OMB 1601-0004;  Exp. 11/30/2018

Citizenship and Immigration Services Ombudsman

Case Assistance (DHS-7001)

Introduction
The Office of the Citizenship and Immigration Services Ombudsman (Ombudsman’s Office) assists individuals and employers who are unable to resolve problems directly with U.S. Citizenship and Immigration Services (USCIS). To receive assistance with a problem regarding an application or petition within USCIS, you may submit this form to the Ombudsman’s Office after trying all means to resolve the problem with USCIS. Please note the Ombudsman’s Office cannot provide legal advice. It is an independent office within the U.S. Department of Homeland Security (DHS) and is not part of USCIS.

Before You Submit a Request to the Citizenship and Immigration Services Ombudsman:

Before asking the Ombudsman’s Office for help with an application or petition, you first should try to resolve the problem with USCIS by using all of the following methods:

  • Obtain information about the case at myUSCIS Case Status at www.uscis.gov.
  • Contact the National Customer Service Center (NCSC) for assistance at 1-800-375-5283.
  • Request assistance from USCIS using their e-Request tool to check on appointment accommodations, typographic errors, delayed delivery of documents, notices or cards by mail or if a pending application is beyond the normal processing times.
  • Make an appointment to speak directly with a USCIS Immigration Services Officer at a local office through the InfoPass system. Appointments may be made online at www.infopass.uscis.gov.

General Instructions

  • The Ombudsman’s Office does not accept fees.
  • If a particular item does not apply to your case assistance request, please leave blank.
  • Please attach scanned copies of any documents you received from or sent to USCIS or any other government entity that is related to your request for assistance. Additionally, you may submit other information or documentation that will help the Ombudsman’s Office review your request for assistance.
  • This form is not required. However, a properly completed form ensures that the Ombudsman’s Office receives the necessary information to assist with your case. If you do not properly complete the form, you may experience a delay in the process of your request for assistance.

While there is no time limit to complete this form, this form cannot be saved. Your session will time out after 20 minutes of inactivity.

You will need to have the following information available in order to complete this form, if applicable: (1) A-Number; (2) All USCIS receipt numbers related to each application or petition; (3) Documents submitted to or received from USCIS; (4) Attorney/Accredited Representative information, if represented; and (5) Other information or documentation that is important to the case.

--NOTICE--

Please note that while the Ombudsman's Office provides impartial and independent recommendations to USCIS on how to resolve problems, the Ombudsman's Office does not have the statutory authority to make or change USCIS decisions.

DHS Form 7001 - Privacy Act Statement:

Authority: 6 U.S.C. Section 272 authorizes the collection of this information.

Purpose: The Ombudsman’s Office will use the information provided to assist an individual or employer with his or her Case Assistance Request.

Routine Use: The information will be used by and disclosed to DHS personnel and contractors or other agents who need the information to assist in activities related to your Case Assistance Request. DHS may also share the information provided in accordance with the routine uses listed in DHS/CISOMB-001 Virtual Ombudsman System of Records Notice, 75 FR 18857 (April 13, 2010).

Disclosure: Furnishing this information is voluntary. However, failure to provide the requested information may delay or prevent the Ombudsman’s Office from providing assistance with your case.

Paperwork Reduction Act Notice:

The public reporting burden to complete this information collection is estimated at one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the necessary data, and completing and reviewing the collected information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number and expiration date. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Office of the Citizenship and Immigration Services Ombudsman, [e-mail: cisombudsman@hq.dhs.gov; Mailing Address: Citizenship and Immigration Services Ombudsman, U.S. Department of Homeland Security, Washington, D.C. 20528-0180], ATTN: PRA OMB 1601-0004.

Name (Section 1)
1. Name: Please identify the name of the individual or employer (applicant/beneficiary/petitioner) encountering difficulties with USCIS. Do not enter the attorney/law firm’s name here.




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Contact Information (Section 2)

2. Contact Information: Please provide the contact information of the individual or employer (applicant/beneficiary/petitioner) encountering difficulties with USCIS. Please include the primary e-mail address for the Ombudsman to provide updates.


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Identification Information - Citizenship and Birth (Section 3) - Not required

Identification Information - Citizenship and Birth (Section 3)
3. Date of Birth, Country of Birth, Country of Citizenship: The person encountering difficulties with USCIS (applicant/beneficiary/petitioner).

