Table of changes Form

TABLE OF CHANGES – FORM

FORM I-914

12-10-2008

LOCATION	CURRENT VERSION	PROPOSED VERSION
Page 1 – Part B	Part B. General Information About Applicant.	Part B. General Information About You (Person filing this form as a victim)
Page 1 – For USCIS Use Only	For USCIS Use Only Bar Code Date Stamp Remarks Bona Fide Application Initials Stamp # Date Waiting List Initials Stamp # Date Action Block	For USCIS Use Only Returned Receipt Date Date Resubmitted Date Date Reloc Sent Date Date Reloc Rec’d Date Date Validity Dates From: To: Remarks Conditional Approval Stamp#: Date Action Block To Be Completed by Attorney or Representative, if any Fill in box, if G-28 is attached to represent the applicant. ATTY State License #
Page 1 – Part C	Part C. Details Related to T Nonimmigrant Status. When answering the following questions about your claim you should explain relevant information. You should attach documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you are relying to support your claim. If only applying for T derivative status subsequent to the Principal Applicant's initial filing, evidence supporting the original application is not required to be resubmitted with the Form I-914. (Attach additional sheets of paper as needed, labeling them as Part C and the question number. Refer to Instructions for further information.) Check either Yes or No, as appropriate. 7. I have complied with requests from U.S. government authorities for assistance in the investigation or prosecution of acts of trafficking. (If No, explain the circumstances. You may add additional pages if necessary, marking them Form I-914, Part C.7.)	Part C. Additional Information Answers to the following questions about your claim require explanation and supporting documentation. You should attach documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you are relying to support your claim. It is strongly encouraged that you attach a personal narrative statement describing the trafficking. If you are only applying for T derivative status for a family member subsequent to your (the principal applicant) initial filing, evidence supporting the original application is not required to be resubmitted with the new Form I-914. Attach additional sheets of paper as needed. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet and indicate the number of the item that you are answering. Include the Part and letter or number relating to the additional information you provided (example: Part C, 3). 7. I have complied with requests from Federal, State, or local law enforcement authorities for assistance in the investigation or prosecution of acts of trafficking. (If “No,” explain the circumstances.)
Page 2 - Part D	Part D. Processing Information. Answer the following questions. (If your answer is "Yes" to any one of these questions, explain on a separate piece of paper. Additionally, if any of the acts or circumstances below are related to your having been a victim of a severe form of trafficking, please explain. Answering "Yes" does not necessarily mean that you are not entitled to adjust your status or register for permanent residence.)	Part D. Processing Information Answer the following questions about yourself. For purposes of this application, if applicable, you must answer “Yes” to the following questions, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. (If your answer is "Yes" to any one of these questions, explain on a separate sheet of paper. Additionally, explain if any of the acts or circumstances below are related to you having been a victim of a severe form of trafficking. Answering "Yes" does not necessarily mean that you will be denied T nonimmigrant status or are not entitled to adjust your status or register for permanent residence.)
Page 2 - Part D, Question 1	1. Have you ever, in or outside the United States: a. knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested? b. been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, excluding traffic violations? c. been the beneficiary of a pardon, amnesty, rehabilitation decree, other act or clemency or similar action? d. exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?	1. Have you EVER: a. Committed a crime or offense for which you have not been arrested? b. Been arrested, cited, or detained by any law enforcement officer (including DHS, former INS, and military officers) for any reason? c. Been charged with committing any crime or offense? d. Been convicted of a crime or offense (even if violation was subsequently expunged or pardoned)? e. Been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)? f. Received a suspended sentence, been placed on probation, or been paroled? g. Been in jail or prison? h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? If you answered “Yes” to any of the above questions, complete the following table. If you need more space, use a separate sheet of paper to give the same information. Why were you arrested, cited, detained, or charged? Date of arrest, citation, detention, charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? (City, State, Country) Outcome or disposition (e.g., no charges filed, charges dismissed, jail, probation, etc.)
Page 2 – Part D, Question 3	3. Have you ever: a. within the past ten years been a prostitute or procured anyone for prostitution, or intend to engage in any such activities in the future? b. engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? c. knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally? d. illicitly trafficked in any controlled substance, firearms, or persons, or knowingly assisted, abetted or colluded in illegal trafficking?	3. Have you: a. Engaged in prostitution or procurement of prostitution or do you intend to engage in prostitution or procurement of prostitution? b. EVER engaged in any unlawful commercialized vice, including, but not limited to illegal gambling? c. EVER knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally? d. EVER illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance?
