Immigrant Visa Case Approved or Selected from the DV or Derivative Program

To apply for a provisional unlawful presence waiver, you must have an immigrant visa case pending with DOS based on:

1. An approved immigrant visa petition and payment of the immigrant visa processing fee to DOS; either

2. Selection by DOS to participate in the DV Program for the fiscal year in which you enrolled.

 

Processing of Immigrant Visas

 

DOS processes immigrant visas for aliens who wish to permanently immigrate to the United States from abroad, including aliens who are not eligible to adjust their status to that of an LPR in the United States.

 

 

Based on a USCIS Approved Immigrant Visa Application

USCIS forwards the approved immigrant visa petition to the DOS NVC for immigrant visa consular processing if the Form I-130, Petition for Alien Relative, Form I-140, Immigrant Petition for Alien Worker, or Form I-360, Petition for American, Widow(er), or Special Immigrant, indicates that the beneficiary will apply for an immigrant visa through consular processing abroad or if the beneficiary is not eligible to modify status in the United States . Once the NVC receives this approved immigrant visa petition, the NVC sends the beneficiary instructions on how to start the immigrant visa process and pay the immigrant visa processing fee.

You must have already paid the DOS immigrant visa processing fee and must provide USCIS with a copy of the DOS-issued immigrant visa processing fee receipt or other fee payment receipt when you file your application. provisional unlawful presence waiver application. You must submit the DOS immigrant visa processing fee receipt or other NVC case fee payment receipt associated with the approved immigrant visa petition. Contact the NVC if you need another copy of the immigrant visa processing fee receipt issued by DOS.

 

Based on the Diversity Visa Program

DOS manages the DV Program. To participate in the program, a foreign national must register with DOS during the designated registration period. If the DOS selects the foreigner from the group of registrants to continue the DV process, the DOS instructs the selected DV Program and any derivatives on how to obtain an immigrant visa.

If you are a selectee or derivative of the DV Program, you may submit a provisional unlawful presence waiver request to USCIS as soon as you are selected. You must submit a printout of the DV Entry Status Verification page on the DOS Electronic Diversity Visa System website at www.dvlottery.state.gov/ , confirming that you are a DV Program selectee or a derivative.

NOTE: Selectees of the DV Program and its derivatives do NOT need to show that they have already paid the DOS immigrant visa processing fee and do NOT need to submit a copy of the immigrant visa processing fee receipt issued by the TWO.

 

Extreme Hardship (Hardship) for a Qualifying Relative

You must show that you have a US citizen or LPR (qualifying relative) spouse or parent who would experience extreme hardship (suffering) if denied admission to the United States. The qualifying relative need not be the relative who filed the immigrant visa petition, but must be your US citizen or LPR spouse or parent. For information on how you can show extreme hardship (distress) of your qualifying relative, see Extreme Hardship (Differing) in the What Evidence Must I Submit with Form I-601A section of these Instructions.

NOTICE to parents of a US citizen or LPR child: A US citizen or LPR child is not a qualifying relative for the purpose of showing extreme hardship on this application. USCIS will not consider extreme hardship (suffering) experienced by your US citizen or LPR children, except to the extent that it affects the extreme hardship (suffering) that your US citizen or LPR spouse or parent would experience.

NOTICE to Surviving Family Members: If your U.S. citizen or legal resident spouse or parent filed your immigrant visa petition, but died after filing the immigrant visa petition on your behalf, USCIS will consider the death of the U.S. citizen or legal resident spouse or parent as the functional equivalent of extreme hardship (distress) for the U.S. citizen or legal resident spouse or parent, if residing in the United States at the time of death and still residing in the United States.

You must still complete Part 3. Information About Your Immigrant Visa Case and Part 4. Information About Your Qualifying Relative with information about the Form I-130 petitioner. In Part 5. Applicant Statement, you must explain why you believe USCIS should approve your request for a provisional unlawful presence waiver as a matter of discretion. You must also provide a copy of the US citizen or legal resident spouse or parent's death certificate with your application.

 

This application is divided into nine parts. See below for more details.

Part 1. Information About You

In this section, provide the requested information about yourself.

 

 

Item 1. Alien Registration Number (A number) (if any). Indicate your A-number. Your A-number is the

number used to identify your immigration records. You can find this number on the documents you receive from USCIS, United States Immigration and Customs Enforcement (ICE), or the Department of Justice's Executive Office for Immigration Review (EOIR), during immigration proceedings in the United States. courts.

Item 2. US Social Security Number (if you have one). Provide your US social security number, if you have one.

Item 3. USCIS Online Account Number (if you have one). If you have previously filed an application, petition, or petition using the USCIS online filing system (formerly called the USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number assigned to you by the system . You can find your USCIS Online Account Number by logging into your account and going to your profile page. If you previously filed certain paper applications, petitions, or petitions through a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice that provides you with a USCIS Online Account Number. If you have received this notice, your USCIS online account number is located at the top of the notice. If you were issued a USCIS Online Account number, enter it in the space provided. The USCIS online account number is not the same as the A Number.

Items 4.a. - 4.c. Your full name. Enter your full legal name in the spaces provided

Items 5.a. - 6c. Other Names Used (if any). List all names you have used, including maiden names, married names, and nicknames in the space provided.

Items 7.a. - 7.f. Your United States Mailing Address. Indicate the address where you wish to receive written correspondence regarding your application.

Items 8. - 9.e. Your Physical Address in the United States. If your current mailing address does not match your physical address, please provide your physical address. You must include the number and the name of the street or the number of the rural route. Do not list a PO Box number here.

Item 10. Sex. Please indicate whether you are male or female.

Item 11. Date of Birth (mm/dd/yyyy). Enter your date of birth in mm/dd/yyyy format.

Items 12. - 13. Place of Birth. Indicate the city or town and the country where you were born in the spaces provided.

Item 14. Country of Citizenship or Nationality. Indicate the name of the country of which you are a citizen or your country of nationality. It is not necessarily the country in which you were born. If you are not a national of any country, type or print "stateless" and provide an explanation in Part 9. Additional Information.

Items 15.a. - 16.b. Full Legal Name of your Mother and Father. List the full legal name of your parents in the spaces provided.

Items 17. - 19. Your Last Entry into the United States. In the appropriate fields, indicate the actual or approximate date and place you last entered the United States and your immigration status, if any, at the time of entry.

If you were inspected at a point of entry as an applicant for admission, and were admitted or paroled by U.S. Customs and Border Protection, indicate the point of entry location and your immigration status at the time of entry (for example, immigrant, any nonimmigrant classification, or parolee).

If you entered the United States without being inspected by US Customs and Border Protection at a point of entry, type or print "PWI" as your immigration status.

Items 20.a. - 26. Your Prior Earnings to the United States (if applicable). In the appropriate fields, indicate the date you previously entered the United States (or around it) and the place (actual or approximate) of each previous entry into the United States. Also indicate your immigration status at the time of each entry above.

If you were inspected at a port of entry as an applicant for admission, and were later admitted or paroled by U.S. Customs and Border Protection, indicate the place of entry and your immigration status in the time of entry (for example, immigrant, any nonimmigrant classification, or parolee).

 

 

If you entered the United States without being inspected by US Customs and Border Protection at a port of entry, type or print "PWI" as your immigration status.

If you need more space to fill out this section, use the space provided in Part 9. Additional Information.

Items 27. - 45. Your Immigration or Criminal History. Please provide information on any and all criminal or immigration history.

1. Immigration Procedures (Items 27. - 30.)

Item 27. You are in the Expulsion Process but there is still no Final Order. Indicate whether you are currently in removal, exclusion, or deportation proceedings because the immigration judge, the Board of Immigration Appeals, or a federal court has not yet issued an order in your case. Generally, you are not eligible for a provisional unlawful presence waiver unless your case is administratively closed and has not been placed back on the court record at the time you file your Form I-601A.

If your answer is "Yes" to Item 27., you must go to Items 28.a - 28.b. Based on the scenario that applies to you in Items 28.a - 28.b., you may be eligible for a provisional unlawful presence waiver.

