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I-918, Petition for
U Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services
START HERE - Please type or print in black ink.
Part 1.
For USCIS Use Only.
Receipt
Returned
Information about you. (Person filing this petition as a victim)
Family Name
Given Name
Date
Middle Name
Date
Resubmitted
Other Names Use (Include maiden name/nickname)
Date
Apt. #
Home Address - Street Number and Name
State/Province
City
OMB No. 1615-XXXX; Expires 00/00/00
Date
Zip/Postal Code
Apt. #
Safe Mailing Address (if other than above) - Street Number and Name
Date
Reloc Sent
Date
Reloc Rec'd
Date
Date
C/O (in care of):
U.S. Embassy/Consulate:
City
State/Province
Validity Dates
Zip/Postal Code
From:
To:
Home Telephone #
(with area code)
Safe Daytime Phone #
(with area code)
E-Mail Address
(optional)
A # (if any)
U.S. Social Security # (if any)
Gender
Male
Marital Status
Single
Married
Date of Birth (mm/dd/yyyy)
Divorced
Remarks
Widowed
Female
Conditional Approval
Stamp #:
Date
Action Block
Country of Birth
Country of Citizenship
Passport #
Place of Issuance
Date of Issue (mm/dd/yyyy)
Place of Last Entry
Date of Last Entry (mm/dd/yyyy)
I-94 # (Arrival/Departure Document)
Current Immigration Status
To Be Completed by
Attorney or Representative, if any.
Fill in box if G-28 is attached to
represent the applicant.
ATTY State License #
Form I-918 (06/19/07) N
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Part 2. Additional information.
Answers to the questions below require explanations and supporting documentation. Attach relevant documents in support of your
claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA), section 101(a)(15)(U). You must
also attach a personal narrative statement describing the criminal activity of which you were the victim. If you are only petitioning for
U derivative status for a qualifying family member(s) subsequent to your (the principal petitioner) initial filing, evidence supporting
the original petition is not required to be submitted with the new Form I-918.
Attach additional sheets of paper as needed. Write your name and Alien Registration Number (A #), if any, at the top of each sheet
and indicate the number of the item that refers to your answer. Include the Part and letter or number relating to the additional
information you provided (example: Part 2, Z).
Check either "Yes" or "No" as appropriate to each of the following questions.
1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U).
Yes
No
2. I have suffered substantial physical or mental abuse as a result of having been a victim of this
criminal activity.
Yes
No
3. I possess information concerning the criminal activity of which I was a victim.
Yes
No
4. I am submitting a certification from a certifying official on Form I-918 Supplement B,
U Nonimmigrant Status Certification.
Yes
No
5. The crime of which I am a victim occurred in the United States including Indian country
and military installations) or violated the laws of the United States.
Yes
No
6. I am under the age of 16 years.
Yes
No
7. I want an Employment Authorization Document.
Yes
No
8. Have you 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)
Recission Date
(mm/dd/yyyy)
Judicial Date
(mm/dd/yyyy)
9. List each date, place of entry and status under which you entered the United States during the five years preceding the filing of this
petition.
Date of Entry (mm/dd/yyyy)
Place of Entry
Status at Entry
Form I-918 (06/19/07) N Page 2
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Part 2. Additional information.
(Continued.)
10. If you are outside the United States, give the U.S. consulate or inspection facility you want notified if this petition is approved.
Type of Office (Check one):
Consulate
Pre-flight inspection
Office Address (City)
Port of Entry
U.S. State or Foreign Country
Apt. #
Safe Foreign Address Where You Want Notification Sent - Street Number and Name
State/Province
City
Country
Zip/Postal Code
Part 3. Processing information.
Please answer the following questions about yourself. For the purposes of this petition, you must answer “Yes” to the following
questions, if applicable, 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. (Answering “Yes” does not necessarily mean that you will be denied U
nonimmigrant status.)
1. Have you EVER:
a.
Committed a crime or offense for which you have not been arrested?
Yes
No
b. Been arrested, cited or detained by any law enforcement officer (including DHS, former INS
and military officers) for any reason?
Yes
No
c.
Yes
No
Yes
No
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)?
Yes
No
f.
Received a suspended sentence, been placed on probation or been paroled?
Yes
No
g.
Been in jail or prison?
Yes
No
h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or
similar action?
Yes
No
i.
Yes
No
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.)
Form I-918 (06/19/07) N Page 3
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Part 3. Processing information.
(Continued.)
2. Have you ever received public assistance in the United States from any source, including the U.S.
government or any State, county, city or other municipality (other than emergency medical
treatment), or are you likely to receive public assistance in the future?
3.
Yes
No
Yes
No
Yes
No
Ever knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the
United States illegally?
Yes
No
d. Ever illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded
in the illicit trafficking of any controlled substance?
Yes
No
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.
4. Have you ever committed, planned or prepared, participated in, threatened to, attempted to, or conspired to commit, gathered
information for, solicited funds for any of the following:
a.
Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle?
Yes
No
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?
Yes
No
c.
Yes
No
Yes
No
Yes
No
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, 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?
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?
Yes
No
Yes
No
Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle?
Yes
No
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?
Yes
No
Assassination?
Yes
No
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?
Yes
No
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:
Form I-918 (06/19/07) N Page 4
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Part 3. Processing information.
(Continued.)
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?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
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?
Yes
No
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?
Yes
No
Soliciting money or members or otherwise providing material support to a terrorist
organization?
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, or the 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?
9. Have you EVER ordered, committed, assisted, helped with, or otherwise participated in any act that involved:
a.
Torture or genocide?
Yes
No
Yes
No
Displacing or moving any persons from their residence by force, threat of force, compulsion, or
duress?
Yes
No
d. Engaging in any kind of sexual contact or relations with any person who was being subjected to
force, threat of force, compulsion, or duress?
Yes
No
e.
Limiting or denying any person's ability to exercise religious beliefs?
Yes
No
f.
The persecution of any person because of race, religion, national origin, membership in a
particular social group, or political opinion?
Yes
No
Yes
No
b. Killing, beating, or injuring any person?
c.
If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper.
10. Have you EVER advocated that another person commit any of the acts described in the preceding
question, urged, or encouraged another person, to commit such acts? (If you answer “Yes,”
describe the circumstances on a separate sheet(s) of paper.)
Form I-918 (06/19/07) N Page 5
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Part 5. Processing information.
(Continued.)
11. Have you EVER been present or nearby when any person was:
a.
Intentionally killed, tortured, beaten, or injured?
Yes
No
b. Displaced or moved from his or her residence by force, compulsion or duress?
Yes
No
c.
Yes
No
In any way compelled or forced to engage in any kind of sexual contact or relations?
If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper.
12. Have you (or has any member of your family) EVER served in, been a member of, or been involved in any way with:
a.
Any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group,
guerrilla group, or insurgent organization?
Yes
No
Yes
No
Yes
No
13. Have your EVER received any type of military, paramilitary or weapons training? (If you answer
“Yes,” please describe the circumstances on a separate sheet(s) of paper.)
Yes
No
14. a.
Yes
No
b. Have removal, exclusion, rescission or deportation proceedings EVER been initiated against you?
Yes
No
c.
Yes
No
Yes
No
b. Any prison, jail, prison camp, detention camp, labor camp, or any other situation that involved
guarding prisoners?
c.
Any group, unit, or organization of any kind in which you or other persons possessed,
transported, or used any type of weapon?
If you answer “Yes,” please describe the circumstances on a separate sheet(s) of paper.
Are removal, exclusion, rescission or deportation proceedings pending against you?
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 seperate sheet of paper.)
Yes
No
f.
Have you EVER been granted voluntary departure by an immigration officer or an immigration
judge and failed to depart within the allotted time?
Yes
No
15. Are you under a final order or civil penality for violating section 274C (producing and/or using
false documentation to unlawfully satisfy a requirement of the Immigration and Nationality Act)?
Yes
No
16. 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?
Yes
No
17. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?
Yes
No
Form I-918 (06/19/07) N Page 6
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Part 3. Processing information.
(Continued.)
18. 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?
Yes
No
19. Have you ever detained, retained, or withheld the custody of a child, having a lawful claim to
United States citizenship, outside the United States from a United States citizen granted custody?
Yes
No
20. Do you plan to practice polygamy in the United States?
Yes
No
21. Have you entered the United States as a stowaway?
Yes
No
22. a.
Yes
No
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?
Yes
No
c.
Yes
No
Do you have a communicable disease of public health significance?
Are you now or have you been a drug abuser or drug addict?
Part 4. Information about spouse and/or children.
1.
Spouse
Family Name
Given Name
Date of Birth (mm/dd/yyyy) Country of Birth
2.
(Continued.)
