompany a copy of

another document. Copies of these documents are acceptable.

B. Completed Form G-325A, Biographic Information, signed and dated by you.

C. If you have ever used a name other than your full legal name as provided on this application, you must list it

on the application. Include any names from previous marriages. Evidence of any legal name changes, such as

marriage certificates, divorce decrees, etc. must be included. Copies are acceptable.

Form I-192 Instructions 12/23/16 N

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Instructions For Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant Page 6