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10.

Name, Contact Information, Statement, Certification, and Signature of the Person Preparing this Application,

If Other Than the Applicant and/or Spouse. If you and/or your spouse (if married) used a preparer to complete this

application, the preparer must complete Part 10., certify that he or she has read to you and/or your spouse the

Acknowledgement of Appointment at USCIS Application Support Center (if applicable), sign and date the

application. If the person completing this application is an attorney or accredited representative whose representation

extends beyond the preparation of this application, he or she must submit a completed Form G-28, Notice of Entry of

Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as Attorney in

Matters Outside the Geographical Confines of the United States, along with your application.

NOTE: An "accredited representative" for purposes of preparation of this form means an individual accredited under

8 CFR 292.2(d) to practice before USCIS and/or the Executive Office for Immigration Review (EOIR). This type of

accreditation is separate and distinct from accreditation under the Department of State regulations at 22 CFR Part 96

to provide adoption services.

We recommend that you print or save a copy of your completed application to review in the future and for your

records. If you must appear for a biometric services appointment at a USCIS ASC, we recommend that you review

your copy of your completed application before you come to the appointment. At that appointment, you will be

permitted to complete the application process only if you are able to confirm, under penalty of perjury, that all of the

information in your application is accurate, true, and complete. If you are not able to make that attestation in good faith at

that time, you will be required to return for another appointment when you are able to do so.

Form I-600A/I-600, Supplement 1, Listing of Adult Member of the Household

You must complete Form I-600A/I-600, Supplement 1, Listing of Adult Member of the Household, for each adult

member of your household. For purposes of this supplement, the definition of an adult member of the household is any

individual other than you and your spouse (if married), who has the same principal residence as you and is 18 years of age

or older on or before the date that Form I-600A or Form I-600 is filed. Residence is defined as the place of general abode

or a person's principal, actual dwelling place in fact, without regard to intent.

NOTE: USCIS reserves the right to request information on any household member who has not yet reached his or her 18th

birthday before the date when Form I-600A or Form I-600 is filed, or who does not actually live at the same residence, but

whose presence in the residence is relevant to the issue of your and your spouse's (if married) suitability to adopt.

Initial Evidence

Proof of Applicant's U.S. Citizenship

A. If you are a U.S. citizen by birth, submit a copy of your birth certificate issued by the civil registrar, vital statistics

office, or other civil authority. If your birth certificate is not available, submit a statement from the appropriate

civil authority certifying that your birth certificate is not available. In such a situation, secondary evidence must

be submitted, such as:

(1) Religious records bearing the seal of the organization showing the baptism, dedication, or comparable rite

occurred within two months after your birth and showing the date and place of your birth, date of the religious

ceremony, and the names of your parents;

(2) School records issued by the authority (preferably the first school you attended) showing the date of your

admission to the school, your age at the time, and your parents' names and places of birth;

(3) Census records (state or Federal) showing your name, place of birth, and date of birth or age;

(4) Affidavits sworn to or affirmed by persons who were living at the time of your birth and who have personal

knowledge of your date and place of birth in the United States. Affidavits should contain the following

information about each person making the affidavit: his or her full name, address, date and place of birth,

relationship to you, full information concerning the event, and complete details on how he or she acquired

knowledge of your birth; or

(5)

An unexpired U.S. passport issued for 10 years.

Form I-600A Instructions 12/23/16 N

Page 5 of 14

Instructions For Form I-600a - Application For Advance Processing Of An Orphan Petition Page 5

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