Form I-800 - Petition To Classify Convention Adoptee As An Immediate Relative Page 4
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9Part 3.
Information About the Beneficiary
(Continued)
7. The child’s legal custodian is (Check only one box):
An individual or entity other than the child’s birth parents. (This includes any child welfare agency, orphanage, or other
individual or entity that has custody of the child, a legal guardian, or any person(s) who is (are) the child’s parent(s) based
on a prior adoption.)
The child’s living birth parents, each of whom has consented to the adoption and who are incapable of providing proper care
to the child.
The child’s surviving birth parent, because the other birth parent is dead, and the child has not acquired another parent (as
defined in 8 CFR Part 204.301).
The child’s sole birth parent, because the competent authority has determined that the child's other birth parent has abandoned
or deserted the child, or has disappeared from the child’s life, and the child has not acquired another parent (as defined in 8
CFR Part 204.301).
8. The child will reside with me (Choose one):
a.
In the United States at the following address:
Street Number and Name
City
State
Zip Code
b.
Outside the United States at the following address: (The child will seek a nonimmigrant visa, in order to travel to
the United States to obtain citizenship under section 322 of the Immigration and Nationality Act (INA)).
Street Number and Name
City
State or Province
Zip/Postal Code
Country
9. Are you submitting with Form I-800:
a. The report as required under Article 16 of the Convention? (See Form I-800 instructions, Pages 4 to 5,
Yes
No
for information on Article 16 report.)
b. The child's background information as provided for under 22 CFR Part 96.49? (See Form I-800
Yes
No
instructions, Pages 4 to 5, for information on 22 CFR Part 96.49.)
If "Yes," to either 9, a, or 9, b, go to Question 12.
10. If you answered "No" to either Question 9, a, or Question 9, b, was this because the Central Authority
Yes
No
of the child's country of habitual residence placed the child for adoption more than 6 months after the
child's 15th birthday but before the child's 16th birthday, and the report that must accompany Form I-800
is not yet available?
11. If you answered "Yes" to Question 10, are you submitting a declaration from the primary provider,
Yes
No
signed under penalty of perjury, verifying that the Central Authority did in fact make the decision to
place the child for adoption before the child's 16th birthday? If you answered "Yes" to Question 10
and Questions 11, go to Question 16.
Form I-800 11/23/10 Y Page 4
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