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Acknowledgement of Appointment at USCIS Application Support Center. Review the ASC Acknowledgement that

appears in Part 5. of the application. The purpose of this ASC Acknowledgement is to confirm that you have completed

your application, reviewed your responses, and affirmed that the information was provided by you and is complete, true,

and correct. If someone helped you fill out your application, that person must review the ASC Acknowledgement with

you to make sure you understand it.

Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you

must submit an original document. The adjudicating agency may request an original document at the time of filing or at

any time during processing of an application. If you submit original documents when not required, the documents may

remain a part of the record, and the adjudicating agency will not automatically return them to you.

Translations. If you submit a document with information in a foreign language, you must also submit a full English

translation. The translator must sign a certification that the English language translation is complete and accurate, and that

he or she is competent to translate from the foreign language into English.

How To Fill Out Form I-212

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this application, use the space provided in Part 8. 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.

3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been

married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise

directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many

children do you have” or “How many times have you departed the United States”), type or print “None,” unless

otherwise directed.

Specific Instructions

Part 1. Information About You

If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Item Number 1. Alien Registration Number (A-Number) (if any). Your A-Number is the number used to identify

your immigration records. You can find this number on documents you received from USCIS, Immigration and

Customs Enforcement (ICE), CBP, Department of Justice (DOJ) Executive Office For Immigration Review (EOIR), and

Department of State (DOS).

Item Numbers 2.a. - 2.c. Your Full Name. Provide your full legal name.

Item Numbers 3.a. - 3.c. Other Names Used. Provide any other names you have used, including maiden names, aliases,

and nicknames.

Item Numbers 4.a. - 4.i. Mailing Address. Provide the address where you would like to receive written correspondence

regarding this application. Use a mailing address in the United States if you have one. If you do not have a U.S. mailing

address, provide your mailing address abroad.

Item Numbers 5. - 6.h. Physical Address. If the place where you live is different from your mailing address, provide

the address where you currently reside.

Item Number 7. U.S. Social Security Number (if any). Provide your U.S. Social Security Number.

Form I-212 Instructions 12/23/16 N

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Instructions For Form I-212 - Application For Permission To Reapply For Admission Into The United States After Deportation Or Removal Page 9