Form TOC

TABLE OF CHANGES – FORM

Form I-765, Application For Employment Authorization

OMB Number: 1615-0040

12/24/2015

Reason for Revision: AC21 NPRM. Incorporated non-substantive change to the form – added data labels to “Other Names Used” field.

Current Page Number and Section	Current Text	Proposed Text
New	[Page 1] …2. Other Names Used (include Maiden Name)… 18. (c)(26) Eligibility Category. If you entered… [Page 2] Certification I certify, under…	[Page 1] …2. Other Names Used (include Maiden Name) (Family Name) (First Name) (Middle Name) [no change] 19. (c)(35) and (c)(36) Eligibility Category a. If you entered the eligibility category (c)(35) or (c)(36) in Question 16 above, please provide the receipt number of the Form I-140 beneficiary's Form I-797 Notice of Approval for Form I-140. b. Have you EVER been convicted of any felony committed in the United States? Y/N c. Have you EVER been convicted of any misdemeanor committed in the United States? Y/N NOTE:  If you answered “Yes” to Item Numbers 19.b. or 19.c., refer to Item Number 5., Item H. or Item I. in the Who May File Form I-765 section of these Instructions for information about providing court dispositions. [Page 2] [no change]

1