KATKUZ28-I found this on the link below pg 38.
It looks to me that they feel you have extreme and unusual hardships, but you need to prove with addt'l evidence. It's not a form you can fill out, you have to let Mr. Janssen know that you did not receive it and see if they can re-send so you know what they're requesting.
2. Extreme Hardship
The application and letter explaining hardship or other grounds for eligibility, where applicable,
may be sufficient to support eligibility for the waiver if detailed and credible. However, in most
cases, the applicant will need to provide supporting documentary evidence (e.g., medical records,
if the hardship claim is based on medical evidence; financial records if the hardship claim is
based on financial considerations) to establish eligibility. If the adjudicating officer determines
that the applicant has a colorable claim for establishing extreme hardship but has failed to
provide sufficient supporting evidence, the officer should issue a Form I-72, Request for
Additional Evidence.Once extreme hardship is established as an eligibility threshold, the extreme hardship becomes a
factor of the discretionary determination for approval of the waiver. Extreme Hardship is
described in detail in section VII.J. of these procedures.