Notice of Appeal of Decision Under Sections 245A or 210 of the Immigration and Nationality Act

• Legal Form Number: I-694
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-694 Edition 12/02/19 Page 1 of 6

Notice of Appeal of Decision Under INA Section 210 or 245A

of the Immigration and Nationality Act

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-694

START HERE - Type or print in black ink.►

For

USCIS

Use

Only

Action Block Fee Stamp

Family Name (Last Name) Given Name (First Name) Middle Name

1.

Part 1. Information About You (Appellant)

Full Legal Name

Any Other Names Used2.

Family Name (Last Name) Given Name (First Name) Middle Name

Family Name (Last Name) Given Name (First Name) Middle Name

B.

A.

3.

In Care Of Name

U.S. Mailing Address

City or Town State ZIP Code

Street Number and Name Flr.Ste.Apt.

Is your current U.S. mailing address the same as your U.S. physical address?

If you answered "No," provide your U.S. physical address in Item Number 5.

4. NoYes

Number

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

►A-

U.S. Physical Address

Street Number and Name

City or Town State ZIP Code

Flr.Ste.Apt.

5.

Number

USCIS Online Account Number (if any)7.

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