Instructions for Record of Abandonment of Lawful Permanent Resident Status Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-407 OMB No. 1615-0130 Expires 02/28/2017 What Is the Purpose of This Form? Form I-407, Record of Abandonment of Lawful Permanent Resident Status, is designed to provide a simple procedure to record an alien's abandonment of status as a lawful permanent resident (LPR) of the United States. Use of Form I-407 also ensures that an alien abandoning their LPR status is informed of the right to a hearing before an immigration judge and that the alien has knowingly, willingly, and affirmatively waived that right. Who May Use This Form? Form I-407 is used by lawful permanent resident aliens who are outside the United States or at a Port of Entry who want to abandon LPR status. Generally, a parent's abandonment of LPR status can be imputed to any minor children who return abroad with the parent. If a parent, custodian, or guardian chooses to file a separate Form I-407 on behalf of a minor child, it will be necessary to show that the parent, custodian, or guardian had custody of the minor child. Form I-407 is also used by Department of Homeland Security (DHS) officers and Department of State (DOS) consular officers to record the facts relating to permanent resident aliens who abandon LPR status during an in-person interview or by correspondence. General Instructions How to Fill Out Form I-407 1. Type or print legibly in black ink. 2. Answer all questions fully and accurately. If the answer to an item is none, type or print "NONE." If the answer is not applicable, type or print "N/A." Specific Instructions Part 1. Information About the Alien Item Number 1. Alien Registration Number. Enter Alien Registration Number (A-Number). Item Number 2. USCIS ELIS Account Number (if any). If you have previously filed a benefit request using the USCIS Electronic Immigration System (ELIS), provide the USCIS Account Number you were issued by the system. The USCIS Account Number is not the same as an Alien Registration Number (A-Number). If you have been issued a USCIS Account Number, enter it in the space provided. Item Numbers 3.a. - 3.c. Your Full Legal Name. Enter alien's name as it appears on the Permanent Resident Card if the document is presented or the information is known. Item Number 4. Date of Birth. Enter the alien's date of birth in month/day/year format MM/DD/YYYY. Item Numbers 5. - 6. Country of Birth and Country of Citizenship or Nationality. Enter the name of the country of the alien's birth and the name of the country of the alien's citizenship or nationality. The name of the country should be the current name of the country. Item Number 7. Date of Last Departure from the United States. Enter the date of last departure from the United States. Item Numbers 8. a. - 8.g. Mailing Address Abroad. Enter the alien's mailing address abroad. Page 1 of 3
Item Number 9. E-mail Address (if any). Provide an E-mail address where the alien can be reached. Item Number 10. Reasons for Abandonment. Enter the reasons for abandoning lawful permanent resident status. Item Numbers 11.a. - 12.c. Documents Surrendered and Location of Submission. Select the corresponding box(es) of documents surrendered, list other documents surrendered, and select the corresponding boxes for location of submission. If Item Number 11.b. is selected, provide a detailed written statement explaining why the document cannot be surrendered. This statement should be signed under oath before a DHS or consular officer. If you cannot appear before a DHS or consular officer, then you must include in the statement, I certify under penalty of perjury under United States law that this statement is true and correct. Item Numbers 13.a. - 13.c. Certification. The permanent resident alien, or if 17 years of age or younger, his or her parents, custodial parents, or legal guardians, must sign Form I-407 before it is accepted by DHS. If the lawful permanent resident is a minor 17 years of age or younger, then each legal parent, custodial parents, or duly appointed legal guardian must sign Form I-407 and consent to the submission of Form I-407. If the minor has only one legal parent, the sole legal parent can sign Form I-407, but must submit proof showing that any other parent has died, has had his or her parental rights terminated according to the law, or that the parent who is signing Form I-407 has sole legal custody of the minor. A guardian should submit letters of guardianship or other proof of the authority to sign for the minor lawful permanent resident alien. Item Numbers 14.a. - 14.d. Parents, Custodial Parents, or Legal Guardian Name, Signature, and Date, if applicable. The parents, custodial parents, or legal guardian must sign and print their name and date in this section if they are consenting to Form I-407 being submitted for the minor (17 years of age or younger) for whom they are responsible. They must also submit evidence to establish sole parental or custodial responsibility, if applicable. Lawful permanent residents submitting Form I-407 by mail should carefully read the following section of the instructions regarding the rights of lawful permanent residents. If Form I-407 is completed in person, then before asking the individual to sign Form I-407, the DHS officer or the DOS consular officer must explain that: By signing Form I-407, the alien waives the right to a hearing before an immigration judge who would decide whether the alien lost his/her legal permanent resident status due to abandonment. If the alien chooses a hearing before an immigration judge instead, the alien would have the right: (1) To be represented at no expense to the U.S. Government by an attorney or accredited representative; (2) To challenge any evidence that DHS may present against the alien; (3) To present evidence in the alien's favor; (4) To require that DHS prove, by clear, unequivocal, and convincing evidence, that the alien has lost his or her lawful permanent resident status through abandonment; and (5) To appeal a decision against the alien. Part 2. Certification and Signature of the Interpreter If an interpreter is used to complete the form or at an interview, provide the interpreter's signature and information. Part 3. For Government Use Only If the alien is interviewed, the interviewing DHS or consular officer must select Item Number 1. and complete Item Numbers 3. - 4.d. on the form. If the alien is not interviewed, the DHS or consular officer must select Item Number 2., provide an explanation, and complete Item Numbers 3. - 4.d. on the form. What Is the Filing Fee? There is no filing fee for processing Form I-407. Page 2 of 3
