Form I 800A PDF Details

The process for Americans seeking to adopt children from abroad necessitates a thorough and diligent approach to ensure the safety and welfare of the children involved. A critical aspect of this process is the Form I-800A, specifically its Supplement 1, which mandates detailed disclosure from each adult member residing in the proposed adoptive household. This form, overseen by the Department of Homeland Security's U.S. Citizenship and Immigration Services, requires these adults to provide comprehensive personal information, including any past interactions with the law, participation in rehabilitation programs, and involvement in child welfare investigations. The form distinguishes between general law violations and those specifically excluding traffic infractions unless they involve intoxication. Furthermore, it extends an ongoing responsibility towards honesty and updates on any new relevant information post-submission. The paramount goal is to protect the prospective adoptive child's best interests by scrutinizing the backgrounds of all adults in the home, compelling honesty under penalty of perjury, and facilitating information sharing under the auspices of the Privacy Act. This rigorous vetting process underscores the commitment of U.S. immigration and child welfare authorities to ensuring that adoptive homes are safe and nurturing environments for children.

QuestionAnswer
Form NameForm I 800A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names800a i form, i information 800a form, form 800a 1, form 800a disclose form

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Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-800A, Supplement 1, Listing of Adult Member of the Household

START HERE - Type or Print (Use black ink)

Part 1. Information About an Adult Member of the Household. (You must complete Form I-800A, Supplement 1, for each adult member of the household age 18 and older. However, if you are married, you do not need to complete one for your spouse.)

Notice to the Adult Member of the Household: By signing Form I-800A, Supplement 1, you agree that USCIS may disclose to the applicant or the applicant's adoption service provider information that USCIS may obtain about you that is relevant to the adjudication of the applicant's Form I-800A, even if the Privacy Act, 5 U.S.C. 552a, might otherwise prevent disclosure of the information.

1. Provide the following information about the adult member of the household:

Family Name (Last Name)

 

Given Name (First Name)

 

Middle Name

 

 

 

 

 

 

 

 

 

Other Names Used (including maiden name if appropriate)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy) Place of Birth (City/Town, State/Province, Country)

 

 

 

 

 

 

 

 

 

A # (if any)

 

 

 

U.S. Social Security # (if any)

 

 

 

 

 

 

 

 

 

For USCIS Use Only

Remarks:

Mailing Address

 

 

 

 

 

 

 

Apt. #

 

 

 

 

 

 

 

 

 

C/O (in care of)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State or Province

 

Zip/Postal Code Country

 

 

 

 

 

 

 

 

 

2.Has the adult member of the household, whether in or outside the United States:

a.Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violations, but including driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant?

b.Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?

c.Received a suspended sentence, been placed on probation or parole, or in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge?

d.At any time been the subject of any investigation by any child welfare agency, court, or other official authority in any State or foreign country concerning the abuse or neglect of any child, other than an investigation that has been completed and formally closed based on a finding that the allegation of abuse or neglect was unfounded or unsubstantiated?

Yes

Yes

Yes

Yes

No

No

No

No

Each of the above questions must be answered. See "Duty of Disclosure" on Page 7 of the instructions to Form I-800A concerning your ongoing duty to disclose information in answer to these questions. If the answer is "Yes" to any of the questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances, about each arrest, signed by the adult member of the household under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, State/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and the adult member of the household would like considered in light of this history on a separate sheet of paper.

Form I-800A, Supplement 1 (Rev. 03/10/17 N)

Part 2. Signature of You, the Prospective Adoptive Parent (Applicant) and Signature and Certification of the Adult Member

of the Household (Read the information on penalties on Page 10 of the instructions before completing this section.)

I declare that I completed Form I-800A, Supplement 1, Part 1 and it is based on all information of which I have knowledge. I have not knowingly withheld any material information that would affect the outcome of this application.

Your Signature (Applicant)

 

 

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

Applicant Family Name (Last Name)

 

Applicant Given Name (First Name)

 

Applicant Middle Name

 

 

 

 

 

 

 

Other Names Used (including maiden name if appropriate)

Date of Birth (mm/dd/yyyy) Place of Birth (City/Town, State/Province, Country)

U.S. Social Security # (if any)

 

A # (if any)

USCIS Account # (if any)

 

 

 

 

 

 

 

 

 

 

Certification of the adult member of the household:

I certify, under penalty of perjury under the laws of the United States, that:

1.Each answer I have given to each question on Form I-800A and attached supplement(s) is true and correct to the best of my knowledge, information, and belief; and

2.I understand the ongoing duty to disclose any change in circumstance, as described on Page 7 of the instructions to Form I-800A. I agree to notify the applicant of any new information that I am required to disclose.

Pursuant to the Privacy Act, 5 U.S.C. 552a, I also authorize USCIS to disclose information about me which may appear in any system of records maintained by the U.S. Department of Homeland Security, or which USCIS may obtain as a result of the collection of my biometrics information, to the applicant(s) who have filed Form I-800A, or to the applicant's adoption service provider, in order to assist USCIS in adjudicating Form I-800A.

Adult Member of the Household's Signature

 

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

Daytime Phone Number

E-Mail Address

(with area code)

(if any)

 

 

 

 

 

 

 

 

 

 

 

 

Form I-800A, Supplement 1 (Rev. 03/10/17 N) Page 2

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uscis i 800a conclusion process outlined (stage 1)

2. Your next stage is to fill out these fields: c Received a suspended sentence, d At any time been the subject of, Yes, authority in any State or foreign, Each of the above questions must, and Form IA Supplement Rev N.

Yes, Each of the above questions must, and d At any time been the subject of inside uscis i 800a

3. The following portion is mostly about Your Signature Applicant, Date mmddyyyy, Applicant Family Name Last Name, Applicant Given Name First Name, Applicant Middle Name, Other Names Used including maiden, Date of Birth mmddyyyy, Place of Birth CityTown, US Social Security if any, A if any, USCIS Account if any, Certification of the adult member, I certify under penalty of perjury, Each answer I have given to each, and knowledge information and belief - fill in these blank fields.

Place of Birth CityTown, Date of Birth mmddyyyy, and Your Signature Applicant of uscis i 800a

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4. You're ready to fill out this next section! In this case you'll have all these Adult Member of the Households, Date mmddyyyy, Daytime Phone Number with area code, EMail Address if any, and Form IA Supplement Rev N Page blanks to fill in.

Completing part 4 in uscis i 800a

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