Application for T Nonimmigrant Status

OMB No. 1615-0099; Expires 05/31/2014
Department of Homeland Security
U.S. Citizenship and Immigration Services

What Is the Purpose of This Form?
You should use Form I-914 to request temporary immigration
benefits if you are a victim of a severe form of trafficking in
persons.

Instructions for Form I-914,
Application for T Nonimmigrant Status
B. If you are over the age of 21, eligible family members for
whom you are filing are your:
1. Spouse; or
2. Unmarried child(ren) under the age of 21.

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Who May File This Form?

Form I-914 should be filed by you, the victim of a severe form
of trafficking in persons, and may include eligible family
members. It can also be used at a later date to file for eligible
family members not included on the original application.
1. Principal Applicant. You must demonstrate all of the
following:
A. You are or have been a victim of a severe form of
trafficking in persons;

B. You are deemed physically present if you meet one of the
criteria below:

C. Regardless of your age at the time of filing, if your family
member faces a present danger of retaliation, as a result
of your escape from the severe form of trafficking in
persons or your cooperation with law enforcement, the
eligible family members for whom you may file are your:
1. Parent(s);
2. Unmarried sibling(s) under the age of 18; or
3. An adult or minor child of your derivative (your child,
your grandchild, your step-child, your niece or
nephew, or your sibling).

General Instructions

1. You are 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 in persons; or

Fill Out Form I-914, Form I-914, Supplement A, and Form
I-914, Supplement B (strongly encouraged).

2. You were allowed entry into the United States to
participate in investigative or judicial processes
associated with an act or a perpetrator of trafficking;

2. If extra space is needed to complete any item, attach a
continuation sheet, write your name and A-Number (if any),
indicate the item number, and date and sign each sheet.

C. You have complied with any reasonable request for
assistance in a Federal, State, or local investigation or
prosecution of acts of trafficking or the investigating of a
crime where the acts of trafficking are at least one central
reason for the commission of that crime, unless:

3. Answer all questions fully and accurately, unless instructed
to leave a part blank. State that an item is not applicable with
"N/A." If the answer is none, write "None."

1. You are under the age of 18; or
2. You are unable to cooperate with a request due to
physical or psychological trauma; and
D. You would suffer extreme hardship involving unusual and
severe harm upon removal.
2. Principal Applicant filing for eligible family member at
the same time, or currently holding T-1 nonimmigrant
status and filing for an eligible family member. You must
also demonstrate that:
A. If you are under the age of 21, eligible family members
for whom you are filing are your:
1. Spouse;
2. Unmarried child(ren) under the age of 21;

1. Type or print legibly in black ink.

Completing Form I-914
You, as the principal applicant, must file Form I-914 for
yourself.
This form is divided into Parts A through G. The following
information will help you fill out the form.
Part A. Purpose for Filing the Application - Check all the
appropriate boxes that apply to why you filed this application.
Part B. General Information About You (person filing this
application as a victim of a severe form of trafficking in
persons).
1. Your Full Name. Provide your legal name, as shown on
your birth certificate or legal name change document. If
you have two last names, include both and use a hyphen (-)
between the names, if appropriate. Write your last, first,
and middle names in each appropriate field.

3. Parent(s); or
4. Unmarried sibling(s) under the age of 18.

2. Other Names Used. Provide all the names you have used,
including maiden name if applicable, married names,
nicknames, etc.

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3. Home Address. Give your physical street address. This
must include a street number and name or a rural route
number. Do not put a post office box (P.O. Box) number
here.

17. Current Immigration Status. Give your current status,
regardless of how you entered the United States (visitor,
student, entry without inspection, etc.).

4. Safe Mailing Address. Give your mailing address, if
different from your home address. If you do not feel secure
in receiving correspondence regarding this application at
your home address, provide a "safe mailing address" in this
space. This address may be a post office box, the address of
a friend, your attorney, a community-based organization
that is helping you, or any other address where you can
safely and punctually receive mail.

