Form I-643 - Health And Human Services Statistical Data For Refugee/asylee Adjusting Status Page 2
Download a blank fillable Form I-643 - Health And Human Services Statistical Data For Refugee/asylee Adjusting Status in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form I-643 - Health And Human Services Statistical Data For Refugee/asylee Adjusting Status with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Privacy Act Notice
USCIS asks for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information is in 8 U.S.C. 1302 and
1304. USCIS may provide this information to other
government agencies. Failure to provide this information,
and any requested evidence, may delay a final decision or
result in denial of your request.
Instructions to USCIS Officer
After this form has been completed, forward it directly to the
address as shown below (If you are mailing a small number
of forms, they may be folded so that the address shows
through a #10 window envelope).
Data Unit, Office of Refugee Resettlement
Department of Health and Human Services
370 L'Enfant Promenade S.W., (6th Floor)
Washington, DC 20447
Form I-643 Instructions (Rev. 10/08/10) Y Page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Dmh 5-72-01 - Examination And Recommendation For Ivc Form - Department Of Health And Human Services - North Carolina
Legal
Form Qr 3 - Mid-quarter Status Report For Cash Aid And Food Stamps - 2006 - State Of California - Health And Human Services Agency
Legal
Form Dhcs 4518 - California Provider Electronic Data Interchange (pedi) Domain Update - Health And Human Services Agency
Legal
Form Dhcs 4512 - California Medical Eligiblity Data System Account Request - Health And Human Services Agency
Legal
Related Categories
Parent category: Legal