Purpose of Form:
This form is used to provide statistical data to the Department of Health and Human Services regarding refugees or asylees who wish to adjust to immigrant status in the United States.
Number of Pages: 2
5/19/06. Versions other than the 5/19/06 edition are not acceptable.
Where to File:
The Immigration Officer assisting you with this form will submit it to:
Data Unit, Office of Refugee Resettlement
Department of Health and Human Services
370 L'Enfant Promenade S.W. (6th Floor)
Washington, DC 20447
Filing Fee: $0.00