I, , declare under penalty of perjury, pursuant to 28 U.S.C. section
1746, that I am the person above and that I am unable to pay the fee. I believe that my appeal/motion is valid, and I declare
that the following information is true and correct to the best of my knowledge:
Assets
Wages, Salary
$
/month
Other Income
/month
(business, profession,
(self-employed, rent
payments, interest, etc.)
Cash
Checking or Savings Account
Property
(real estate, automobile,
stocks, bonds, etc.)
Other Financial Support
/month
(public assistance, alimony,
child support, gift, parent,
spouse, other family members, etc.
U.S. Department of Justice
Executive Office for Immigration Review
Board of Immigration Appeals
Fee Waiver Request
Form EOIR-26A
October 2005
Name:
Alien Number (“A” Number:)
Expenses (including dependents)
Housing
$
/month
(rent, mortgage, etc.)
Food
/month
Clothing
/month
Utilities
/month
(phone, electric, gas,
water, etc.)
Transportation
/month
Debts, Liabilities
/month
Other
$
/month
(specify)
Signature
Date
Under the Paperwork Reduction Act, a person is not required to respond to
a collection of information unless it displays a valid OMB control
number. We try to create forms and instructions that are accurate, can
be easily understood, and which impose the least possible burden on
you to provide us with information. The estimated average time to
complete this form is one (1) hour. If you have comments regarding
the accuracy of this estimate, or suggestions for making this form
simpler, you can write to the Executive Office for Immigration
Review, Office of the General Counsel, 5107 Leesburg Pike, Suite
2600, Falls Church, Virginia 22041.
If more than one alien is included in your
appeal or motion, only the lead alien need
file this form.
OMB# 1125-0003