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Instructions pour le formulaire G-1041A, Demande de documents généalogiques

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Instructions for Genealogy Records Request  
Form G-1041A  
OMB No. 1615-0096  
Expires 08/31/2025  
Department of Homeland Security  
U.S. Citizenship and Immigration Services  
What Is the Purpose of Form G-1041A?  
You should use Form G-1041A to obtain copies of U.S. Citizenship and Immigration Services (USCIS) historical records.  
If you do not have a valid USCIS File Number to complete this request, submit an index search of USCIS historical  
records using Form G-1041, Genealogy Index Search Request.  
Who Should Use Form G-1041A?  
You should use this request if you are a:  
1. Researcher requesting a copy of a USCIS historical record by file number (see descriptions of USCIS historical  
records in the How Are Historical Records and Files Identified section of these Instructions);  
2. Researcher who has received file numbers resulting from the G-1041; or  
3. Researcher seeking records for genealogical or family history purposes or heir location, and who can provide a precise  
historical record series file number and can identify the immigrant by name and/or other information.  
If the immigrant’s date of birth is less than 100 years before today’s date, you must attach documentary proof of death to  
this request. Examples of acceptable documentary proof of death include:  
1. Death certificate (uncertified copy);  
2. Printed obituaries, funeral programs, or photographs of gravestones;  
3. Bible, church, or other religious records;  
4. U.S. Social Security Death Index records (individual records only, not lists);  
5. Records relating to the payment of death benefits; and  
6. Other documents demonstrating that the immigrant of the request is deceased.  
Submit a copy of one of these items with this request. Do not include original records because USCIS will not return  
such documents.  
When Should Form G-1041A Not Be Used?  
You should not use Form G-1041A to request:  
1. Records of naturalization prior to September 27, 1906. Consult Federal court records stored at the National Archives  
and Records Administration (NARA) Record Group 21, at  
groups/021.html or contact the clerk of the court where the naturalization occurred;  
2. Sea, land, or air manifest lists prior to December 1982. For these lists, contact NARA at  
3. The return of original documents. For such documents, use Form G-884, Request for the Return of Original  
4. Certified Copies of USCIS Historical records. This office can only provide photocopies;  
5. Deportation records; or  
Form G-1041A Instructions 08/10/22  
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6. Certification of Nonexistence of a Naturalization Record. All these requests must be submitted to the USCIS Records  
NOTE: If you are seeking records of living immigrants, or immigrants who arrived after 1945, or who naturalized after  
April 1, 1956, use Form G-639, Freedom of Information/Privacy Act Request.  
How Are Historical Records and Files Identified?  
Records and files are identified by file numbers.  
To help identify historical USCIS file numbers, review the chart below that lists available series of USCIS historical files  
and shows sample file numbers.  
Requests for copies of USCIS historical records or files must identify the record by the file number or another file  
identifier. USCIS cannot retrieve a record without a file number. If you do not have the file number, you should first  
submit Form G-1041. For more information, visit the Requesting Records page at  
If you are requesting a:  
Naturalization Certificate File (C-File)  
Records relating to all U.S. naturalization  
certificates, replacement certificates, and Certificates  
of Citizenship issued between September 27, 1906  
and March 31, 1956. The majority of C-Files exist  
only on microfilm.  
C-1234567, Supreme  
Ct., Kings Co., NY,  
March 1922.  
(1) The certificate number; and  
(2) The name of court, location, and  
date of naturalization.  
Non-Standard C-Files  
Repatriation - Certificates issued to persons who  
regained U.S. citizenship between 1918 and 1956.  
B- _ _ _  
The certificate number obtained from  
the original certificate or from prior  
Form G-1041.  
D- _ _ _ _  
Military Naturalization - Certificates issued to  
persons who served in the U.S. Armed Forces or  
U.S. Coast Guard from 1942 to 1956.  
OM- _ _ _ _ _  
OS- _ _ _ _ _  
The certificate number obtained from  
prior Form G-1041, if applicable.  
Derivative - Certificates issued to persons who  
derived U.S. citizenship through the naturalization  
of a parent while they were a minor, or through birth  
abroad to U.S. citizen parents.  
A- _ _ _ _ _ _  
AA- _ _ _ _ _  
DA- _ _ _ _ _  
The certificate number obtained from  
prior Form G-1041, if applicable.  
Old Law - Replacement certificates issued to  
persons who naturalized prior to September 27,  
1906 (i.e., under the Old Law), and who applied for  
a replacement certificate during or after 1929.  
OL- _ _ _ _ _  
The certificate number obtained from  
prior Form G-1041, if applicable.  
The Alien Registration Number.  
Alien Registration Form (AR-2).  
Microfilmed copies of Form AR-2 completed by  
all aliens 14 years of age and older residing in or  
entering the United States between August 1940 and  
March 31, 1944.  
A-0002345, A-001234  
AR-1234567, A 1 234  
A-File numbered below 8 million.  
Form G-1041A Instructions 08/10/22  
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If you are requesting a:  
Visa File  
The visa number and arrival  
Visa 2025432,  
04/29/1933; (seaport)-  
Boston, MA; SS  
Original arrival records of immigrants admitted for  
permanent residence between July 1, 1924 and March information as obtained from prior  
31, 1944. The Visa File number does not appear on Form G-1041.  
a ship passenger list.  
