Application for Advance Permission to Enter as a Nonimmigrant

• Legal Form Number: I-192
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-192 Edition 07/20/21 Page 1 of 11

START HERE - Type or print in black ink.►

Attorney State Bar Number

(if applicable)

Select this box if

Form G-28 or

Form G-28I is

attached.

Volag Number

(if any)

To be completed by an attorney or accredited representative (if any).

Attorney or Accredited Representative

USCIS Online Account Number (if any)

Application for Advance Permission to Enter

as a Nonimmigrant

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-192

OMB No. 1615-0017

Expires 10/31/2023

I am applying to the Secretary of Homeland Security for

permission to enter the United States temporarily under the

provisions of the Immigration and Nationality Act (INA)

section 212(d)(3)(A)(ii), section 212(d)(13), or section

212(d)(14).

I am seeking this permission so that I may obtain (select only

one box):

Admission as a nonimmigrant (other than as a T or U

nonimmigrant).

Status as a victim of trafficking (T nonimmigrant

status) or a victim of a crime (U nonimmigrant

status).

1.

2.

Part 1. Application TypePart 2. Information About You

Your Full Name

1.a.

1.b.

1.c.

Family Name

(Last Name)

Given Name

(First Name)

Middle Name

ReceivedReturned Trans. Out

Trans. InCompleted

Fee Stamp

Action by the Department of Homeland Security

T Nonimmigrant/Waiver under INA 212(d)(13) and 8 CFR 212.16

U Nonimmigrant/Advance Permission under INA 212(d)(3)(A) and

8 CFR 212.17

U Nonimmigrant/Waiver under INA 212(d)(14) and 8 CFR 212.17

Granted, subject to revocation at any time,

upon the following terms and conditionsNonimmigrant other than T or U nonimmigrant/Advance Permission

under INA 212(d)(3)(A) and 8 CFR 212.4

INA 212(a)(6)

T Nonimmigrant/Advance Permission under INA 212(d)(3) and

8 CFR 212.16

INA 212(a)(2)

INA 212(a)(1)

Action Stamp

Benefits Category:

INA 212(a)(3)

INA 212(a)(10)

INA 212(a)(4)

Other:

Ground of Inadmissibility

Date of Action (mm/dd/yyyy)DD or OICOffice

INA 212(a)(9)

For DHS Use Only

INA 212(a)(7)

INA 212(a)(8)