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

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

Form 1; Instructions 2.

Edition Date

01/08/13. 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

This page can be found at

Last Reviewed/Updated: 04/10/2013