Application for Permission to Reapply for Admission into the United States After Deportation or Removal

• Legal Form Number: I-212
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-212 Edition 03/21/22 Page 1 of 11

Application for Permission to Reapply for Admission

Into the United States After Deportation or Removal

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-212

OMB No. 1615-0018

Expires 03/31/2024

For DHS Use Only

Transferred InInitial Receipt

Remarks

Action Block

Approved

INA 212(a)(9)(A) for Advance

Approval

INA 212(a)(9)(A)

INA 212(a)(9)(C)

Relocated Returned

Denied

Transferred Out

DHS Office Name/Location

Fee Stamp

A-

Alien Registration Number

Apt. Ste. Flr.

Select this box if

Form G-28 or

Form G-28I is

attached.

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

To be completed by an

Attorney or Accredited

Representative (if any).

START HERE - Type or print in black ink.►

Part 1. Information About You

Alien Registration Number (A-Number) (if any)

►A-

1.

2.a. Family Name

(Last Name)

2.b. Given Name

(First Name)

2.c. Middle Name

Your Full Name

3.a. Family Name

(Last Name)

3.b. Given Name

(First Name)

3.c. Middle Name

Other Names Used

Provide all other names you have 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.

4.a. Family Name

(Last Name)

4.b. Given Name

(First Name)

4.c. Middle Name

Mailing Address USPS ZIP Code Lookup

5.b. Street Number

and Name

5.c.

5.d. City or Town

5.e. State 5.f. ZIP Code

5.g. Province

5.h. Postal Code

5.i. Country

NOTE: If you are outside the United States, provide a U.S.

mailing address, if available. If a U.S. mailing address is not

available, provide your mailing address abroad.

In Care Of Name (if any)5.a.