Middle Name
Relationship
Current Location
Children
Family Name
Given Name
Date of Birth (mm/dd/yyyy) Country of Birth
Family Name
Middle Name
Relationship
Given Name
Date of Birth (mm/dd/yyyy) Country of Birth
Current Location
Middle Name
Relationship
Current Location
(If more space is needed, attach additional sheet(s) of paper.)
Form I-918 (06/19/07) N Page 7
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Part 5.
Filing on behalf of family members.
I am now petitioning for one or more qualifying family member(s). (If "Yes," complete and include
Form I-918, Supplement A and Supplement B, for each family member for whom you are petitioning.)
Yes
No
Part 6. Attestation, release and signature. (Read information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this petition is all
true and correct. I certify also that I have not withheld any information that would affect the outcome of this petition.
Date (mm/dd/yyyy)
Signature
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found
eligible for the benefit sought and this petition will be denied.
Part 7. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this petition 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 petition.
Attorney or Representative: In the event of a Request for Evidence, may USCIS contact you by Fax or E-Mail?
Preparer's Signature
Yes
No
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)
)
Form I-918 (06/19/07) N Page 8
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OMB No. 1615-XXXX: Expires00/00/0000
I-918 Supplement A, Petition for
Qualifying Family Member of U-1 Recipient
Department of Homeland Security
U.S. Citizenship and Immigration Services
START HERE - Please type or print in black ink.
For USCIS Use Only.
(The recipient of the U-1 nonimmigrant classification is referred to as the "principal."
Receipt
Returned
His or her family member(s) is referred to as a "derivative." Form I-918, Supplement A is
to be completed by the principal.)
Date
Part 1.
Family member(s) relationship to you (the principal).
The family member that I am filing for is my:
Spouse
Child
Parent
Unmarried sibling under 18 years of age
Part 2.
Date
Information about you.
Family Name
Date
Resubmitted
Given Name
Middle Name
Date
Reloc Sent
Date
Date of Birth (mm/dd/yyyy)
A # (if any)
Date
Reloc Rec'd
Status of your Form I-918, Petition for U Nonimmigrant Status.
Pending
Part 3.
Date
Approved
Information about your family member (the derivative).
Family Name
Given Name
Middle Name
Date
U.S. Embassy/Consulate:
Validity Dates
From:
Other Names Used (Include maiden name/nickname)
To:
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Residence or Intended Residence in the U.S. - Street Number and Name
City
State/Province
Apt. #
Zip/Postal Code
Safe Mailing Address (if other than above) - Street Number and Name
Remarks
Apt. #
Conditional Approval
Stamp #:
Date
Action Block
C/O (in care of):
State/Province
City
A # (if any)
Zip/Postal Code
U.S. Social Security # (if any)
Home Phone # (with area code)
Marital Status
I-94 # (if any)
Safe Daytime Phone # (with area code)
Gender
Single
Married
Male
Divorced
Widowed
Female
To Be Completed by
Attorney or Representative, if any.
Fill in box if G-28 is attached to
represent the applicant.
ATTY State License #
Form I-918 Supplement A (06/19/07) N
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Part 4. Additional information about your family member.
1. Give the following information about your family member if he or she is currently in the United States.
Date of Last Entry
Place of Last Entry
Current Immigration Status
Passport #
Date of Issue (mm/dd/yyyy)
Place of Issuance
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 relative 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.
Date Mariage Ended
(mm/dd/yyyy)
Name of Former Spouse(s)
Where and How Marriage Ended
4. If your relative is outside the United States give the U.S. consulate or inspection facility you want notified if this petition is
approved.
Type of Office (Check one):
Office Address (City)
Consulate
Pre-flight inspection
Port of Entry
U.S. State or Foreign Country
Foreign Address Where You Want Notification Sent.
5. Has your family member ever been in immigration proceedings?
If "Yes," what type of proceedings? (Check all that apply.)
Removal Date
(mm/dd/yyyy)
Exclusion Date
(mm/dd/yyyy)
No
Yes
Deportation Date
(mm/dd/yyyy)
Recission Date
(mm/dd/yyyy)
Judicial Date
(mm/dd/yyyy)
6. Is your family member requesting an Employment Authorization Document? (If "Yes,"
No
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 an I-765 for a family member living outside the United States.
7. List your family member's spouse and children. (Attach additional sheet(s) of paper if necessary.)
Full Name
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
Form I-918 Supplement A (06/19/07) N Page 2
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Part 4. Additional information about your family member. (Continued.)