Page 3 – Part D, Question 4	4. Have you ever engaged in, conspired to engage in, or do you intend to engage in, sabotage, kidnapping, political assassination, hijacking or any other form of terrorist activity?	4. Have you EVER committed, planned or prepared, participated in, threatened to, attempted to, or conspired to commit, gathered information for, or solicited funds for any of the following: a. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? c. Assassination? d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property? e. The use of any biological agent; chemical agent; or nuclear weapon or device; explosive; or other weapon or dangerous device with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property?
Page 3 – Part D, Question 5	5. Have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to, any person or organization that has engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking or any other form of terrorist activity?	5. Have you EVER been a member of, solicited money or members for, provided support for, attended military training (as defined in section 2339D(c)(1) of title 18, United States Code) by or on behalf of, or been associated with an organization that is: a. Designated as a terrorist organization under section 219 of the Immigration and Nationality Act? b. Any other group of two or more individuals, whether organized or not, which has engaged in or has a subgroup which has engaged in: 1. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? 2. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? 3. Assassination? 4. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property? 5. The use of any biological agent; chemical agent; or nuclear weapon or device; explosive; or other weapon or dangerous device with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? 6. Soliciting money or members or otherwise providing material support to a terrorist organization?
Page 3 – Part D, Question 6	6. Do you intend to engage in the United States in: a. espionage? b. any activity a purpose of which is opposition to, or the control or overthrow of, the government of the United States, by force, violence or other unlawful means? c. any activity to violate or evade any law prohibiting the export from the United States of goods, technology or sensitive information?	6. Do you intend to engage in the United States in: a. Espionage? b. Any unlawful activity, or any activity the purpose of which is in opposition, to control or overthrow of the government of the United States? c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law involving the export of goods, technology, or sensitive information?
Page 3 – Part D, Question 7	7. Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?	7. Have you ever been or do you continue to be a member of the Communist or other totalitarian party, except when membership was involuntary?
Page 3 – Part D, Question 8	8. Did you, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist or otherwise participate in the persecution of any person because of race, religion, national orgin or political opinion?	8. Have you, during the period of March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever ordered, incited, assisted, or otherwise participated in the persecution of any person because of race, religion, nationality, membership in a particular social group, or political opinion?
Page 3 – Part D, Question 9	9. Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin or political opinion?	9. Have you EVER been present or nearby when any person was: a. Intentionally killed, tortured, beaten, or injured? b. Displaced or moved from his or her residence by force, compulsion, or duress? c. In any way compelled or forced to engage in any kind of sexual contact or relations?
Page 3 – Part D, Question 10	10. Have you ever been deported from the United States, or removed from the United States at government expense, excluded within the past year, or are you now in exclusion or deportation proceedings?	10. a. Are removal, exclusion, rescission, or deportation proceedings pending against you? b. Have removal, exclusion, rescission, or deportation proceedings EVER been initiated against you? c. Have you EVER been removed, excluded, or deported from the United States? d. Have you EVER been ordered to be removed, excluded, or deported from the United States? e. Have you EVER been denied a visa or denied admission to the United States? (If a visa was denied, explain why on a separate sheet of paper.) f. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time?
Page 3 – Part D, Question 11	11. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the United States or any immigration benefit?	11. Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: a. Acts involving torture or genocide? b. Killing any person? c. Intentionally and severely injuring any person? d. Engaging in any kind of sexual contact or relations with any person who was being forced or threatened? e. Limiting or denying any person's ability to exercise religious beliefs?
Page 3 – Part D, Question 12	12. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?	12. Have you EVER: a. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, or insurgent organization? b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons?
Page 3 – Part D, Question 13	13. Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and not yet complied with that requirement or obtained a waiver?	13. Have you EVER been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so?
Page 3 – Part D, Question 14	14. Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child?	14. Have you EVER assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person?
Page 3 – Part D, Question 15	15. Do you plan to practice polygamy in the United States?	15. Have you EVER received any type of military, paramilitary, or weapons training?
New – Part D, Question 16		16. Are you under a final order or civil penalty for violating section 274C (producing and/or using false documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)?
New – Part D, Question 17		17. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure, or procured, a visa or other documentation, for entry into the United States or any immigration benefit?
New – Part D, Question 18		18. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces?
New – Part D, Question 19		19. Have you EVER been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and not yet complied with that requirement or obtained a waiver of such?
New – Part D, Question 20		20. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to U.S. citizenship, outside the United States from a U.S. citizen granted custody?
