Ds 117 Form PDF Details

When a person needs to file an application for benefits with the Social Security Administration, they will use form Ds 117. This form is used to request Disability Insurance Benefits, and it must be completed in full and filed with supporting documentation. The Ds 117 form can be confusing for some people, so it's important to understand what is required before filing. In this blog post, we'll provide an overview of the Ds 117 form and discuss the supporting documents that are needed. We'll also provide tips for completing the form correctly. Let's get started!

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

Form Preview Example

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

How to Edit Ds 117 Form Online for Free

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When it comes to blanks of this particular PDF, here's what you should know:

1. Begin completing the form ds 117 application with a number of essential blank fields. Consider all the necessary information and ensure absolutely nothing is missed!

Filling in section 1 of how to fill out form ds 117

2. Right after finishing the previous part, go to the next step and complete the essential particulars in all these blank fields - Full Name, Relationship, Resident Status, Place of Residence, Previous Immigration Record, a DHS A Number c Previous, Date of Issue mmddyyyy, Place of Issue, b Immigration Category d, Place of Adjustment of Status with, e Initial Entry into the United as, f Last Entry into the United, Date of Entry mmddyyyy, Port of Entry, and Date of Entry mmddyyyy.

Date of Entry mmddyyyy, Date of Issue mmddyyyy, and Place of Adjustment of Status with in how to fill out form ds 117

Concerning Date of Entry mmddyyyy and Date of Issue mmddyyyy, ensure that you do everything properly here. The two of these could be the most important ones in the page.

3. Completing Reasons for not returning to the, List below all periods that you, Dates mmddyyyy, From To, Country, Have you been employed outside of, Yes, If Yes complete the following, Name of Employer, Address, From mmddyyyy, and To mmddyyyy is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling in section 3 of how to fill out form ds 117

4. The following part needs your input in the subsequent areas: I wish to return to the United, By typing my name in the field, Date mmddyyyy, Name of Applicant, Date mmddyyyy, DO NOT WRITE BELOW THIS SPACE, Approved aA, Disapproved, Reason, Type Name of Consular Officer, Signature of Consular Officer, Date mmddyyyy, Post, Will add electronic signature when, and Reviewed. Be sure that you enter all of the required information to move forward.

By typing my name in the field, Disapproved, and Date mmddyyyy of how to fill out form ds 117

5. This document must be finished within this segment. Further you'll see a detailed set of blanks that need accurate information to allow your document usage to be faultless: Type Name of Reviewing Officer, Signature of Reviewing Officer, Date mmddyyyy, Will add electronic signature when, and Page of.

how to fill out form ds 117 writing process shown (stage 5)

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