Part C. Additional Information
You must answer each question. You must explain relevant
information about your claim. Attach documents in support of
your claim and the specific facts on which you are relying to
support your claim.

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5. Home Telephone Number. Give the phone number with
area code. If you live outside the United States, give the
country and city code.

6. Safe Daytime Telephone Number. If you do not feel
secure in receiving telephone calls regarding this
application at your home telephone number, provide a "safe
telephone number" in this space. This number may be for a
friend, your attorney, a community-based organization that
is helping you, or any other number where you can safely
and punctually receive a call or a message.
7. E-Mail Address. This is optional. If you do not have an email address or feel that your e-mail address is not secure,
write "None."

8. A-Number. This is your USCIS (former INS) file number.
If you do not have an A-Number or do not know it, leave
this blank.
9. U.S. Social Security Number. If you do not have a Social
Security Number, leave this blank.
10. Gender and Marital Status. Check the appropriate box
for each.
11. Date of Birth. Use eight numbers to show your date of
birth (example: May 1, 1979, should be written
(05/01/1979).
12. Country of Birth. Give the name of the country where
you were born. Include the city, state or province, and
country.
13. Country of Citizenship. Give the name of the country
where you are a citizen. This is not necessarily the country
where you were born.

14. Passport. Give the number of the passport used to enter
the United States, if applicable. Give the location where
your passport was issued. Give the date when your passport
was issued.
15. Last Entry Into the United States. Give the date and
place where you last entered the United States, regardless
of whether that entry was legal or illegal.
16. Form I-94, Arrival-Departure Document, Number. If
applicable, give the number on Form I-94 issued at the time
of entry.

Complete Item Number 10 to indicate whether you would like
an Employment Authorization Document (EAD). If your
application is approved, you will be authorized to work. USCIS
will send you an EAD as evidence of your authorization to work
if you indicate "Yes" for Item Number 10. As the principal
applicant you do not need to file a Form I-765, Application for
Employment Authorization Document.

Complete Question 11 to indicate whether you are applying for
one or more eligible family members at this time. See the
section below entitled "Completing Form I-914 Supplement A,
Application for a Family Member T-1 Recipient," for
information on completing an application on behalf of your
eligible family member.
Part D. Processing Information
You must answer each question. If you answer “Yes” to any of
the questions, explain on a separate sheet of paper. Explain if
any of the acts or circumstances relate to your having been a
victim of a severe form of trafficking in persons.

Part E. Information about Your Family Members
Even if you are not applying to bring your family member(s) to
the United States, you must provide the requested information
about your spouse and children, if any.
Part F. Attestation, Release, and Signature
First read the information below regarding penalties. Then you,
the applicant, must sign and date the form. If you do not sign
the form, the application will be returned as incomplete.
Part G. Preparer and/or Interpreter Certification
If you, the applicant, did not fill out Form I-914, the preparer
must also sign, date, and give his or her address.

Completing Form I-914, Supplement A, Application
for Family Member of T-1 Recipient
If you are filing for an eligible family member, you must
complete Form I-914, Supplement A, Application for
Immediate Family Member of T-1 Recipient. Form I-914,
Supplement A, must be submitted for each family member for
whom you are filing.
Form I-914, Supplement A, may be filed concurrently with the
principal applicant's initial Form I-914 or at any time thereafter.
However, any Form I-914, Supplement A, submitted
subsequently must have the appropriate boxes checked in Part
A, and must be accompanied by a copy of the principal
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applicant's Form I-914. Evidence submitted with the original
application, however, need not be resubmitted.
This form is divided into Parts A - G. The following
information should help you fill out the form.
Part A. Family Member Relationship to You (the principal)
Check the appropriate box if you are filing for your spouse,
child(ren), parent(s), or sibling(s) based on your age. This part
can be left blank if you are only applying for your derivative's
adult or minor child (see Part B).

