Preparation Packet for the Form N-400
Ø Complete this packet with 100% honest and complete answers and bring to the naturalization
workshop. It is necessary to have this packet completed in order to complete your application during
the workshop.
Ø This packet is designed ONLY to collect data and documents required for our naturalization workshop.
Ø Even if you have this packet completed, it is possible that during the workshop it is determined that
you are not eligible to complete your application for citizenship. In this case you will be provided a
list of agencies associated with us that can help you individually at a low cost.
Ø Leave questions blank only if they do not apply to you.
Bring the following documents with you
□ Permanent Residence Card “Green Card”
□ 2 U.S. Passport Photos
□ Personal Check or Money Order for $680
□ Documentation of any ticket, arrest, detention, imprisonment, or involving the police or immigration
Bring the following documents ONLY if you believe you qualify for a Fee Waiver
□ Documentation of Public Benefits that you, your current spouse, or children under 21 that live with
you currently receive.
Examples of Public Benefits: Medicaid, Medi-Cal, Healthy Families, Food Stamps/CalFresh, Cash Assistance
(TANF), Supplemental Security Income (SSI), CalWORKs, WIC or other Federal benefits.
□ Documentation of your household’s income
Examples of current income: 2014 household or individual 2014 Taxes and stubs for the last three
months of income or letter from the Social Security Office, letter of unemployment, or any other
documentation that shows your monthly household income.
Remember: This packet and the documents mentioned above, are needed to help
you fill out the application for citizenship.
p. 1 – April 1, 2015
Information for Form N-400
1. A- Number from Permanent Residence Card:
___ ___ ___ ___ ___ ___ ___ ___ ___
2. Full and complete name
First Name:
Middle Name:
Last Name(s):
3. Social Security Number:
___ ___ ___ – ___ ___ – ___ ___ ___ ___
4. Addresses for the last 5 years
Begin with the most recent address and work your way back to your last address.
If you need additional space, use another sheet of paper to continue listing addresses (use the same format used
below). The month and year is enough, unless you know the exact dates.
If you are requesting a Language Waiver for the citizenship interview and exam, you will need to bring
your addresses for the last 15 or 20 years.
Beginning
Ending
(Month/Day/Year)
(Month/Day/Year)
Address
Today’s date
p. 2 – April 1, 2015
City
State/ County
Zip Code
5. Occupation for the last 5 years
Start with your current occupation and continue in reverse order. Include military service. The month and year is
enough, unless you know the exact dates. If additional space is needed, use another sheet of paper to continue
the list of occupations (use the same format used below).
Beginning
Ending
(Month/Day/Year)
(Month/Day/Year)
Employer’s or School’s address
(Address, City and State)
Occupation
Today’s date
6. List all trips made outside the United States since receiving your permanent residence. Only
include trips that have lasted more than 24 hours.
Begin with your most recent trips and work in reverse order.
Note: Trips made within the last 5 years must have the exact date of when you left and when you came back.
Repeating trips that happened more than 5 years ago may be entered in narrative format
Example of narrative format: “Since becoming a permanent resident I left every year for Christmas for 10-14 days”
Exit Date
Re-entry Date
(Month/Day/Year)
(Month/Day/Year)
Did the trip last
more than 6
months
Country where you traveled
Total days spent
outside of the
United States
1.
Yes
No
days
2.
Yes
No
days
3.
Yes
No
days
4.
Yes
No
days
5.
Yes
No
days
6.
Yes
No
days
7.
Yes
No
days
8.
Yes
No
days
9.
Yes
No
days
10.
