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

Download Form I-643

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 :


Edition Date :

10/29/09. Previous editions accepted.

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 :


Special Instructions :

Note on Expiration: USCIS continues to accept the 10/29/09 version of Form I-643, despite the passing of the form’s expiration date. An updated form with a new expiration date will be posted as soon as it becomes available.


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