U.S. Department of State
APPLICATION TO DETERMINE RETURNING RESIDENT STATUS
Single (Never Married)
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.
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9. Most Recent Departure from the United States
*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data,
providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a
currently valid OMB control number. Send