Please answer the following questions about your family member. For the purposes of this petition, you must answer “Yes” to the
following questions, if applicable, 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. (Answering “Yes” does not necessarily
mean that your family member will be denied U nonimmigrant status.)
8. 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?
Yes
No
b. Been arrested, cited, or detained by any law enforcement officer (including DHS (former INS)
and military officers) for any reason?
Yes
No
c.
Yes
No
Yes
No
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)?
Yes
No
f.
Received a suspended sentence, been placed on probation, or been paroled?
Yes
No
g.
Been in jail or prison?
Yes
No
h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar
action?
Yes
No
i.
Yes
No
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(s) 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 or disposition.
(e.g., no charges filed, charges
dismissed, jail, probation, etc.)
9. Has the family member for whom you are filing ever received public assistance in the United States
from any source, including the U.S. government or any State, county, city or other municipality
(other than emergency medical treatment), or is he or she likely to receive public assistance in the
future?
Yes
No
Form I-918 Supplement A (06/13/07) N Page 3 9
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Part 4. Additional information about your family member. (Continued.)
10. 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?
Yes
No
Yes
No
c.
Ever knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the
United States illegally?
Yes
No
d.
Ever illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded
in the illicit trafficking of any controlled substance?
Yes
No
11. 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, solicited funds for any of the following:
a.
Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle?
Yes
No
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?
Yes
No
c.
Yes
No
Yes
No
Yes
No
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, 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?
12. 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?
Yes
No
Yes
No
1. Highjacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle?
Yes
No
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?
Yes
No
3. Assassination?
Yes
No
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:
Form I-918 Supplement A (06/19/07) N Page 4
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Part 4. Additional information about your family member. (Continued.)
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?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
14. Has the family member for whom you are filing ever been or does her or she continue to be a
member of the Communist or other totalitarian party, except when membership was involuntary?
Yes
No
15. 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?
Yes
No
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?
13. 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, or the 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?
16. Has the family member for whom you are filing EVER ordered, committed, assisted, helped with, or otherwise participated in
any act that involved:
a.
Torture or genocide?
Yes
No
Yes
No
Displacing or moving any persons from their residence by force, threat of force, compulsion, or
duress?
Yes
No
d. Engaging in any kind of sexual contact or relations with any person who was being subjected to
force, threat of force, compulsion, or duress?
Yes
No
e.
Limiting or denying any person's ability to exercise religious beliefs?
Yes
No
f.
The persecution of any person because of race, religion, national origin, membership in a
particular social group, or political opinion?
Yes
No
b. Killing, beating, or injuring any person?
c.
If the answer is “Yes,” please describe the circumstances on a separate sheet(s) of paper.
Form I-918 Supplement A (06/19/07) N Page 5
DRAFT - Not For Publication
Part 4. Additional information about your family member. (Continued.)
17. Has the family member for whom you are filing EVER advocated that another person commit any
of the acts described in the preceding question, urged, or encouraged another person, to commit
such acts? (If the answer is “Yes,” describe the circumstances on a separate sheet(s) of paper.)
Yes
No
Yes
No
b. Displaced or moved from his or her residence by force, compulsion or duress?
Yes
No
c.
Yes
No
18. 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?
In any way compelled or forced to engage in any kind of sexual contact or relations?
If the answer is “Yes,” please describe the circumstances on a separate sheet(s) of paper.
19. Has the family member for whom you are filing (or has any member of his or her family) EVER served in, been a member of, or
been involved in any way with:
a.
Any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group,
guerrilla group, or insurgent organization?
Yes
No
Yes
No
Yes
No
Yes
No
Are removal, exclusion, rescission or deportation proceedings pending against the family
member for whom you are filing?
Yes
No
b.
Have removal, exclusion, rescission or deportation proceedings EVER been initiated against
the family member for whom you are filing?
Yes
No
c.
Has the family member for whom you are filing EVER been removed, excluded or deported
from the United States?
Yes
No
Yes
No
b. Any prison, jail, prison camp, detention camp, labor camp, or any other situation that involved
guarding prisoners?
c.
Any group, unit, or organization of any kind in which you or other persons possessed,
transported, or used any type of weapon?
If the answer is “Yes,” please describe the circumstances on a separate sheet(s) of paper.
20. Has the family member for whom you are filing EVER received any type of military, paramilitary or
weapons training? (If the answer ia “Yes,” please describe the circumstances on a separate sheet(s)
of paper.)
