Table of Changes (form)

TOC - FORM

Form I-821D, Consideration of Deferred Action for Childhood Arrivals

2/20/2013

Reason for Revision

• Provide more detailed information to help Deferred Action for Childhood Arrival requestors

Location	Current Text	Proposed Revised Text
Bottom of each page		Addition of 2D barcode - 2D bar code capability has been added to the bottom of each page so that if the form is filled out electronically, data will be captured and transferred to USCIS systems more expediently, and processing times for the public will be decreased.
Page 1, Start Here	[Page 1] START HERE – Type or print in black ink.	[Page 1] START HERE – Type or print in black ink. Read the instructions for information on how to complete this form.
Page 1, Part 1. Information About You	[Page 1] I am requesting consideration of deferred action for childhood arrivals and I have included Form I-765, Application for Employment Authorization, and Form I-765WS, Form I-765 Worksheet.	[Page 1] I am not in immigration detention and I am requesting consideration of deferred action for childhood arrivals and I have included Form I-765, Application for Employment Authorization, and Form I-765WS, Form I-765 Worksheet.
Page 1-2, Part 1. Information About You	[Page 1] …Mailing Address [sub-heading] …Removal Proceedings Information [sub-heading] 3.a. Are you now or have you ever been in removal proceedings? If you answered "Yes" to the above question, you must check a box below indicating your current status or outcome of your removal proceedings. 3.b. Type of proceedings: a. Currently in Proceedings b. Administratively Closed c. Terminated d. Subject to a Final Order 3.c. Date and Location of Proceedings [Page 2] … Other Information [sub-heading] 9. Country of Residence … U.S. Entry Information[sub-heading] …15. Status at Entry (e.g., B2, F1, J1, No Lawful Status, etc.) …16.b. List your I-94 number (if applicable) … Education Information [sub-heading] 18. Current Education Status (e.g., In School, General Educational Development, High School Graduate) 19. Name, City, and State of School Currently Attending or Where Education Received 20. Date of Last Attendance, Graduation, Receipt of General Educational Development Certificate, and/or Completion Certificate (mm/dd/yyyy)	[Page 1] U.S. Mailing Address (Enter the same address on Form I-765) [sub-heading] …Removal Proceedings Information [sub-heading] 3.a. Are you now or have you ever been in removal proceedings (which includes exclusion or deportation proceedings initiated before April 1, 1997, an INA section 240 removal proceeding, expedited removal, reinstatement of removal, an INA section 217 removal after admission under the Visa Waiver Program, or removal as a criminal alien under INA section 238), or do you have a removal order issued in any other context (for example, at the border or within the United States by an immigration agent)? If you answered “Yes” to the above question, you must check a box below indicating your current status or outcome of your removal proceedings. 3.b. Status or outcome: 1. Currently in Proceedings (Active) 2. Currently in Proceedings (Administratively Closed) 3. Terminated 4. Subject to a Final Order 3.c. Most Recent Date of Proceedings (mm/dd/yyyy) 3.d. Location of Proceedings [Page 2] … Other Information [sub-heading] 9. Current Country of Residence … U.S. Entry and Status Information [sub-heading] …15. Status on June 15, 2012. (e.g., No Lawful Status, Status Expired, Parole Expired) …16.b. If you answered “Yes”, provide your I-94 number (if applicable) … Education Information [sub-heading] 18. Education Status (e.g., High School Graduate, Recipient of GED, or Currently in School) 19. Name, City, and State of School Currently Attending or Where Education Received 20. Date of Graduation (e.g., Receipt of a Certificate of Completion, GED Certificate, or other equivalent State-authorized exam) or, if Currently in School, Date of Last Attendance
Page 3, Part 2. Arrival/Residence Information	1.a. I arrived in the United States on or before June 15, 2007.  Yes  No 1.b. I have been continuously residing in the United States since at least June 15, 2007.  Yes  No NOTE: If you answer “No” to Item Numbers 1.a. or 1.b., use Part 7., Additional Information, to include a full explanation.	1.a. I initially arrived and established residence in the U.S. prior to the age of 16.  Yes  No 1.b. I have been continuously residing in the U.S. since at least June 15, 2007 up the present time..  Yes  No NOTE: If you departed the United States for some period of time before your 16th birthday and returned to the United States on or after your 16th birthday to begin your current period of continuous residence, submit evidence that you established residence in the United States prior to age 16 as set forth in the instructions of this form.
Page 4, Part 3. Criminal, National Security and Public Safety Information	If any of the following questions apply to you, use Part 7., Additional Information, to describe the circumstances and include a full explanation. 1. Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? Do not include minor traffic violations that only resulted in a fine, unless it was alcohol- or drug-related.  Yes  No If you answered “Yes” you must also include copies of all arrest records, charging documents, dispositions (outcomes), sentencing records, etc. 2. Have you ever been arrested for, charged with, or convicted of a crime in any country other than the United States?  Yes  No If you answered “Yes” you must also include copies of all arrest records, charging documents, dispositions (outcomes), sentencing records, etc.	If any of the following questions apply to you, use Part 7., Additional Information, to describe the circumstances and include a full explanation. 1. Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? Do not include minor traffic violations unless they were alcohol- or drugs-related. Do include incidents handled in juvenile court.  Yes  No If you answered “Yes” you must include a certified court disposition, arrest record, charging document, sentencing record, etc., for each arrest, unless disclosure is prohibited under state law. 2. Have you ever been arrested for, charged with, or convicted of a crime in any country other than the United States?  Yes  No If you answered “Yes” you must include a certified court disposition, arrest record, charging document, sentencing record, etc., for each arrest.
Page 4, Part 4. Signature of Requestor	… Requestor's Certification …3. Daytime Phone Number	[Page 4] …3. Daytime Phone Number 4. Did someone help you prepare this request? (You must answer Yes or No.) If yes, complete Part 5., Signature of Person Preparing This Request, If Other Than the Requestor.
Page 5, Part 5. Signature of Person Preparing This Request, If Other Than the Requestor	NOTE: If you are an attorney or representative, you must submit a completed Form G-28, Notice of Entry or Appearance as Attorney or Accredited Representative, along with this request.	Part 5. Signature and Contact Information of Person Preparing This Request, If Other Than the Requestor [Deleted]
Pag5 5, Preparer’s Declaration	Preparer's Declaration To be completed by all preparers, including attorneys and authorized representatives. I declare that I prepared this FormI-821D at the requestor's behest, that it is based on all the information of which I have knowledge, and that the information is true to the best of my knowledge. 6.a. Signature of Preparer 6.b. Date of Signature	Preparer's Declaration To be completed by all preparers, including attorneys and authorized representatives. I declare that I prepared this Form I-821D at the requestor’s behest, and it is based on all the information of which I have knowledge. 6.a. Signature of Preparer 6.b. Date of Signature

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