Request for Cancellation of Public Charge Bond

• Legal Form Number: I-356
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-356 Edition 12/23/22 Page 1 of 9

To be Completed by the Alien's Attorney or Accredited Representative (if any).

To be Completed by the Obligor and Agent/Co-Obligor's Attorney or Accredited Representative (if any).

Request for Cancellation

of Public Charge Bond

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-356

Initial Receipt

Bar Code Area Action Block

For USCIS Use Only

RelocatedResubmitted

Received Sent Bond is Breached Comments (if needed):

Cancelled

Continued

Volag Number

(if any) Attorney or Accredited Representative

USCIS Online Account Number (if any)

Select this box if

Form G-28 is

attached.

Attorney State Bar Number

(if applicable)

Attorney State Bar Number

(if applicable)

Select this box if

Form G-28 is

attached.

Attorney or Accredited Representative

USCIS Online Account Number (if any)

Volag Number

(if any)

Part 1. Obligor and Agent/Co-Obligor Information (To Be Completed by the Obligor or Agent/Co-Obligor)

Information About Obligor

1.

Mailing Address2.

Name of Obligor

Provide the following information.

START HERE - Type or print in black ink.►

City or Town State ZIP Code

Street Number and Name Apt. Flr. NumberSte.

In Care Of Name (if any)

(USPS ZIP Code Lookup)