Request for Reduced Fee

• Legal Form Number: I-942
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-942 Edition 12/02/21 Page 1 of 9

START HERE - Type or print in black ink.►

For

USCIS

Use

Only

Request Receipted At (Select only one box)

USCIS Field Office USCIS Service Center

Reduced Fee Approved

Date:______________

Reduced Fee Denied

Date:______________

Reduced Fee Approved

Date:______________

Reduced Fee Denied

Date:______________

Request for Reduced Fee

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-942

OMB No.1615-0133

Expires 12/31/2023

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

1. Full Name

Part 1. Information About You (Requestor)

Provide information about yourself. If you are the legal guardian filing on behalf of a person with a physical disability or

developmental or mental impairment, provide information about the person for whom you are filing this form.

Date of Birth (mm/dd/yyyy)2. 3. Alien Registration Number (A-Number)

Marital Status4.

Marriage AnnulledSingle, Never Married Married Divorced Widowed

Other (Explain)

Separated

►A-

Part 2. Information About Family Members Filing This Request With You

1. In the table below, add the family members filing this request with you

Full Name A-Number (if any) Date of Birth Relationship to You

A-

A-

A-

A-

Part 3. Household Income

Your Employment Status

Employment Status1.

Other (Explain)

Retired

Employed (full-time, part-time,

seasonal, self-employed) Unemployed or

Not Employed