Form I-881 Application for Suspension of Deportation or Special Rul

OMB No. 1615-0072; Exp. 12/31/2014

Department of Homeland Security
U.S. Citizenship and Immigration Services

I-881, Application for Suspension of Deportation
or Special Rule Cancellation of Removal

Department of Justice
U.S. Executive Office for Immigration Review

(Pursuant to Section 203 of Public Law 105-100, NACARA)

START HERE - Type or print in black ink. If any question does not apply to
you, write "None" or "N/A" in the appropriate space.

For USCIS Use Only
Returned

Part 1. Background Information About YOU

Receipt

Alien Registration Number(s), if any (List every A-Number you have been given)
Family Name(s)

Given Name

Middle Name

Resubmitted
What other names have you used? (include maiden name and aliases)
Address - Street Number and Name (or P.O. Box)

Apartment No.

City

State

Zip Code

Date of Birth (mm/dd/yyyy)

Place of Birth (City or Town and Country)

U.S. Social Security Number

Gender
Male

Present Nationality (Citizenship)

Female

Reloc Sent

Reloc Rec'd

Home Phone Number (with area code)

Decision
Part 2. Application (Check all that apply to you)
I am eligible to apply for suspension of deportation or special rule cancellation of
removal under the Nicaraguan Adjustment and Central American Relief Act
(NACARA) because I have not been convicted of an aggravated felony and:
(a) I am a national of El Salvador who first entered the United States on or before
September 19, 1990, or a national of Guatemala who first entered the United States on or
before October 1, 1990. I also timely registered for benefits under the settlement agreement in
American Baptist Churches v. Thornburgh (ABC), 760 F. Supp. 796 (N.D. Cal. 1991), either
directly or, if Salvadoran, by applying for Temporary Protected Status (TPS), and I have not
been apprehended at time of entry after December 19, 1990.
(b) I am a national of Guatemala or El Salvador who filed an application for asylum on or
before April 1, 1990.
(c) I entered the United States on or before December 31, 1990; filed an application for
asylum on or before December 31, 1991; and at the time of filing was a national of the Soviet
Union (USSR), Russia, any Republic of the former Soviet Union, Latvia, Estonia, Lithuania,
Poland, Czechoslovakia, Romania, Hungary, Bulgaria, Albania, East Germany, Yugoslavia
(including Bosnia and Herzegovina, Croatia, Kosovo, Macedonia, Montenegro, Slovenia, and
Serbia).
(d) I am the spouse, child (unmarried and under 21 years of age), unmarried son or
unmarried daughter of someone who has already applied, or is presently filing with me, for
suspension of deportation or special rule cancellation of removal under NACARA. If I am an
unmarried son or unmarried daughter, I entered the United States on or before October 1,
1990, or my parent was granted suspension of deportation or special rule cancellation of
removal when I was less than 21 years of age. Attach proof of relationship and provide the
following information about that spouse or parent:
Name:
A-Number(s):
The person who has applied for suspension of deportation or special rule cancellation of
removal is your:
Spouse
Parent

Suspension of Deportation or Special
Rule Cancellation of Removal and
Adjustment of Status granted
Referred to Immigration Judge in
accordance with 8 CFR Section 240.70

(Adjudicating Officer's Signature)
(Date of Action)

(Office Location)

EOIR Actions

Attorney or Representative, if any
Check Box if G-28 is attached.
Attorney State License Number:

(e) I am or was the
spouse or
child of an individual described in Part 2(a), (b), or
(c) on Page 1, and I or my child has been battered or subjected to extreme cruelty by that
individual described in Part 2(a), (b), or (c).
Form I-881 12/14/12 Y Page 1

Part 3. Information About Your Presence In the United States
1. Provide information about the places where you have resided in the United States during the past 10 years: (List PRESENT ADDRESS FIRST and
work back in time. List only places where you resided 60 days or more. Attach additional sheets of paper as needed.)
Street Number and Name

Apt Number

City or Town

State

Zip Code

Resided From:
(Month/Year)