Yes
No
days
Total number of trips of more than 24 hrs.:
Total number of days outside the U.S?
p. 3 – April 1, 2015
7. Marital Status (If you have never been married skip to section 8.)
If you are not currently married, but you have been married in the past skip to section 7.4
If you are married but separated, you still need to answer the following questions
First Name:
Middle Name:
Last Name(s):
Date of birth (Month/Day/Year):
Date of marriage (Month/Day/Year):
Social Security Number (if he/she has one):
Address:
___ ___ ___ – ___ ___ – ___ ___ ___ ___
City:
State/Country:
7.1 Is your spouse a citizen of the United States?
Is you answered “Yes” skip to section 7.2
□ Yes
Zip Code:
□ No
If you answered “No” Skip to section 7.3
7.2 Answer the following questions only if your spouse is a U.S Citizen
□ My spouse is a U.S Citizen from birth
Date of when your spouse became a U.S. Citizen (Month/Day/Year):__________________
City were your spouse because a U.S. Citizen: ____________________
7.3 Answer the follow questions only if your spouse is NOT a U.S Citizen
Spouse’s country of citizenship:
Spouse’s A-Number from Permanent Residence Card (if applicable):
___ ___ ___ ___ ___ ___ ___ ___ ___
Spouse’s immigration status:
7.4 Information from your previous marriages
Answer the following questions for all of your previous marriages even if the marriages were annulled
If you have been married more than once, use another sheet of paper to list that information
First Name:
Middle Name:
Last Name(s):
Immigration Status:
□Permanent Resident □ U.S. Citizen □ Other:
Date of marriage (Month/Day/Year):
Way in which the marriage ended:
Date of divorce (Month/Day/Year):
□ Divorce □ Widowed
□ Other reason/ unknown:
p. 4 – April 1, 2015
7.5 How many times have you been married (include annulled marriages)?
7.6 Information about the previous marriages from your current spouse
If your spouse has been married more than once use another sheet of paper to list those marriages (use the
same format used below)
If your current spouse has never been married skip to section 8.
First Name:
Middle Name:
Last Name(s):
Immigration Status:
□Permanent Resident □ U.S. Citizen □ Other:
Date of marriage (Month/Day/Year):
Way in which the marriage ended:
Date of divorce (Month/Day/Year):
□ Divorce □ Widowed
□ Other reason/ unknown:
7.7 How many times has your current spouse been married (include annulled marriages)?
8. Information about all of your children
Include ALL of your children regardless of their age, marital status, or even if:
• • • • • • They have passed away or are disappeared
Where born in another country
Are living in another country
Are living with another person under their parental care
Were born out of wedlock;
Are step-children or adopted
If you need additional space use another sheet of paper and use the same format
Child’s Full Name
Date of Birth
(Month/Day/Year)
A-Number From USCIS
(if applicable)
A__ __ __ __ __ __ __ __ __
A__ __ __ __ __ __ __ __ __
A__ __ __ __ __ __ __ __ __
A__ __ __ __ __ __ __ __ __
A__ __ __ __ __ __ __ __ __
A__ __ __ __ __ __ __ __ __
p. 5 – April 1, 2015
Country of
birth
Current Address (Address, City,
State, and Country)
9. Will you be requesting a Fee Waiver for the Naturalization cost?
□ Yes □ No
If you answered “Yes” continue with the rest of the packet.
If you answered “No” you may stop here. You are done with the packet.
9.1 If you believe you qualify for a fee waiver, please select one of the options below
□ I or a member of my household is currently receiving public benefits. (Examples: Food Stamps, Supplemental
Security Income (SSI), Temporary Assistance for Needy Families (TANF), etc.
□ My household income is less than 150% of Federal Poverty Level
Additional instructions for those who want to apply for a Fee Waiver based on Public Benefits
You will need to bring documentation that you, your spouse, or your parents (if you are under 21 and unmarried)
are receiving public benefits.
• Evidence must be:
• An official document - award or letter - which includes:
1. The name of the agency that awarded the benefit
2. The name of the person receiving the benefit and
3. Quantity, period of coverage and / or terms and conditions of the benefit.
This document must be in English. If the documents received from the agency are not in English, you
should request a copy of the agency with their benefits in English.
Additional instructions for those who want to apply for a Fee Waiver based on Income
Please bring the following documents for each household member
• The most recent W2 (if available)
• 2014 Taxes
• Pay stubs for the last 3 months or a letter from your employer stating your salary or wages.
p. 6 – April 1, 2015