21. a.
d. Has the family member for whom you are filing EVER been ordered to be removed, excluded
or deported from the United States?
Form I-918 Supplement A (06/19/07) N Page 6
DRAFT - Not For Publication
Part 4. Additional information about your family member. (Continued.)
e.
Has the family member for whom you are filing EVER been denied a visa or denied admission
to the United States? (If a visa was denied, explain why on a seperate sheet of paper.)
Yes
No
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?
Yes
No
22. Is the family member for whom you are filing under a final order or civil penality for violating
section 274C (producing and/or using false documentation to unlawfully satisfy a requirement of
the Immigration and Nationality Act)?
Yes
No
23. 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?
Yes
No
24. Has the family member for whom you are filing ever left the United States to avoid being drafted
into the U.S. Armed Forces?
Yes
No
25. 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?
Yes
No
26. Has the family member for whom you are filing ever detained, retained, or withheld the custody of
a child, having a lawful claim to United States citizenship, outside the United States from a United
States citizen granted custody?
Yes
No
27. Does the family member for whom you are filing plan to practice polygamy in the United States?
Yes
No
21. Have you entered the United States as a stowaway?
Yes
No
22. a.
Yes
No
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?
Yes
No
c.
Yes
No
Do you have a communicable disease of public health significance?
Are you now or have you been a drug abuser or drug addict?
Form I-918 Supplement A (06/19/07) N Page 7
DRAFT - Not For Publication
Part 5. Attestation, release and signature. (Read information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this petition is all
true and correct. I certify also that I have not withheld any information that would affect the outcome of this petition.
Date (mm/dd/yyyy)
Signature of Principal (you)
Please Note: Your qualifying family member for whom you are filing must sign if he or she is present in the United States.
Signature of Qualifying Family Member if in the United States
Date (mm/dd/yyyy)
WARNING: Petitioners who are in the United States illegally are subject to removal if their claims are not granted. Any information
provided while completing this supplementary petition may be used as a basis for the institution of, or as evidence in, removal
proceedings even if the petition is withdrawn.
Part 6. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this petition 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 petition.
Attorney or Representative: In the event of a Request for Evidence, may USCIS contact you by Fax or E-Mail?
Preparer's Signature
Yes
No
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)
)
Form I-918 Supplement A (06/19/07) N Page 8
DRAFT - Not For Publication
OMB No. 1615-0000; Expires 00/00/00
Instructions for I-918, Supplement B,
U Nonimmigrant Status Certification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the part and number of the item to which the answer refers.
What Is the Purpose of This Form.
You should use Form I-918, Supplement B, to certify that an
individual submitting a Form I-918, Petition for U
Nonimmigrant Status, is a victim of certain qualifying
criminal activity and is, has been, or is likely to be helpful in
the investigation or prosection of that activity.
When Should I Use Form I-918, Supplement B.
If you, the certifying official, determine that this individual
(better known as the petitioner) is, has been, or is likely to be
helpful in your investigation or prosecution, you may
complete this supplement form. The petitioner must then
submit the supplement to USCIS with his or her petition for U
nonimmigrant status.
NOTE: An agency's decision to provide a certification is
entirely discretionary; the agency is under no legal obligation
to complete a Form I-918, Supplement B, for any particular
alien. However, without a completed Form I-918, Supplement
B, the alien will be ineligible for U nonimmigrant status.
To be eligible for U nonimmigrant status, the alien must be a
victim of qualifying criminal activity. The term “victim”
generally means an alien who has suffered direct and
proximate harm as a result of the commission of qualifying
criminal activity.
The alien spouse, unmarried children under 21 years of age
and, if the victim is under 21 years of age, parents and
unmarried siblings under 18 years of age, will be considered
victims of qualifying criminal activity where:
1. The direct victim is deceased due to murder or
manslaughter, or
2. Where a violent qualifying criminal activity has caused the
direct victim physical harm of a kind and degree that makes
the direct victim incompetent or incapacitated, and,
therefore, unable to provide information concerning the
criminal activity or to be helpful in the investigation or
prosecution of the criminal activity.
An alien may be considered a victim of witness tampering,
obstruction of justice, or perjury, including any attempt,
conspiracy, or solicitation to commit one or more of those
offenses if:
1. The victim has been directly and proximately harmed by
the perpetrator of the witness tampering, obstruction of
justice, or perjury; and
2. There are reasonable grounds to conclude that the
perpetrator committed the witness tampering, obstruction
of justice, or perjury offense, at least in principal part, as a
means:
A. To avoid or frustrate efforts to investigate, arrest,
prosecute, or otherwise bring to justice the perpetrator
for other criminal activity; or
B. To further the perpetrator's abuse or exploitation of or
undue control over the petitioner through manipulation
of the legal system.