4. Safe Mailing Address. Give his or her mailing address, if
different from his or her intended home address. If he or
she does not feel secure in receiving correspondence
regarding this application at his or her home address,
provide a "safe mailing address" in this space. This address
may be a post office box, the address of a friend, your/his
or her attorney, a community-based organization, or any
other address where he or she can safely and punctually
receive mail.

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Part B. Family Member Relationship to Your Derivative
Check the box if you are filing for the adult or minor child of
your derivative (your child, your grandchild, your step-child,
your niece or nephew, or your sibling) who faces a present
danger of retaliation as a result of your escape from the severe
form of trafficking in persons or your cooperation with law
enforcement.

Part C. General Information About You
1. Your Full Name. Provide your legal name, as shown on
your birth certificate or legal name change document. If
you have two last names, include both and use a hyphen (-)
between the names, if appropriate. Write your last, first,
and middle names in each appropriate field.

2. Date of Birth. Use eight numbers to show your date of birth
(example: May 1, 1979, should be written 05/01/1979).

5. Home Telephone Number. Give the telephone number
with area code where he or she lives and can be reached
during the day.
6. Safe Daytime Telephone Number. If he or she does not
feel secure receiving telephone calls regarding this
application at his or her home, provide a “safe telephone
number” in this space. This number may be for a friend, his
or her attorney, a community-based organization, or any
other number where he or she can safely and punctually
receive a call or a message.
7. E-Mail Address. This is optional. If you do not have an
e-mail address or feel that your e-mail address is not
secure, write "None."
8. A-Number. This is his or her USCIS (former INS) file
number. If he or she does not have an A-Number or you do
not know it, leave this blank.
9. U.S. Social Security Number. If he or she does not have a
U.S. Social Security Number, leave this blank.

3. A-Number. This is your USCIS (former INS) file number.
If you do not have an A-Number or do not know it, leave this
blank.

10. Gender and Marital Status. Check the appropriate box
for each.

4. Status of your Form I-914, Application for T
Nonimmigrant Status. Check the appropriate box.

11. Date of Birth. Use eight numbers to show his or her date
of birth (example: May 1, 1979, should be written
05/01/1979).

Part D. Information About Your Family Member (the
derivative)

12. Country of Birth. Give the name of the country where he
or she was born. Include the city, state or province, and
country.

1. Full Name. Provide the name of the family member, as
shown on his or her birth certificate or legal change of name
document. If the person has two last names, include both and
use a hyphen (-) between the names, if appropriate. Write the
person's last, first, and middle names in each appropriate
field.
2. Other Names Used. Provide all the names he or she has
used, including maiden name, if applicable, married names,
nicknames, etc.
3. Residence or Intended Address in the United States.
Give his or her intended physical street address. This must
include a street number and name or a rural route number.
Do not put a post office box (P.O. Box) number here.

13. Country of Citizenship. Give the name of the country
where he or she is a citizen. This is not necessarily the
country where he or she was born.
14. Passport. Give the number of the passport used to enter
the United States, if applicable. Give the location where his
or her passport was issued. Give the date when his or her
passport was issued.
15. Last Entry Into the United States. Give the date and
place where he or she last entered the United States,
regardless of whether that entry was legal or illegal.
16. Form I-94, Arrival-Departure Document, Number. If
physically present in the United States, give the number on
Form I-94 issued at the time of entry.
17. Current Immigration Status. Give your current status,
regardless of how you entered the United States (visitor,
student, entry without inspection, etc.).
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18. Previously Traveled to the United States. Give the
following information about your family member if he or
she has previously traveled to the United States.

Completing Form I-914, Supplement B, Declaration of
Law Enforcement Officer for Victim of Trafficking in
Persons

19. Family Member's Prior Marriage(s) Information. If
your family member was previously married, list the names
of his or her prior spouse(s), the dates the previous
marriage terminated, the location where and how the
marriage(s) terminated.

