Form I-694 - Notice Of Appeal Of Decision Under Sections 245a Or 210 Of The Immigration And Nationality Act

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Notice of Appeal of Decision Under INA Section 210 or 245A
of the Immigration and Nationality Act
USCIS
Form I-694
Department of Homeland Security
OMB No. 1615-0034
U.S. Citizenship and Immigration Services
Expires: 03/31/2018
Action Block
Fee Stamp
For
USCIS
Use
Only
►
START HERE - Type or print in black ink.
Part 1. Information About You (Appellant)
1.
Full Legal Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
Any Other Names Used
A.
Family Name (Last Name)
Given Name (First Name)
Middle Name
B.
Family Name (Last Name)
Given Name (First Name)
Middle Name
3.
U.S. Mailing Address
In Care Of Name
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
4.
Is your current U.S. mailing address the same as your U.S. physical address?
Yes
No
If you answered "No," provide your U.S. physical address in Item Number 5.
5.
U.S. Physical Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
6.
Alien Registration Number (A-Number) (if any)
7.
U.S. Social Security Number (if any)
►
►
A-
8.
USCIS Online Account Number (if any)
►
Form I-694 12/23/16 N
Page 1 of 6

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