1.c. |
I have another type of disability and/or impairment |
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(Describe the nature of your disability and/or |
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impairment and the accommodation you are |
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requesting): |
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Part 5. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-90 Instructions before completing this part.
Applicant's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
1.a. |
I can read and understand English, and I have read |
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and understand every question and instruction on this |
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application and my answer to every question. |
1.b. |
The interpreter named in Part 6. read to me every |
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question and instruction on this application and my |
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answer to every question in |
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, |
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a language in which I am fluent and I understood |
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everything. |
2. |
At my request, the preparer named in Part 7., |
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prepared this application for me based only upon information I provided or authorized.
Applicant's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1)I reviewed and provided or authorized all of the information in my application;
2)I understood all of the information contained in, and submitted with, my application; and
3)All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.
Applicant's Signature
6.a. Applicant's Signature (sign in ink)
6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.