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
Edition Date :
10/08/10. Previous editions accepted.
Note on Expiration: USCIS continues to accept the 10/08/10 edition of Form I-643 available here despite the passing of the form's expiration date. An updated form will be posted as soon as it becomes available.
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