If your removal proceedings have been completed, you must submit a copy of all documents related to the removal, deportation, or exclusion proceedings, including the order for the termination of removal proceedings. If removal proceedings have been terminated, you are not in removal proceedings.

Items 28.a. - 28.b. Removal Proceedings Administratively Closed or Removal Proceedings Put Back on EOIR Calendar to Continue Case. Please indicate which statement applies to you if you are currently in removal, deportation, or exclusion proceedings.  Provide the evidence requested in the situation that applies to you.

If your case is administratively closed and you have not been put back on the EOIR calendar to continue your case, you may be eligible for a provisional unlawful presence waiver. If your case was administratively closed but you have been put back on the EOIR calendar to continue your case, you are not eligible for a provisional unlawful presence waiver.

Items 29.a. - 29.b. Being the Subject of a Final Order of Removal, Exclusion or Deportation. Please indicate whether you are currently subject to a final order of removal, exclusion, or deportation.

NOTE: If you answer "Yes" to Item 29.a., you are not entitled to a provisional unlawful presence waiver unless you have applied and USCIS has approved an application for permission to reapply for admission under section 212( a)(9)(A)(iii) of the INA and 8 CFR 212.2 on Form I-212, Application for Permission to Reapply for Admission to the United States after Deportation or Removal. If you have already applied, and USCIS has already granted you, permission to reapply for admission, provide the relevant information about the approved Form I-212 in Item 29.b. You can also provide a copy of the approval notice that USCIS sent you when it approved your Form I-212.

Item 30.a. Reinstatement of Expulsion. Indicate in Item 30.a. if DHS has served you with a Form I-871, Notice of Intent/Decision to Reinstate Prior Order, indicating that DHS intends to reinstate a prior order of deportation, exclusion, or removal against you under section 241(a )(5) of the INA.

Item 30.b. If you answered "Yes" to Item 30.a., indicate whether DHS has issued a final order reinstating a prior deportation, exclusion, or removal proceeding.

Item 31. Subject to an Unexpired Voluntary Departure Concession. Indicate whether you are currently subject to an unexpired voluntary departure grant that was granted to you by an immigration judge or by the Board of Immigration Appeals (BIA) during your removal proceedings.

If you are currently subject to an unexpired voluntary departure grant from the immigration judge or the BIA, you are not eligible for a provisional unlawful presence waiver. If you were granted voluntary departure in the past, but later withdrew your request for voluntary departure or otherwise ended it, you should not select "Yes" in Item 31. In this case, you may be in removal proceedings. or you may be the subject of a final order of removal, deportation, or exclusion. You must select the statements that apply to you in Items 27. - 28.b. or 29th

 

 

If you withdrew your request for voluntary departure or otherwise terminated it, please provide a copy of all relevant court documents.

If you did not leave during the voluntary departure period, you now have an outstanding final order of removal, deportation, or exclusion. You should not select "Yes" to Item 31., but "Yes" to Item 29.a.

2. Criminal record (Items 32. - 45.)

A. If you answer "Yes" to any of the questions in Items 32. - 38., indicate the place, date and a brief description of the event in Part 9. Additional Information. If you answer "Yes" to any of the questions in Items 39.a. to 45.a., provide a full explanation in Part 9. Additional Information. The Provisional Unlawful Presence Waiver only addresses the grounds of inadmissibility associated with unlawful presence under section 212(a)(9)(B)(i) of the INA. USCIS may deny your application on a discretionary basis due to unfavorable factors related to your immigration and/or criminal history, unless you can show that a favorable exercise of discretion is warranted.

1. If you were arrested or detained, but not charged with any crime or misdemeanor, you must provide information about the event, regardless of the country in which it occurred.

2. If you have been charged with a crime, you must submit certified court dispositions showing the outcome of the court process. You must also provide copies of any arrest reports, charging statements, charging information, or any other charging documents issued against you. You MUST provide this information even if:

   1. His records were expunged;

   2. You have been placed in a rehabilitative or alternative sentencing program (eg, diversion, prosecution, suspended sentence, deferred sentence);

   3. Your records were sealed or expunged in some way; either

   4. You have been told by anyone, including a judge, law enforcement officer, or attorney, that you no longer have a criminal record.