Form I-914, Supplement B, is used by Federal, State, or local
law enforcement authorities and given to you.
You are not required to file Form I-914, Supplement B, to prove
your claim. However, the endorsement of a Federal, State, or
local law enforcement authority is one form of evidence that
you are a victim of a severe form of trafficking in persons and
that you have complied with any reasonable request for
assistance in the investigation or prosecution. Follow the
additional instructions on Form I-914, Supplement B.

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20. U.S. Consulate or Inspection Facility Where You Want
Notification Sent. If your family member is outside the
United States, indicate the U.S. Consulate or inspection
facility you want notified if the Form I-914 Supplement A
is approved.

21. Foreign Address Where You Want Notification Sent. If
your family member is outside the United States, indicate
the address where you want notification sent if the Form
I-914, Supplement A is approved.
22. Immigration History. Give your family member's
immigration proceedings history, if any.

23. Employment Authorization. If the Form I-914,
Supplement A is approved for your family member, he or
she is authorized to work. Check the box to indicate if you
are applying for an Employment Authorization Document
(EAD) as evidence of your family member's authorization
to work. If you indicate "Yes," each family member must
also file Form I-765 with the appropriate fee or request for
fee waiver. The Form I-765 can be filed with the Form
I-914, Supplement A, or at a later time. 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 who is living outside of the United
States.
Part E. Processing Information
You must answer each question about your family member. If
you answer “Yes” to any of the questions, explain on a separate
sheet of paper.
Part F. Attestation, Release, and Signature
First read the information below regarding penalties. Then you,
the applicant, must sign and date the form. If you do not sign
the form, your application will be returned as incomplete.
If the family member for whom you are filing is in the United
States, he or she must sign and date the form. If he or she does
not sign or date the form, then Form I-914, Supplement A, will
be returned as incomplete.
Part G. Preparer and/or Interpreter Certification and
Signature
If you, the applicant, did not fill out Form I-914, Supplement A,
the preparer must also sign, date, and give his or her address.

Initial Evidence

You must submit:

1. A completed and signed Form I-914;
2. A personal narrative statement;

3. Evidence to establish each eligibility requirement (see next
section for details); and
If applying for your family member, you must also submit:
1. A completed and signed Form I-914, Supplement A, for each
family member for whom you are applying. You may file
Form I-914, Supplement A, at the same time with your
initial application or at a later time.
Nonimmigrant, for each family member for whom you are
applying. You may file Form I-914, Supplement A,
concurrently with your initial application or at a later time.
Any Form I-914, Supplement A, submitted subsequent to the
principal applicant's initial filing, however, must be
accompanied by:
A. A new Form I-914, Supplement A, with the appropriate
boxes checked in Part A and with an original signature in
Part 6; and
B. A copy of the original Form I-914.
2. Evidence to establish eligibility for each family member (see
next section for details).
NOTE: Evidence submitted with the original Form I-914
does not need to be resubmitted.

Evidence to Establish T Nonimmigrant Status
You must file Form I-914 with evidence sufficient to
demonstrate that you satisfy each of the eligibility requirements.
If you have in your possession, or have access to, a document
showing how you entered the United States, you must submit a
copy of that document with your application.

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To qualify for T-1 nonimmigrant status, you must demonstrate
that you:
1. Are or have been a victim of a severe form of trafficking in
persons;
2. Are physically present in the United States, American
Samoa, or the Commonwealth of the Northern Mariana
Islands, or at a port of entry, as a result of trafficking,
including physical presence based on your having been
allowed entry into the United States to participate in
investigative or judicial processes associated with an act or a
perpetrator of trafficking;

If you do not provide a completed Form I-914, Supplement B,
you must submit credible evidence to establish that you are or
have been a victim of a severe form of trafficking in persons
and that you complied with any reasonable request from law
enforcement. Such evidence may include, but is not limited to:
trial transcripts, court documents, police reports, news articles,
copies of reimbursement forms for travel to and from court,
affidavits, or any other form of evidence. Even if you do
provide Form I-914, Supplement B, you may submit additional
evidence.

