Interagency Alien Witness and Informant Record

OMB No. 1615-0046; Expires 01/31/07

I-854, Inter-Agency Alien
Witness and Informant Record

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions
Contents
Parts

Page No.

I.

General Information.

1

II.

Who Should Use This Form?

1-2

III.

Required Documentation.

2-3

IV.

Required Certifications.

3

V.

Where to File.

3

VI.

Other Information.

4

Provide exact information about the request you are making
(e.g., for S classification waivers of grounds of inadmissibility
or adjustment of status) and complete and attach all necessary
certifications and documentation.

Part II. Who Should Use This Form?
This form may be used only by a Federal or State and Local
LEA (The U.S. Attorney's Office is considered an LEA for
purpose of this application) and only to request that an alien
witness or informant, be allowed to:

Part I. General Information.

(1) Proceed into the United States pursuant to the S
nonimmigrant classification;

Purpose of This Form.

(2) Change nonimmigrant classification to an S
classification, or;

This form is used by law enforcement agencies (LEAs) to
bring alien witnesses and informants to the United States in
an “S” non-immigrant classification.

(3) Adjust to lawful permanent resident status from the S
nonimmigrant classification.
For the witness/informant the LEA must specifically request:

This form provides the Department of State (DOS) and
Department of Homeland Security (DHS) with information
necessary to identify the requesting LEA, the alien witness
and/or informant, and others, e.g., the United States Attorney,
needing the information or testimony of that alien. It assists
DOS and USCIS in the exercise of their joint responsibility to
adjudicate requests by LEAs for S classification.

General Instructions.
Please read the instructions and carefully complete all
relevant parts of this form. A separate form must be used for
each witness/informant requested.
Answer all questions by typing or clearly printing in black
ink. Failure to answer all questions will delay the processing
of this application and may result in its denial. Indicate a
non-applicable question with “N/A.” If the answer is “none,”
so state.
If you, as requesting agent, need extra space to answer any
item, attach a sheet of paper with your name on it, as well as
the name of the alien, the LEA requestor and the control
agent. You should make copies of this completed form for
your records.

S-5 or S-6 nonimmigrant classification.
The S classification may be requested when an alien
witness or informant intends to remain permanently in
the United States
An S-5 classification may be requested.
For an alien who possesses and is willing to provide to
the requesting LEA critical, reliable information on a
criminal organization and who otherwise qualifies under
section 101(a)(15)(S) of the Immigration and Nationality
Act and 8 CFR 214.2(t).
S-6 Classification may be requested.
For an alien who possesses and is willing to provide
information on a terrorist organization, who will be or is
placed in danger as a result, and is eligible for an award
under section 36(a) of the State Department Basic
Authorities Act of 1956, 22 U.S.C. 2708(a), and who
otherwise qualifies under section 101(a)(15)(S) of the Act
and 8 CFR 214.2(t).
NOTE: A federal or state LEA may request S-5. However,
only a Federal LEA or Federal court may request an S-6
classification for an alien witness or informant.
Form I-854 Instructions (Rev. 09/25/06) Y

An LEA May Also Make a Request for
Derivative Beneficiaries (Part A-6 of Form).
Qualifying relatives (spouse, married and unmarried sons and
daughters, and parents) of the principal alien witness and
informant may be included in a request for the S
nonimmigrant classification.
All required information for such derivative beneficiaries of
this request must be included at the time of filing the request
for nonimmigrant classification.
Only qualifying relatives identified at the time of filing will
be considered as accompanying or following to join. Proof of
family relationship, biological data and grounds of
inadmissibility must be attached for each named qualifying
relative.

LEA May Request Status Change
to S-5 or S-6 Classification.
The sponsoring LEA may request USCIS to change the
classification of an alien already in the United States from
another classification to S-5 or S-6 classification [8 CFR
214.2(t)(12)] by filing this form and Form I-539, Application
to Extend/Change Nonimmigrant Status, together with the
relevant documentation and requisite fees, pursuant to the
instructions below relating to filing requests for an S
classification.