Visa 2046367,  
12/17/1933; (land  
port)-Detroit, MI.  
Registry File  
R-12345, R-1234567,  
March 2, 1929 to March 31, 1944. Original records  
documenting the creation of immigrant arrival records  
for persons who entered the United States prior to  
July 1, 1924, and for whom no arrival record could be  
The Registry file number as obtained  
from prior Form G-1041.  
Do not provide  
Certificate of  
Registry number (for  
example, CR-12345).  
General Instructions  
USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should  
use the latest version of Adobe Reader, which you can download for free at If you do not  
have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that we mail  
a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.  
Signature. Each request must be properly signed and filed. For all signatures on this request, USCIS will not accept a  
stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may  
sign the request on your behalf. A legal guardian may also sign for a mentally incompetent person.  
Filing Fee. Each request must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section of  
these Instructions.)  
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the How Are  
Historical Records and Files Identified section of these Instructions.  
Copies. You may submit legible photocopies of documents requested, unless the Instructions specifically state that you  
must submit an original document. USCIS may request an original document at the time of filing or at any time during  
processing of an application, petition, or request. If you submit original documents when not required, the documents  
may remain a part of the record, and USCIS will not automatically return them to you.  
Translations. If you submit a document with information in a foreign language, you must also submit a full English  
translation. The translator must sign a certification that the English language translation is complete and accurate, and that  
he or she is competent to translate from the foreign language into English. The certification should also include the date,  
the translator’s signature and printed name, and may contain the translator’s contact information.  
How To Fill Out Form G-1041A  
1. Type or print legibly in black ink.  
2. If you need extra space to complete any item within this request, use the space provided in Part 4. Additional  
Information or attach a separate sheet of paper.  
Form G-1041A Instructions 08/10/22  
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3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been  
married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise  
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many  
children do you have” or “How many times have you departed the United States”), type or print “None,” unless  
otherwise directed.  
We recommend that you print or save a copy of your completed request to review in the future  
and for your records.  
What is the Filing Fee?  
The filing fee for Form G-1041A varies depending on the number of files requested.  
1. The fee for a copy from microfilm is $65 per request; and  
2. The fee for a copy from hard copy file is $65 per request.  
NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this request. If the file number provided  
does not match the immigrant named on this request, and there is no previous Genealogy Index Search case identification  
number provided, we will not refund any fee. DO NOT MAIL CASH. You must submit all fees in the exact amounts.  
Use the following guidelines when you prepare your check or money order for the Form G-1041A filing fee:  
1. The check or money order must be drawn on a bank or other financial institution located in the United States and must  
be payable in U.S. currency; and  
2. Make the check or money order payable to U.S. Department of Homeland Security.  
NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”  
Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it into an electronic funds  
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your  
account for the amount of the check. The debit from your account will usually take 24 hours and your bank will show it  
on your regular account statement.  
You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS  
cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If your  
check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the check is  
returned as unpayable a second time, we will reject your request and charge you a returned check fee.  
How To Check If the Fees Are Correct  
Form G-1041A’s filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS  
fees change periodically, you can verify that the fees are correct by following one of the steps below.  
1. Visit the USCIS website at, select “FORMS,” and check the appropriate fee; or  
2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or  
hard of hearing) call: 1-800-767-1833.  
Where To File?  
Please see our website at or call our National Customer Service Center at 1-800-375-5283 for  
the most current information about where to file this request. For TTY (deaf or hard of hearing) call: 1-800-767-1833.  
Form G-1041A Instructions 08/10/22  
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Processing Information  
Initial Processing. Once USCIS accepts your request, we will check it for completeness. If you do not completely fill  
out this request, you will not establish a basis for your eligibility and USCIS may reject or deny your request.  
Requests for More Information. We may request that you provide more information or evidence to support your  
request. We may also request that you provide the originals of any copies you submit. USCIS will return any requested  
originals when they are no longer needed.  
DHS Privacy Notice  
AUTHORITIES: The information requested on this historical records request, and the associated evidence, is collected  
under 8 CFR §§ 103.38 through 103.41.  
PURPOSE: The primary purpose for providing the requested information on this request form is to assist USCIS with  
identifying and obtaining copies of the requested USCIS historical records.  
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and  
any requested evidence, prevents USCIS from processing your request.  
ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, and foreign  
government agencies and authorized organizations. DHS follows approved routine uses, as described in the associated  
published system of records notice [DHS/USCIS/ICE/CBP-001 Alien File, Index, and National File Tracking System of  
Records] and as described in the published privacy impact assessment [DHS/USCIS/PIA-017(a) Microfilm Digitization  
Application System], which you can find at DHS may also share the information, as appropriate,  
for law enforcement purposes or in the interest of national security.  
Paperwork Reduction Act  
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection  
of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The  
public reporting burden for this collection of information is estimated at 30 minutes per response, including the time for  
reviewing instructions, gathering the required documentation and information, completing the request, attaching necessary  
documentation, and submitting the request. Send comments regarding this burden estimate or any other aspect of this  
collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services,  
Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp  
Springs, MD 20588-0009; OMB No. 1615-0096. Do not mail your completed Form G-1041A to this address.  
Form G-1041A Instructions 08/10/22  
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