Translators Note: These instructions were retyped from the printed form distributed by INS.
Who can file? To use this form, you must be a United States citizen and the parent of an adopted child who was born outside the United States. Your spouse (if any) must also be a United States citizen and also the child's adoptive parent. The child must be under 18 years of age and residing with you in the United States as a lawfully admitted permanent resident alien. The approval of this application before the child's 18th birthday will make the child a United States citizen as of the date the application is approved. You will receive a certificate of citizenship as proof of the child's citizenship.
What is the fee? You must pay $80.00 to file this form. The fee will not be refunded. Do not mail cash. All checks or money orders must be payable in the U.S. currency in the United States. Make check or money order payable to "Immigration and Naturalization Service" in the exact amount. If the check is not honored, INS will charge you an additional $5.00.
If you live in Guam and are filing this application in Guam, make your check payable to "Treasurer, Guam", or if you live in the U.S. Virgin Islands and are filing the application there, make it payable to "Commissioner of Finance of the Virgin Islands".
What photographs are needed? You must send three identical, unglazed photographs of the child taken within 30 days of the date of filing of the application. The photographs must be in natural color and taken without a hat. The dimensions of the face should be about 1 inch from the top of the hair to the chin. The face should be a 3/4 frontal view with the entire right ear visible. They must be on thin paper with a light background and not mounted in any way. The photographs must not be signed but you should print the child's name and alien registration number in the center of the back of each photograph in pencil.
What documents are needed?
Any document in a foreign language must be accompanied by a translation in English. The translator must certify that he/she is competent to translate and that the translation is accurate.
What if a document is not available? If the documents needed are not available, you may submit the following (INS may require a certification from the appropriate civil authority that the document is not available):
For each document needed, you may submit the original documents or a clear readable copy (INS may still require the originals).
Where should the application be filed?
Submit this application at the local INS office having jurisdiction over your place of residence.
What are the penalties for submitting false information? Title 18 United States Code, Section 1001, states that whoever willfully and knowingly falsifies a material fact, makes a false statement, or makes use of a false document will be fined up to $10,000 or imprisoned up to five years or both. In addition, civil penalties may be imposed in accordance with Title 8 Unites States Code, Section 1324c(a)(2).
What is the authority for collecting this information? Information on this form is requested to carry out the immigration laws contained in Title 8 United States Code 1304 (c). This information is needed to determine whether an applicant is eligible for immigration benefits. The information provided may also be disclosed to other federal, state, local, and foreign law enforcement and regulatory agencies during the course of the investigation required by this Service. It is not necessary to provide this information, however if you refuse, your application may be denied.
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