Form I-690 - Application For Waiver Of Grounds Of Inadmissibility

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OMB No. 1615-0032; Expires 01/31/2012

Form I-690, Application for Waiver

Department of Homeland Security

of Grounds of Inadmissibility

U.S. Citizenship and Immigration Services

Government Use Only.

For

Fee Stamp

Fee Receipt Number (This application):

Alien Registration Number (A# of This Applicant):

APPLICANT: Start here. See instructions before completing this application. If you need more space to answer fully any question

on this form, use a separate sheet and identify each answer with the number of the corresponding question. Type or print in black ink.

1. Family Name (Last Name in CAPITAL letters)

(First Name)

(Middle Name)

2. Date of Birth (mm/dd/yyyy)

(State/Country)

(Zip/Postal Code)

3. Address (No. and Street)

(Apt. No.)

(City/Town)

4. Place of Birth (City or Town and County, Province or State)

(Country)

5. U.S. Social Security Number

7. Visa applied for at:

6. Date of Visa Application (mm/dd/yyyy) for:

Permanent Residence

Temporary Residence

8. I am applying for a waiver of:

212 (a) (1)(A)(i), (ii), (iii) or (iv)

212 (a)(2)(C)(i)(II) - possession of marijuana, 30 gms or less

212 (a)(6)(A)(i)

212(a)(6)(C)(i) or (ii)

212(a)(6)(D) and/or (E)

212(a)(8)(A) and/or (B)

212(a)(9)(A)(i) or (ii)

212(a)(9)(B)(i)(I) or (i)(II)

212(a)(9)(C)(i)(I) or (i)(II)

212 (a)(10)(A), (B), (C), (D) and/or (E) - Please specify:

9. List reasons of inadmissibility:

10. List all immediate relatives in the United States (Parents, spouse and children):

Name

Address

Relationship

Immigration Status

11. I should be granted a waiver because: (Describe family unity considerations or humanitarian or public interest reasons for granting a waiver. If more space is

needed, attach an additional sheet.)

12. Applicant's Signature

13. Date

Recommended by:

FOR USCIS USE ONLY.

(Print Name and Title)

Date

Signature

Stamp #

Director

Form I-690 (11/23/10)Y