New – Part D, Question 21		21. Do you plan to practice polygamy in the United States?
New – Part D, Question 22		22. Have you entered the United States as a stowaway?
New – Part D, Question 23		23. a. Do you have a communicable disease of public health significance? b. Do you have or have you had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? c. Are you now or have you been a drug abuser or drug addict?
Page 3 – Part E.	Part E. Information about Your Family Members. Provide the following information about your spouse and all of your sons and daughters. If you need more space, use a separate sheet of paper. Full Name Family Relationship Date of Birth (mm/dd/yyyy) “A” – Number (if applicable) Country of Birth Current Address (Street, City, State and Country)	Part E. Information about Your Family Members Provide the following information about your spouse and all of your sons and daughters. If you need more space, attach an additional sheet of paper. 1. Spouse Family Name (Last Name) Given Name (First Name) Middle Name (if any) Date of Birth (mm/dd/yyyy) Country of Birth Relationship Current Location 2. Children a. Family Name (Last Name) Given Name (First Name) Middle Name (if any) Date of Birth (mm/dd/yyyy) Country of Birth Relationship Current Location b. {repeat} c. {repeat}
Page 4 – Part F	Part F. Attestation and Release. … I authorize the release of any information from my record that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking, to investigate my claim and to investigate fraudulent claims. I further authorize the U.S. Citizenship and Immigration Services to release information to law enforcement agencies and prosecutors investigating or prosecuting crimes of trafficking or related crimes. Signature of Applicant (the Person in Part A.) (Sign your name within the brackets) Date (mm/dd/yyyy)	Part F. Attestation, Release, and Signature … I authorize the release of any information from my record that U.S. Citizenship and Immigration Services (USCIS) needs to determine eligibility for the benefit I am seeking, to investigate my claim and to investigate fraudulent claims. I further authorize USCIS to release information to law enforcement agencies and prosecutors investigating or prosecuting crimes of trafficking or related crimes. I further authorize USCIS to release information to Federal, State, and local public and private agencies providing benefits, to be used solely in making determinations of eligibility for benefits pursuant to 8 USC 1641(c). Applicant's Statement (Check one): I can read and understand English, and I have read and understand each and every question and instruction on this form, as well as my answer to each question. Each and every question and instruction on this form, as well as my answer to each question, has been read to me in the language, a language in which I am fluent, by the person named in Interpreter's Statement and Signature. I understand each and every question and instruction on this form, as well as my answer to each question. I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this application is all true and correct. I certify also that I have not withheld any information that would affect the outcome of this application. Signature of Applicant (the person in Part A.) Date (mm/dd/yyyy)
Page 4 – Part G	Part G. Preparer and/or Translator Certification. To be completed and signed if form is prepared by a person other than the applicant. I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct. (Preparer’s/Translator’s Printed Name) (Preparer’s/Translator’s Signature) Address Phone Number Date (mm/dd/yyyy) Relationship to the Applicant	Part G. Preparer and/or Interpreter Certification (To be completed and signed if form is prepared by a person other than the applicant) Preparer’s Statement and Signature (if applicable) I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge. I have not knowingly withheld any material information that would affect the outcome of this application. Attorney or Representative: In the event of a Request for Evidence, may USCIS contact you by Fax or E-Mail? Yes No Preparer’s Signature Date (mm/dd/yyyy) Preparer’s Printed Name Preparer’s Firm Name (if applicable) Preparer’s Address Daytime Phone Number (with area code) Fax Number (if any) E-Mail Address (if any) Interpreter's Statement and Signature (if applicable) I certify that I am fluent in English and the below-mentioned language. Language Used (language in which applicant is fluent): I further certify that I have read each and every question and instruction on this form, as well as the answer to each question, to this applicant in the above-mentioned language, and the applicant has understood each and every instruction and question on the form, as well as the answer to each question. Interpreter's Signature Date (mm/dd/yyyy) Printed Name Telephone Number (with area code)
New – Part H		Part H. Checklist I completely filled out and signed the form. I have attached evidence that: a. I am or have been a victim of a severe form of trafficking; b. I am physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands, or at a port of entry, on account of trafficking; c. I am cooperating with Federal, State, or local Law Enforcement authorities in the investigation or prosecution of the traffickers (unless under age 18); and d. I would suffer extreme hardship involving unusual and severe harm upon removal from the United States. If I am applying for one or more family members: I have completed Form I-914, Supplement A for each member for whom I am now applying and, if he or she is in the United States, each family member has signed that Form I-914, Supplement A. I have submitted the required evidence, including evidence of: a. My relationship to the family member for whom I am applying; b. My age, if I am applying for my parent or unmarried sibling under the age of 18; c. My child's age, if I am applying for my child; and d. My sibling's age, if I am applying for my unmarried sibling; and I have included three photographs of each family member for whom I am now applying. I have included Form I-765 Application for Employment Authorization, if I am requesting employment authorization for my family member, along with fee or request for fee waiver.

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