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3. Have complied with any reasonable request for assistance in
a Federal, State, or local law enforcement investigation or
prosecution of acts of trafficking in persons, unless you are
under 18 years old, or you are unable to cooperate with a
request due to physical or psychological trauma; and

4. Would suffer extreme hardship involving unusual and severe
harm upon removal.
To establish that you are or have been a victim of a severe form
of trafficking in persons, you must demonstrate that you were
brought to the United States either:
1. For the purpose of a commercial sex act, which was either
induced by force, fraud or coercion, or occurred when you
were under 18 years of age; or

2. For recruiting, harboring, transportation, provision, or
obtaining of a person for labor or services induced by force,
fraud, or coercion for the purpose of subjecting you to
involuntary servitude, peonage, debt bondage, or slavery.
You are encouraged to raise all arguments and to document all
elements of your claim, including allegations of extreme
hardship, in your initial application.

Evidence of Cooperation with Reasonable
Requests from Law Enforcement
Form I-914 Supplement B, Declaration of Law Enforcement
Officer for Victim of Trafficking in Persons (optional)
One type of evidence of your claim to be a victim of a severe
form of human trafficking in persons is Form I-914,
Supplement B. That declaration and instructions are appended
to this form.
You are not required to file Form I-914, Supplement B, to prove
your claim. However, the endorsement of a Federal, State, or
local law enforcement officer on Form I-914, Supplement B, is
one type of evidence that you are a victim and that you have
complied with any reasonable request from Federal, State, or
local law enforcement authority for assistance in the
investigation or prosecution of the acts of trafficking. USCIS
(not the Federal, State, or local law enforcement authority) will
make the decision if you meet the eligibility requirements for T
nonimmigrant status.

Personal Statement

A personal narrative statement is required. That statement
should describe the trafficking crime of which you were a
victim, including:
1. The circumstances of your entry into the United States;
2. The purpose for which you were brought to the United
States;
3. How you were recruited or otherwise became involved in the
trafficking situation;
4. When these events took place;
5. Who was responsible;

6. How long you were detained by the traffickers;
7. How and when you escaped, were rescued, or otherwise
became separated from the traffickers; and
8. What you have been doing since you were separated from
the traffickers.

Evidence to Establish Derivative T
Nonimmigrant Status

You, as the principal applicant or as current T-1 nonimmigrant
status holder filing for your family members, must file Form
I-914, Supplement A, with evidence sufficient to demonstrate
that your family members satisfy each of the eligibility
requirements.
If you are under the age of 21, eligible family members for
whom you are filing must be your:
1. Spouse;
2. Unmarried child(ren) under the age of 21;
3. Parent(s); or
4. Unmarried sibling(s) under the age of 18.
If you are over the age of 21, eligible family members for whom
you are filing are your:
1. Spouse; or
2. Unmarried child(ren) under the age of 21.

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If a family member faces a present danger of retaliation as a
result of your escape from the severe form of trafficking in
persons or cooperation with law enforcement, you may file for
the following eligible family members, regardless of your age:
1. Parent(s);
2. Unmarried sibling(s) under the age of 18; or
3. Adult or minor child of your derivative (your child, your
grandchild, your step-child, your niece or nephew, or your
sibling).
You must include:

documents showing that any prior marriages of either
your father or mother were legally terminated. If you and
your brother or sister are related through adoption or
through a stepparent, or if you have a common father and
either of you were not legitimated before your 18th
birthday, see also G and H.
G. Stepparent/Stepchild. If your application is based on a
stepparent-stepchild relationship, you must file your
application with a copy of the marriage certificate of the
stepparent to the child's natural parent showing that the
marriage occurred before the child's 18th birthday, and
copies of documents showing that any prior marriages
were legally terminated.

