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    Petition To Classify Special Immigrant Under Ina 203 (B) (4) As An Employee or Former Employee of The U.S. Government Abroad Do Not Write in This Block - For Official Use Only

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    angelgirlfab
    This document is a petition form for classifying a special immigrant under Section 203(b)(4) of the Immigration and Nationality Act as a current or former employee of the U.S. government abroad. The form requests information such as the petitioner's name, date and place of birth, total years of employment by the U.S. government abroad, location and agency of employment, and biographical information for spouse and children. It includes a certification that the petitioner will pursue an immigrant visa application immediately upon approval and intends to permanently separate from U.S. government employment upon departing for the United States.

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    Petition To Classify Special Immigrant Under Ina 203 (B) (4) As An Employee or Former Employee of The U.S. Government Abroad Do Not Write in This Block - For Official Use Only

    Uploaded by

    angelgirlfab
    40 views1 page
    This document is a petition form for classifying a special immigrant under Section 203(b)(4) of the Immigration and Nationality Act as a current or former employee of the U.S. government abroad. The form requests information such as the petitioner's name, date and place of birth, total years of employment by the U.S. government abroad, location and agency of employment, and biographical information for spouse and children. It includes a certification that the petitioner will pursue an immigrant visa application immediately upon approval and intends to permanently separate from U.S. government employment upon departing for the United States.

    Original Description:

    142907

    Original Title

    142907

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    This document is a petition form for classifying a special immigrant under Section 203(b)(4) of the Immigration and Nationality Act as a current or former employee of the U.S. government abroad. The form requests information such as the petitioner's name, date and place of birth, total years of employment by the U.S. government abroad, location and agency of employment, and biographical information for spouse and children. It includes a certification that the petitioner will pursue an immigrant visa application immediately upon approval and intends to permanently separate from U.S. government employment upon departing for the United States.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views1 page

    Petition To Classify Special Immigrant Under Ina 203 (B) (4) As An Employee or Former Employee of The U.S. Government Abroad Do Not Write in This Block - For Official Use Only

    Uploaded by

    angelgirlfab
    This document is a petition form for classifying a special immigrant under Section 203(b)(4) of the Immigration and Nationality Act as a current or former employee of the U.S. government abroad. The form requests information such as the petitioner's name, date and place of birth, total years of employment by the U.S. government abroad, location and agency of employment, and biographical information for spouse and children. It includes a certification that the petitioner will pursue an immigrant visa application immediately upon approval and intends to permanently separate from U.S. government employment upon departing for the United States.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    OMB APPROVED NO.

    1405-0082
    U.S. Department of State EXPIRATION DATE: 12/31/2015
    ESTIMATED BURDEN: 10 minutes*
    PETITION TO CLASSIFY SPECIAL IMMIGRANT UNDER
    INA 203(b) (4) AS AN EMPLOYEE OR FORMER EMPLOYEE
    OF THE U.S. GOVERNMENT ABROAD
    DO NOT WRITE IN THIS BLOCK - FOR OFFICIAL USE ONLY
    Date Petition Filed (mm-dd-yyyy) Fee collected Approved for the Secretary of State: INA 204(a)(1)(G)(ii)

    (Signature and Title)


    At Date (mm-dd-yyyy)

    ATTACHMENTS
    Recommendation of Principal Officer Approval by the Secretary of State
    1. Name (Last, First, Middle)

    2. Date of Birth (mm-dd-yyyy) 3. Place of Birth

    4. Total Number of Years of Employment by United States Government Abroad

    5. Location(s) of Employment 6.
    Currently Employed

    Honorably Retired
    7. Employing U.S. Government Agency Name(s)

    8. Name of Spouse Date of Birth (mm-dd-yyyy) Place of Birth

    9. Name(s) of Child(ren) Date(s) of Birth (mm-dd-yyyy) Place(s) of Birth

    I understand that the Secretary of State has approved special immigrant status for me under the provisions of INA 101(a)(27)(D) and that
    such approval remains valid for one year. In accordance with INA 204(a)(1)(G)(ii), I hereby petition for status under 203(b)(4) of the
    Immigration and Nationality Act. I understand that the petition, if approved, remains valid for six months. If granted such status, I will pursue
    my application for an immigrant visa immediately upon being notified that my petition has been approved. Also, upon approval of my
    petition, if I am then employed by the United States Government, I certify that I intend permanent separation from such employment no later
    than the date of my departure for the United States following issuance of an immigrant visa. I swear or affirm that all statements which
    appear in this petition are true and complete to the best of my knowledge and belief. I understand that any willfully false or misleading
    statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion from the United States.

    Signature of Applicant

    Subscribed and sworn to before me this day of


    at

    Consular Officer
    *Paperwork Reduction Act Statement - Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time required for searching
    existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this
    information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it,
    please send them to: PRA_BurdenComments@state.gov .
    Confidentiality Statement - INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment,
    administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the
    information contained in such records is needed in a case pending before the court.

    DS-1884
    01-2013

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