Form filed: Filing date: Case #: Form filed: Filing date: Case #: Form LOCATION OF CASE Have you been interviewed at a USCIS office for this case? If so, please list date and location of the USCIS interview: If your case has been sent from USCIS to the riational Visa Center complete Section 2. If your case has been sent to a U.S. Embassy or U.S. Consulate for processing, complete Section 3. If none of these apply, please skip to Section 4. Please review, all instructions. SECTION 2: Complete this section ifyour case is in process at the Department of State NATIONAL VISA CENTER State Department Case Number: Visa Preference Category: Case Priority Date: Foreign State Chargeability: (Usually the beneficiary's country of birth) SECTION 3: Complete this section ifyour case is at a U.S EMBASSY or U.S CONSULATE Embassy or Consulate location (City and Country): Case Number: Date of interview(s): (For non-immigrant visas, provide the applicant's passport number) Has the case been transferred to another office? Where? SECTION 4: FINAL INSTRUCTIONS o FOR ALL CASES: On a separate sheet of paper, please describe briefly what problems you are experiencing with this case and how you think Senator Feinstein might be able to assist you. o Include copies of the most recent correspondence received from the agency on your case. o For expedite requests, please include evidence that your case meets the agency's set expedite criteria. USCIS expedite criteria is available online at uscis.gov. o Due to Privacy Act authorization requirements, we may not be able to open a case for you if proper authorization is not provided. Please note: ALL CASES require a petitioner's signature. For nonimmigrant visas where there is no petitioner, U.S. host must sign. Deneficiary signature is required kr l-290B and 1-730 cases. For 1-212 and 1-601 waivers, the beneficiary of the case must sign as the petitioner for the waiver. You may submit separate forms with each signature if needed. o Mail or fax the form to Senator Feinstein's San Francisco office. SIGNATURE I certify, under penalty of perjury, that I ) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct. I. (print your name) " its , authorize USCIS and the Department of State to release information contained in my agency records as relevant to checking my case status, and to the extent permitted by law, to Senator/Representative and the Member's staff. Petitioner's Signature: Date: 11i06/2018 Beneficiary's Signature: /- Date: 11/%2018 NOTE: The beneficiary's signature b 'n cases. Sec notes above regarding signature. EFTA01600312