Form I-290b - Notice Of Appeal Or Motion Page 2

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In the Matter of:
File Number: A -
Part 2. Information About the Appeal or Motion
(Continued)
Information on the relating application/petition.
Application/Petition Form #
Receipt #
Date of Denial (mm/dd/yyyy)
USCIS Office Where Decision Issued
Part 3. Basis for the Appeal or Motion
Motion to Reopen: The motion must state new facts and must be supported by affidavits and/or documentary evidence.
Motion to Reconsider: The motion must be supported by citations to appropriate statutes, regulations, or precedent decisions.
Appeal: Provide a statement explaining any erroneous conclusion of law or fact in the decision being appealed.
Part 4. Signature of Person Filing the Appeal/Motion or His or Her Authorized Representative
Date (mm/dd/yyyy)
Signature
Printed Name
Make sure your appeal or motion is complete before filing.
Form I-290B (Rev. 12/02/11) Y Page 2

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