Form I-698 - Application To Adjust Status From Temporary To Permanent Resident
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6OMB No. 1615-0035
Form I-698, Application to Adjust Status
From Temporary to Permanent Resident
Department of Homeland Security
U.S. Citizenship and Immigration Services
(Under Section 245A of the INA)
Do not write in this block - For USCIS use only.
Fee Stamp
Action Block
Remarks
START HERE - Type or print in black ink. If you need more space, see Page 3 of the instructions.
1. Name
Family Name (in capital letters)
Given Name
Middle Name
A-Number
2. Gender
3. Name as it appears on Form I-688, Temporary
4. Telephone Number (include area code)
Resident Card
Home
Work
Male
Female
5. Reason for difference in name, if any. (marriage, divorce, etc.)
6. Home Address in the United States
In care of
Street Number and Name
Apt. #
City
State
Zip Code
7. Mailing Address in the United States (if different from address in Number 6 above)
In care of
Street Number and Name
Apt. #
City
State
Zip Code
8. Place of Birth (City or Town)
County, Province, or State
Country
Country of Citizenship/Nationality
Date of Birth (mm/dd/yyyy)
10. Your Mother's First Name
11. Your Father's First Name 12. Your U.S. Social Security #
9.
13. Marital Status
Married
Never Married
Separated
Divorced
Widowed
Form I-698 (Rev. 01/12/11) Y
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Parent category: Legal