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USCIS Forms and Information

To ensure you are using the latest version of this application, visit the USCIS website at

where you can

obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order

USCIS forms by calling the Forms Request Line at 1-800-870-3676. You may also obtain forms and information by

calling the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:

1-800-767-1833.

Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at

. Select “Schedule an Appointment” and follow the screen prompts to set up your appointment. Once you

finish scheduling an appointment, the system will generate an appointment notice for you.

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-612, we will

deny your Form I-612, and may deny any other immigration benefit. In addition, you will face severe penalties provided

by law and may be subject to criminal prosecution.

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA

section 212(e) and 8 CFR 212.7(e).

PURPOSE: The primary purpose for providing the requested information on this application is to apply for a waiver of

the two year foreign residence requirement. The information you provide will be used to grant or deny the waiver sought.

DISCLOSURE: The information you provide, is voluntary. However, failure to provide the requested information,

including your Social Security number, may delay a final decision or result in denial of your waiver.

ROUTINE USES: The information you provide on this application may be shared with other Federal, state, local,

and foreign government agencies and authorized organizations in accordance with approved routine uses, as described

in the associated published system of record notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking

System of Records and DHS/USCIS-007 - Benefits Information System, which you can find at

The information may also be made available, as appropriate, for law enforcement purposes or in the interest of national

security.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection

of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The

public reporting burden for this collection of information is estimated at 20 minutes per response, including the time for

reviewing instructions, gathering the required documentation and information, completing the application, preparing

statements, attaching necessary documentation, and submitting the application. Send comments regarding this burden

estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S.

Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts

Ave NW, Washington, DC 20529-2140; OMB No. 1615-0030. Do not mail your completed Form I-612 to this address.

Form I-612 Instructions 04/24/17 N

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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 7