Information Request Form for N400

Information Request for N400
A. Personal Information
1. What is your full legal name?

First NameMiddle NameLast Name
2. Have your ever used any other names?

First NameMiddle NameLast Name
3. What is your date of birth?

MonthDayYear
Date
4. Country of birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
5. Country of citizenship

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
6. Your current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
7. How long have you lived at this address?
Start Date
End Date
8. Where did you live before this in the past 5 years from now back to October 2021?
Address 1:
Street Address   Address Line 2   City   State   Zip
Start Date
End Date
Address 2:
Street Address   Address Line 2   City   State   Zip
Start Date
End Date

B. Family Information
1. Are you married?
If yes, what is the date of your wedding?
2. What is your spouse's full name?

First NameMiddle NameLast Name
3. Is your spouse a U.S. citizen?
4. Do you have any children? If yes, what are their names and dates of birth?
Children 1:
First Name   Middle Name      Last Name
Date of birth
Children 2:
First Name   Middle Name      Last Name
Date of birth
Children 3:
First Name   Middle Name      Last Name

C. Immigration History
1. When did you become a permanent resident?

MonthDayYear
Date
2. What was the date you received your green card?

MonthDayYear
Date
3. Have you ever traveled outside the U.S. since becoming a permanent resident?
If yes, when did you leave?
Country 1:
Started Date
Returned Date
Country 2:
Started Date
Returned Date
Country 3:
Started Date
Returned Date
Country 4:
Started Date
Returned Date
Country 5:
Started Date
Returned Date

D. Employment and Education

Have you worked anywhere else in the past five years?
Employer 1:
Employer's Name
Street Address   Address Line 2   City   State   Zip
Position
Start Date
End Date

Employer 2:
Employer's Name
Street Address   Address Line 2   City   State   Zip
Position
Start Date
End Date

Employer 3:
Employer's Name
Street Address   Address Line 2   City   State   Zip
Position
Start Date
End Date

Employer 4:
Employer's Name
Street Address   Address Line 2   City   State   Zip
Position
Start Date
End Date
Should be Empty: