Table of Changes Supp A Form

TABLE OF CHANGES – FORM

FORM I-914 SUPP A

12-10-2008

LOCATION	CURRENT VERSION	PROPOSED VERSION
Page 1 – Part A	Part A. Relationship. The derivative applicant is my: (Check one) Husband/Wife Child Parent	Part A. Family Member Relationship to You (the principal) The family member for whom I am filing is my: (Check one) Husband/Wife Child Parent Unmarried sibling under 18 years of age
Page 1 – Part B	Part B. Information About Principal Applicant. … Principal applicant's application has been previously: (Check One) Submitted Found Bona Fide Granted Conditional Approval Approved for T Nonimmigrant Status	Part B. General Information About You (the principal) … Status of your Form I-914, Application for T Nonimmigrant Status: (Check One) Filing this Form I-914, Supplement A, concurrently Pending Approved
Page 1 – For USCIS Only	For USCIS Use Only Bar Code Date Stamp Remarks Actions 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. Information About Derivative Applicant. Family Name Given Name Middle Name A# (If any) U.S. Social Security # (If any) Other Names Used (If any)? (Include maiden name and aliases) Intended Residence in U.S. (Street Number and Name) Apt. No. City State Zip Code Home Phone Daytime Phone SAFE Mailing Address in the U.S., if other than above. Apt. No. City State ZIP Code Gender Male Female Marital Status Single Married Divorced Widowed Date of Birth (mm/dd/yyyy) Names of Prior Husband/Wives (if any), Dates Marriages Ended and Current Immigration Status (if any) Country of Birth Country of Citizenship Passport # Issue Date (mm/dd/yyyy) Place of Issuance Is the derivative applicant currently in the United States? Yes (If Yes, complete the following.) He or she last arrived as a (visitor, student, stowaway, without inspection, other, please specify.) His or her status is ______. No (If No, please list the United States consulate by city and country, where the derivative applicant will apply for a visa. (Designation of a consulate outside of the country of your relative's last residence does not guarantee acceptance for processing by that consulate.  Acceptance is at the discretion of the designated consulate.) Has the derivative applicant previously entered the United States? Yes No (If Yes, list each previous entry during the past five years. Attach additional sheets, if necessary.) Date of Entry Place of Entry Status Arrival/Departure Record (I-94) Number, date arrived, and date authorized stay expired, or will expire. (As shown on Form I-94 or I-95) Has family member for whom you are applying ever been under immigration proceedings? Yes No If Yes, answer the following: Where: When (mm/dd/yyyy): Exclusion Deportation Recission Judicial Proceeding List your family member’s spouse and children. (Attach additional sheets of paper, if necessary. If family member is your spouse, list only his or her children.) Name Relationship Date of Birth (mm/dd/yyyy) Country of Birth Are you applying for employment authorization for your family member? Yes No (If Yes, submit a Form I-765, Application for Employment Authorization for the family member.)	Part C. Information About Your Family Member (the derivative) Family Name (Last Name) Given Name (First Name) Middle Name (if any) Other Names Used (include maiden name/nickname) Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship Residence or Intended Residence in the U.S. – Street Number and Name Apt. # City State Zip Code Safe Mailing Address (if other than above) – Street Number and Name Apt. # C/O (in care of): City State/Province Zip/Postal Code Home Telephone # (with area code) Safe Daytime Phone # (with area code) I-94# (Arrival-Departure Document) A# (if any) U.S. Social Security # (if any) Gender Male Female Marital Status: Married Single/Never Married Divorced Widowed 1. Give the following information about your family member if he or she is currently in the United States. Place of Entry Date of Last Entry (mm/dd/yyyy) Current Immigration Status Passport # Place of Issuance Date of Issuance (mm/dd/yyyy) 2. Give the following information about your family member if he or she has previously traveled to the United States. Place of Entry Date of Entry (mm/dd/yyyy) Date Authorized Stay Expired (mm/dd/yyyy) Immigration Status 3. If your family member was previously married, list names of prior spouses and dates of termination of marriage. Documents such as divorce decrees or death certificates must be attached. Names of Former Spouse(s) Date Marriage Ended (mm/dd/yyyy) Where and How Marriage Ended 4. If your family member is outside the United States, indicate the U.S. consulate or inspection facility you want notified if this application is approved. Type of Office (Check one): Consulate Pre-Flight Inspection Port of Entry Office Address (City) U.S. State or Foreign Country Foreign Address Where You Want Notification Sent 5. Has your family member ever been in immigration proceedings? Yes No If “Yes,” what type of proceedings? (Check all that apply) Removal Date (mm/dd/yyyy) Exclusion Date (mm/dd/yyyy) Deportation Date (mm/dd/yyyy) Rescission Date (mm/dd/yyyy) Judicial Date (mm/dd/yyyy) 6. Is your family member requesting an Employment Authorization Document? (If “Yes,” submit Form I-765, Application for Employment Authorization Document, separately.) NOTE: If your family member is living outside the United States, he or she is not eligible to receive employment authorization until he or she is lawfully admitted to the United States. Do not file Form I-765 for a family member living the United States.