A person who is culpable for the qualifying criminal activity
being investigated or prosecuted is excluded from being
recognized as a victim.
A victim of qualifying criminal activity must provide evidence
that he or she (or in the case of an alien under the age of 16
years or who is incapacitated or incompetent, the parent,
guardian, or next friend of the alien) has been, is being, or is
likely to be helpful to a certifying official in the investigation
or prosecution of the qualifying criminal activity as listed in
Part 3 of this form. Being “helpful” means assisting law
enforcement authorities in the investigation or prosecution of
the qualifying criminal activity of which he or she is a victim.
General Instructions.
Step 1. Fill Out the Form I-918, Supplement B
1. Type or print legibly in black ink.
2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.
Form I-918, Supplement B, Instructions (Rev. 06/19/07) N
DRAFT - Not For Publication
3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
write "none."
This form is divided into Parts 1 through 7. The following
information should help you fill out the form.
Part 1 - Victim information.
A. Family Name (Last Name) - Give victim's legal name.
B. Given Name (First name) - Give victim's full first
name, do not use "nicknames." (Example: If victim's
name is Albert, do not use Al.)
C. Other Names Used - Provide all the names the victim
has used that you are aware of, including maiden name
if applicable, married names, nicknames, etc.
D. Date of Birth - Use eight numbers to show his or her
date of birth (example: May 1, 1979, should be written
05/01/1979).
E. Gender - Check the appropriate box.
Part 2 - Agency information.
A. Name of certifying agency - The certifying agency
must be a Federal, State, or local law enforcement
agency, prosecutor, or authority, or Federal or State
judge, that has responsibility for the investigation or
prosecution, conviction or sentencing of the qualifying
criminal activity of which the petitioner was a victim.
This includes traditional law enforcement branches
within the criminal justice system, and other agencies
that have criminal investigative jurisdiction in their
respective areas of expertise, such as the child
protective services, Equal Employment Opportunity
Commission, and Department of Labor.
B. Name of certifying official - A certifying official is:
1. The head of the certifying agency or any person in a
supervisory role, who has been specifically
designated by the head of the certifying agency to
issue a U Nonimmigrant Status Certification on
behalf of that agency; or
2. A Federal, state or local judge.
If the certification is not signed by the head of the
certifying agency, please attach evidence of the agency
head's written designation of the certifying official for
this specific purpose.
C. Agency address - Give the agency's mailing address.
Part 3 - Criminal acts.
A. Check all of the crimes of which the petitioner is a
victim that your agency is investigating,
prosecuting, or sentencing - If the crime(s) of which
the petitioner is a victim is not listed, please list the
crime(s) and provide a written explanation regarding
how it is similar to one of the listed crimes. Similar
activity refers to criminal offenses in which the nature
and elements of the offenses are substantially similar to
the list of criminal activity found on the certification
form itself.
B. Indicate whether the qualifying criminal activity
violated the laws of the United States or occurred
within the United States (including in Indian
country and military installations) or the
territories and possessions of the United States Qualifying criminal activity of which the applicant is a
victim had to violate U.S. law or occur within the
United States.
Please indicate whether the qualifying criminal activity
occurred within the United States (including in Indian
country and military installations) or the territories and
possessions of the United States.
1. United States means the continental United States,
Alaska, Hawaii, Puerto Rico, Guam, and the U.S.
Virgin Islands.
2. Indian country refers to all land within the limits
of any Indian reservation under the jurisdiction of
the United States Government, notwithstanding the
issuance of any patent, and including rights-of-way
running through the reservation; all dependent
Indian communities within the borders of the United
States whether within the original or subsequently
acquired territory thereof, and whether within or
without the limits of a state; and all Indian
allotments, the Indian titles to which have not been
extinguished, including rights-of-way running
through such allotments.
3. Military installation means any facility, base,
camp, post, encampment, station, yard, center, port,
aircraft, vehicle, or vessel under the jurisdiction of
the Department of Defense, including any leased
facility, or any other location under military control.
