Instructions For Form I-612 - Application For Waiver Of The Foreign Residence Requirement (Under Section 212(E) Of The Immigration And Nationality Act, As Amended) Page 5

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C. If the naturalization of your spouse or child occurred within 90 days immediately before you filed this application,
you must submit a copy of the naturalization certificate;
D. If your spouse or child is a lawful permanent resident, submit a copy of a valid I-551, Permanent Resident Card,
of the spouse or child.
2. If you select Part 3., Item Number 1., you must submit evidence of the relationship between you and your spouse
or child. You must also include a certificate of marriage to your spouse and proof of legal termination of all prior
marriages for you and your spouse, with each application. If the application is based on hardship to your child, you
must also submit his or her birth certificate. (If a birth certificate is not available, see Item A. above.)
3. To support your application for a waiver, in addition to your own required statement detailing the hardship or
persecution that will occur if you return to your country of citizenship or nationality or last foreign residence, submit
copies of all forms DS-2019/IAP-66, Certificate of Eligibility for Exchange Visitor Status, for all exchange programs
in which you or your spouse participated (if applicable). You may also submit any available evidence that you believe
demonstrates the exceptional hardship or persecution issues raised in your statement.
4. Form I-94 Arrival-Departure Record. If you are in the United States, you must submit a copy of your Form I-94,
Arrival-Departure Record, and a copy of your spouse’s Form I-94, if he or she is in the United States and not a U.S.
citizen or lawful permanent resident. If the entry permit is attached to or stamped in your passport, submit a complete
copy of all pages in your passport. Do not submit your original passport.
If U.S. Customs and Border Protection (CBP) or USCIS issued you a Form I-94, Arrival-Departure Record, provide
your Form I-94 number and date that your authorized period of stay expires or expired (as shown on Form I-94). The
Form I-94 number is also known as the Departure Number on some versions of Form I-94.
NOTE: If you were admitted to the United States by CBP at an airport or seaport after April 30, 2013, you may have
been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. You may visit the CBP website at
to obtain a paper version of an electronic Form I-94. CBP does not charge a fee for this service.
Some travelers admitted to the United States at a land border, airport, or seaport, after April 30, 2013, with a passport
or travel document, who were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form
I-94 from the CBP website without charge. If your Form I-94 cannot be obtained from the CBP website, it may be
obtained by filing Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with
USCIS. USCIS does charge a fee for this service.
Passport and Travel Document Numbers. If you used a passport or travel document to travel to the United States,
enter either the passport or travel document information in the appropriate space on the application, even if the
passport or travel document is currently expired.
What is the Filing Fee?
The filing fee for Form I-612 is $930.
NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this application. DO NOT MAIL
CASH. You must submit all fees in the exact amounts.
Use the following guidelines when you prepare your check or money order for the Form I-612 filing fee:
1. The check or money order must be drawn on a bank or other financial institution located in the Unites States and must
be payable in U.S. currency; and
2. Make the check or money order payable to U.S. Department of Homeland Security.
NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”
3. If you live outside the United States, contact the nearest U.S. Embassy or U.S. Consulate for instructions on the
method of payment.
Form I-612 Instructions 04/24/17 N
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