  
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Country of Citizenship and Birth:


Hold down the Ctrl key for multiple selections.
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Identification Information - Alien Number (Section 4) - Not required

Identification Information - Alien Number (Section 4)

4. Alien Registration Number (A-number): The A-number appears in the following format: A123-456-789.
Note: Not every person is assigned an A-Number by USCIS. If you do not have an A-Number, leave this section blank. Do not include the letter "A" when entering the A-Number. If you have an eight digit A-Number, please add a zero ("0") as the leading number.

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Application/Petition Information (Sections 5 and 6)
5. Applications/Petitions Filed: List all applications and/or petitions pending with USCIS related to your request for assistance. Please provide the USCIS Receipt Date, USCIS Form Number, and Receipt Numbers in the three columns below.

USCIS Receipt
Date:
(mm/dd/yyyy)
Receipt Numbers:
List all available
USCIS Receipt
Numbers.

The receipt number is located in the top left corner
of your Notice of Action (USCIS Form I-797).
Receipt number format: EAC1012345678; MSC0944556677.
Do not include dashes between the characters.
* USCIS Form Number:


6. Type of Immigration Benefit Sought: Please provide the type of immigration benefit sought from USCIS. Check all that apply.



Case Description (Sections 7 and 8)

7. Reason for Inquiry/Case Assistance Request: Check all that apply. Provide a description in Section 8 and add documentation in Section 12 related to your inquiry.


 

 

 

 

 

 


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Prior Actions Taken to Remedy the Problem (Section 9)


9. Prior Actions Taken: Check all that apply and provide the additional information requested for each selection in the "Please Describe" section provided below. Note that if selecting "Visited MyUSCIS Case Status at www.uscis.gov," you must indicate what additional actions were taken to remedy the problem before submitting your inquiry to the Ombudsman.


  Visited MyUSCIS Case Status at www.uscis.gov.

  Contacted the National Customer Service Center (NCSC) for information and/or assistance regarding this case at its toll-free number 1-800-375-5283.

Provide Referral Number (also referred to as SRMT Number):


  Attended InfoPass Appointment with USCIS.

Provide InfoPass Confirmation Number:


  Sent an e-mail to USCIS.

Provide date e-mail sent:


Provide USCIS e-mail address:


  Contacted a U.S. Government Department or Agency for assistance.

Provide name and contact information:


  Contacted a U.S. Congressional Representative for assistance.

Provide name and contact information:


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Person Preparing this Form (Section 10)
10. Person Preparing this Form: Please indicate who is completing this form.

Important: If you are the beneficiary of a pending petition, the petitioner must provide consent to the release of information relating to your case.

*I am:
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Attorney/Accredited Representative (Section 11) - Only required if attorney is selected in Section 10

Attorney/Accredited Representative (Section 11) - Attorney was selected in Section 10
11. Attorney/Accredited Representative: Please complete this section if you are an attorney or an accredited representative preparing this form on behalf of the individual or employer encountering difficulties with USCIS. Please attach a copy of your Form G-28.


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Supporting Documentation (Section 12)

12. Supporting Documentation: Additional information related to your case, such as paperwork you submitted to USCIS, documents you received from USCIS, or other information or documentation you feel is important to your case.
Include up to 10 attachments (scanned images, PDF files, TXT files, and Word
documents, valid file extensions are: doc, docx, gif, jpg, jpeg, pdf, png, ppt, pptx,
rtf, txt, tif, xls, xlsx.). No more than 5 megabytes of data may be uploaded.

Documents can also be faxed to 202-357-0042 or mailed to:
    Citizenship and Immigration Services Ombudsman
    Department of Homeland Security
    Attention: Case Assistance
    Mail Stop 0180
    Washington, DC 20528
Please Note: Any files greater than 5MB in size will be rejected. In addition, the total size for all files for each request cannot exceed 5MB in size.

Attachments
Fax Attachments
e-mail Attachments
Mail Attachments

Verification (Section 13)
13. Consent: Please note that if you are the beneficiary of an immigration petition, consent of the individual or employer that submitted the petition on your behalf is required. The petitioner must sign.

I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct, and that I am the person encountering difficulties with USCIS (applicant/beneficiary/petitioner) and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C § 1001 by a fine of not more than $10,000 or by imprisonment of not more than five years or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. § 522a(i)(3) by a fine of not more than $5,000. Alternatively, I am the legal representative of record for the person encountering difficulties with USCIS (applicant/beneficiary/petitioner). I have included a copy of Form G-28 previously filed with USCIS.

Pursuant to 5 U.S.C § 522a(b), I authorize the Office of the Citizenship and Immigration Services Ombudsman to release any and all information relating to me to U.S. Citizenship and Immigration Services.



Attorney/Accredited Representative Declaration:

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