Request for an S Nonimmigrant to
File for Adjustment of Status to
Lawful Permanent Resident (LPR)
A request to allow a nonimmigrant in an S classification to
file for adjustment of status as a lawful permanent resident
pursuant to 8 CFR 245.11 must be submitted by the LEA that
originally requested the S classification, and may not be filed
until the alien has fulfilled the terms and conditions of his or
her S classification.
Attach to the request on Part F of this form all relevant
documentation establishing that the alien has fulfilled the
terms and conditions of this or her S classification and related
recommendations.
Only the derivative beneficiaries named on the request for S
classification are eligible to adjust pursuant to 8 CFR 245.11.

Part III. Required Documentation.
For S Classification.
Requests for the S classification (8 CFR 214.2(t)) are
premised on the alien witness and informant's willingness to
provide critical, reliable information. You must provide clear,
very specific statements of the following:
The operations that form the basis of the request. For
example, if you need the alien to appear as a witness,
give the date and place of the trial and the nature of the
testimony you expect to receive.
The objective of the request. Explain fully why the
admission of this alien is necessary, essential and in the
national interest. The terms and conditions must be
stated very clearly on or attached to this form.
The nature of the alien's cooperation with the
Government, any bargains you have made with the alien
and any benefits promised in returned.
NOTE: No promises for immigration benefits may be
made to an alien seeking S classification.

For Ground(s) of Inadmissibility.
Part A. All grounds of inadmissibility (i.e., the reasons the
alien may not be admissible to the United States) must be
ascertained and a statement of each ground, or suspected
ground, must be attached to this form.
Review the grounds of inadmissibility carefully with the alien
and remind him or her that failure to disclose all grounds of
inadmissibility (conduct or conditions) on this form may
result in removal from the United States.
For each ground checked in Part A 7, you must provide a
statement of all reasons why you believe discretionary waiver
authority should be exercised favorably for this alien so that
he or she may be admitted in the S classification.
Be as specific as possible and attach affidavits, statements,
memorandums or other documentation as necessary to explain
circumstances. Specific reasons for exercising discretionary
waiver authority should be presented whenever possible, e.g.,
if the alien has a history of drug abuse, you may present
evidence of rehabilitation, such as the affidavits from doctors,
psychiatrists or other experts.

Form I-854 Instructions (Rev. 09/25/06) Y Page 2

Documentation. Evidence submitted with this request to
verify the basis of the request, i.e., for a waiver, classification
or adjustment of status, may be in the form of affidavits,
statements, memorandums or other documentation.

You Must Also Submit for Each
Alien Named in This Request:
Two-sets of fingerprints and signatures on Form
FD-258;
Two passport-style photographs of the alien, with a
white background and taken no earlier than 30 days
before submission. The photo should be un-mounted,
printed on thin paper and show the alien's face in a full
frontal position. The head should be bare unless the
alien is wearing a headdress as required by a religious
order. Using a pencil, lightly print the alien's name
and the alien registration number (A#), if known, on
the back of each photo. The name of the LEA may also
be noted.
The alien's A #, FBI number, U.S. Social Security
number, if one has been issued, and Form G-325,
Biographical Information.

Part IV. Required Certifications.

LEA Certification.
Your signature as a witness to the alien's certification certifies
your assurance of the alien's understanding of his or her
certification. LEA headquarters level certification is required
to ensure that no promises have been made other than those
afforded by section 101(a)(15)(S) of the Act, and that full
assumption of the responsibilities outlined in the request has
been authorized. The name of the LEA agency contact on the
case who is available by telephone for questions and
verification of information is also necessary.

United States Attorney Certification.
The United States Attorney's certification is necessary if the
alien witness or informant will be participating in a
prosecution or investigation that falls within the jurisdictional
authority of a United States Attorney, or if this form is to be
submitted by a State or Local LEA.
The United States Attorney may and sometimes does refer to
the Criminal Division or another federal entity. In such a
case, the referred entity must provide the required
certification and documentation of the referral by the United
States Attorney.

