Application for Waiver of Grounds of Inadmissibility

• Legal Form Number: I-601
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Page 1 of 12Form I-601 Edition 04/07/22

To be completed

by an Attorney

or Accredited

Representative (if any).

Select this box if

Form G-28 is

attached or G-28I

is attached.

Inadmissible Under

Benefits Category

For

USCIS

Use

Only

Application for Waiver of Grounds of Inadmissibility

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-601

OMB No. 1615-0029

Expires 07/31/2023

Fee Stamp Initial

Receipt Resubmitted Action Block

Relocated

Received Sent

Part 1. Information About You

Your Full Name

3.a.

4.c.

4.b.

4.a.

Family Name

(Last Name)

Middle Name

Given Name

(First Name)

Family Name

(Last Name)

3.b. Given Name

(First Name)

3.c.

List all other names you have ever used, including maiden names,

aliases, and nicknames. If you need extra space to complete this

section, use the space provided in Part 10. Additional

Information.

Middle Name

Alien Registration Number (A-Number) (if any)1.

►A-

USCIS Online Account Number (if any)2.

►

Other Names Used

Mailing Address

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

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

available, provide your mailing address outside the United States.

If you answered "No" to Item Number 6., provide your

physical address in Item Numbers 7.a. - 7.h.

6. Is your current physical address the same as your mailing

address? Yes No

5.a. In Care Of Name

Street Number

and Name

5.b.

5.c. Apt. Flr.Ste.

5.d. City or Town

5.g. Province

5.i. Country

5.e. State 5.f. ZIP Code

5.h. Postal Code

START HERE - Type or print in black ink.►

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

Immigrant Adjustment of Status TPS

V Nonimmigrant K Nonimmigrant

212(a)(1)

212(a)(2)

212(a)(3)

212(a)(4)

212(a)(6)

212(a)(9)

212(a)(10)

Other

(USPS ZIP Code Lookup)