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1. A completed Form I-914, Supplement A, for each eligible
family member you want included on your application.
2. Credible documentation of the claimed relationship.
Documents acceptable for this purpose are listed below.
If you are filing for your:

A. Husband or Wife. Submit a copy of your marriage
certificate issued by a civil authority.

If either you or your spouse were married before, you
must submit documents to show all previous marriages
were legally terminated. (Example: a divorce decree or
death certificate.)
B. Child, and you are the mother. Submit a copy of the
child's birth certificate showing your name and the name
of the child issued by a civil authority.

C. Child, and you are the father. Submit a copy of the
child's birth certificate issued by a civil authority showing
both parents' names and your marriage certificate. If the
child was born out of wedlock, give proof that a parentchild relationship exists or existed. (Example: the child's
birth certificate showing your name and evidence that you
have financially supported the child. In some cases, a
blood test may be necessary.)
D. Mother. Submit a copy of your birth certificate issued by
a civil authority showing your name and your mother's
name.
E. Father. Submit a copy of your birth certificate showing
the names of both parents, your parents' marriage
certificate establishing that your father was married to
your mother before you were born, and copies of
documents showing that any prior marriages of either
your father or mother were legally terminated. If you are
filing for a stepparent or adoptive parent, or if you are
filing for your father and were not legitimated before your
18th birthday, also see C, G, and H.
F. Brother or Sister. Submit a copy of your birth certificate
and a copy of your brother's or sister's birth certificate
showing that you have at least one common parent. If you
and your brother or sister have a common father but
different mothers, submit copies of the marriage
certificates of the father to each mother and copies of

H. Adoptive parent or adopted child. If you and the
person you are filing for are related by adoption, you
must submit a copy of the adoption decree(s) showing
that the adoption took place before the child became 16
years of age.
If the relationship was created by the adoption of the
sibling of a child already adopted, then you must submit a
copy of the adoption decree(s) showing that the adoption
of the sibling took place before the child became 18 years
of age.

In either case, you also must submit copies of evidence
showing that each child was in the legal custody of and
resided with the parent(s) who adopted him or her for
some time within 2 years before or after the adoption.
Legal custody may only be granted by a court or
recognized government entity and is usually granted at the
time the adoption is finalized. However, if legal custody
is granted by a court or recognized government agency
prior to the adoption, that time may count to fulfill the 2year legal custody requirement.

I. Your unmarried sibling under age 18. Submit a
certified copy of your birth certificate and a copy of your
brother's or sister's birth certificate showing that you have
at least one common parent.
If you are filing for your parents, unmarried siblings under age
18, and/or the adult minor child of another derivative because of
a present danger of retaliation based on your escape from the
severe form of trafficking in persons or cooperation with law
enforcement, you should include the following:
1 . A description of the danger the family member faces and
how the danger is linked to your escape or cooperation with
law enforcement;
2 . Documentation of a previous grant of advance parole to a
family member, if available; and
3. Any other credible evidence describing the danger of
retaliation, including a signed statement from a law
enforcement official, trial transcripts, court documents,
police reports, news articles, copies of reimbursement forms
for travel to and from court, and affidavits from other
witnesses.
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Unavailable Documents
If a required document is not available, you may give USCIS
the following secondary evidence instead:
NOTE: USCIS may require a statement from the appropriate
civil authority certifying that the necessary document is
unavailable.
1. Church record: A certificate under the seal where the
baptism, dedication, or comparable rite occurred within two
months after the birth, showing the date and place of the
child's birth, date of the religious ceremony, and the names
of the child's parents.

Applicants seeking a waiver of inadmissibility must submit
Form I-192, Application for Advance Permission to Enter as a
Nonimmigrant (Pursuant to Section 212(d)(3) of the
Immigration and Nationality Act). A separate fee or request for
fee waiver must be filed with Form I-192. Form I-192 should be
filed concurrently with Form I-914. USCIS, in its discretion,
will decide eligibility for the waiver.

