I-643, Health and Human Services Statistical Data for Refugee/Asylee Adjusting Status

• Download Form I-643 (1024KB PDF)

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

Edition Date :

10/08/10. Previous editions accepted.

A new edition of this form is coming soon. In the meantime, customers may file using the 10/08/10 edition.

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

Special Instructions :

This page can be found at http://www.uscis.gov/i-643