Resided To:
(Month/Year)
Present

2. Provide information about your first entry into the United States:
Name used when first entered the United States: (Family Name, First, Middle)
Status when you first entered the United States:

Place of first entry into the United States: (City and State)

Date of first entry into the United States: (mm/dd/yyyy)

Period admitted: (mm/dd/yyyy)
From:

If you changed nonimmigrant status after entry, list status you
changed to:

Date you first changed status:
(mm/dd/yyyy)

To:

Last Extension of Stay expired on:
(mm/dd/yyyy)

3. Provide information about any departure from and return to the United States you have made since your first entry: (List all departures, including
brief ones. Attach additional sheets of paper as needed.)
If you have not departed the United States since your first date of entry, please mark an "X" in this box:
Port of Departure: (Place or Port, City, State)

Departure Date: (mm/dd/yyyy)

Purpose of Travel:

Destination:

Port of Return: (Place or Port, City, State)

Return Date: (mm/dd/yyyy)

Status at Entry:

Inspected and Admitted:
Yes
No

Port of Departure: (Place or Port, City, State)

Departure Date: (mm/dd/yyyy)

Purpose of Travel:

Destination:

Port of Return: (Place or Port, City, State)

Return Date: (mm/dd/yyyy)

Status at Entry:

Inspected and Admitted:
Yes
No

4. Have you ever:
(a) Been ordered deported or removed?

Yes

No

(b) Departed the United States under an order of deportation or removal?

Yes

No

(c) Overstayed a grant of voluntary departure from an immigration judge or DHS?

Yes

No

(d) Departed the United States under a grant of voluntary departure or voluntary return?

Yes

No

(e) Failed to appear for deportation or removal?

Yes

No

If you responded "Yes" to any of the above, indicate the name and Alien Registration Number (A-Number) you were using at that time, along
with the date you left the United States, if applicable:

Form I-881 12/14/12 Y Page 2

Part 3. Information About Your Presence in the United States (Continued)
If you are unsure about any of your answers to questions 4(a)-(e) in Part 3 on Page 2, indicate which question(s) and explain why you are unsure
about the response(s) you have given: (Attach additional sheets of paper as needed.)

Part 4. Information About Your Financial Status and Employment
1. Provide information about the places where you have been employed for the last 10 years: (List PRESENT EMPLOYMENT FIRST and work back
in time. Include all employment, even if less than full-time. If you did the same type of work for three or more employers during any six-month
period and you do not know the names and addresses of those employers, you may state "multiple employers." Indicate the city or region where
you did the work, list the type of work you did, and estimate your earnings during that period. Any periods of unemployment, unpaid work (as a
homemaker or intern, for example), or school attendance should be specified.) (Attach additional sheets of paper as needed.)
Full Name and Address of Employer or School:
(If self-employed, give name and address of business.)

Earnings per Week:
(approximate)

Type of Work
Performed:

Employed From:
(Month/Year)

Employed To:
(Month/Year)
Present

2. Provide information about your assets in the United States and other countries, including those held jointly with your spouse, if you are married,
or with others. Do not include the value of clothing and household necessities. If married, provide information about your spouse's assets that he or
she does not hold jointly with you: (Attach additional sheets of paper as needed.)
Self (Including assets jointly owned with spouse or others)
Cash, Checking, or Savings Accounts:
Motor Vehicle(s):
(Minus any amount owed)
Real Estate: (Minus any amount owed)
Other:
(Describe below, e.g., stocks, bonds)
Total:

$
$
$
$
$

Spouse
Cash, Checking, or Savings Accounts:
Motor Vehicle(s):
(Minus any amount owed)
Real Estate: (Minus any amount owed)
Other:
(Describe below, e.g., stocks, bonds)
Total:

$
$
$
$
$

3. Have you filed a Federal income tax return while in the United States?
Yes
No If "Yes," indicate the years you filed and attach
evidence that you filed the returns. If you did not file a tax return during any particular year(s), explain why you did not file: (Attach additional
sheets of paper as needed.)

Form I-881 12/14/12 Y Page 3

Part 5. Information About Your Marital Status and Spouse
Marital Status:

Married

Single (If "single," skip this Part and go to Part 6.)