Form I-918, Supplement B, Instructions (Rev. 06/19/07) N Page 2
DRAFT - Not For Publication
4. Territories and possessions of the United States
means American Samoa, Bajo Nuevo (the Petrel
Islands), Baker Island, Howland Island, Jarvis
Island, Johnston Atoll, Kingman Reef, Midway
Atoll, Navassa Island, Northern Mariana Islands,
Palmyra Atoll, Serranilla Bank, and Wake Atoll.
If the qualifying criminal activity did not occur within
the United States as discussed above, but was in
violation of U.S. law, it must violate a Federal
extraterritorial jurisdiction statute. There is no
requirement that a prosecution actually occur. Please
provide the statutory citation for the extraterritorial
jurisdiction.
Part 4 - Helpfulness of the victim.
A. Indicate whether the victim possesses information
about the crime(s). A petitioner must be in possession
of information about the qualifying criminal activity of
which he or she is a victim. A petitioner is considered
to possess information concerning qualifying criminal
activity of which he or she is a victim if he or she has
knowledge of details concerning that criminal activity
that would assist in the investigation or prosecution of
the criminal activity. Victims with information about a
cime of which they are not the victim will not be
considered to possess information concerning
qualifying criminal activities.
When the victim is under 16 years of age, incapacitated
or incompetent, he or she is not required to personally
possess information regarding the qualifying criminal
activity. The parent, guardian, or "next friend" of the
minor petitioner may provide that information. "Next
friend" is a person who appears in a lawsuit to act for
the benefit of an alien victim. The "next friend" is not
a party to the legal proceeding and is not appointed as a
guardian.
B. Provide an explanation of the victim's helpfulness to
the investigation or prosecution of the criminal
activity. A victim must provide evidence to USCIS
that he or she (or, in the case of an alien child under the
age of 16 or who is incapacitated or incompetent, the
parent, guardian, or next friend of the alien) has been,
is being, or is likely to be helpful to a certifying law
enforcement official in the investigation or prosecution
of the qualifying criminal activity.
Being “helpful” means assisting law enforcement
authorities in the investigation or prosecution of the
qualifying criminal activity of which he or she is a
victim. Alien victims who, after initiating cooperation,
refuse to provide continuing assistance when needed
will not meet the helpfulness requirement. There is an
ongoing responsibility on the part of the victim to be
helpful, assuming there is an ongoing need for the
victim's assistance.
You, the certifying official, will make the initial
determination as to the helpfulness of the petitioner.
USCIS will give a properly executed Supplement B, U
Nonimmigrant Status Certification significant weight,
but it will not be considered conclusory evidence that
the victim has met the eligibility requirements. USCIS
will look at the totality of the circumstances
surrounding the alien's involvement with your agency
and all other information known to USCIS in
determining whether the alien meets the elements of
eligibility.
Part 5 - Family members implicated in criminal activity.
List whether any of the victim's family members are
believed to have been involved in the criminal
activity of which he or she is a victim. An alien victim is
prohibited from petitioning for derivative U nonimmigrant
status on behalf of a qualifying family member who
committed battery or extreme cruelty or trafficking against
the alien victim which established his or her eligibility for
U nonimmigrant status. Therefore, USCIS will not grant
an immigration benefit to a qualifying family member who
committed qualifying criminal activities in a family
violence of trafficking context.
Part 6 - Certification.
Please read the certification block carefully. NOTE: If
the victim unreasonably refuses to assist in the
investigation or prosecution of the qualifying criminal
activity of which he or she is a victim, even after this
form is submitted to USCIS, you must notify USCIS by
sending a written statement to: USCIS - Vermont
Service Center, 75 Lower Welden Street, St. Albans, VT
05479-0001. Please include the victim's name, date of
birth, and A-number (if available) on all
correspondence.
Form I-918, Supplement B, Instructions (Rev. 06/19/07) N Page 3
DRAFT - Not For Publication
I-918 Supplement B,
U Nonimmigrant Status Certification
Department of Homeland Security
U.S. Citizenship and Immigration Services
START HERE - Please type or print in black ink.
Part 1.
For USCIS Use Only.
Receipt
Returned
Victim information.
Family Name
Given Name
Middle Name
Date of Birth (mm/dd/yyyy)
Date
Gender
Female
Male
Agency information.
Name of Certifying Agency
Date
Reloc Sent
Date
Name of Certifying Official
Title and Division/Office of Certifying Official
Date
Reloc Rec'd
Date
Name of Head of Certifying Agency
Suite #
Agency Address - Street Number and Name
City
Date
Date
Resubmitted
Other Names Use (Include maiden name/nickname)
Part 2.
