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Item Number 2. USCIS Online Account Number (if any). If you have previously filed an application, petition, or

request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)),

provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account

Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,

or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice

issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be

found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The

USCIS Online Account Number is not the same as an A-Number.

Item Numbers 3.a. - 3.c. Your Full Name. Provide your full legal name as shown on your identity documents or legal

change of name document in the spaces provided.

Item Numbers 4.a. - 4.c. Other Names Used. Provide other names you have used since birth, including your maiden

name, any nicknames, and any names that appear in your documents. If you need extra space to complete this section, use

the space provided in Part 10. Additional Information to provide other names used.

Item Numbers 5.a. - 5.i. Mailing Address. Provide a valid mailing address. Use an address in the United States, if one

is available. If you do not have a U.S. mailing address, provide your foreign mailing address.

Item Numbers 6. - 7.h. Physical Address. If the place where you live is different from your mailing, type or print the

address where you currently live.

Item Number 8. U.S. Social Security Number (if any). Provide your U.S. Social Security Number. Also include all

social security numbers you have ever used. If you need extra space to complete this section, use the space provided in

Part 10. Additional Information to provide additional U.S. Social Security Numbers.

Item Number 9. Gender. Select the box that indicates whether you are male or female.

Item Number 10. Date of Birth. Provide your date of birth in mm/dd/yyyy format in the space provided.

Item Numbers 11. - 13. Place of Birth. Provide the name of the city or town, province, and country where you were

born. Type or print the name of the country as it was named when you were born, even if the country’s name has changed

or the country no longer exists.

Item Number 14. Country of Citizenship or Nationality. Type or print the name of the country where you are

currently a citizen or national. If you are stateless, type or print the name of the country where you were last a citizen

or national. If you are a citizen or national of more than one country, type or print the name of the foreign country that

issued your last passport.

Item Numbers 15.a. - 15.b. Form I-601 Waivers Filed with Immigrant Visa or K or V Nonimmigrant Visa

Applications. If you are seeking an immigrant visa or a K or V nonimmigrant visa and you were already interviewed by a

DOS consular officer, provide the DOS Consular Case Number for your visa application (if available) and indicate where

your visa interview occurred (that is, the location of the U.S. Embassy or U.S. Consulate.)

Item Numbers 16.a. - 16.b. Form I-601 Waivers Filed with Adjustment of Status Applications. If you are filing this

application after you have filed an application to adjust your immigration status to that of a lawful permanent resident,

provide the USCIS receipt number for your Form I-485.

Item Numbers 17.a. - 17.b. Form I-601 Waivers Filed with Temporary Protected Status Applications. If you are

filing your Form I-601 after you have already filed Form I-821, provide the USCIS receipt number for your Form I-821.

Item Numbers 18.a. - 19. Form I-601 Waivers Filed with Consent to Reapply Applications. If you previously filed

an application for consent to reapply, provide the USCIS receipt number for your Form I-212. If you are filing Form

I-212 with your Form I-601, select “Yes” for Item Number 19.

Form I-601 Instructions 08/21/17 N

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Instructions For Form I-601 - Application For Waiver Of Grounds Of Inadmissibility - Department Of Homeland Security - U.s. Citizenship And Immigration Services Page 5