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离开美国超过一年申请SB1签证填表DS-117

U.S. Department of State=美国国务院

APPLICATION TO DETERMINE
RETURNING RESIDENT STATUS=确定返回居民身份的申请

OMB CONTROL NO.1405-0091=OMB 控制编号：1405-0091

EXPIRATION Date: 05/31/2026=到期日期：2026年5月31日

ESTIMATED BURDEN: 30 MINUTES*=预计耗时：30分钟*

INSTRUCTIONS=指示

This is an application for Special Immigrant Status under Section 101(a)(27)(A) of the Immigration and Nationality Act, for lawfully admitted permanent residents who are returning from a temporary visit abroad. To qualify you must submit with this application evidence that=这是根据《移民和国籍法》第101(a)(27)(A)条申请特殊移民身份的申请材料，适用于合法入境的永久居民，他们从国外临时访问后返回美国。为了符合资格，您必须提交以下证明：

(1) You had the status of an alien lawfully admitted for permanent residence at the time of departure from the United States;=（1）您在离开美国时具有合法获得永久居留权的外国人身份；

(2) You departed from the United States with the intention of returning and you have not abandoned this intention; and=（2）你离开美国时就打算返回，并且你没有放弃这个打算；

(3) You are returning to the United States from a temporary visit abroad and, if the stay abroad was protracted, this was caused by reasons beyond your control and for which you are not responsible.=（3）您从国外临时访问返回美国，如果您在国外停留时间较长，这是由于您无法控制的原因造成的，并且不由您负责。

Applicants must submit evidence with this application to support the above requirements, including proof of lawful permanent residence (Examples: Form I-151, I-551, Reentry Permit, etc.), dates of travel outside of the United States (Examples: airline tickets, passport stamps, etc.), proof of ties to the United States and intention to return (Examples: tax returns, and evidence of economic, family and social ties to the United States), and proof a protracted stay was for reasons beyond the applicant's control (Examples: medical incapacitation, employment with a U.S. company, accompanying a U.S. citizen spouse, etc.) All documents will be returned to you.=申请人必须随申请提交相关证据以支持上述要求，包括合法永久居留证明（例如：I-151 表格、I-551 表格、再入境许可等）、美国境外旅行日期（例如：机票、护照印章等）、与美国关系的证明和返回意向的证明（例如：纳税申报单以及与美国的经济、家庭和社会关系证明），以及因申请人无法控制的原因而长期居留的证明（例如：医疗原因丧失行为能力、在美国公司工作、陪同美国公民配偶等）。所有文件将被退还给您。

1、Family Name 姓氏 ，First Name名，Middle Name中间名字

2、Other Names Used, Aliases (If Married Woman, Give Maiden Name)使用过的其他名字、别名（如果是已婚女性，请提供娘家姓）

3、Current Home Address and Telephone Number当前家庭住址和电话号码

4、Place of Birth (City, Province, Country)出生地（城市、省、国家）

5、Date of Birth (mm-dd-yyyy)5. 出生日期（月-日-年）

6、Marital Status 婚姻状况,选择：Married 已婚、Single (Never Married)、单身（从未结婚）、Widowed丧偶、Divorced离婚

If married, information about spouse如果已婚、配偶信息

a、Name (Last, First, MI)姓名（姓氏、名字、中间名缩写）

b、 Address地址

c、Place of Birth出生地

d、Date of Birth (mm-dd-yyyy)出生日期（月-日-年）

e、U.S. Residence Status, if any (U.S. Citizen, Legal Permanent Resident, Etc.)美国居留身份（如有）（美国公民、合法永久居民等）

f. Date of Marriage to You (mm-dd-yyyy)f. 与您结婚的日期（月-日-年）

7、List Below All Close Family Members in the United States (Continue on Separate Page if Necessary.)

7、请在下方列出所有在美国的近亲属（如有必要，请另附页面继续填写。）

Full Name 姓名、Relationship关系、Resident Status居民身份、Place of Residence居住地、

8、Previous Immigration Record8. 以前的移民记录

a. DHS "A" Number a. 国土安全部“A”号码

b. Immigration Category=b. 移民类别

c. Previous Immigrant Visa=c. 之前的移民签证 

Date of Issue (mm-dd-yyyy)=签发日期（月-日-年）

Place of Issue=签发地点

d. Adjustment of Status=d. 身份调整

Date of Adjustment of Status 

with DHS (IF ANY) (mm-dd-yyyy)=向 DHS 调整身份的日期（如有）（月-日-年）

Place of Adjustment of

Status with DHS (IF ANY)=国土安全部调整身份的地点（如有）

e. Initial Entry into the United as Lawful Permanent Resident=e. 首次以合法永久居民身份进入美国

Date of Entry (mm-dd-yyyy)=入境日期（月-日-年）

Port of Entry =入境口岸

f. Last Entry into the United States as Lawful Permanent Resident=f. 最后一次以合法永久居民身份进入美国

Date of Entry (mm-dd-yyyy)=入境日期（月-日-年）

Port of Entry=入境口岸

9、Most Recent Departure from the United States=9. 最近一次离开美国

Date of Departure (mm-dd-yyyy) =出发日期（月-日-年）、Destination=目的地、Reason=原因

10、What continuing ties have you maintained with the United States? What efforts have you made to avoid abandoning your permanent resident status in the United States?=10、您与美国保持着哪些持续的联系？您做了哪些努力来避免放弃您的美国永久居民身份？

11、Reasons for not returning to the United States until time of this application=11、截至本申请时，尚未返回美国的原因

12、List below all periods that you have lived outside of the United States for six months or longer since your initial entry into the United States as a permanent resident.=12、请列出您自首次以永久居民身份进入美国以来，在美国境外居住六个月或以上的所有时期。

Dates (mm-dd-yyyy)日期（月-日-年） From=从 To=到  Country=国家

13、Have you been employed outside of the United States since your most recent departure?13. 自最近一次离开美国以来，您是否在美国境外工作过？选择yes还是no。If "Yes" complete the following:=如果“是”，请完成以下内容：

Name of Employer=雇主名称，Address=地址，From (mm-dd-yyyy) 从 (月-日-年)，To (mm-dd-yyyy)到月日年

14、I wish to return to the United States on or about=14、我希望大约在什么时候返回美国，Date (mm-dd-yyyy)日期（月-日-年）

15. By typing my name in the field below, I swear or affirm that all statements which appear on this application are true and complete to the best of my knowledge and belief. I understand that any false or misleading statement or willful concealment of a material fact may subject me to permanent exclusion from the United States. I understand that if this application for special immigrant status is approved, I must apply for an immigrant visa within six months from the date of approval.=15. 在下方字段中填写我的姓名，即表示我宣誓或确认，本申请表中的所有陈述均真实完整，且尽我所知所信。我理解，任何虚假或误导性陈述，或故意隐瞒重要事实，都可能导致我被永久禁止进入美国。我理解，如果此特殊移民身份申请获得批准，我必须在批准之日起六个月内申请移民签证。

Name of Applicant=申请人姓名，Date (mm-dd-yyyy)日期（月-日-年）

DO NOT WRITE BELOW THIS SPACE - OFFICIAL USE ONLY=请勿在此空间下方书写 - 仅供官方使用

Approved 101(a)(27)(A)=批准101(a)(27)(A)

Disapproved=未批准，Reason=理由或原因

Type Name of Consular Officer=类型 领事官员姓名

Signature of Consular Officer=领事官员签名

Reviewed=已审核Concur=同意 Do NOT Concur=不同意

Privacy Act Statements=隐私法声明

AUTHORITIES: The information is sought pursuant to 8 U.S.C. § 1101 et seq, 8 U.S.C. §§ 1201-1202, and by regulations issued pursuant to 8 CFR 211.1 and 22 CFR 42.22.

PURPOSE: The information solicited on this form will be used to determine your eligibility for returning resident status.

ROUTINE USES: The information on this form maybe shared with federal, state, and local government agencies, members of Congress, and officials of foreign governments in accordance with certain approved routine uses. More information on the Routine Uses for the system can be found in the System of Records Notice State-39, Visa Records.

DISCLOSURE: Providing this information is mandatory. Failure to provide the information requested on this form may result in the applicant's inability to receive returning resident status.

授权：根据美国法典第8卷第1101节及以下条款、美国法典第8卷第1201-1202节以及根据联邦法规第8卷第211.1节和联邦法规第22卷第42.22节发布的法规，本信息收集。

目的：本表格中收集的信息将用于确定您是否有资格获得返乡居民身份。

常规用途：本表格中的信息可能会根据某些经批准的常规用途与联邦、州和地方政府机构、国会议员以及外国政府官员共享。有关系统常规用途的更多信息，请参阅记录系统通知State-39中的“签证记录”。

披露：提供此信息是强制性的。未能提供本表格中要求的信息可能会导致申请人无法获得返乡居民身份。

Confidentiality Statement=保密声明

INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation,amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is needed in a case pending before the court. Confidentiality Statement

《移民与国籍法》第222(f)条规定，签证签发和拒签记录应被视为机密，仅可用于制定、修订、执行或执行美国移民、国籍法及其他法律。经认证的签证记录副本可提供给法院，如果法院证明此类记录中包含的信息是法院待审案件所必需的。保密声明