OMB No. 1615-XXXX: Expires 00/00/0000
State/Province
Daytime Phone # (with area code and/or extension)
Date
Remarks
Zip/Postal Code
Fax # (with area code)
Agency Type
Federal
State
Local
Case Status
On-going
Completed
Other
Certifying Agency Category
Judge
Law Enforcement
Case Number
Prosecutor
Other
FBI # or SID # (if applicable)
Part 3. Criminal acts.
1. The applicant is a victim of criminal activity involving or similar to violations of one of the following Federal, State or local
criminal offenses. (Check all that apply.)
Abduction
Female Genital Mutilation
Obstruction of Justice
Slave Trade
Abusive Sexual Contact
Hostage
Peonage
Torture
Blackmail
Incest
Perjury
Trafficking
Domestic Violence
Involuntary Servitude
Prostitution
Unlawful Criminal Restraint
Extortion
Kidnapping
Rape
Witness Tampering
False Imprisonment
Manslaughter
Sexual Assault
Related Crime(s)
Felonious Assault
Murder
Sexual Exploitation
Atempt to commit any of
the named crimes
Conspiracy to commit any
of the named crimes
Solicitation to commit any
of the named crimes
Other: (If more space needed,
attach seperate sheet of paper.)
Form I-918 Supplement B (06/19/07) N
DRAFT - Not For Publication
Part 3. Criminal acts.
(Continued.)
2. Provide the date(s) on which the criminal activity occurred.
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
3. List the statutory citation(s) for the criminal activity being investigated or prosecuted, or that was investigated or prosecuted.
4. Did the criminal activity occur in the United States, including Indian country and military installations,
or the territories or possessions of the United States?
a. Did the criminal activity violate a Federal extraterritorial jurisdiction statute?
Yes
No
Yes
No
b. If "Yes," provide the statutory citation providing the authority for extraterritorial jurisdiction.
c. Where did the criminal activity occur?
5. Briefly describe the criminal activity being investigated and/or prosecuted and the involvement of the individual named in Part 1.
Attach copies of all relevant reports and findings.
6. Provide a description of any known or documented injury to the victim. Attach copies of all relevant reports and findings.
Part 4. Helpfulness of the victim.
The victim (or parent, guardian or next friend, if the victim is under the age of 16, incompetent or incapacitated.):
1. Possesses information concerning the criminal activity listed in Part 3.
Yes
No
2. Has been, is being or is likely to be helpful in the investigation and/or prosecution of the
criminal activity detailed above. (Attach an explanation briefly detailing the assistance the
victim has provided.)
Yes
No
3. Has not been requested to provide further assistance in the investigation and/or presecution.
(Example: prosecution is barred by the statute of limitation.) (Attach an explanation.)
Yes
No
4. Has unreasonably refused to provide assistance in a criminal investigation and/or prosecution
of the crime detailed above. (Attach an explanation.)
Yes
No
Form I-918 Supplement B (06/19/07) N Page 2
DRAFT - Not For Publication
Part 4. Helpfulness of the victim.
(Continued.)
5. Other, please specify.
Part 5. Family members implicated in criminal activity.
1. Are any of the victim's family members believed to have been involved in the criminal activity of
which he or she is a victim?
Yes
No
2. If "Yes," list relative(s) and criminal involvement. (Attach extra reports or extra sheet(s) of paper if necessary.)
Full Name
Relationship
Involvement
Part 6. Certification.
I am the head of the agency listed in Part 2 or I am the person in the agency who has been specifically designated by the head of the
agency to issue U nonimmigrant status certification on behalf of the agency. Based upon investigation of the facts, I certify, under
penalty of perjury, that the individual noted in Part 1 is or has been a victim of one or more of the crimes listed in Part 3. I certify
that the above information is true and correct to the best of my knowledge, and that I have made, and will make no promises regarding
the above victim's ability to obtain a visa from the U.S. Citizenship and Immigration Services, based upon this certification. I further
certify that if the victim unreasonably refuses to assist in the investigation or prosecution of the qualifying criminal activity of which
he/she is a victim, I will notify USCIS.
Signature of Certifying Official Identified in Part 2.
Date (mm/dd/yyyy)
Form I-918 Supplement B (06/19/07) N Page 3
| File Type | application/pdf |
| File Modified | 2007-06-19 |
| File Created | 2007-06-19 |