Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant
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8Application for Advance Permission to Enter
as a Nonimmigrant
USCIS
Form I-192
Department of Homeland Security
OMB No. 1615-0017
U.S. Citizenship and Immigration Services
Expires 06/30/2018
Received
Returned Trans. Out
Fee Stamp
Trans. In
Completed
For
DHS
Use
Only
Action by the Department of Homeland Security
Granted, subject to revocation at any time, upon the
Date of Action (mm/dd/yyyy)
following terms and conditions:
DD or OIC
Office
To be completed by an attorney or accredited representative (if any).
Select this box if
Volag Number
Attorney State Bar Number
Attorney or Accredited Representative
Form G-28 or
(if applicable)
USCIS ELIS Online Number (if any)
Form G-28I is
attached.
►
START HERE - Type or print in black ink.
Part 1. Application Type
I am applying to the Secretary of Homeland Security for permission to enter the United States temporarily under the provisions of
section 212(d)(3)(A)(ii), section 212(d)(13), or section 212(d)(14) of the Immigration and Nationality Act (INA).
I am seeking this permission so that I may obtain (Select only one box):
1.
A.
Admission as a nonimmigrant (other than as a T or U nonimmigrant)
B.
Status as a victim of trafficking (T nonimmigrant status) or a victim of a crime (U nonimmigrant status)
Part 2. Information About You
1.
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
Alien Registration Number (A-Number) (if any)
3. USCIS Online Account Number (if any)
4.
Date of Birth (mm/dd/yyyy)
►
►
A-
5.
Place of Birth
City or Town
State or Province
Country
6.
Country of Citizenship or Nationality
Form I-192 12/23/16 N
Page 1 of 8
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