Approved Visa Petition
Dependent of Principal Alien
START HERE - Please type or print in black ink.
For USCIS Use Only
Part 1. Information about you.
Date of Birth (mm/dd/yyyy)
U.S. Social Security #
A # (if any)
Date of Last Arrival (mm/dd/yyyy)
Current USCIS Status
Expires on (mm/dd/yyyy)
Part 2. Application Type. (Check one.)
Section of Law
An immigrant petition giving me an immediately available immigrant visa number has been
approved. (Attach a copy of the approval notice, or a relative, special immigrant juvenile, or
special immigrant military visa petition filed with this application that will give you an
immediately available visa number, if approved.)
Sec. 209(b), INA
Sec. 13, Act of 9/11/57
Sec. 245, INA
Sec. 249, INA
Sec. 1 Act of 11/2/66
Sec. 2 Act of 11/2/66
Eligibility Under Sec. 245
To be Completed by
Attorney or Representative, if any
Fill in box if G-28 is attached to represent the
I am a native or citizen of Cuba and meet the description in (e) above.
ATTY State License #
OMB No. 1615-0023; Expires 09/30/08
I am already a permanent resident and am applying to have the date I was granted permanent
residence adjusted to the date I originally arrived in the United States as a nonimmigrant or
parolee, or as of May 2, 1964, whichever date is later, and: (Check one.)
I am applying for an adjustment to permanent resident status because:
My spouse or parent applied for adjustment of status or was granted lawful permanent
residence in an immigrant visa category that allows derivative status for spouses and children.
I was granted asylum or derivative asylum status as the spouse or child of a person granted
asylum and am eligible for adjustment.
I am a native or citizen of Cuba