Form I-907 Request for Premium Processing Service

Request for Premium Processing Service

USCIS
Form I-907

Department of Homeland Security
U.S. Citizenship and Immigration Services

For
USCIS
Use
Only

Request Physically
Received by USCIS

Returned

Resubmitted

Date

Date

Date

Date

Date

Date

OMB No. 1615-0048
Expires 01/31/2018

Receipt

DRAFT
NOT FOR
PRODUCTION
10/15/2015
Action Block

Remarks

To be completed by an
attorney or accredited
representative (if any).

Attorney State Bar Number
(if applicable)

Select this box if
Form G-28 is
attached.

Attorney or Accredited Representative
USCIS ELIS Account Number (if any)

►START HERE - Type or print in black ink.

Part 1. Information About the Person Filing This Request
1.

Alien Registration Number (A-Number) (if any)
► A-

2.

Family Name (Last Name)

3.

Company or Organization Named in the Related Case: If filed on behalf of a company or organization

4.

Mailing Address

Given Name (First Name)

Middle Name

In Care Of Name

Street Number and Name or PO Box Number

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

5.

Postal Code

Is your current mailing address the same as your physical address?

Country

Yes

No

If you answered "No," provide your physical address in Item Number 6.

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Page 1 of 6

Part 1. Information About the Person Filing This Request (continued)
6.

Physical Address
Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

7.

Postal Code

Country

Request for Premium Processing Service: (select only one box)
I am the petitioner who is filing or has filed a petition eligible for Premium Processing Service.
I am the attorney or accredited representative for the petitioner who is filing or has filed a petition eligible for Premium
Processing Service. (Complete and submit Form G-28, if Form G-28 has not been submitted with the petition.)
I am the applicant who is filing or has filed an application eligible for Premium Processing Service.
I am the attorney or accredited representative for the applicant who is filing or has filed an application eligible for
Premium Processing Service. (Complete and submit Form G-28, if Form G-28 has not been submitted with the
application.)

Part 2. Information About the Request
1.

Form Number of Related
Petition or Application

4.

Petitioner or Applicant in the Related Case
Family Name (Last Name)

5.

Receipt Number of Related
Petition or Application

3.

Classification or Eligibility
Requested

Given Name (First Name)

Middle Name

Given Name (First Name)

Middle Name

Beneficiary in the Related Case
Family Name (Last Name)

6.

2.

Name of Point of Contact for the Company or Organization
Family Name (Last Name)

Given Name (First Name)

Middle Name

Position Title

7.

Company or Organization IRS Tax Number (if any)

Form I-907 01/29/2015 N

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Part 2. Information About the Request (continued)
8.

Address of Petitioner, Applicant, Company or Organization Named in Related Case
Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

Postal Code

Country

Part 3. Requestor's Statement, Certification, Signature, and Contact Information
I understand that U.S. Citizenship and Immigration Services (USCIS) will refund the Premium Processing Service fee to the person
listed in Part 1. of this request if USCIS does not take an action on the related case within 15 calendar days after the appropriate
USCIS office physically receives this request. I understand that case actions include a referral for investigation of suspected fraud or
misrepresentation, or the issuance of:
1.
2.
3.
4.

An approval notice;
A request for evidence;
A notice of intent to deny; or
A denial notice.

Requestor's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Requestor's Statement Regarding the Interpreter
A.

I can read and understand English, and have read and understand each and every question and instruction on this request,
as well as my answer to each question.

B.

The interpreter named in Part 4. has read to me each and every question and instruction on this request, as well as my
answer to each question, in
, a language in which I am fluent.
I understand each and every question and instruction on this request as translated to me by my interpreter, and have
provided true and correct responses in the language indicated above.

2.

Requestor's Statement Regarding the Preparer
I have requested the services of and consented to

,

who is

is not

an attorney or accredited representative, preparing this request for me.

Requestor's Certification
I certify, under penalty of perjury under the laws of the United States of America, that the information in my request and any
document submitted with my request is complete, true and correct.
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 my
records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this request and in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration of U.S. immigration laws.

Form I-907 01/29/2015 N

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Part 3. Requestor's Statement, Certification, Signature, and Contact Information (continued)
Requestor's Signature
3.

Requestor's Signature

Date of Signature
(mm/dd/yyyy) ►

Requestor's Contact Information
Requestor's Mobile Telephone Number (if any)

4.

Requestor's Daytime Telephone Number

5.

6.

Requestor's Email Address (if any)

7. Requestor's Fax Number (if any)

Part 4. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter:

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

Province

State

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5. Interpreter's Email Address (if any)

Interpreter's Certification
I certify that:
I am fluent in English and
Item B. in Item Number 1.;

, which is the same language provided in Part 3.,

I have read to this requestor each and every question and instruction on this request, as well as the answer to each question, in the
language provided in Part 3., Item B. in Item Number 1.; and
The requestor has informed me that they understand each and every instruction and question on the request, as well as their answer to
each question.

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Part 4. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Signature
6.

Interpreter's Signature

Date of Signature
(mm/dd/yyyy) ►

Part 5. Name, Contact Information, Declaration, and Signature of the Person Preparing this Request,
If Other Than the Requestor
Provide the following information about the preparer:

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Given Name (First Name)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

Province

State

ZIP Code

Country

Postal Code

Preparer's Contact information
4.

Preparer's Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Fax Number

Preparer's Statement
7.A.

I am not an attorney or accredited representative but have prepared this request on behalf of the requestor with the
requestor's consent.

7.B.

I am an attorney or accredited representative and my representation of the requestor
in this case (choose one)
extends
does not extend beyond the preparation of this request.

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Part 5. Name, Contact Information, Declaration, and Signature of the Person Preparing this Request,
If Other Than the Requestor (continued)
Preparer's Declaration
By my signature, I certify, swear or affirm, under penalty of perjury, that I prepared this request on behalf of, at the request of, and
with the express consent of, the requestor. I completed the request based only on responses the requestor provided to me. After
completing the request, I reviewed it and all of the requestor's responses with the requestor, who agreed with each and every answer
provided for each question on the request and, when required, supplied additional information to respond to a question on the request.

Preparer's Signature
8.

Preparer's Signature

Form I-907 01/29/2015 N

Date of Signature
(mm/dd/yyyy) ►

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