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Iraqi Refugee Assistance Project

Urban Justice Center

Complete Guide to Preparing

Requests for

Reconsideration

1

Iraqi Refugee Assistance Project

September 15, 2010

Urban Justice Center

Index: Requests for Reconsideration

Document Name/Description

1 Memorandum: Refugee Application Appeals Processes

2 Steps to Filing a Request for Reconsideration

Appendices

A DHS/USCIS Form I-590

B Sample Rejection Letter

C DHS Form G-28

D DHS/USCIS Form G-639

E DHS/CIS Ombudsman Form 7001

F Sample RFRs

2

Memorandum

To:

IRAP

From:

Sylvia Chi

Date:

September 15, 2010

Re:

Refugee Application Appeals Processes

I.

Introduction

The purpose of this memorandum is to provide information on the applicable procedures and

standards involved in appealing adverse refugee application decisions made by UNHCR and DHS. More

detailed guidance is available in documents such as “Steps to Filing a Request for Reconsideration.”

II.

UNHCR Refugee Status Determination Appeals

A. Background and Initial UNHCR Procedures

The United Nations High Commissioner for Refugees (“UNHCR”) is an agency of the United

Nations focused on the international protection and rescue of refugees. UNHCR facilitates procedures

for refugee registration and individualized Refugee Status Determination (“RSD”) applications. Iraqis

fleeing their country have been treated as “persons of concern to UNHCR as prima facie refugees.”1

However, in May 2009, UNHCR revised its guidelines in light of the improved security situation to

recommend that asylum-seekers from Al-Anbar and the southern provinces should be individually

assessed, although people from these regions who belong to specific, high-risk groups should receive

favorable consideration. These groups include: “members of religious and ethnic minorities; public

officials; Iraqis perceived as opposing armed groups or political factions; Iraqis affiliated with the

multinational forces or foreign companies; certain professionals; media workers; UN and NGO workers;

human rights activists; and homosexuals.”2 In addition, UNHCR advised that in the countries

neighboring Iraq, where individualized RSDs are not practicable due to the number of applicants,

asylum-seekers from the central governorates of Baghdad, Diyala, Kirkuk, Ninewa and Salah Al-Din

should be treated as prima facie refugees. UNHCR recommends individualized RSDs for asylum-seekers

from the northern provinces of Dahuk, Erbil and Sulaymaniyah. In practice, UNHCR recognizes most

Iraqi refugees on a prima facie basis, so most Iraqi applicants need not undergo an individualized RSD.3

First, clients may register with UNHCR’s ProGres registration system. In the registration process,

staff will flag cases appearing to meet the UNHCR’s priority resettlement profiles, as well as “cases

which appear to require a full RSD interview including an exclusion assessment.”4 Next, cases are

1 UNHCR, “Resettlement of Iraqi Refugees,” March 12, 2007, at 2 (emphasis in the original).

2 UNHCR, “UNHCR revises guidelines for Iraqi asylum claims,” May 5, 2009,

http://www.unhcr.org/4b6af7984b.html.

3 UNHCR, “Resettlement of Iraqi Refugees,” supra note 1 at 6.

4 Id.

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reviewed by the Protection Unit for “need for resettlement intervention” and compliance with

protection management and anti-fraud guidelines.5 Then, cases are referred as required for an

individualized RSD or other specialized intervention, or else directly to the Resettlement Unit for

interviewing. Following a streamlined process, the Resettlement Unit conducts interviews to confirm

registration information and generates a Resettlement Registration Form (“RRF”).

The process of adjudicating an RSD, including how RSD interviews are conducted, is outlined in

Unit 4 of Procedural Standards for RSD under UNHCR’s Mandate (“RSD Procedural Standards”). RSD

decisions should be provided to applicants in writing.

B. Appealing RSDs

Iraqi refugee applicants have the right to appeal an adverse RSD. Appeal procedures, including

appeals of exclusion decisions, are described in Unit 7 of RSD Procedural Standards. Applicants

continue to “enjoy the rights accorded to them as registered Applicants for RSD” during the appeal

process.6

Rejected applicants should be informed of their right to appeal and provided with an Appeal

Application Form. Negative notification letters should contain the reasons for the rejection; the RSD

Procedural Standards provides that rejected applicants should be given “sufficient information regarding

the reasons for the rejection to permit them to determine whether an appeal is appropriate and to

focus their submissions on issues that are relevant to the appeal application.”7

The applicant’s intention to appeal must be communicated in writing, preferably through a

completed and signed Appeal Application Form.

The applicable standard in the appeal process is whether the original RSD decision was “based

on a reasonable finding of fact and a correct application of the refugee criteria.”8 The appeal

determination is based on a thorough review of the existing file, and may only be limited to a paper

review if (1) all relevant evidence has been presented; (2) the determination of the facts is supported by

the transcript interview and RSD Assessment; and (3) the RSD decision is “based on a clearly correct or

incorrect application of the refugee criteria to the accepted facts.”9 If these conditions do not exist,

applicants are afforded the opportunity to present their appeal in person.

An appeal interview may be granted under the following circumstances:

1. The RSD decision was based on credibility findings.

2. Evidence was not adequately considered.

3. New evidence is raised in the appeal.

5 Id.

6 RSD Procedural Standards, § 7.1.1 (2005).

7 Id. at § 7.1.2.

8 Id. at § 7.4.1 (emphasis in the original).

9 Id.

4

4. There was a breach of procedural fairness, such as inadequate interpretation, inappropriate

questioning, or the applicant’s discomfort with the interviewer or interpreter.10

Applicants will be notified in writing of the appeal decision. UNHCR does not require the

disclosure of reasons for the appeal decision, although the deciding Eligibility Officer is required to

document those reasons on an Appeal Assessment Form.

Possible Dispositions: If the applicant is approved as meeting the criteria for refugee status, he

will receive a UNHCR Refugee Certificate. If the applicant’s appeal is rejected, his file will be referred for

closure procedures. However, UNHCR provides that cases which were rejected in the final instance

may be re-opened in the following circumstances:

1. There is reliable evidence of significant change in the applicant’s personal circumstances or

conditions in the applicant’s country of origin that substantially affect the applicant’s

eligibility for refugee status.

2. There is reliable and material new evidence that the claim may have been improperly

decided.

3. There is “serious reason to believe that the claim was improperly decided,” such as the

failure to adequately examine or address grounds for eligibility for refugee status.11

In these cases, re-opened files will be referred to RSD procedures.

III. DHS USCIS Appeals (Requests for Review)

A. Background

In the United States program for resettling refugees, the U.S. Citizenship and Immigration

Services (“USCIS”), a division within the Department of Homeland Security (“DHS”), both adjudicates

applications for refugee status and reviews case decisions. IOM typically prepares I-590 forms (see

Appendix A12) on behalf of applicants, who must undergo individual interviews with USCIS officers.

USCIS officers then complete a Refugee Application Assessment to determine whether the applicant

meets the United States’ eligibility criteria for refugee classification and resettlement. Applicants are

notified of decisions in writing.

B. Requests for Review

There is no direct right to judicial appeal of denial of a refugee application. 8 CFR 207.4 states:

“There is no appeal from a denial of refugee status.”

10 Id.

11 Id. at § 9.2.

12 The version of I-590 attached here notes that the form expires March 31, 2010. This expiration date is

in reference to the Paperwork Reduction Act, and has no effect on the validity of the form or the data collected

therein. USCIS has proposed the removal of such expiration dates since it confuses the public. 75 Fed. Reg. 5,101

(Feb. 1, 2010). USCIS, “Supporting Statement: Registration for Classification as Refugee (Form I-590),” OMB No.