Divorced

Separated

Widow(er)

1. Information About Spouse:
Name: (Family Name(s), First, Middle)

Date of Marriage: (mm/dd/yyyy)

Place of Marriage: (City and Country)

Place of Birth: (City and Country)

Date of Birth: (mm/dd/yyyy)

Citizenship:

Your spouse currently resides at:
(Indicate "with me" if spouse
resides with you.)

Number and Street

Apt #

If presently residing in the United States, your spouse's present status is:
Asylum Applicant

City or Town

U.S. Citizen

is

Lawful Permanent Resident

Zip Code
Asylee

Other (Describe):

His/her alien registration number(s) are: (List all A-Numbers your spouse has been given)
Your spouse

State/Country

A-

is not employed. If employed, give salary and the name and address of the place(s) of employment.
Earnings Per Week:
(Approximate)

Full Name and Address of Employer:

Type of Work:

Employed from:
(mm/dd/yyyy)

Employed to:
Present

2. Information about previous spouse(s):
have
have not been previously married: (If previously married, list the names of each prior spouse, the dates on which each marriage
I
began and ended, the place where the marriage ended, and describe how each marriage ended. Attach additional sheets of paper as needed.)
Name of Prior Spouse:
(Family Name(s), First, Middle)

Date Married:
(mm/dd/yyyy)

Date Marriage Ended: Place Marriage Ended:
(mm/dd/yyyy)
(City and Country)

Manner in which marriage
was terminated or ended:
(e.g., death, divorce)

3. Have you been ordered by any court, or are you otherwise under any legal obligation to provide child support and/or spousal maintenance?
Yes
No (If "Yes," on a separate sheet of paper, explain what type of obligation you have, to whom it is owed, and whether you are
fulfilling that obligation.)

Part 6. Information About Your Child/Children
1. Do you have children?

Yes

No (If "No" then skip this Part and go to Part 7.)

2. List all your children below, regardless of their age, giving the requested information about each of them. (In the address box, indicate "with me"
if the child currently resides with you, or if the child does not live with you, provide his or her address and relationship to the person with whom he
or she lives. Attach additional sheets of paper as needed.)
Name of Child:
(Family Name(s), First, Middle)

A-Number:

Place of Birth:
(City and Country)

Date of Birth:
(mm/dd/yyyy)

Immigration
Status:

(1)
Current Address:

Citizenship:

(2)
Current Address:

Citizenship:

(3)
Current Address:

Citizenship:

(4)
Current Address:

Citizenship:
Form I-881 12/14/12 Y Page 4

Part 7. Information About Your Parent(s)
You do not need to provide information about your parents' assets and earnings unless you believe that your removal would result in extreme
hardship to your parent or parents.
Name of Parent: (Family Name(s), First, Middle)

A -Number

Place of Birth:
(City and Country)

Immigration
Status:

Date of Birth:
(mm/dd/yyyy)

Father:
Citizenship:

Current Address:
(Number and Street, City,
State, or Country)
Estimated total assets: $

Weekly Earnings: $

Mother:
Citizenship:

Current Address:
(Number and Street,
City, State, or Country)
Estimated total assets: $

Weekly Earnings: $

Part 8. Miscellaneous Information
Respond to the following questions. If you answer "Yes" to any of these questions, provide an explanation on an attached sheet of paper.
1. Have you ever (either in the United States or in another country) been arrested, summoned into court as a defendant, convicted, fined,
imprisoned, placed on probation, or forfeited collateral for an act involving a felony, misdemeanor, or breach of any public law or ordinance
(including, but not limited to, driving violations involving alcohol)?
Yes
No (If you answered "Yes," your explanation must include a
brief description of each offense, including the name and location of the offense, date of conviction, any penalty imposed, any sentence imposed,
and the time actually served.)
2. Have you ever been:
Yes

No

A habitual drunkard?

Yes

No

One who has derived income principally from illegal gambling?

Yes

No

One who has given false testimony for the purpose of obtaining immigration benefits?

