EFTA00799220.pdf

PID#: ATTN: (For Staff Use Only) IMMIGRATION ASSISTANCE REQUEST FORM U.S. Senator Dianne Feinstein One Post Street, Suite 2450 San Francisco, CA 94104 PLEASE PRINT CLEARLY OR TYPE Please complete all sections that apply to your case and review instructions at the end of the form. Title: o Mr. o Mrs. o Ms. o Miss o Dr. o Other Name: Date: Street Address: Apt. #: City: State: Zip Code: Primary Phone #: ( ) Alternate Phone #: ( ) E-mail Address: If you have contacted another Congressional office about this case, please list the office(s) contacted and the date(s) of contact: SECTION 1: NOTE: The "beneficiary" is the alien who will receive the direct benefit of a filed petition (i.e. visa or green card). Please see further instructions for waiver applications. Please use one form per beneficiary. A. Petitioner's Name: Alien Registration #: A Petitioner's relationship to beneficiary: Date of Birth (MM/DD/YY): Country of Birth: Beneficiary's Name: Alien Registration #: A Date of Birth (MM/DD/YY): Country of Birth: B. Mark an 'X' to the right of the forms filed For 1-130,1-140, 1-485, waivers and appeals, see notes below. G-639 1-131 I-730 I-824 Other: I-90 1-360 1-751 N-400 I-129 1-539 1-765 N-565 I-129F 1-600/A I-821 N-600 1-130 1-140 I-485 I-212 I-290B I-601 1-130/1-140• Be sure to indicate the visa category of your petition and verify that a visa is available by checking the Department of State Visa Bulletin: hup://travel.state.govivisafirviibulletinibulleun_1770.html OR by phone: 202- 6631541. Include case priority date(s) from your 1-797 Notice of Action below. For 1485, 1-601,1-290B, all appeals or waivers: Include case information on the related petitions (i.e. the 1140 or 1130 filed), as well as the visa category and priority date for those petitions. USCIS case information (from I-797 Notice of Action): Please list all petitions you need help with, as well as the related visa petitions. Include case priority date for I-I40 petitions. Form filed: Filing date: Receipt #: EFTA00799220 Form filed: Filing date: Case #: Form filed: Filing date: Case #: Form LOCATION OF CASE Have you been interviewed at a USCIS office for this case? If so, please list date and location of the USCIS interview: If your case has been sent from USCIS to the National Visa Center, complete Section 2. If your case has been sent to a U.S. Embassy or U.S. Consulate for processing, complete Section 3. If none of these apply, please skip to Section 4. Please review all instructions. SECTION 2: Complete this section if your case is in process at the Department of State NATIONAL VISA CENTER State Department Case Number: Visa Preference Category: Case Priority Date: Foreign State Chargeability: (Usually the beneficiary's country of birth) SECTION 3: Complete this section if your case is at a U.S. EMBASSY or U.S. CONSULATE Embassy or Consulate location (City and Country): Case Number: Date of interview(s): (For non-immigrant visas, provide the applicant's passport number) Has the case been transferred to another office? Where? SECTION 4: FINAL INSTRUCTIONS o FOR ALL CASES: On a separate sheet of paper, please describe briefly what problems you are experiencing with this case and how you think Senator Feinstein might be able to assist you. o Include copies of the most recent correspondence received from the agency on your case. o For expedite requests, please include evidence that your case meets the agency's set expedite criteria. USCIS expedite criteria is available online at uscis.gov. o Due to Privacy Act authorization requirements, we may not be able to open a case for you if proper authorization is not provided. Please note: ALL CASES require a petitioner's signature. For nonimmigrant visas where there is no petitioner, U.S. host must sign. Beneficiary signature is required for I -290B and 1-730 cases. For I-212 and I-601 waivers, the beneficiary of the case must sign as the petitioner for the waiver. You may submit separate forms with each signature if needed. o Mail or fax the form to Senator Feinstein's San Francisco office. SIGNATURE I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct. I, (print your name) authorize USCIS and the Department of State to release information contained in my agency records as relevant to checking my case status, and to the extent permitted by law, to Senator/Representative and the Member's staff. ONO Petitioner's Signature: Date: Beneficiary's Signature: Date: NOTE: The beneficiary's signature Is required for certain cases. See notes above regarding signature. EFTA00799221