Information Collection

Supplement A to Form I-485, Adjustment of Status Under Section 245(i)

IC 218034 under ICR 201511-1615-006 · OMB 1615-0023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0023 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Supplement A Supplement A to Form I-485, Adjustment of Status Under Section 245(i)	Form
I485SuppA-INS-WIP-AC21-11172015.pdf	Instruction
Supplement A Form I-485, Supplement A I485SuppA-WIP-AC21-11172015.pdf	Form

IC Title:

Supplement A to Form I-485, Adjustment of Status Under Section 245(i)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Supplement A	Form I-485, Supplement A	I485SuppA-WIP-AC21-11172015.pdf		Yes	No	Fillable Printable
Instruction			I485SuppA-INS-WIP-AC21-11172015.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: USCIS Benefits Information System

FR Citation: 73 FR 56596

Number of Respondents: 3,888

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	3,888	3,888
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.