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2. School record: A letter from the authority of the school
attended (preferably the first school) showing dates of
admission to the school, child's date and place of birth, and
the names and birthplaces of both parents if shown in the
school records.
3. Census records: Federal or State census records showing
the names place of birth and date of birth or age of the
person listed.

4. Affidavits: Written statements sworn to or affirmed by two
persons who were living at the time and who have personal
knowledge of the event you are trying to prove. (Example:
the date and place of birth, marriage, divorce, or death.) The
persons making the affidavits need not be citizens of the
United States. Each affidavit should contain the following
information:
A. The relationship, if any, between you and the affiant;
B. Full information concerning the event; and

C. Complete details concerning how the person acquired
knowledge of the event.

NOTE: In a case where you or your relative's name has
changed from what is shown on the supporting document,
submit the legal document authorizing such name change.
(Example: marriage certificate, adoption decree, court order,
etc.)

Waiver of Ground(s) of Inadmissibility
To be eligible for T nonimmigrant status, you must be
admissible to the United States. If you or your eligible family
member(s) answered "Yes" to one or more of the questions in
Part D of Form I-914 or Form I-914, Supplement A, you or
your eligible family member(s) may be inadmissible.
If you and/or your eligible family member(s) is or becomes
inadmissible under section 212(a) of the Immigration and
Nationality Act, you and/or your family member(s) will not be
eligible for T nonimmigrant status unless the ground of
inadmissibility is waived by USCIS.

What Is the Filing Fee?

There is no filing fee for Form I-914.
No biometrics services fee is required.

Where To File?

Mail your complete application to the following address:
USCIS
Vermont Service Center
75 Lower Welden Street
St. Albans, VT 05479-0001

Address Changes

If you have changed your address, you must inform USCIS of
your new address. For information on filing a change of
address go to the USCIS Web site at www.uscis.gov/
addresschange or contact the USCIS National Customer
Service Center at 1-800-375-5283.

Processing Information

Any Form I-914 that is not signed will be rejected with a
notice that Form I-914 is deficient. You may correct the
deficiency and resubmit Form I-914. An application is not
considered properly filed until accepted by USCIS.

Initial Processing
Once Form I-914 has been accepted, it will be checked for
completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it
without required initial evidence, you will not establish a basis
for eligibility, and we may deny your Form I-914.
Requests For More Information or Interview
We may request more information or evidence, or we may
request that you appear at a USCIS office for an interview. We
may also request that you submit the originals of any copy.
Employment Authorization
If your application is approved, you will be authorized to work.
For a principal applicant, USCIS will send an Employment
Authorization Document (EAD) as evidence of your
authorization to work if you indicate “Yes” for Item Number 10
in Part C. As the principal applicant you do not need to file

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Form I-765, Application for Employment Authorization
Document. Derivative family members are also authorized to
work if Form I-914, Supplement A, is approved. If your
derivative family member wants to obtain an EAD as evidence
of his or her authorization to work, each family member must
file Form I-765 with the appropriate fee or request for fee
waiver. Form I-765 can be filed with Form I-914, Supplement
A, or at a later time. 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 who is
living outside of the United States.

As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system, visit
our Web site. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment. InfoPass
generates an electronic appointment notice that appears on the
screen.

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Derivative family members are also authorized employment. If
they wish to obtain an Employment Authorization Document as
evidence of authorization, Form I-765, Application for
Employment Authorization Document, with appropriate fee,
may be filed concurrently with Form I-914 and Form I-914,
Supplement A.

Penalties

If you knowingly and willfully falsify or conceal a material fact
or submit a false document with your Form I-914, we will deny
Form I-914 and may deny any other immigration benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

USCIS Privacy Act Statement

Derivative family members living outside the United States are
not eligible to receive employment authorization until they
lawfully enter the United States. Do not file Form I-765 for a
derivative family member who is outside the United States.

AUTHORITIES: The information requested on this benefit
application, and the associated evidence, is collected pursuant to
Public Law106-386, Sections 107(e) and 1513(c) and 8 USC
1101(a)(15)(T).