Yes

No

One who has engaged in prostitution or unlawful commercialized vice?

Yes

No

Involved in a serious criminal offense and asserted immunity from prosecution?

Yes

No

One who has aided and/or abetted another to enter the United States illegally?

Yes

No

A trafficker of a controlled substance, or one who knowingly assisted, abetted, conspired, or colluded with others in any
such trafficking (not including a single offense of simple possession of 30 grams or less of marijuana)?

Yes

No

A practicing polygamist?

Yes

No

Admitted into the United States as a crewman after June 30, 1964?

Yes

No

Admitted into the United States as, or after arrival acquired the status of, an exchange visitor?

Yes

No

Inadmissible or deportable on security related grounds under sections 212(a)(3) or 237(a)(4) (for cancellation applicants), or
under pre-IIRIRA section 241(a)(4) (for suspension applicants) of the Immigration and Nationality Act (INA)?

Yes

No

One who has ordered, incited, assisted, or otherwise participated in the persecution of an individual on account of his or her
race, religion, nationality, membership in a particular social group, or political opinion?

Yes

No

A person previously granted relief under section 212(c) (waiver for certain grounds of inadmissibility) or 244(a) (suspension
of deportation) of the INA or whose removal has previously been canceled under section 240A (cancellation of removal) of
the INA?

Form I-881 12/14/12 Y Page 5

Part 9. Information About Hardship You and/or Your Family Will Face If You Are Deported or
Removed from the United States
Answer the following questions by checking "Yes," "No" or "Not Applicable" in the boxes provided. Where required, provide an explanation of your
answer on an attached sheet of paper. You should reference the number of each question for which you are providing an explanation.
Your responses in this Part should be about you and/or your qualifying family member(s), except for your response to Question 11. A qualifying
family member is a parent, spouse, or child who is a U.S. Citizen (USC) or lawful permanent resident (LPR) of the United States. When providing
responses about a family member, provide the family member's name and his or her relationship to you. Attach any documents you have to
support the responses you give below. (See the instructions for types of documents that you may wish to submit.)
IMPORTANT: If you meet the eligibility requirements for NACARA suspension of deportation or special rule cancellation of removal listed in (a) or
(b), under Part 2, Application on Page 1 of this form and you complete this form, you will be presumed to meet the extreme hardship requirement,
unless evidence in the record establishes that neither you nor your qualified relative are likely to experience extreme hardship if you are deported or
removed from the United States. If you qualify for a presumption of extreme hardship, you do not need to submit documents that support your
answers below regarding your claim to extreme hardship; but you need to provide explanations to your answers below, where required.
1.

Yes

No

Not applicable

If you have (USC/LPR) children, do your children speak, read, and write English?

2.

Yes

No

Not applicable

If you have (USC/LPR) children, do your children speak, read and write the native language of the
country you would be returned to if deported or removed?

3.

Yes

No

Do you or any of your qualified family members suffer or have suffered from any illness, health
problem, or disability that requires or required medical attention? If "Yes," provide information
about the health problem, include whether you or your qualified family member suffer(s) or
suffered from it, and any care you or the person receives in the United States that would not be
available in the country to which you would be deported or removed.

4.

Yes

No

Would you be able to obtain employment in the country to which you would be deported or
removed? If "Yes," explain the type of employment you would be able to obtain. If "No," explain
why you would be unable to find employment.

5.

Yes

No

Not applicable

If you or a qualified family member are currently pursuing educational opportunities in the United
States, would you or the qualified family member continue to pursue the educational opportunities
if deported or removed from the United States? If "No," explain why not.

6.

Yes

No

Not applicable

If you are deported or removed from the United States, would all qualified family member(s)
accompany you? If "No," list which qualified family member(s) would not accompany you. Also,
explain why the qualified family member(s) would not accompany you and how that affects you
and your family member(s).

7.

Yes

No

Would you or qualified members of your family experience any emotional or psychological impact
if you were deported or removed from the United States? If "Yes," explain.

8.