1615-0068 (Feb. 4, 2010).

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However, USCIS may exercise is discretion to review denied applications upon the timely receipt

of a request for review (“RFR”).13 USCIS guidelines establish two principal requirements for RFRS:

1. Time Limitations: An RFR must be submitted within 90 days from the date of the Notice of

Ineligibility of Resettlement. USCIS may at its discretion excuse delayed filing upon showing

that “the delay was reasonable and was beyond the control of the applicant.”14 In practice,

this has proven to be a generous standard as RFR’s are regularly reviewed which are

submitted outside the 90-day deadline. According to “current practice,” RFRs may be

submitted to “the Officer-in-Charge (OIC) who has jurisdiction over the case or to the

Overseas Processing Entity (OPE) via mail or in person.”15 The date of the RFR is the

postmark date or date of personal submission.

2. Single Request: An applicant may only file one RFR. In the case of subsequent RFRs, USCIS

may establish exceptions at its discretion. Typically, applicants who file an initial RFR pro se

have been allowed to submit a subsequent RFR with the assistance of counsel.

USCIS treats RFRs as falling into one or both of two categories: (1) cases involving an allegation

of error in the determination to deny eligibility; and (2) cases where new information allegedly provide a

basis for resettlement eligibility.16 Therefore, RFRs must allege error and/or identify new issues; a

submission merely consisting of criticism or pleading for favorable consideration will not necessarily be

treated as an RFR.

1. Allegation of Error

If an RFR is based on an allegation of error, the applicable standard of review is “significant

error.” According to the RFR Guidance, the reviewing officer must first determine whether any errors

were made in adjudicating the case in the first instance. Then, the officer determines whether the error

was “significant,” meaning “it is more likely than not to have affected the result.”17

USCIS reviews denied applications by considering (1) credibility findings and (2) the scope of

review. If a denial is based on a finding of lack of credibility, then fact-finding and analysis failures

constitute significant error. Thus, with respect to any matter forming the basis of the credibility finding,

the original adjudicator’s Refugee Applicant Assessment must demonstrate all of the following:

• The matter(s) must be clearly described in the Assessment

and support the adjudicator’s assertion that the applicant is

not telling the truth;

• The matter(s) must be material to the refugee’s application

for resettlement; and

13 USCIS treats reviews of RFRs as distinct from the formal reopening and reconsideration procedures

provided by 8 C.F.R. 103.5. See USCIS, Joseph D. Cuddihy, Memorandum re: “Guidance for Adjudicating Requests

for Review of Denied I-590 Refugee Applications,” (hereinafter “RFR Guidance”) (May 3, 2005), note 2 at 2.

14 RFR Guidance at 2.

15 Id.

16 Id.

17 Id. at 3.

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• The applicant must have been made aware of the matter(s)

and provided a fair opportunity to provide an explanation.

The documentation must include a description of the

applicant’s attempt to explain the matter(s).18

A review of the case should encompass the entire case file and examine the sufficiency of the

fact-finding. The original adjudicator’s failure to sufficiently develop and examine the facts of the case

also constitutes significant error. However, USCIS has not elaborated on what constitutes sufficient fact-

finding.

Possible Dispositions: If significant error is found, the reviewing officer may either require a re-

interview or reverse the denial. According to the RFR Guidance, re-interviews are appropriate if the

reviewing officer finds that there is insufficient information to determine the applicant’s eligibility for

resettlement. An application may be reversed and approved without re-interview if “it is clear that in

the absence of the error the case may be approved.”19 If no significant error is found, the denial will be

affirmed.

2. New Information

If an RFR is based on the submission of new evidence, the standard of review is whether a

preponderance of the evidence, considering new information and prior facts together, indicates that

the applicant qualifies for resettlement.

Such new information may be existing evidence that was unavailable at the time of the original

application and interview, or evidence that came into existence after the denial was issued. The new

information must be sufficient and relevant to prove that the applicant qualifies for resettlement. The

new information must be factually related to the original case; for example, it “should pertain to the

same persecutor, same protected characteristic, or both.”20

In addition, the information must have been unavailable at the time of the original interview

and application. Thus, if the new information concerns events that occurred or evidence that existed at

the time of the original application, the RFR should include a reasonable explanation as to why the

information was not presented at the interview. The reasonableness of the explanation is determined

by the reviewing officer.21

Credibility findings made in the original adjudication raise no presumption regarding the

credibility of new information submitted in an RFR. The RFR Guidance provides that new evidence is to

be assessed de novo, following a re-interview concerning the new information or “other appropriate

consideration as determined by USCIS.”22

18 Id. at 4.

19 Id. at 3.

20 Id. at 5. If the new information is not associated with the facts of the original case, the applicant is

proposing a new and unrelated claim which requires establishing new access to the U.S. refugee program.

21 Id.

22 Id. at 5-6.

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The RFR Guidance provides that if a request lacks sufficient description of alleged new

information, the request should be returned with instructions to provide better information via a

standardized form letter. Additional information must be submitted within 90 days of USCIS’ request.

Finally, all RFRs, even those not alleging error, are to be reviewed for error in the original

adjudication. Thus, in RFRs based on new information, the reviewing officer is to “also examine

whether there were any other possible errors in the adjudication.”23

Possible Dispositions: If the preponderance of new and old information indicates that the

applicant should qualify for resettlement, USCIS may schedule a re-interview in order to assess the

credibility of the new information. Alternatively, the reviewing officer may at her discretion reverse and

approve the application without a re-interview if (1) the reliability of the new information is clear; (2)

the original denial was specifically based on non-corroboration of material information; and (3) the new

information provides the specified corroboration.24 The RFR Guidance provides an example of when

such reversal would be appropriate: “if the applicant’s testimony was generally credible except for the

fact that his or her story was not consistent with known country conditions, a subsequent submission of

verifiable country conditions information which supports the applicant’s claim could form the basis of a

reversal without re-interview.”25 A denial will be affirmed if the preponderance of the evidence fails to

indicate the applicant’s qualification for resettlement.

23 Id. at 6.

24 Id. at 5.

25 Id. at note 3.

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Urban Justice Center

Steps to Filing a Request for

Reconsideration (“RFR”)

Checklist overview:

1. Rejection letter from DHS/USCIS

2. Interview applicant

3. G-28 Notice of Appearance to USCIS

4. G-639 FOIA Request to USCIS

5. 7001 Request to USCIS Ombudsman (Optional)

6. Supporting evidence

7. Letter brief addressed to Embassy

8. Send RFR packet to Embassy and USCIS

9. Follow up

1. Obtain a copy of the rejection letter.

When the Department of Homeland Security (“DHS”) rejects an applicant for refugee status, the

applicant receives a written notification in English (see Sample Rejection Letter, attached as Appendix

B). The letter generally has very little information about the specific reasons for rejection, other than

checking off a box next to the general language of the bar. This means that the information you have

about the reason for rejection will essentially be “failed to prove nexus” or “firm resettlement.”

Generally, the rejection letter will be provided along with the case referral, but in some cases it

may need to be obtained directly from the applicant. We typically have applicants scan and email copies

of the letters to us. For applicants who are unable to do so, we have interns on the ground in Amman

and Damascus who can assist them with the scanning and emailing.