Decision

PURPOSE: The primary purpose for providing the requested
information on this application is to determine if you have
established eligibility for temporary immigration benefits for
which you are filing. The information you provide will be used
to grant or deny the benefit sought.

The decision on Form I-914 involves a determination of
whether you have established eligibility for the requested
benefit. You will be notified of the decision in writing.
Confidentiality

Information provided in the application is confidential and
protected from disclosure. It will be used to determine
eligibility, to investigate fraudulent claims, to enforce penalties
for false statements, to assist in the investigation and
prosecution of trafficking and related crimes but for no other
purpose. The information provided is subject to verification by
USCIS. Adverse determination of admissibility or deportability
cannot be made solely based on information obtained from the
trafficker. The disclosure of information relating to a pending
or approved application for T nonimmigrant status is prohibited
except in certain circumstances, such as to investigative
agencies who have a reason to know based on a legitimate law
enforcement purpose.

USCIS Forms and Information
To order USCIS forms, call our toll-free number at
1-800- 870-3676. You can also get USCIS forms and
information on immigration laws, regulations, and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our Internet Web site at
www.uscis.gov.

DISCLOSURE: The information you provide, including
Social Security Number, is voluntary. However, failure to
provide the requested information, and any requested evidence,
may delay a final decision or result in denial of your benefit
request.

ROUTINE USES: The information you provide in the
application is confidential and protected from disclosure under
8 USC 1367. Your information will be used to determine
eligibility, to investigate fraudulent claims, to enforce penalties
for false statements, and to assist in the investigation and
prosecution of trafficking and related crimes. The information
will be used by and disclosed to DHS personnel and contractors
or other agents in accordance with approved routine uses, as
described in the associated published system of records notices
[DHS-USCIS-007 - Benefits Information System and DHSUSCIS-001 - Alien File (A-File) and Central Index System
(CIS), which can be found at www.dhs.gov/privacy]. The
information may also be made available, as appropriate for law
enforcement purposes or in the interest of national security.

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Paperwork Reduction Act
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a collection
of information unless it displays a currently valid OMB control
number. The public reporting burden for Form I-914 is
estimated at 2 hours and 15 minutes per response, and an
estimated 1 hour and 10 minutes for biometrics processing. The
public reporting burden for Form I-914, Supplement A, is
estimated to be 1 hour per response, including the time for
reviewing instructions, completing and submitting the form.
Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions
for reducing this burden, to: U.S. Citizenship and Immigration
Services, Regulatory Coordination Division, Office of Policy
and Strategy, 20 Massachusetts Ave., NW, Washington, DC
20529-2140. OMB No. 1615-0099. Do not mail your
completed Form I-914 and Form I-914, Supplement A to this
address.

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Checklist

Fill out the checkboxes. This will ensure that you have completed the form properly.
1.

I completely filled out and signed the form.

2.

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, or I have been allowed entry into the United States to participate in
investigative or judicial processes associated with the an act or perpetrator of trafficking;
C. I am cooperating with Federal, State, or local law enforcement authorities in the investigation or prosecution of the
trafficker(s) (unless under age 18 or I am unable to cooperate with such requests due to physical or psychological
trauma); and
D. I would suffer extreme hardship involving unusual and severe harm upon removal from the United States.
3.

I have included a personal narrative statement.

If I am applying for one or more family members:
1.

I have completed Form I-914, Supplement A for each family 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.

2.

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
E. If applicable, present danger of retaliation as a result of my escape from trafficking or my cooperation with law
enforcement.

3.

I will or have filed Form I-765 with the appropriate fee or request for fee waiver, for each family member requesting an
Employment Authorization Document (EAD).

WARNING: Applicants who are in the United States illegally are subject to removal if their claims are not granted. Any
information provided in completing this application may be used as a basis for the institution of, or as evidence in, removal
proceedings even if the application is later withdrawn.

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