Part V. Where to File.

Alien Certification.
The certifications made by the alien and you, the LEA
requestor, provide a critical record for the future.
After you have carefully explained the certifications in Part B
and reviewed all statements on or attached to the form for
accuracy, read the certifications to the alien and be sure that
the alien understands each condition of admission and
continued stay in lawful status.
If the certification is translated to ensure the alien's
understanding, please so indicate. Make sure the alien
understands that adjustment of status is not available unless
and until he or she has satisfied the conditions of admission
and continued stay in lawful status in the S classification.

Requests for an S nonimmigrant classification or for an S
nonimmigrant to file for adjustment of status, should be
submitted to:

U.S. Department of Justice
Criminal Division, Office of Enforcement
Operations
Policy and Statutory Enforcement Unit
John C. Keeney Building, 10th Floor
10th And Constitution Avenue, NW
Washington, D.C. 20530-0001
NOTE: The Criminal Division, will forward certified
requests for processing to DHS for S classification. No
request for S classification may be adjudicated without the
certification of the Criminal Division.

Form I-854 Instructions (Rev. 09/25/06) Y Page 3

Part VI. Other Information.
Employment Authorization.
Witnesses and informants who have received S nonimmigrant
classification are entitled to receive an Employment
Authorization Document (EAD), enabling them to seek
employment in the United States. Aliens so entitled may
request an EAD by filing Form I-765, Application for
Employment Authorization, according to the instructions on
that form. Form I-765 may not accompany this form and
must be filed separately.

Authority for Collecting This Information.
The authority to require you to file Form I-854, Inter-Agency
Alien Witness and Informant Record, when requesting
authorization to bring a witness or informant into the United
States, is found at section 101(a)(15)(S) of the Act and the
Congressional concerns behind that provision.
Information you provide on Form I-854 is used to determine
eligibility for the requested classification/authorization to
record the numbers of requests and determinations made on
this form, track and monitor the alien, and provide Congress
with a required annual report on the admission of alien
witnesses and informants.
Failure to provide all information as required may result in
the denial or rejection of this application. The information
you provide may also be disclosed to other Federal, State,
local and foreign law enforcement, intelligence and regulatory
agencies.

The knowing placement of false information on this
application may subject you and/or the preparer of this
application to criminal penalties under Title 18 of the U. S.
Code. The knowing placement of false information on this
application may also subject you and/or the preparer to civil
penalties under section 274C of the Act, 8 U.S.C. 1324c.
Under 8 U.S.C. 1324c, a person subject to a final order for
civil document fraud is removable from the United States and
may be subject to fines.

Paperwork Reduction Act Notice.
A person is not required to respond to a collection of
information unless it displays a currently valid OMB control
number.
We try to create forms and instructions that are accurate, can
be easily understood and impose the least possible burden on
you to provide us with information. Often this is difficult
because some immigration laws are very complex.
Accordingly, this collection of information is computed as
follows: (1) learning about the law and form, 60 minutes; (2)
completing the form, 75 minutes; and (3) assembling and
filing the application 120 minutes, for an estimated average of
4 hours and 15 minutes per response.
If you have comments regarding the accuracy of this estimate
or suggestions for making this form simpler, you can write to
U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W.,
Room 3008, Washington, D.C. 20529; OMB Number
1615-0046.
Do not mail your completed application to this address.

Penalties for Perjury.
All statements made in response to questions on this
application are declared to be true and correct under penalty
of perjury 18 U.S.C 1546, provides in part:
Whoever knowingly makes under oath, or as
permitted under penalty under 28 U.S.C. 1746,
knowingly subscribes as true, any false statement
with respect to a material fact in any application,
affidavit, or other document required by the
immigration laws or regulations prescribed hereunder,
or knowingly presents any such application, affidavit,
or other document containing any such false
statement - shall be fined in accordance with this title
or imprisoned for not more than five years, or both.

Form I-854 Instructions (Rev. 09/25/06) Y Page 4