Page 2 – Part D	Part D. Processing Information. Please answer the following questions. (If your answer is "Yes" to any one of these questions, explain on a separate piece of paper. Answering "Yes" does not necessarily mean that your family member will be denied T nonimmigrant status.)	Part D. Processing Information Answer the following questions about your family member. For the purposes of this application, if applicable, you must answer “Yes” to the following questions even if the records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that your family member no longer has a record. (If your answer is "Yes" to any one of these questions, explain on a separate sheet of paper. Answering "Yes" does not necessarily mean that your family member will be denied T nonimmigrant status.)
Page 2 – Part D, Question 1	1. Has the family member for whom you are applying ever: a. knowingly committed any crime of moral turpitude or a drug-related offense for which he or she 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 of clemency or similar action? d. illicitly trafficked in any controlled substance, firearms, or persons, or knowingly assisted, abetted or colluded in illegal trafficking?	1. Has the family member for whom you are filing EVER: a. Committed a crime or offense for which he or she has not been arrested? b. Been arrested, cited, or detained by any law enforcement officer (including DHS, former INS, or 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 the answer is “Yes” to any of the above questions, complete the following table. If you need more space, use a separate sheet of paper. Why was the family member for whom you are filing arrested, cited, detained, or charged? Date of arrest, citation, detention, charge (mm/dd/yyyy) Where was the family member for whom you are filing arrested, cited, detained, or charged? (City, State, Country) Outcome of disposition (e.g., no charges filed, charges dismissed, jail, probation, etc.)
Page 2 – Part D, Question 3	3. Has the family member for whom you are applying: a. within the past ten years been a prostitute or procured anyone for prostitution, or does he or she 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. Has the family member for whom you are filing: a. Engaged in prostitution or procurement of prostitution or does he or she 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 2 – Part D, Question 4	4. Has the family member for whom you are applying ever engaged in, conspired to engage in, or does he or she intend to engage in, sabotage, kidnapping, political assassination, hijacking or any other form of terrorist activity?	4. Has the family member for whom you are filing 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 2 – Part D, Question 5	5. Has the family member for whom you are applying ever solicited membership or funds for, or 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. Has the family member for whom you are filing 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. Assassination? 2. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? 3. 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? 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, or 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 2 – Part D, Question 6	6. Does the family member for whom you are applying 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. Does the family member for whom you are filing 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 2 – Part D, Question 7	7. Has the family member for whom you are applying ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?	7. Has the family member for whom you are filing EVER been or does he or she continue to be a member of the Communist or other totalitarian party, except when membership was involuntary?
Page 2 – Part D, Question 8	8. Did the family member for whom you are applying, 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. Has the family member for whom you are filing, 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 2 – Part D, Question 9	9. Has the family member for whom you are applying 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. Has the family member for whom you are filing 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 2 – Part D, Question 10	10. Has the family member for whom you are applying ever been deported from the United States, or removed from the United States at government expense, excluded within the past year, or is he or she now in exclusion or deportation proceedings?	10. a. Are removal, exclusion, rescission, or deportation proceedings pending against the family member for whom you are filing? b. Have removal, exclusion, rescission, or deportation proceedings EVER been initiated against the family member for whom you are filing? c. Has the family member for whom you are filing EVER been removed, excluded, or deported from the United States? d. Has the family member for whom you are filing EVER been ordered to be removed, excluded, or deported from the United States? e. Has the family member for whom you are filing EVER been denied a visa or denied admission to the United States? f. Has the family member for whom you are filing EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time?
