Form I-690 - Application For Waiver Of Grounds Of Inadmissibility Page 4
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8Part 2. Additional Information About You (continued)
D. Your Relative's Information
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
A-Number (if any)
Date of Birth (mm/dd/yyyy) Relationship
►
A-
Immigration Status (for example, U.S. citizen, lawful permanent resident, valid nonimmigrant status,
deferred action recipient)
7.
I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for
granting a waiver. If you need more space, Part 6. Additional Information or attach a separate sheet of paper; type or print
your name and Alien Registration Number (A-Number) (if any), at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and sign and date each sheet.
Part 3. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature
NOTE: Read the information on penalties in the Penalties section of the Form I-690 Instructions before completing this part.
Applicant's Statement
NOTE: Select the box for either Item Number A. or B. If applicable, select the box for Item Number 2.
1.
Applicant's Statement Regarding the Interpreter
A.
I can read and understand English, and have read and understand every question and instruction on this application, as
well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS
Application Support Center.
B.
The interpreter named in Part 4. has also read to me every question and instruction on this application, as well as my
answer to every question, in
, a language in which I am fluent.
I understand every question and instruction on this application as translated to me by my interpreter, and have provided
complete, true, and correct responses in the language indicated above. The interpreter named in Part 4. has also read
the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am
fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter.
2.
Applicant's Statement Regarding the Preparer
I have requested the services of and consented to
,
who
is
is not an attorney or accredited representative, preparing this application for me. This person who assisted me
in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center
with me, and I understand the ASC Acknowledgement.
Form I-690 12/23/16 N
Page 4 of 8
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