Where To File? Please see the USCIS Web site at www.uscis.gov/i-407 or call the National Customer Service Center at 1-800-375-5283 for the most current information about where to file this form. For TTY (deaf or hard of hearing) call: 1-800-767-1833. USCIS Privacy Act Statement AUTHORITIES: The information requested on this form, and the associated evidence, is collected pursuant to section 103(a)(3) of the Immigration and Nationality Act. PURPOSE: The primary purpose for providing the requested information on this form is to provide a means for lawful permanent resident aliens of the United States to abandon their status. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and any requested evidence, may delay or prevent USCIS from processing your request to abandon your status. ROUTINE USES: The information you provide on this form may be shared with other Federal, State, local, and foreign government agencies and authorized organizations in accordance with approved routine uses, as described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and the DHS-USCIS-007 - Benefits Information System September 29, 2008, which can be found at www.dhs.gov/privacy]. Paperwork Reduction Act An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at 15 minutes per response, including the time for reviewing instructions and completing and submitting the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave., NW, Washington, DC 20529-2140; OMB No. 1615-0130. Do not mail your completed Form I-407 to this address. Page 3 of 3
Record of Abandonment of Lawful Permanent Resident Status Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-407 OMB No. 1615-0130 Expires 02/28/2017 Part 1. Information About the Alien 1. Alien Registration Number (A-Number) A- 10. State the reasons for abandoning lawful permanent resident status. 2. USCIS ELIS Account Number (if any) Your Full Legal Name 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name Documents Surrendered and Location of Submission 11.a. Form I-551 (Permanent Resident Card) 11.b. If the Form I-551 is not surrendered, select the reason why. Lost Stolen Mutilated Yes Other No Other Information 11.c. List other documents surrendered (if any). 4. Date of Birth (mm/dd/yyyy) 5. Country of Birth 6. Country of Citizenship or Nationality 7. Date of Last Departure from the United States (mm/dd/yyyy) Mailing Address Abroad 8.a. 8.b. 8.d. 8.e. In Care Of Name (if applicable) Street Number and Name 8.c. Apt. Ste. Flr. City or Town Province or State 12.a. 12.b. 12.c. Certification I am submitting Form I-407 outside of the United States in-person. I am submitting Form I-407 outside of the United States by mail. I am submitting Form I-407 at a U.S. Port of Entry. I knowingly, willingly, and affirmatively declare that I have no intention of residing permanently in the United States, and that by signing and submitting this form, I intend to record the fact that I have knowingly and willingly abandoned my lawful permanent resident status in the United States. I have been informed of, and I understand my rights to a hearing before an immigration judge about whether I have abandoned my lawful permanent resident status in the United States. By signing and submitting this form, I knowingly, willingly, and affirmatively waive my rights to such a hearing. 13.a. Signature of Alien 8.f. 8.g. Postal Code Country 13.b. 9. E-mail Address (if any) Form I-407 02/26/15 N Page 1 of 2
Part 1. Information About the Alien (continued) For Consent of Parents, Custodial Parents, or Legal Guardian to Submit Form I-407 for Minors 17 Years of Age or Younger The alien has informed me that he or she understands each and every instruction and question on the form, as well as the answer to each and every question. 1.a. Signature of Interpreter (if applicable) As the parents or guardian of the alien minor who is identified in Part 1. of this form, I/we consent to the alien minor's submission of this form. 14.a. Signature of Parents, Custodial Parents, or Legal Guardian 1.b. 1.c. Full Name of Interpreter Part 3. For Government Use Only 14.b. Name of Parents, Custodial Parents, or Legal Guardian 14.c. If signed by only one parent, custodian, or legal guardian, indicate evidence to show sole parental, custodial, or legal guardianship responsibility. 14.d. Check all that apply: Death of other parent Termination of other parent's rights Instructions to officer: Select Item Number 1. if you interviewed the alien. If you did not, select Item Number 2. and state the basis for your conclusion that the alien may have abandoned lawful permanent resident status. Sign the form and provide other information requested. 1. 2. I certify that I personally interviewed the alien who is identified in Part 1., who has signed this Form I-407, and that I advised the alien of the hearing rights specified in the Instructions. The alien stated he or she fully understands the effect of signing this Form I-407. I further certify that, if an interpreter was used, I confirmed that the alien understood the interpreter. I certify that I was not able to interview the alien who is identified in Part 1. of this Form I-407. My basis for concluding that the alien may have abandoned lawful permanent resident status is: Award of sole legal custody Appointment as guardian 3. A copy of the signed Form I-407 was provided to the alien. Yes No Part 2. Certification and Signature of the Interpreter DHS/Consular Officer Information 4.a. Name of DHS/Consular Officer Interpreter Certification I certify that: I am fluent in English and (write the other language in the box provided above). I further certify that I have read each and every question and instruction on this form, as well as the answer to each and every question on this form, in the language provided above; and 4.b. 4.c. 4.d. 4.e. Signature of DHS/Consular Officer Title of DHS/Consular Officer Name of DHS Component, if signed by a DHS officer Form I-407 02/26/15 N Page 2 of 2