OMB No. 1140-0061
U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
Certification of Compliance with 18 U.S.C. 922(g)(5)(B)
Note: The Person Certifying to Citizenship must Complete this Form.
Certification
You MUST complete this certification or ATF will NOT be able to act upon your application and the application will be returned to you.
18 U.S.C. 922(g)(5)(B) generally makes it unlawful for any nonimmigrant alien to ship or transport in interstate or foreign commerce, or possess in or affecting commerce, any firearm or
ammunition; or to receive any firearm or ammunition which has shipped or transported in interstate or foreign commerce.
A nonimmigrant alien is an alien in the United States in a nonimmigrant classification. The definition includes, in large part, persons traveling temporarily in the United States for business or pleasure,
persons studying in the United States who maintain a residence abroad, and certain foreign workers. The definition does NOT include permanent resident aliens.
If applying for a Federal firearms license (FFL), ALL listed responsible persons must complete a CERTIFICATION.
1. Name under which the application was filed. (Last Name, First Name, Middle Initial - or - Name of Corporation, Partnership, or Association, if applicable)
2. Name of person certifying to citizenship. (Last Name, First Name, Middle Initial)
3. What is your COUNTRY(ies) of citizenship? (List additional countries if applicable)
If you are a citizen of the United States, skip to question 7.
4. Immigration and Naturalization Service (INS) issued alien number or admission number.
5. Are you a NONIMMIGRANT alien? (Answer "YES," or "NO.")
If you answered "No" to question 5, skip to question 7.
6. If you answered "Yes" to question 5, you must answer the following questions:
a. Are you in possession of a valid hunting license or permit lawfully issued in the United States? (Answer "YES" or "NO.") (If "YES," you must submit appropriate documentation in support of your
"YES" answer.)
If you answered "Yes" to question 6a, complete the following items:
Hunting license/permit number, if any
State of issuance
Expiration date, if any
b. Are you an official representative of a foreign government who is accredited to the United States Government or your Government's mission to an international organization having its headquarters in
the United States? (Answer “YES” or “NO.”)
c. Are you an official of a foreign government or a distinguished foreign visitor who has been designated by the United States Department of State? (Answer "YES" or "NO.")
d. Have you received a waiver from the nonimmigrant alien prohibition from the Attorney General of the United States? (Answer "YES" or "NO.") (If "YES," you must submit appropriate
documentation in support of your "YES" answer.)
7. Under penalties imposed by 18 U.S.C. 924, I certify that the statements contained in this Certification of Compliance with 18 U.S.C. 922 (g)(5)(B) form, and any attached statements in support
thereof, are true and correct to the best of my knowledge and belief.
Signature of Individual Who is Identified in Question 2:
Date:
ATF Form 5330.20
Revised June 2005
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine whether the operations will be in conformity with Federal laws and regulations.
The information requested is required to obtain or retain a benefit and is mandatory by statute (26 U.S.C. 5172).
The estimated average burden associated with this collection of information is 3 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this
burden estimate and suggestions for reducing this burden should be addressed to Reports Management Officer, Document Services Branch, Bureau of Alcohol, Tobacco, Firearms and Explosives,
Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
ATF Form 5330.20
Revised June 2005