3. If you were arrested but not charged with a crime or misdemeanor, you must provide the arrest report as well as documentation from the arresting authority, prosecutor's office, or court, if available, showing that you were not charged of a crime or offence.

4. If you have ever participated, ordered, abetted, assisted, or participated in any way in any human rights violation (for example, acts involving torture, genocide, or human trafficking; murder; serious injury to anyone; engaging in sexual activity with someone who is compelled to participate by force or threats), must provide information on the events, place, date and description, regardless of the country in which they occurred.

 

Part 2. Biographical Information

Provide the biographical information requested in Part 2., Items 1. - 6. Providing this information as part of your application may reduce the time you spend at your appointment with the USCIS ASC, as described in the Appointment of Services section. Biometrics of these Instructions.

Items 1. - 2. Ethnic Origin and Race. Check the boxes that best describe your ethnicity and race.

Categories and Definitions of Ethnicity and Race

1. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American culture or origin, or other Spanish culture or origin, regardless of race. (NOTE: This category is only included in the ethnicity section of Part 2., Item 1.)

2. White. Person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

3. Asian. Person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

4. Black or African American. Person having origins in any of the black racial groups of Africa.

 

 

1. American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

2. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Item 3. Height. Select the values that best fit your height in feet and inches. For example, if you are 1.5 feet 9 inches tall, select "5" for feet and "09" for inches. Do not enter your height in meters or centimeters.

Item 4. Weight. Enter your weight in pounds. If you don't know your weight, or need to enter a weight less than 30 pounds or more than 699 pounds, enter "000".  Do not enter your weight in kilograms.

Item 5. Eye Color. Check the box that best describes your eye color.

Item 6. Hair Color. Please select the box that best describes your hair color.

 

Part 3. Information about your Immigrant Visa Case

In this section, provide information about the approved immigrant visa petition (either Form I-130, Form I-140, or I-360) and the status of your immigrant visa application at the NVC.

Items 1.a. - 1st Indicate the reason you are immigrating to the United States (Check only one box).

NOTICE: If you are a Diversity Visa Program (DV) selectee or a derivative, please provide the information requested in Items 2.a - 2.d. If you are not submitting this application as a Diversity Visa Selectee, skip to Item 3

Item 2.a. DOS DV Program Case Number. Provide the DV case number that was assigned to you (or your spouse or parent) by the KCC when you (or your spouse or parent) became a selectee of the DV Program. You can find the number by printing out the DV Entry Status Verification page on the DOS Electronic Diversity Visa System website at www.dvlottery.state.gov/ .

Items 2.b. - 2d. Full Name of the Selected of the DV Program. (If you are not submitting this application as a Diversity Visa Program Selectee, skip to Item 3.) If you are applying as a derivative of a DV program selectee, please provide the name of the primary DV program selectee (your spouse or parent).

Item 3. If you (or your spouse or parent) are the beneficiary of an immigrant visa petition filed by a relative family member or an employer, provide the information requested in Item 3.

Item 3.a. USCIS Receipt Number. Provide the receipt number of the approved immigrant visa petition that was filed on your behalf (or that of your spouse or parent) or that you used to self-petition on your behalf. File a copy (if available) of the petition approval notice (Form I-797, Notice of Action). This will help USCIS process your request for a provisional unlawful presence waiver. Failure to submit a copy of the immigrant visa petition approval notice of the immigrant visa petition may result in delays in processing or denial of your application.

NOTE: Failure to provide a copy of the request approval notice will not, of itself, deny your request.

Item 3.b. DOS Consular Case Number (NVC Case Number). Provide your consular case number (also called NVC case number).  It is found on the DOS immigrant visa processing fee payment receipt. The NVC case number must correspond to the approved immigrant visa petition that you noted in Part 3., Item 3.a.

Items 3.c. - 3.f. Full Name of the Applicant and Name of the Company or Organization. Enter the full name of the relative or the company that filed Form I-130, Form I-140, or Form I-360 on your behalf (or that of your spouse or parent). If you self-petitioned using Form I-140 or Form I-360, type or print "Self."

 

Part 4. Information about your Qualifying Relative

In this section, provide information about the US citizen or legal resident spouse or parent who you believe would experience extreme hardship (suffering) if denied admission to the United States.

Items 1.a. - 2d. Full Name of Your Qualifying Relative and Relationship to You. Enter the full name of your qualifying relative and indicate whether the qualifying relative is your US citizen or legal resident spouse or parent.

 

 

Item 3. Your Other Qualifying Relative. Please indicate if you have any other qualifying relative (US citizen or legal resident spouse or parent) who would experience extreme hardship (suffering) if denied admission to the United States. If yes, list the additional qualifying relative's name, relationship, and evidence of United States citizenship or lawful resident status in the space provided.

Items 4.a. - 5 d. Full Name of Additional Qualifying Relative and Relationship to You. Enter the full name of your eligible additional qualifying relative and indicate whether the eligible additional qualifying relative is your US citizen or legal resident spouse or parent.

 

Part 5. Declaration of the Applicant

In the space provided, describe all of the reasons you believe support your request for a provisional unlawful presence waiver. If you need additional space to complete your return, use the space provided in Part 9. Additional Information.

Your statement must explain why you believe your qualifying relative would experience extreme hardship (hardship) if denied admission to the United States. For information on how you can show extreme hardship (suffering), see Extreme Hardship (Suffering) in the What Evidence Must I Submit with Form I-601A section of these Instructions.

Your statement should also explain why you believe USCIS should approve your waiver (waiver) request as a matter of discretion. Approval of a provisional unlawful presence waiver is discretionary, and the USCIS officer will weigh the favorable and unfavorable factors presented in your case to determine whether to approve your application. You should explain why you believe USCIS should approve your application for a provisional unlawful presence waiver based on favorable factors, and why unfavorable factors should not outweigh favorable factors.

 

Part 6. Applicant Declaration, Contact Information, Declaration, Certification and Signature

Items 1.a. - 6.b. Check the appropriate box to indicate whether you read this application yourself or had an interpreter assist you. If someone helped you fill out the application, check the box that indicates you used a preparer. In addition, you must sign and date your application and provide your daytime phone number, mobile phone number (if you have one), and email address (if you have one). All applications MUST bear the signature of the applicant (or their parents or legal guardians, if applicable). A stamped or typed name is not acceptable in place of a signature.

 

Part 7. Contact Information, Certification and Signature of the Interpreter

Items 1.a. - 7.b. If you have used someone as an interpreter to read the Instructions and questions on this application to you in a language you speak, the interpreter must complete this section; indicate your name, the name and address of your company or organization (if you have one), your daytime phone number, your mobile phone number (if you have one), and your email address (if you have one). The interpreter must sign and date the request.

 

Part 8. Contact Information, Declaration and Signature of the Person Preparing this Application, if different from the Applicant

Items 1.a. - 8.b. This section must contain the signature of the person who completed your application, if not you, the applicant. If the same person acted as your interpreter and preparer, that person must complete both Part 7 and Part 8. If the person completing this application is associated with a business or organization, that person must complete the name and address information. address of the company or organization. Anyone who helped you fill out this application MUST sign and date the application. A stamped or typed name is not acceptable in place of a signature. If the person who helped you prepare your application is an attorney or accredited representative, you may also be required to submit a completed Form G-28, Notice to Appear as Attorney or Accredited Representative, with your application.

 

 

Part 9. Additional Information

Items 1.a. - 7.d. If you need extra space to provide any additional information within this application, use the space provided in Part 9. Additional Information. If you need more space than is provided in Part 9, you may make copies of Part 9 to complete and file with your application, or attach a separate sheet of paper. Please type or print your name and your A-Number (if you have one) at the top of each sheet; indicate the Page Number, the Part Number and the Item Number to which your answer refers; and sign and date each page.