Page 2 – Part D, Question 11	11. Is the family member for whom you are applying under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of fraudulent documents or has he or she, 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. Has the family member for whom you are filing 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 2 – Part D, Question 12	12. Has the family member for whom you are applying ever left the United States to avoid being drafted into the United States Armed Forces?	12. Has the family member for whom you are filing EVER: a. Served in, been a member of, assisted in, or participated in any military unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla 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 2 – Part D, Question 13	13. Has the family member for whom you are applying 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. Has the family member for whom you are filing EVER been a member of, assisted in, or participated in any group, unit, or organization of any kind in which he or she or any other persons used any type of weapon against any person or threatened to do so?
Page 2 – Part D, Question 14	14. Is the family member for whom you are applying now withholding custody of a U.S. citizen child outside the United States. from a person granted custody of the child?	14. Has the family member for whom you are filing EVER assisted or participated in selling or providing weapons to any person who to his or her knowledge used them against another person, or in transporting weapons to any person who to his or her knowledge used them against another person?
Page 2 – Part D, Question 15	15. Does the family member for whom you are applying plan to practice polygamy in the United States?	15. Has the family member for whom you are filing EVER received any type of military, paramilitary, or weapons training?
New – Part D, Question 16		16. Is the family member for whom you are filing 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. Has the family member for whom you are filing 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. Has the family member for whom you are filing EVER left the United States to avoid being drafted into the U.S. Armed Forces?
New – Part D, Question 19		19. Has the family member for whom you are filing 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. Has the family member for whom you are filing 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. Does the family member for whom you are filing plan to practice polygamy in the United States?
New – Part D, Question 22		22. Did the family member for whom you are filing enter the United States as a stowaway?
New – Part D, Question 23		23. a. Does the family member for whom you are filing have a communicable disease of public health significance? b. Does the family member for whom you are filing have or has he or she 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 himself or herself or others? c. Is the family member for whom you are filing now or ever been a drug abuser or drug addict?
Page 3 - Part E	Part E. Attestation and Release. The Derivative Applicant, the family member for whom you are applying, must sign below if he or she is presently in the United States. If someone helped you prepare this supplementary application, he or she must complete Part F. I have read, or had read to me, this form, the information provided on it, and the evidence provided with it, and certify, under penalty of perjury under the laws of the United States of America, that the information on this supplementary application and the evidence submitted with it are true and correct. I authorize the release of any information from the record that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking for the family member for whom I am applying, 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 Derivative Applicant (The family member for whom you are applying.) Date (mm/dd/yyyy) Signature of Principal (Sign your name within the brackets) Date (mm/dd/yyyy)	Part E. Attestation, Release, and Signature After reading the information regarding penalties in the instructions, you, the principal must sign below. Your family member for whom you are applying must also sign below if he or she is presently in the United States. If someone helped you prepare this supplementary application, he or she must complete Part F. I have read, or had read to me, this form, the information provided on it and the evidence provided with it. 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 for the family member for whom I am applying, 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). Principal Applicant’s Statement and Signature (Choose one of the following): [ ] 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. Principal Applicant’s Signature (you) Date (mm/dd/yyyy) Signature of Derivative (your family member if physically present in the United States) Date (mm/dd/yyyy)
Page 3 – Part F	Part F. Preparer and/or Translator Certification. To be completed and signed if this 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 F. Preparer and/or Interpreter Certification and Signature To be completed and signed if form is prepared by a person other than the applicant. Preparer’s Statement and Signature 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 the 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)
Delete - Page 4 – Part G		Delete entire Part G

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