2. Interview the applicant to determine the reason for rejection.

Once you know the general reason for the rejection based on the rejection letter, conduct an in-

depth interview with the applicant to try to discover more detail about what went on at the DHS

interview. Typically, the reason for rejection will be the result of the DHS interview because applicants

who receive interviews with DHS will have already successfully completed both the United Nations High

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Commissioner for Refugees (“UNHCR”) and International Organization for Migration (“IOM”) portions of

the application process.

Ask the applicant to tell you as much as she can about what occurred during the interview. This

interview with the applicant will likely be your best source of information for how to file the appeal.

Example questions to ask about the DHS interview:

• What questions were asked and what answers did the applicant

give?

• Did the interview stop at any point? Did the interviewer

temporarily leave the room?

• Were there any problems with the translation?

• How long was the interview?

• Does the applicant feel she was given the opportunity to tell

her entire story?

• Did the interviewer seem caught up on certain details?

3. Fill out and file a G-28 Notice of Appearance with USCIS.

The G-28 must be signed by you and filled out with your contact information (see copy of G-28

at Appendix C). It also asks for a street address for your client. In the signature box for the applicant, it

notes that a signature is only necessary if the applicant is a citizen or lawful permanent resident.

However, because we are using G-28s to provide notice of representation to U.S. Citizenship and

Immigration Services (“USCIS”) in order to get access to confidential information about the applicant, we

try to obtain the client’s signature. It does not need to be an original signature, so you can follow the

same process for scanning as in step 1, above.

4. File a G-639 Freedom of Information Act request to obtain access to

the applicant’s file.

The G-639 is a Freedom of Information Act (“FOIA “) request to USCIS. See attached at Appendix

D. It is the only way to get access to the applicant’s file, and to obtain information beyond what the

client can recollect from the interview.

In practice, we typically end up filing the RFR before the G-639 comes back. There is a 30-90 day

window (depending on which form letter the applicant receives) in which to file the RFR, although this

does not seem to be enforced. The FOIA requests take a very long time to come back, and follow-up is

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almost always necessary with the USCIS FOIA office. However, we believe these are worth filing because

they will provide the only real record of the reasons for denial.

In past cases, USCIS has frequently denied that there is any information available. However, a

recent general FOIA request by IRAP uncovered documentation about the record-keeping procedures

that USCIS uses for individual refugee files. These procedures, attached as Appendix D, describe where

the files are located and what documentation they are required to contain, and should be helpful in

pursuing FOIA requests for individual clients.

5. If necessary, file a 7001 form with the USCIS Ombudsman’s Office.

A 7001 form requests that the USCIS Ombudsman’s Office look into the circumstances of a

particular case. (See attached at Appendix E). The form itself is very basic. Although it requests an Alien

Number (or “A Number”) you can fill in the applicant’s IOM registration number. You can submit a copy

of the G-28 in lieu of having the applicant sign this form.

A 7001 form is useful when it is difficult or impossible to determine why the applicant was

rejected, or if there is something wrong with the rejection letter. For example, sometimes an applicant

will be rejected and only the box for “other” will be checked on the rejection letter. While this often

indicates a problem with the security clearance, the “other” box has been used in other cases as well.

Alternatively, if there is no clear reason for the applicant’s rejection or something inappropriate

happened during the interview, it may also be useful to get the Ombudsman’s office involved.

6. Identify the evidence necessary to establish the applicant’s

qualification for resettlement in light of the reason for rejection.

At the very least, include a sworn declaration from the applicant with as much detail as possible

addressing the relevant issue. For example, if the applicant is denied because she failed to prove that

she would be persecuted on account of race, religion, national origin, social group or political opinion, a

detailed declaration should outline how her past persecution was based on one of these factors. If an

applicant is denied because of his military service, a detailed declaration will include as much

information as possible about his army service in an effort to show he did not persecute anyone. For

example, where was he stationed, for how long, what did he do there? Etc.

Beyond the applicant’s declaration, the additional evidence will vary depending on the reason

for rejection. This might include supporting affidavits from neighbors or family members who can attest

to the persecution, newspaper articles or reports about violence against certain groups or in certain

neighborhoods, as well as copies of any relevant personal records (such as military service booklets or

threatening letters).

If the applicant was employed by an international NGO or company, a letter from the employer

is also very helpful.

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If no other evidence is available, the declaration from the applicant should explain why. For

example, it is extremely common for people to receive written threats which get left in front of their

doors, but most people do not save these and take them to Jordan.

If there are extenuating humanitarian circumstances, it is also useful to provide evidence of

these. For example, if a member of the applicant’s family has an urgent medical issue, you should

provide medical records or a letter from the doctor. If the applicant is in danger in Amman or Damascus

and has registered with the UNHCR protection service, you might obtain a letter from the UNHCR

protection service.

Supporting evidence:

• Sworn declaration from applicant addressing reason for

rejection (required)

• Supporting affidavits or other reports of persecution

• Relevant personal records

• Letter from international employer

• Evidence of humanitarian concerns

7. Prepare the letter brief explaining why the applicant meets the

legal standard at issue.

Once the new evidence is gathered, prepare a brief in the form of a letter to the Embassy or

Embassy official specified on the rejection letter (typically, this will be Phyllis Coven, the director of

Overseas Processing at the U.S. Embassy in Amman, Jordan). The letter should summarize the

applicant’s background story, including the persecution suffered and the fear of future persecution.

The letter should then explain the contours of the legal standard at issue. For example, if the

applicant was rejected for failing to prove nexus, the letter should outline what the USC, CFR and case

law say about what is necessary to prove a “nexus.” If the applicant is rejected for military service, there

is a fair amount of case law detailing when a refugee or asylum applicant may be rejected based on

military service (i.e., was the applicant in a leadership role? Did the applicant see combat? Was duress

involved?).

The letter should then go on to explain, using old as well as new evidence, why the applicant

meets this standard. This should be done in the same style as a legal brief.

Finally, the letter should explain any humanitarian concerns involved, such as continued risk of

persecution (whether in Iraq or the secondary country), single women at risk, religious minorities,

urgent medical cases, etc.

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Elements of letter brief:

• Applicant’s background story

• Relevant legal standard

• Evidence of how applicant meets legal standard

• Humanitarian concerns

8. Compile and send the packet to the appropriate U.S. Embassy, cc’ing

the USCIS district director.

The complete RFR packet should contain:

• The cover letter-brief

• All supporting evidence organized into Exhibits (and cited to as

such in the cover letter)

• A copy of the G-28 with the applicant’s signature

For examples of RFR packets, see Appendix F.

A copy of the RFR should be mailed to the Embassy indicated on the rejection letter (either

Athens or Amman), as well as emailed (with a note indicating a hard copy has been mailed) to

John.Lafferty@dhs.gov and Jennifer.Higgins@dhs.gov.

9. Follow up, follow up.

Because there is no clear procedure by which USCIS reviews and processes RFRs, a fair amount

of follow-up is typically necessary to ensure processing. One week after the RFR is supposed to be

received, it is useful to follow up with the Overseas Processing Director at the Embassy to ensure that it

was received for processing. USCIS is not currently providing receipt numbers for RFR’s.

If four weeks go by with no response, it is worth following up again with the OPD at the

Embassy. If time continues with no response, follow up with the USCIS District Director in Rome, John

Lafferty, or his deputy, Jennifer Higgins, who works out of Washington, D.C. IRAP can assist with contact

information for relevant parties.

Be sure to also stay in regular touch with your client so you can remain apprised of changed

circumstances on the ground and answer questions that will come up for them during the process.

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Appendix A

14

Department of Homeland Security

U.S. Citizenship and Immigration Services

I-590, Registration for

Classification as Refugee

OMB No. 1615-0068; Expires 03/31/10

Type or print the following information in black ink. (Read instructions on Page 2.)

A-Number:

1. Name: (First)

2. Present Address: (Street Number and Name/Town or City/State or Province/Country)

3. Date of Birth: (mm/dd/yyyy) Place of Birth (City or Town)

Present Citizenship/Nationality

4. Country from which I fled or was displaced:

On or about (mm/dd/yyyy):

(Middle)

(Last)

Province

Country

5. Reasons (State in detail):

6. My present immigration status in (Country in which residing)

is:

Evidence of my immigration status is:

(Describe):

11. Name of Child(ren)

7. Name of Spouse:

8. Present Address of Spouse (if different):

9. Citizenship/Nationality of Spouse:

10. My Spouse:

Date of Birth (mm/dd/yyyy)

Place of Birth

Present Address (if different):

will

will not accompany me to the United States:

Place a mark (X) in front of name of each child who will accompany you to the United States.

12. Schooling or Education

Title of Degree or Diploma

Dates Attended

Type

Name and Location of School

13. Military Service

Country

Branch and Organization

Dates

Serial No.

Rank Attained

Form I-590 (Rev. 03/23/09) Y

15

15. I

been in the United States. (If you have ever been in the United States, provide the dates of entry and departure and the

16. I

14. Political, professional, or social organizations of which I am now or have been a member or with which I am now or have been affiliated since

my 16th birthday. (If you have never been a member of any organization, state "None.")

been charged with a violation of law. (If you have ever been charged with a violation of law, give date, place, and

File or Alien Registration Number:

nature of each charge and the final result.)

purpose of your entry (visitor, permanent resident, student, seaman, etc.).)

have

have not

have

have not

17. I have the following close relatives in the United States:

18. I am being sponsored by (Name and address of sponsor in United States):

Name

Date:

Signature of Registrant:

Present Address

Relationship

Do not write below this line. For Government Use Only.

)

were made by me or at my request, and that this registration was signed by me with my full, true name:

(mm/dd/yyyy)

(Signature and Title of Officer)

(Complete and true signature of registrant)

Subscribed and sworn to before me by the above-named registrant at

on

) to (

I

, do swear (affirm) that I know the contents of this registration subscribed by me,

Interview

Date

At

Approved

Date

Immigration Officer

Officer in Charge

Action Block

Instructions

Submission of Form -This form should be filled out, signed, and submitted to the District Director or Officer in Charge of the nearest overseas office of U.S.

Citizenship and Immigration Services. When USCIS begins processing your form, you will be receive additional instructions.

Registration - A separate Form I-590 is required for each registrant. Form I-590 on behalf of a child under 14 years of age shall be submitted by the parent or

guardian.

Public Reporting Burden - A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. This collection

of information is estimated to average 35 minutes per response. If you have comments regarding the accuracy of this estimate or suggestions for simplifying this form,

write to: U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC

20529-2210: OMB No. 1615-0068. Do not mail your completed application to this address.

Form I-590 (Rev. 03/23/09) Y Page 2

including the attached documents, that the same are true to the best of my knowledge, and that corrections numbered (

16

Appendix B

17

18

19

Appendix C

20

Department of Homeland Security

Instructions

An attorney or accredited representative appearing before the

Department of Homeland Security (DHS) must file Form G-28

in each case. Form G-28 must be properly completed and

signed by the petitioner, applicant, or respondent to authorize

representation for the appearance to be recognized by U.S.

Citizenship and Immigration Services (USCIS), U.S. Customs

and Border Protection (CBP), and U.S. Immigration and

Customs Enforcement (ICE). Under 8 CFR 103.2(a)(3), a

beneficiary of a petition is not a recognized party in a

proceeding before USCIS. Form G-28 will be recognized by

USCIS, CBP, or ICE until the conclusion of the matter for

which it was entered. This does not change the requirement

that a new Form G-28 must be filed with the Administrative

Appeals Office when filing an appeal to that office on Form

I-290B, Notice of Appeal or Motion.

Form G-28 (Rev. 04/22/09)N

OMB No. 1615-0105; Expires 04/30/2012

G-28, Notice of Entry of Appearance

as Attorney or Accredited Representative

General Instructions

Part 1. Notice of Appearance as Attorney or

Accredited Representative

A. Check one block to indicate the DHS agency

where the matter is filed. If it is USCIS, list the

form number(s) filed with Form G-28. If it is

CBP or ICE, list the specific matter in which the

appearance is entered.

B. Fill in all information. The mailing address of

the applicant, petitioner, or respondent is

required in this part of the form, except when

filed under the Violence Against Women Act

(VAWA). The applicant, petitioner, or

respondent must sign the form, preferably in

dark blue or black ink.

What Is the Purpose of This Form?

Part 2. Information about Attorney or

Accredited Representative

A. Attorneys admitted to practice in the United

States, as defined in 8 CFR 1.1(f):

Check the box and fill in required information

regarding the State bar(s) of admission. If you

are subject to any order of any court suspending,

enjoining, restraining, disbarring, or otherwise

restricting you in the practice of law, you must

disclose this information on Form G-28.

Attorneys are required to notify DHS of

convictions or discipline pursuant to 8 CFR

292.3.

An attorney or accredited representative who seeks to

withdraw his or her appearance in a proceeding before DHS

must file a written request with the DHS office with

jurisdiction over the pending matter. An attorney or accredited

representative who seeks to be recognized by DHS as the new

representative for an applicant, petitioner, or respondent must

file a properly completed Form G-28 with the DHS office with

jurisdiction over the pending matter. An attorney or accredited

representative who is appearing for a limited purpose at the

request of the attorney or accredited representative of record

must file a properly completed Form G-28 as noted on the

form.

Appearances for Immigration Matters

This form is used only by attorneys and accredited

representatives (as defined in 8 CFR 1.1(f) and 292.1(a)(4)).

Attorneys admitted to the practice of law in countries other

than the United States must use Form G-28I and may only

represent individuals in matters filed in DHS offices outside

the geographical confines of the United States.

Who May Use This Form?

When a person acts in a representative capacity, his or her

personal appearance or signature shall constitute a

representation under the provisions of 8 CFR 103.2(a)(3) and

292.1(a)(1) or 292.1(a)(4) that he or she is authorized and

qualified to represent the individual. Further proof of

authority to act in a representative capacity may be required.

21

Paperwork Reduction Act

An agency may not conduct or sponsor an information

collection, and a person is not required to respond to a

collection of information, unless it displays a currently valid

OMB control number. The public reporting burden for this

collection of information is estimated at 20 minutes per

response, including the time for reviewing instructions and

completing and submitting the form. Send comments

regarding this burden estimate or any other aspect of this

collection of information, including suggestions for reducing

this burden, to: U.S. Citizenship and Immigration Services,

Regulatory Products Division, 111 Massachusetts Avenue,

NW, 3rd Floor, Suite 3008, Washington, DC 20529-2210,

OMB No. 1615-0105. Do not mail your application to this

address.

This form may not be used to request records under the

Freedom of Information Act or the Privacy Act 5 USC 552 &

552a. The procedures for requesting such records are

contained in 6 CFR 5.

Freedom of Information/Privacy Act

Warning

Individuals appearing as attorneys or accredited

representatives are subject to the rules of Professional Conduct

for Practitioners found in 8 CFR 292.3.

Part 3. Name and Signature of Attorney or

Accredited Representative

Fill in all information and sign the form, preferably

in dark blue or black ink.

Form G-28 (Rev. 04/22/09)N

You must also check Box A or B and provide

the required information.

C. Attorneys or accredited representatives

associated with the attorney or accredited

representative with Form G-28 previously filed

in this matter:

Check the box and fill in the name of the

attorney or accredited representative who has

previously filed Form G-28 in this matter. A

new Form G-28 must be filed by each attorney

associated with that attorney or accredited

representative.

B. Accredited representatives of recognized

organizations, as defined in 8 CFR 292.1(a)(4):

Check the box and fill in the name of the

organization recognized by the Board of

Immigration Appeals (BIA) under 8 CFR

292.2 and provide the expiration date of your

accreditation.

22

Form G-28 (Rev. 04/22/09)N

G-28, Notice of Entry of Appearance

as Attorney or Accredited Representative

Department of Homeland Security

OMB No. 1615-0105; Expires 04/30/2012

Part 2. Information about Attorney or Accredited Representative (Check applicable items(s) below)

I am an attorney and a member in good standing of the bar of the highest court(s) of the following State(s), possession(s), territory(ies),

A.

commonwealth(s), or the District of Columbia:

restraining, or otherwise restricting me in the practice of law (If you are subject to any order(s), explain fully on reverse side).

I am an accredited representative of the following qualified non-profit religious, charitable, social service, or similar organization

established in the United States, so recognized by the Department of Justice, Board of Immigration Appeals pursuant to 8 CFR 1292.2.

Provide name of organization and expiration date of accreditation:

B.

I am associated with

C.

The attorney or accredited representative of record previously filed Form G-28 in this case, and my appearance as an attorney or

accredited representative is at his or her request (If you check this item, also complete item A or B above in Part 2, whichever is

appropriate).

.

I have read and understand the regulations and conditions contained in 8 CFR 103.2 and 292 governing appearances and representation

before the Department of Homeland Security. I declare under penalty of perjury under the laws of the United States that the information I

have provided on this form is true and correct.

Name of Attorney or Accredited Representative

Signature of Attorney or Accredited Representative

Part 3. Name and Signature of Attorney or Accredited Representative

Complete Address of Attorney or Organization of Accredited Representative (Street Number and Street Name, Suite No., City, State, Zip Code)

Date

Attorney Bar Number(s), if any

Phone Number (Include area code)

E-Mail Address, if any

Fax Number, if any (Include area code)

List Petitioner, Applicant, or Respondent. NOTE: Provide the mailing address of Petitioner, Applicant, or Respondent being represented, and

not the address of the attorney or accredited representative, except when filed under VAWA.

Name: Last

First

Middle

Address: Street Number and Street Name Apt. No.

City

State Zip Code

Petitioner

Principal Petitioner, Applicant, or Respondent

B. I hereby enter my appearance as attorney or accredited representative at the request of:

Part 1. Notice of Appearance as Attorney or Accredited Representative

A Number or Receipt

Number, if any

Signature of Petitioner, Applicant, or Respondent

Date

USCIS - List the form number(s):

A. This appearance is in regard to immigration matters before:

Pursuant to the Privacy Act of 1974 and DHS policy, I hereby consent to the disclosure to the named Attorney or Accredited Representative of any

record pertaining to me that appears in any system of records of USCIS, USCBP, or USICE.

ICE - List the specific matter in which appearance is entered:

Applicant

Respondent

am subject to any order of any court or administrative agency disbarring, suspending, enjoining,

I am not

or

CBP - List the specific matter in which appearance is entered:

23

Appendix D

24

Form  G-­639,  Freedom  of  

Information/Privacy  Act  Request  

Department  of  Homeland  Security  

U.S.  Citizenship  and  Immigration  Services

OMB  No.  1615-­0102;;  Expires  10/31/10

1.  Type  of  Request  (Check  appropriate  box)

NOTE:  Use  of  this  form  is  optional.  Any  written  format  for  a  Freedom  of  Information  or  Privacy  Act  request  is  acceptable.

2.  Requester  Information

3.      Consent  to  Release  Information  (Complete  if  person  is  different  from  requester.)  (Numbers  7  and  8  must  be  completed.)

START  HERE  -­  Type  or  print  in  black  ink.    Read  instructions  before  completing  this  form.

Name  of  Requester    (Last,  First,  and  Middle  Names)

Date  (mm/dd/yyyy)

Daytime  Telephone

Address  (Street  Number  and  Name)

Apt.  Number

City

State

Zip  Code

Privacy  Act  (PA)  (Number  6  must  be  completed  in  addition  to  all  other  applicable  items.)

Freedom  of  Information  Act  (FOIA)  (Complete  all  items  except  Number  6.)

Amendment  of  Record  (PA  only)  (Number  5  must  be  completed  in  addition  to  all  other  applicable  items.)

Signature  of  requester:

By  my  signature,  I  consent  to  pay  all  costs  incurred  for  search,  duplication  and  review  of  materials  up  to  $25  (See  instructions)

Deceased  Subject  -­  Proof  of  death  must  be  attached  (Obituary,  Death  Certificate,  or  other  proof  of  death  required)

Print  Name  of  Person/Record  Subject  Giving  Consent

Signature  of  Person  Giving  Consent  (Original  signature  required)

All  of  my  records

A    portion  of  my  records  (If  a  portion,  specify  below  what  part,  i.e.,  copy  of  application.)

By  my  signature,  I  consent  to  allow  the  requester  named  in  Number  2  above  to  review  (Check  applicable  box):

(Consent  is  required  for  records  of  U.  S.  citizens  (USC)  and  lawful  permanent  residents  (LPR).)

Identify  the  documents,  records,  or  information  you  are  seeking.    Be  as  specific  as  possible.

Purpose:  (Optional:  You  are  not  required  to  state  the  purpose  of  your  request.  However,  doing  so  may  assist  USCIS  in  locating  the  

records  needed  to  respond  to  your  request.)

*Family  Name  (Last  Name)

Given  Name  (First  Name)

Middle  Name

4.      Information  Needed  to  Search  for  Record(s)

5.      Data  Needed  on  Subject  of  Record    (Note:  Items  marked  with  an  asterisk  (*)  must  be  provided  if  known.)

Form  G-­639  (02/04/09)  N

25

 Form  G-­639  (02/04/09)  N  Page  2

Names  of  other  family  members  that  may  appear  on  requested  record(s)  (i.e.,  spouse,  daughter,  son):

*Father's  Name:    Given  Name  (First  Name) Middle  Name

Family  Name  (Last  Name)

*Family  Member's  Name:  Given  Name  (First  Name) Middle  Name

Family  Name  (Last  Name)

Relationship

*Mother's  Name:    Given  Name  (First  Name) Middle  Name

Family  Name  (Last  Name)  (including  Maiden  Name)

Manner  of  Entry  (Air,  Sea,  Land)

Mode  of  Travel  (Name  of  Carrier)

Country  of  Origin  (Place  of  Departure)

Port  of  Entry  Into  the  U.S.

Date  of  Entry  (mm/dd/yyyy)

*Other  Names  Used  (if  any)

*  Name  at  time  of  entry  into  the  U.S.

I-­94  Admission  #

*Alien  Registration  Number  (A#) *  Petition  or  Claim  Receipt  # *  Country  of  Birth

*Date  of  Birth  (mm/dd/yyyy)

Other  (Specify):

In-­Person  With  ID

Notarized  Affidavit  of  Identity

Telephone  No.

Date  (mm/dd/yyyy)

(Original  signature  required):

My  Commission  Expires  on

Signature  of  Notary

Signature

Signature

Subscribed  and  sworn  to  before  me  this

day  of

in  the  year

Executed  in  the  United  States

NOTE:  If  a  declaration  is  provided  in  lieu  of  a  notarized  signature,  it  must  state  at  a  minimum  the  following  (include  notary  seal  or  

stamp  in  the  appropriate  space  below):

If  executed  within  the  United  States,  its  territories,  possessions,  

or  commonwealths:  ''I  declare  (certify,  verify,  or  state)  under  

penalty  of  perjury  that  the  foregoing  is  true  and  correct.

If  executed  outside  the  United  States:  ''I  declare  (certify,  

verify,  or  state)  under  penalty  of  perjury  under  the  laws  of  the  

United  States  of  America  that  the  foregoing  is  true  and  correct.

OR

Executed  outside  the  United  States

Seal  or  Stamp

Seal  or  Stamp

5.      Data  Needed  on  Subject  of  Record                    (Continued)

6.  Verification  of  Subject  of  Record's  Identity  (See  instructions  for  explanation.  Check  one  box.)

7.    Signature  of  Subject  of  Record

8.    Notary      (Normally  needed  from  persons  who  are  the  subject  of  the  record  sought  or  for  a  sworn  declaration  under  

penalty  of  perjury.  See  below.)

26

Appendix E

27

Instructions

Case Problem Submission Worksheet

(CIS Ombudsman Form DHS-7001)

Department of Homeland Security

CIS Ombudsman

Form DHS-7001 (07/14/08)

General Information.

1. Who May Use This Form?

If you are experiencing problems during the adjudication

of an immigration benefit with U.S. Citizenship and

Immigration Services (USCIS), you can submit this

worksheet form. You may also use this form to submit a

case problem on behalf of somebody else who

experiences a case problem with USCIS. If you submit a

case problem on behalf of somebody other than yourself,

you should ensure that the person the case problem is

about (the applicant for a USCIS immigration benefit, or

the petitioner who seeks to obtain an immigration benefit

for a third party) consents to your inquiry (see section

15).

2. Do I Have to Use This Form to Submit a

Case Problem to CIS Ombudsman?

You do not have to use this form to submit your case

problem to CIS Ombudsman. However, by submitting a

properly completed form, the CIS Ombudsman will

receive the necessary information to process your case

problem. If you do not use the form and do not provide

us with the necessary information, you may experience a

delay in the processing of your case problem.

3. When Should I Submit a Case

Problem to CIS Ombudsman?

You should contact the CIS Ombudsman if you have an

ongoing or immediate issue with USCIS, such as:

You are facing, or are about to face, an immediate

adverse action or impact, an emergency or any other type

of significant hardship caused by an action/inaction/delay

in processing by USCIS, or a problem, which could not

be resolved through the normal processes provided for by

USCIS;

Your case experienced processing delays beyond

anticipated processing times;

You will incur, or are about to incur, significant and

unusual costs (including fees for professional

representation that are not normally incurred);

Have not received a response or resolution within the

anticipated time frames as published by USCIS.

4. Do I Have to Do Anything Before I Can

Submit a Case Problem to CIS Ombudsman?

It is best if you contact our office for assistance after

utilizing other resources for case problems with USCIS,

such as:

USCIS Case Status Service Online at http://www.uscis.gov;

Made an InfoPass appointment at the local office;

Contacted the National Customer Service Center (NCSC)

for assistance at (800) 375-5283.

While we do not require that you take these steps before you

contact our office, the above listed resources can resolve

many frequently asked questions such as (1) what forms to

file; (2) where to file a particular form; (3) how to notify

USCIS of a change of address; (4) how to inquire about

processing times at the various service centers or field offices

or (5) how to receive case status updates. Additionally,

certain information can be obtained from USCIS directly,

such as information about individual immigration benefits.

NOTICE: Please be aware that CIS Ombudsman cannot

provide legal advice. Our office does not have the

statutory authority to tell you what type of immigration

benefit you may be eligible for or how to remedy your

particular immigration situation.

5. What Are the General Filing

Instructions for This Form?

Type or print legibly in black ink.

If extra space is needed to complete any item, please attach

a continuation sheet and indicate the item number.

If you feel that a particular item does not apply, please

indicate by writing "N/A."

Please attach copies of any documentation you received

from or sent to USCIS or any other government entity in

relation to your case problem. Any additional

documentation that is helpful to your case should be

submitted. Do not send us original applications or original

documentation.

6. Do I Need to Submit a Fee

Along With This Form?

No fee is required. Please do not send us any fees.

OMB No. 1601-0004; Exp. 01/01/10

28

Form DHS-7001(07/14/08) Page 2

Please mail your completed, signed and dated form, including

supporting documentation, to the following address:

7. Where Should I Send the Completed Form?

Via Regular Mail:

Citizenship and Immigration Services Ombudsman

Department of Homeland Security

Attention: Case Problems

Mail Stop 1225

Washington, D.C. 20528-1225

Via Courier Service:

Citizenship and Immigration Services Ombudsman

Department of Homeland Security

Attention: Case Problems

245 Murray Lane

Mail Stop 1225

Washington, D.C. 20528-1225

Due to security concerns, mail is screened prior to being

forwarded to our office. Please allow up to 14 days from the

mailing date until our office receives your case problem. We

confirm in writing the receipt of each case problem received

within two to four business days.

Once we receive your case problem, we will review your case,

determine if we are able to assist you, and if appropriate, forward

your case to USCIS for resolution. If for some reason we are not

able to help you obtain a resolution to your case problem, we will

inform you of the reasons in writing. If another government office

or agency is better able to assist you with your case problem, we

will make every effort to provide you with the contact information

of that office or agency.

8. What Assistance Does the Ombudsman

Provide to Resolving Case Problems?

If you believe that our office should have accepted your case for

assistance, you may resubmit your case problem with additional

explanations as to why your case problem should have been

accepted.

9. Can the Ombudsman Provide Legal Advice?

CIS Ombudsman cannot:

Adjudicate immigration applications or petitions;

Reverse an adverse decision issued by USCIS;

Serve as a substitute for legal options available to you to

correct a problem; or

Provide legal advice.

NOTE: CIS Ombudsman only has jurisdiction to provide

assistance resolving case problems that arise under the jurisdiction

of USCIS. The Ombudsman is not able to provide assistance with

case problems that arise under the jurisdiction of other agencies

dealing with immigration-related issues, such as:

The Department of Justice (DOJ);

Customs and Border Protection (CBP);

Immigration and Customs Enforcement (ICE);

Department of State (DOS), including the National Visa

Center (NVC) and U.S. Embassies and Consulates; or

Department of Labor (DOL).

10. Privacy Act Requirements.

When you submit your information and case problem to the

office of CIS Ombudsman, you are consenting to our review

of your information and contacting USCIS on your behalf.

You also consent to the release of your information to

authorities within USCIS or any person acting on behalf of

USCIS.

In addition, it's the CIS Ombudsman's statutory mandate

under the Homeland Security Act, Section 452, to capture and

address systemic problems. As such, individual case problems

serve as one of the basis to establish current systemic trends

and problems individuals and employers experience during

the immigration benefits seeking process. For this purpose,

we will remove your personal information and use the

remaining information collected for statistical purposes.

The scope of your consent to release your information is

limited to the furtherance of resolving the case problem

associated with your case, and the capturing of declassified

data to establish systemic immigration problems occuring at

USCIS.

(For additional information, please see Page 3 on these

instructions, "Legal Notification Requirements: What Is

Our Authority for Collecting This Information?")

Specific Instructions.

The following instructions will assist you in completing

the form correctly. The items numbered below correspond to

the section number of the form requesting the particular

information:

1. Name of subject: The "subject" is the person the case is

about. Please enter the person's full legal name (first,

middle, last name). If the person possesses an alias,

provide your alias by indicating "aka" and then listing the

alias and all other legal names.

2. Contact information: Please provide the contact

information of the person the case is about. If you are

submitting the case problem on behalf of somebody else,

please also complete Section 14.

3. Subject's date of birth: Self-explanatory.

4. Subject's country of birth and citizenship:

Self-explanatory.

5. Alien ("A") Number: Provide your alien ("A") number, if

applicable. Note that not every person has an alien number

assigned by USCIS. For example, if you are seeking non-

immigrant status in the United States, you may or may

not have an "A" number. The "A" number can be found

on many frequently issued USCIS documents, such as

work permits or Notices of Actions.

The Immigration Courts and the Board of Immigration

Appeals (BIA), which are part of the Executive Office

of Immigration Review (EOIR);

29

6. Type of case problem: Indicate whether the case problem

concerns an individual or an employer.

7. Person preparing this form: Indicate whether the preparer

of this form is the person the case problem is about ("the

subject"), an organization, attorney/representative or

whether you are completing this form in any other capacity

(such as a friend of the family, friend, uncle, etc.).

Important: If you are the beneficiary of an immigration

application and the one submitting the case problem,

you will need the consent of the individual who submitted

the petition on your behalf ("the Petitioner"). In this case,

you are (although the beneficiary) simply a representative

of the Petitioner, and will need the consent of the Petitioner

to submit this case problem (please see also Section 15).

8. Applications and petitions filed: List all applications/

petitions that are currently pending with USCIS and that

pertain to the case problem you are experiencing. List the

applications/petitions by identifying the date when the

application/petition was received by USCIS (Receive date);

the form number of the application/petition, which may be

located on the lower right corner of USCIS form (e.g. ,

Form I-485); and the name of USCIS form (e.g.

Application to Register Permanent Residence or to Adjust

Status).

9. Receipt number: Provide the receipt number(s) for the

application(s)/petition(s) currently pending with USCIS.

The receipt number is located on the top left hand corner

of your Notice of Action (Form I-797) you received from

USCIS in response to the application/petition you filed.

Please provide each receipt number associated with

this case.

10. Immigration status or interim benefit Applied or

Petitioned for: Provide information about the

immigration status or the immigration benefit the person

of the case problem is seeking (non-immigrant, immigrant,

citizenship, naturalization, refugee or asylum status, work

authorization, travel document, etc.)

11. Source of case problem: Please choose the options

provided that best describe the source of the case problem.

12. Description of your case problem: Please provide a

detailed description of your case problem. If additional pages

are needed, please attach them on separate sheets of paper.

Provide also the legal category of the immigration status

you are seeking. If you are unsure about the category,

submit as much information as you can in Number 12

of the form, Description of case problem. If possible,

provide us with a copy of the application you filed with

USCIS so that we will be able to determine what

immigration category you are seeking.

13. Prior actions taken to remedy the problem: Check all

the boxes that apply to the subject's or the representative's

action(s) already taken to remedy the problem.

14. Designated Attorney/Representative: Please complete this

section if you are an attorney, organization or designated

representative who is submitting this case problem. You

are also a representative if you are, for example, a friend

of the person the case problem is about, and if you would

like to assist the individual in resolving the case problem.

15. Consent: For privacy reasons, if you wish USCIS to disclose

all the information in the file, we require the consent of the

petitioner (the person who filed the petition with USCIS). As

a general rule, the person who filed the application/petition

with USCIS has to consent to the submission of a case

problem to our office. This general rule, however, does not

apply if the beneficiary is a lawful permanent resident or

U. S. citizen.

16. Verification: If the person who submitted the inquiry is also

the subject of the inquiry, this section should be signed and

dated by the subject of the inquiry. If a person is the

representative and acts on behalf of the subject the case

problem is about, the representative should not sign and date

the verification statement.

17. Declaration: If you are an attorney or representative sub-

mitting the case problem you should sign and date the

statement. If you are submitting the case problem for

yourself, and you are the subject of the case problem, you

should sign this statement.

18. Submission of the worksheet form: Self-explanatory.

Legal Notification Requirements.

1. What Are the Penalties for

Submitting Incorrect Information?

Section 1001 of Title 18, United States Code states that whoever

willfully and knowingly falsifies a material fact, makes a false

statement or makes use of false documents will be fined up to

$10,000, imprisoned for up to five (5) years, or both.

2. What Is Our Authority for

Collecting This Information?

We request the information on this form to carry out our mandate

as provided by Section 452 of the Homeland Security Act of

2002. We need the information to assist individuals and

employers in resolving problems with USCIS; to identify areas in

which individuals and employers have problems in dealing with

USCIS; and to the extent possible, to propose changes in the

administrative practices of USCIS to mitigate problems identified.

When you submit your information and case problem to this

office, you are consenting to our review of your information to our

office and contacting USCIS on your behalf. With the submission

of your case problem, you also consent to the release of your

information to authorities within USCIS or any person acting on

behalf of USCIS. In addition, it's CIS Ombudsman's statutory

mandate under the Homeland Security Act, Section 452, to

capture and address systemic problems. As such, individual case

problems serve as one of the bases to establish current systemic

trends and problems. For this purpose, we will remove your

personal information and use only the remaining information for

statistical purposes.

Form DHS-7001 (07/14/08) Page 3

30

The scope of your consent to release your information is limited

to the furtherance of resolving the case problem associated with

your case and capturing statistical data to identify systemic

immigration problems.

You do not have to provide us with the particular information

requested. However, if you omit certain information, our office

may not be able to assist you, or the resolution of your case

problem may be delayed.

3. Paperwork Reduction Act Notice.

A person is not required to respond to a collection of information

unless it displays a current valid OMB control number.

The public reporting burden for this collection of information is

estimated to average 60 minutes per response, including the time

for reviewing instructions, searching existing data sources,

gathering and maintaing the data needed and completing and

reviewing the collection of information.

Send comments regarding this burden estimate or any other

aspects of this collection of information, including suggestions

for reducing this burden to cisombudsman@dhs.gov. Do not

mail your case problem to this email address.

Form DHS-7001 (07/14/08) Page 4

31

Case Problem Submission Worksheet

(CIS Ombudsman Form DHS-7001)

Department of Homeland Security

CIS Ombudsman

NOTE: Please read the attached instructions before submitting this worksheet. In completing this worksheet, the "subject" refers to

the person whom the inquiry is about. In submitting your inquiry, please provide as much information as possible. Places requiring your

signature are indicated with the symbol.

1. Name of subject.

The person this case problem is

about who is seeking the

immigration benefit.

First Name:

Middle Name:

Last Name:

2. Contact information.

The contact information of the

person the case problem is about.

If you are submitting this form for

someone else, complete number 14.

Street Address:

Apartment/Suite: City:

State/Province:

County:

Zip Code: E-Mail Address:

Phone Number:

(with Area Code)

Fax Number:

(with Area Code)

3. Subject's date of birth.

Please indicate in the following

format: (mm/dd/yyyy).

Date of Birth:

4. Subject's country of

birth and citizenship.

A Number:

A

Country of Birth:

Country of Citizenship:

5. Alien or "A" number.

The "A" number appears in the

following format: A123-456-789.

NOTE: Not every person is

assigned an "A" number by USCIS.

If you do not have an "A" number,

leave this section blank.

Tip: Your "A" number can be found on many USCIS documents including your

work permit.

6. Type of case problem.

Check all that apply.

I am an:

a.

b.

Individual;

Employer;

7. Person preparing

this form:

Please indicate who is filing this

case problem.

a.

b.

I am:

d.

c.

The person this case problem is about who is seeking the immigration benefit;

An organization on behalf of an individual;

An attorney/representative;

Other (Explain fully);

8. Applications/Petitions

filed:

List all applications or petitions

pending with USCIS that pertain

to your case problem.

Date Application/Petition was

received by USCIS:

USCIS Form Number: USCIS Name of Form:

USCIS Name of Form:

USCIS Form Number:

Date Application/Petition was

received by USCIS:

USCIS Name of Form:

USCIS Form Number:

Date Application/Petition was

received by USCIS:

Tip: List all forms that are the subject of this case problem. E.g.: If you are filing for a Green Card

and are experiencing a problem with your work permit application that was submitted with your

Green Card application, list both Forms I-485 (Application Adjustment of Status) and I-765

(Application for Employment Authorization Document) above.

9. Receipt Number.

Please do not include dashes

between the characters.

Receipt Number:

Tip: Your receipt number is located in the top left hand corner of your Notice of Action (USCIS

Form I-797).

Form DHS-7001 (07/14/08)

(mm/dd/yyyy)

OMB No. 1601-0004; Exp. 01/31/09

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10. Immigration status or

interim benefit applied

or petitioned for:

The subject of the case problem is

applying for immigration status:

a.

As a Nonimmigrant (e.g. extension of a stay

for a visitor for pleasure-business, change of

status to student, fiance/e, temporary worker,

Temporary Protected Status (TPS) etc.)

Category:

(e.g.: H-1B1, J2,

F1, L1A)

b.

As an Immigrant (often called

"Green Card" application)

based on:

i.

A marital relationship of less than two years;

ii.

A marital relationship of more than two years;

iii.

A family relationship and is the parent, child,

brother/sister, etc. of the sponsor;

iv.

An employment relationship and is the (future)

employee or the spouse of child of the principle

(future) employee;

v.

Refugee/Asylum;

vi.

Other;

c.

For Citizenship or Naturalization;

d.

For Refugee/Asylum;

e.

For Interim Benefits

(Work Permit/Travel

Document, etc.)

Type:

ii.

i.

Employment

Authorization

Document (e.g.:

Work Permit)

Work Permit Category:

Advance Parole Document (Travel Document);

f.

Other (Application for

Waiver, Replacement

Document, etc.)

Type:

Waiver (I-601/I-212):

Replacement of a Document

Citizenship Certificate

Naturalization Certificate

Permanent Resident Card

Other:

Other:

11. Source of case

problem:

Check all that apply. Provide a

description in Number 12 below,

Description of Your case problem. b.

a.

I am facing or am about to face an immediate adverse action or impact, an emergency or

any other type of significant hardship, caused by an action/inaction/delay in processing by

USCIS, or a problem that could not be resolved through the normal processes provided for

by the USCIS:

I am experiencing processing delays with a case that are beyond anticipated processing

times;

c.

I am incurring or am about to incur significant and unusual costs (including fees for

professional representation that are not normally incurred);

d.

I have brought this case problem to the attention of USCIS and have not received a

response or resolution within the anticipated time frames;

e.

Other (specify):

12. Description of your

case problem:

Describe the case problem you are

experiencing with USCIS. Attach

additional pages if needed.

Form DHS-7001 (07/14/08) Page 2

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13. Prior actions taken to

remedy the problem:

Check all that apply:

e.

d.

c.

b.

a.

Contacted my attorney/representative who is representing me regarding this issue for

assistance (if represented);

Visited USCIS Case Status Service Online at http://www.uscis.gov.

Contacted the National Customer Service Center (NCSC) for information and/or

assistance regarding this case at their toll-free telephone number 1-800-375-5283.

Contacted the following government department/agency for assistance:

Contacted the following congressional representative for assistance:

14. Designated Attorney/

Representative:

Please complete this section if you

are an attorney, organization or

designated representative who is

submitting this case problem.

If you are the beneficiary of a

pending petition and have

obtained consent from the

petitioner (see Number 15), check

box 3, sign and date.

State/Province:

City:

Apartment/Suite:

Street Address:

Last Name:

Middle Name:

First Name:

Fax Number:

(with Area Code)

Phone Number:

(with Area Code)

E-Mail Address:

Zip Code:

County:

1.

I am an attorney and a member in good standing of the bar of the Supreme Court of the

United States of the highest court of the following State, territory, insular possession, or

District of Columbia and am not under a court or administrative agency order suspending,

enjoining, restraining, disbarring, or otherwise restricting me in practicing law.

State of Admission:

Name of Court:

2.

I am an accredited representative of the following named religious, charitable, social service

or similar organization established in the United States and recognized by the Board of

Immigration Appeals pursuant to 8 CFR 292.1.

3.

I am the beneficiary of a pending petition and the petitioner is consenting to the release of

information about a pending case to me.

4.

Other (Explain fully):

5.

I have submitted a USCIS Form G-28 as the attorney/representative for the application/

petition for which case problem is being submitted.

Date (mm/dd/yyyy):

Signature of Attorney/Representative:

15. Consent:

If you are the beneficiary of a

pending petition, and you are not a

lawful permanent resident or U.S.

citizen, the petitioner must sign

here to give consent to the release

of his or her information.

Pursuant to 5 U.S.C. Section 552a(b), I authorize U.S. Citizenship and Immigration Services and

CIS Ombudsman to release any and all information relating to me to: [Print or Type Name]. I

declare under the penalty of perjury that the foregoing is true and correct.

Signature of Subject:

Print Subject's Name:

Date (mm/dd/yyyy):

Form DHS-7001 (07/14/08) Page 3

16. Verification:

This item should be signed and

completed by the subject of the

inquiry.

I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true

and correct, and that I am the subject of the inquiry and I understand that any falsification of this statement is

punishable under the provisions of 18 U.S.C. Section 1001 by a fine of not more than $10,000 or by

imprisonment of not more than five years or both, and that requesting or obtaining any record(s) under the

false pretenses is punishable under the provisions of 5 U.S.C. 552a(i)(3) by a fine of not more than $5,000.

Further, pursuant to 5 U.S.C. Section 522a(b), I authorize U.S. Citizenship and Immigration Services and

CIS Ombudsman to release any and all information relating to me to : [Print or Type Name].

Signature of Subject:

Date (mm/dd/yyyy):

Print Subject's Name:

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17. Declaration:

If you are an attorney or

representative, you should sign

your name. Otherwise, the subject

should sign his or her name.

I delcare that I have prepared this document at the request of the person named in Number 14 and

that the responses are based on all information of which I have knowledge.

Signature of Representative:

Print Subject's or Attorney/Representative's Name:

Title (if applicable):

Date (mm/dd/yyyy):

18. Submission:

Case problems may be sent via

regular mail or courier service to

the following addresses:

Send your completed information to:

Via Regular Mail:

Citizenship and Immigration Services Ombudsman

Department of Homeland Security

Attention: Case Problems

Mail Stop 1225

Washington, D.C. 20528-1225

Via Courier Mail:

U.S. Citizenship and Immigration Services Ombudsman

Department of Homeland Security

Attention: Case Problems

245 Murray Lane

Washington, D.C. 20528-1225

Form DHS-7001 (07/14/08) Page 4

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