Fillable Immigration Inquiry Form printable pdf download

Immigration Inquiry Form

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Department of Homeland Security (DHS)

U.S. Citizenship and Immigration Services, Congressional Liaison Unit – Inquiry Form

(Please print legibly in English and attach proof of filing)

Date of Inquiry

Follow-Up:

Congressional Office:

Staffer:

Telephone:

Rep. Lois Capps

FAX:

Check one: □ Mr. □ Mrs. □ Ms.

Applicant Information

Last Name:

First Name:

Middle Name:

A-File Number:

Receipt Number (WAC, LIN, TSC…):

Phone Number:

(

)

E-mail Address:

Other Names Used:

Check, if applicable:

Petitioner

Beneficiary

Date and Place of Birth:

Date and Place of Entry:

Class of Admission:

Current Residential Address:

Current Immigrant Status (check one)

U.S. Citizen

Permanent Resident

Refugee

Asylee

Undocumented

Type of Application

I-90

Replacement Alien Registration Card

I-539

Application to Change Status or Extend Stay

I-130

Immediate Relative Petition

I-589

Request for Asylum in the USA

I-131

Travel Document, Advance Parole

I-730

Refugee/Asylee Relative Petition

I-140

Immigrant Petition for Foreign Worker

N-400 Application for Naturalization

I-212

Admission After Deportation or Removal

N-565 Replacement for Natz. or Citz. Document

I-485

Adjustment of Status

N-600 Certificate of Citizenship

I-506

Change of Non-Immigrant Classification

Other:

Date filed:

Have you been interviewed?

Yes

Date:

Where:

Additional Information

Attorney (if any):

Outreach/Community Based Organization (if any):

May we discuss your case with your Attorney?

Yes

May we discuss your case with the CBO?

Yes

Telephone: (

)

Have you contacted your Senator or another Member of Congress?

Yes_______ No________

Member’s Office:

Rep. Capps and her

Rep. Schiff and his staff may discuss my case with the following individuals:

Name:

Telephone: (

)

Summary of Inquiry

Privacy Act Statement

Authority to collect this information is contained in Title 5 U.S.C. 552 and 552a. The purpose of the collection is to enable the D.H.S. to locate applicable

records and to respond to requests made under the Freedom of Information and Privacy Acts. I authorize the Congressional office named above to request

information on my behalf. Also, I understand that I am not required to make payment, in any form, for services rendered to me from the office of

Congresswoman Lois Capps.

Congressman Adam B. Schiff.

______________________________________________________________

______________________

(Signature)

(Date)

DHS USE ONLY

Inquiry Number Assigned:

Related Inquiry Number (s)

Date Completed:

Method of Response: