Application For Advance Processing of An Orphan Petition: For USCIS Use Only
Application For Advance Processing of An Orphan Petition: For USCIS Use Only
Application For Advance Processing of An Orphan Petition: For USCIS Use Only
Remarks
Approval Valid Until (mm/dd/yyyy):
To be Completed by Select this box if Attorney State Bar Number Attorney or Accredited Representative
an Attorney or Form G-28 or G-28I (if applicable) USCIS Online Account Number (if any)
Accredited is attached.
Representative (if any)
► START HERE - Type or print in black ink. This application is used to determine whether you (and your spouse, if married)
are suitable and eligible to adopt a child from a non-Hague Convention country, who has been or will be adopted and who
qualifies as an orphan under U.S. immigration law.
You must be a U.S. citizen in order to file this application. See the What Are the Eligibility Requirements section of the
Form I-600A Instructions for more information.
If you answered “No,” provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as
appropriate.
15. How did you obtain your U.S. citizenship? Birth Parents Naturalization
A. If you obtained your citizenship through your parents, have you obtained a Certificate of Citizenship in Yes No
your own name?
If you answered “Yes,” provide the following information about your Certificate of Citizenship:
Your Name On the Certificate of Citizenship
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
16. Have you EVER renounced or lost U.S. citizenship or has anyone you obtained citizenship through Yes No
(such as your parent or grandparent) EVER lost U.S. citizenship?
NOTE: If you answered “Yes,” provide a detailed explanation in the space provided in Part 9. Additional Information.
17. What is your marital status? Single Married Separated Divorced Widowed
18. How many times have you been married (including your current marriage, if applicable)?
NOTE: If you are not currently married, skip to Item Number 30.
22. Other Names Your Current Spouse Has Used (if any)
Provide all other names your spouse has ever used, including aliases, maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 9. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
24. How many times has your current spouse been married (including your current marriage, if applicable)?
27. Your Spouse's Daytime Telephone Number 28. Your Spouse's Mobile Telephone Number (If any)
If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household,
for each person.
31. List all of your children who are under 18 years of age. Also include any other children under 18 years of age who reside in your
household, regardless of your relationship to those children. If you need extra space to complete this table, use the space provided
in Part 9. Additional Information.
Date of Birth
Name (First/Middle/Last) Country of Birth A-Number (if any) Relationship to You
(mm/dd/yyyy)
Form I-600A Form I-600 Form I-800A Form I-800 Form I-130 (for an adopted child)
Date (mm/dd/yyyy)
33. Have you previously completed a domestic adoption of a child within the U.S.? Yes No
If you answered “Yes,” provide the following information for each completed domestic adoption of a child.
State And Country Where Adoption Was Finalized Date Adoption Was Finalized (mm/dd/yyyy)
34. Have you ever previously attempted to adopt a child internationally or domestically, but the adoption Yes No
was disrupted before it was finalized? An adoption is disrupted if you (or a custodian escorting the child
on your behalf) are granted legal custody or guardianship of the child but the adoptive placement is
interrupted before the adoption was finalized.
If you answered “Yes,” provide a detailed description of the disruption.
35. Have you ever previously completed an adoption, either in the United States or abroad, that was later Yes No
dissolved? An adoption is dissolved if your parental rights over the adopted child are terminated at any
time after the adoption was finalized.
If you answered “Yes,” provide a detailed description of the dissolution.
36. Have you ever previously placed a child in the care of another person with the intent to transfer permanent Yes No
custody of the child?
If you answered “Yes,” provide a detailed description of the placement.
37. Have you ever received a child with the intent to gain permanent custody but without involving child Yes No
welfare or other state/local authorities or following a state/local process?
If you answered “Yes,” provide a detailed description of the custody transfer.
Duty of Disclosure
You and your spouse (if married), must answer the following questions. See the Duty of Disclosure section in the Form I-600A
Instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to
any of the questions in Item Numbers 38. and 39., provide a certified copy of the documentation showing the final disposition of each
incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving
details, including any mitigating circumstances about each arrest, signed by you and/or your spouse (if married) under penalty of perjury
under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country);
name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if
applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married)
would like considered in light of this history in the space provided in Part 9. Additional Information.
38. Have you EVER, whether in or outside the United States:
A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or Yes No
violating any law or ordinance? (Answer “Yes” even if the record of the arrest, conviction, or other
adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration.
Do not include traffic violations, except for violations for driving or operating a vehicle while
intoxicated or while impaired by or under the influence of alcohol or other intoxicant.)
B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No
C. Received a suspended sentence, been placed on probation or parole, or been in an alternative Yes No
sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld
adjudication, or expungement of a criminal charge?
D. Been the subject of any investigation at any time, even if closed or unsubstantiated, by any child Yes No
welfare agency, court, or other official authority in any state or foreign country concerning the abuse
or neglect of any child?
39. Has your spouse EVER, whether in or outside the United States:
A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or Yes No
violating any law or ordinance? (Answer “Yes” even if the record of the arrest, conviction, or other
adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration.
Do not include traffic violations, except for violations for driving or operating a vehicle while
intoxicated or while impaired by or under the influence of alcohol or other intoxicant.)
B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No
C. Received a suspended sentence, been placed on probation or parole, or been in an alternative Yes No
sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld
adjudication, or expungement of a criminal charge?
D. Been the subject of any investigation at any time, even if closed or unsubstantiated, by any child Yes No
welfare agency, court, or other official authority in any state or foreign country concerning the abuse
or neglect of any child?
B. IS NOT attached to this Form I-600A, but will be submitted within one year from the date you file this Form I-600A.
(If your home study is not received within one year, U.S. Citizenship and Immigration Services (USCIS) will deny your
Form I-600A under 8 CFR 204.3(c)(2) and (h)(5).)
D. Home Study Preparer's Daytime Telephone Number E. Home Study Preparer's Fax Number (if any)
Information About Your Home Study Reviewer and Approver (if applicable)
If your home study was not performed by an accredited agency, an accredited agency must review and approve your home study
before you submit it to USCIS. This requirement does not apply to a home study that was prepared by a public domestic authority or a
public foreign authority.
3. Information About Who Reviewed And Approved (or will review and approve) Your Home Study (if applicable)
A. Name of Home Study Reviewer/Approver
D. Home Study Reviewer's/Approver's Daytime Telephone E. Home Study Reviewer's/Approver's Fax Number
Number (if any)
C. Primary Adoption Service Provider's Daytime Telephone D. Primary Adoption Service Provider's Fax Number
Number (if any)
2. Do you or your spouse (if married) plan to travel abroad to locate or adopt a child? Yes No
3. If you answered “Yes” to Item Number 2., provide the following information (if available):
A. Your Intended Departure Date B. Your Spouse's Intended Departure Date
(mm/dd/yyyy) (mm/dd/yyyy)
Country
4. Will you and your spouse (if married) adopt the child abroad after either you or your spouse (if married) Yes No
have personally seen and observed the child before or during the adoption proceedings?
5. If you know that the child will be adopted in the United States, provide a written description of all the pre-adoption requirements
of the state of the child's proposed residence. Cite any relevant state statutes and regulations, and describe the steps you have
already taken or will take to comply with these requirements. Identify and explain any pre-adoption requirements that you cannot
meet at this time as a result of state law. If you need extra space to complete this Item Number, use the space provided in Part
9. Additional Information.
6. Where do you wish to file your Form I-600 orphan petition? (Complete one of the options below)
8. If you answered “Yes,” enter the number of children you plan to adopt.
C. Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and the requested
accommodation):
Applicant's Statement
1. Applicant's Statement Regarding the Interpreter (Select the box for either Item A. or B.)
A. I can read and understand English, and I have read and understand every question and instruction on this application and
my answer to every question.
B. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every
question in , a language in which I am fluent, and I
understood everything.
Applicant's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my suitability and eligibility as an adoptive parent.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
Applicant's Signature
3. Applicant's Signature Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and ,which is the same language specified in Parts 5. and 6.,
Item B in Item Number 1., and I have read to this applicant and/or the applicant's spouse in the identified language every question
and instruction on this application and their answer to every question. The applicant and/or the applicant's spouse informed me that he
or she understands every instruction, question, and answer on the application, including the Applicant's Certification and the Your
Spouse's Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7. Interpreter's Signature Date of Signature (mm/dd/yyyy)
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, If
Other Than the Applicant and Spouse
If you and/or your spouse (if married) used a preparer to complete this application, provide the following information about the
preparer.
Preparer's Statement
7. A. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and/or the
applicant's spouse (if married) with the applicant's and/or the applicant's spouse's (if married) consent.
B. I am an attorney or accredited representative and my representation of the applicant and/or the applicant's spouse
(if married) in this case extends does not extend beyond the preparation of this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant and/or the
applicant's spouse (if married). The applicant and the applicant's spouse (if married) then reviewed this completed application and
informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the
Applicant's Certification and the Your Spouse's Certification, and that all of this information is complete, true, and correct. I
completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
Preparer's Signature
8. Preparer's Signature Date of Signature (mm/dd/yyyy)
D.
D.
D.
D.