**Congressional Liaison Unit - Inquiry Form**

**[PLEASE PRINT AND COMPLETE IN ITS ENTIRETY LEGIBLY AND IN
ENGLISH]{.underline}**

**Congressional Office**: Rep Diane E. Watson

**Telephone**: 323-965-1422; **Fax:** 323-965-1113

**[APPLICANT/PETITIONER INFORMATION]{.underline}**

MUST BE COMPLETED

+------------------------+-----------------------+--------------------+
| **Last Name:**         | **First Name:**       | **Middle Name:**   |
+------------------------+-----------------------+--------------------+
| **Alien #:**           | **Receipt #: (WAC,    | **Phone (H) #:**   |
|                        | LIN. . .)**           |                    |
|                        |                       | **Phone (C) #:**   |
+------------------------+-----------------------+--------------------+
| **Beneficiary (if      | **Date & Place of     | **Date & Place of  |
| applicable):**         | Birth:**              | Entry:**           |
+------------------------+-----------------------+--------------------+
| **Case #:**            | **Class of            | **Email Address:** |
|                        | Admission:**          |                    |
+------------------------+-----------------------+--------------------+

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  **Current Mailing Address:**

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Current Immigrant Status (check one)

  -- ------------ -- ------------------ -- ------------ -- ------------- -- ------------------
     **US            **Permanent           **Asylee**      **Refugee**      **Undocumented**
     Citizen**       Resident**                                             

  -- ------------ -- ------------------ -- ------------ -- ------------- -- ------------------

Type of Application - Must be completed

  -- ----------------------------------- -- ------------------------------
     **I -90 Replacement Alien              **I-290B Notice of Appeal to
     Registration Card**                    AAU**

     **I-129 Petition for Non-Immigrant     **I-485 Adjustment of Status**
     worker**                               

     **I -129F Petition for Alien           **I-506 Change of
     Fiancé**                               Non-Immigrant Classification**

     **I-130 Immediate Relative             **I-539 Application to Change
     Petition**                             Status or Extend Stay**

     **I-131 Travel Document, Advance       **I-589 Request for Asylum in
     Parole**                               the U.S.**

     **I-140 Immigrant Petition for         **I-765 Application for
     Foreign Worker**                       Employment Auth.**

     **I-212 Admission After Deportation    **N-400 Application for
     or Removal**                           Naturalization**

     **N-565 Replacement for Nat            **N-600 Certificate of
     Certification**                        Citizenship**

     **Other:**                             **Other:**
  -- ----------------------------------- -- ------------------------------

+-------------------------------+--------------------------------------+
| **Date filed:**               | **Have you been interviewed?**       |
|                               |                                      |
|                               | **Yes No Date:**                     |
+-------------------------------+--------------------------------------+

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| **Outreach/Community Based Organization assisting you?**              |
|                                                                       |
| **Name: Telephone:**                                                  |
+-----------------------------------------------------------------------+

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| **Rep. Diane Watson and her staff may discuss your case with the      |
| following individuals:**                                              |
|                                                                       |
| **Name: Relationship: Phone:**                                        |
+-----------------------------------------------------------------------+

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  **Summary of Inquiry (Must be Completed)**

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**Privacy Act Statement**

**Authority to collect this information is contained in Title 5 U.S.C.
552 and 552a. The purpose of the collection is to enable the D. H. S to
locate applicable records and to respond to requests made under the
Freedom of Information and Privacy Acts. I authorize the Congressional
office name above to request information on my behalf. Also, I
understand that I am not required to make payment in any form, for
services rendered to me from the office of Congresswoman Diane E.
Watson**

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**Signature Date**