Yes

No

Would the current conditions in the country to which you would be deported or removed cause you
or your qualified family members extreme hardship if you are deported or removed? If "Yes,"
explain.

9.

Yes

No

Do you presently have any other way, besides this application for suspension of deportation or
special rule cancellation of removal, to adjust status to that of a lawful permanent resident in the
United States? If "Yes," explain.

10.

Yes

No

11.

Yes

No

Not applicable

If you belong to any civic, political, religious, community, or social organization, association,
foundation, club, or similar group or participate in volunteer activities, would your separation from
these community ties and activities affect you if you are deported or removed from the United
States? If "Yes," explain.
Is there any other type of hardship that you or your family would face if you are deported or
removed from the United States? Include any hardship to your non USC/LPR children, spouse or
parents and any hardship to brothers, sisters, grandparents or other extended family members. If
"Yes," explain.

Form I-881 12/14/12 Y Page 6

Part 10. Signature
After reading the information on penalties in the instructions, complete and sign below. If someone helped you prepare this application, he or she
must complete Part 11.
I certify, under penalty of perjury under the laws of the United States of America, that this
application and the evidence submitted with it are all true and correct. Title 18, United States Code,
Section 1546, provides in part: "Whoever knowingly makes under oath, or as permitted under
penalty of perjury under Section 1746 of Title 28, United States Code, knowingly subscribes as
true, any false statement with respect to a material fact in any application, affidavit, or other
document required by the immigration laws or regulations prescribed thereunder, or knowingly
presents any such application, affidavit, or other document which contains any such false
statements or which fails to contain any reasonable basis in law or fact" shall be fined in accordance
with this title or imprisoned not more than ten years, or both.

Staple your
photographs
here

I authorize the release of any information from my record that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit I am seeking.
WARNING: Applicants who are in the United States illegally are subject to deportation or removal if their applications are not granted by
an asylum officer or an immigration judge. Any information provided in completing this application may be used as a basis for the
institution of, or as evidence in, deportation or removal proceedings, even if the application is later withdrawn. Applicants and eligible
dependents in removal proceedings who fail to provide DHS with their biometrics or other biographical information as required within the
time allowed, except for good cause, may have their applications found abandoned by the immigration judge. If filing with USCIS,
unexcused failure to appear for an appointment to provide biometrics and other biographical information within the time allowed may
result in the dismissal or referral of your application to an Immigration Judge.
Signature of Applicant:

Date: (mm/dd/yyyy)

Print Name:

Write your name in your native alphabet:

Part 11. Signature of Person Preparing Form, If Other Than Above
(Read the following information and sign below.)
I declare that I have prepared this application at the request of the person named in Part 10, that the responses provided are based on all information
of which I have knowledge, or which was provided to me by the applicant, and that the completed application was read to the applicant in a language
the applicant speaks fluently for verification before he or she signed the application in my presence. I am aware that the knowing placement of false
information on the Form I-881 may subject me to civil penalties under 8 U.S.C. 1324c.
Signature of Preparer:

Print Name:

Daytime Telephone Number:

Date: (mm/dd/yyyy)

Address of Preparer: (Street Number and Name, City or Town, State, Zip Code)

Part 12. To Be Completed at Interview or Hearing
You will be asked to complete this Part when you are before an Asylum Officer of U.S. Citizenship and Immigration Services or an immigration
judge of the Executive Office for Immigration Review (EOIR) for examination.
I swear (affirm) that I know the contents of this application that I am signing, including the attached documents and supplements, are
all true or
not all true to the best of my knowledge and that the corrections numbered
to
were made by me or
at my request.

Signature of Applicant

Write your name in your native alphabet

Signed and sworn to before me by the above-named applicant on:
Date (mm/dd/yyyy)

Signature of Asylum Officer or Immigration Judge
Form I-881 12/14/12 Y Page 7

NOTE: Use this blank sheet to supplement any information requested. Please copy this page and submit additional information as needed.
A-Number:

Print Name:

Signature of Applicant:

Date: (mm/dd/yyyy)

Part:
Question:

Supplemental Data/Clarifications

Form I-881 12/14/12 Y Page 8