Ds 117 Form PDF Details

The process for lawfully admitted permanent residents of the United States to maintain their status after a temporary visit abroad is encapsulated within the DS-117 form, an Application to Determine Returning Resident Status. This form plays a crucial role in the immigration system, serving as a pathway for individuals to prove their intention of returning to the U.S. and consequently retain their permanent resident status. Applicants are required to demonstrate, firstly, their initial lawful admission for permanent residence, secondly, their departure from the U.S. with the intention of returning, and finally, their need to return to the U.S. following what may have been an unavoidably extended stay overseas due to circumstances beyond their control. The form requires thorough evidence submission, including proof of lawful permanent residence, travel history, ties to the U.S., and reasons for the extended stay abroad. Ensuring the completeness and accuracy of this application is pivotal, as the U.S. Department of State utilizes the information provided to make a determination regarding the applicant’s eligibility for returning resident status under Section 101(a)(27)(A) of the Immigration and Nationality Act.

QuestionAnswer
Form NameDs 117 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesform ds 117 immigration, us form ds 117, ds117, us ds 117

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U.S. Department of State

APPLICATION TO DETERMINE RETURNING RESIDENT STATUS

OMB CONTROL NO.1405-0091

EXPIRATION Date: 05/31/2023

ESTIMATED BURDEN: 30 MINUTES*

INSTRUCTIONS

This is an application for Special Immigrant Status under Section 101(a)(27)(A) of the Immigration and Nationality Act, for lawfully admitted permanent residents who are returning from a temporary visit abroad. To qualify you must submit with this application evidence that:

(1)You had the status of an alien lawfully admitted for permanent residence at the time of departure from the United States;

(2)You departed from the United States with the intention of returning and you have not abandoned this intention; and

(3)You are returning to the United States from a temporary visit abroad and, if the stay abroad was protracted, this was caused by reasons

beyond your control and for which you are not responsible.

Applicants must submit evidence with this application to support the above requirements, including proof of lawful permanent residence

(Examples: Form I-151, I-551, Reentry Permit, etc.), dates of travel outside of the United States (Examples: airline tickets, passport stamps, etc.), proof

of ties to the United States and intention to return (Examples: tax returns, and evidence of economic, family and social ties to the United States), and

proof a protracted stay was for reasons beyond the applicant's control (Examples: medical incapacitation, employment with a U.S. company,

accompanying a U.S. citizen spouse, etc.)

All documents will be returned to you.

 

 

 

 

 

1. Family Name

 

First Name

Middle Name

 

 

 

 

2.Other Names Used, Aliases (If Married Woman, Give Maiden Name)

3.Current Home Address and Telephone Number

4. Place of Birth (City, Province, Country)

5.Date of Birth (mm-dd-yyyy)

6. Marital Status

 

 

 

Married

Single (Never Married)

Widowed

Divorced

If married, information about spouse

a.Name (Last, First, MI)

b.Address

c.Place of Birth

d.Date of Birth (mm-dd-yyyy)

e.U.S. Residence Status, if any (U.S. Citizen, Legal Permanent Resident, Etc.)

f.Date of Marriage to You (mm-dd-yyyy)

7.List Below All Close Family Members in the United States (Continue on Separate Page if Necessary.)

Full Name

Relationship

Resident Status

Place of Residence

8. Previous Immigration Record a. DHS "A" Number

c. Previous Immigrant Visa

Date of Issue (mm-dd-yyyy)

 

Place of Issue

 

 

 

 

 

 

e. Initial Entry into the United

as Lawful Permanent Resident

Date of Entry (mm-dd-yyyy)

 

Port of Entry

b. Immigration Category

d. Adjustment of Status

 

Date of Adjustment of Status

Place of Adjustment of

with DHS (IF ANY) (mm-dd-yyyy)

Status with DHS (IF ANY)

f. Last Entry into the United States as Lawful Permanent Resident

Date of Entry (mm-dd-yyyy)

Port of Entry

9.Most Recent Departure from the United States

Date of Departure (mm-dd-yyyy)

 

Destination

Reason

 

 

 

 

 

10.What continuing ties have you maintained with the United States? What efforts have you made to avoid abandoning your permanent resident status in the United States?

DS-117

Page 1 of 3

10-2019

 

11. Reasons for not returning to the United States until time of this application.

12.List below all periods that you have lived outside of the United States for six months or longer since your initial entry into the United States as a permanent resident.

Dates (mm-dd-yyyy)

 

Country

From

To

 

13.Have you been employed outside of the United States since your most recent departure? If "Yes" complete the following:

Yes

No

Name of Employer

Address

From (mm-dd-yyyy)

To (mm-dd-yyyy)

14. I wish to return to the United States on or about

Date (mm-dd-yyyy)

15.By typing my name in the field below, I swear or affirm that all statements which appear on this application are true and complete to the best of my knowledge and belief. I understand that any false or misleading statement or willful concealment of a material fact may subject me to permanent exclusion from the United States. I understand that if this application for special immigrant status is approved, I must apply for an immigrant visa within six months from the date of approval.

Name of Applicant

Date (mm-dd-yyyy)

DO NOT WRITE BELOW THIS SPACE - OFFICIAL USE ONLY

Approved 101(a)(27)(A)

Disapproved

Reason

 

 

Will add electronic signature when converted to pdf

 

at

 

 

 

 

 

 

Type Name of Consular Officer

 

Signature of Consular Officer

Date (mm-dd-yyyy)

 

Post

Reviewed

Concur

Do NOT Concur

Will add electronic signature when converted to pdf

Type Name of Reviewing Officer

Signature of Reviewing Officer

Date (mm-dd-yyyy)

DS-117

Page 2 of 3

Privacy Act Statements

AUTHORITIES: The information is sought pursuant to 8 U.S.C. § 1101 et seq, 8 U.S.C. §§ 1201-1202, and by regulations issued pursuant to 8 CFR 211.1 and 22 CFR 42.22.

PURPOSE: The information solicited on this form will be used to determine your eligibility for returning resident status.

ROUTINE USES: The information on this form maybe shared with federal, state, and local government agencies, members of Congress, and officials of foreign governments in accordance with certain approved routine uses. More information on the Routine Uses for the system can be found in the System of Records Notice State-39, Visa Records.

DISCLOSURE: Providing this information is mandatory. Failure to provide the information requested on this form may result in the applicant's inability to receive returning resident status.

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-117

Page 3 of 3

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