Table of Changes Form

TABLE OF CHANGES – FORM

Form I-566, Interagency Record of Request - A, G, or NATO Dependent Employment Authorization or Change/Adjustment To/From A, G, or NATO Status

OMB Number: 1615-0027

11/29/2016

Reason for Revision: 83C revision for NATO updates.

Current Page Number and Section	Current Text	Proposed Text
Page 6, Part 8. Certification by Diplomatic Mission, International Organization, NATO/HQ SACT, or NATO Member State	[page 6] For Official Use Only Part 8. Certification by Diplomatic Mission, International Organization, NATO/HQ SACT, or NATO Member State NOTE: Certifying official must have this information and page to complete process. 1. I certify that the information provided on the first page of this Form I-566 is true and correct to the best of my knowledge and according to our official records. 2. I further certify that the requestor's eligibility for employment authorization was verified under the provisions of: 2.a. A bilateral agreement with 2.b. A de facto agreement with 2.c. Select all that apply Without a numerical limit Based on principal alien's G-4 status With a numerical limit and this requestor is within the limit 3. I further certify that the requestor for status as a principal alien is being offered the position below and DOS was notified. Position DOS Notification Date (mm/dd/yyyy) 4.a. Certifying Officer or Official's Last Name 4.b. Certifying Officer or Official's First Name 5. Certifying Officer or Official's Duty/Title 6.a. Certifying Officer or Official's Signature 6.b. Date of Signature (mm/dd/yyyy) 7. Telephone Number (including area code) 8. Name of Diplomatic Mission, International Organization, NATO/HQ SACT, or NATO Member State Address of Diplomatic Mission, International Organization, NATO/HQ SACT, or NATO Member State 9.a. In Care Of Name 9.b. Street Number and Name 9.c. Apt. Ste. Flr. 9.d. City or Town 9.e. State 9.f. ZIP Code 9.g. Province 9.h. Postal Code 9.i. Country Official Seal	For Official Use Only Part 8. Certification by Diplomatic Mission, International Organization, NATO/HQ SACT, or NATO Member State NOTE: Certifying officer or official must have this information and page to complete process. 1. [no change] 2. [no change] 3. [no change] 4.a. [no change] 4.b. [no change] 5. [no change] 6.a. [no change] 6.b. [no change] 7. [no change] 8. [no change] [no change] [no change] [no change]
Page 7, Part 9. DOS. NATO/HQ SACT, and/or USUN USE ONLY	[page 7] Part 9. DOS. NATO/HQ SACT, and/or USUN USE ONLY 1. The Department of State, NATO/HQ SACT, and/or USUN Recommends the request be granted Recommends the request be denied If the recommendation is for denial, provide a reasons for such a recommendation 2. Date of Decision (mm/dd/yyyy) 3. Telephone Number (include area code) 4. Office Protocol USUN NATO/HQ SACT Visa 5. Signature 1 6. Signature 2	Part 9. DOS OFM, DOS Visa Office, NATO/HQ SACT, and/or USUN USE ONLY 1. [no change] [no change] [no change] If the recommendation is for denial, provide the reasons for such a recommendation 2. [no change] 3. [no change] 4. Office DOS Protocol USUN DOS OFM NATO/HQ SACT DOS Visa 5. [no change] 6. [no change]
Page 7, Part 10. USCIS USE ONLY	[page 7] Part 10. USCIS USE ONLY 1. From Adjudicator ID Number USCIS Office Office Telephone Number (with area code) A-Number/File Number 2. To Protocol USUN NATO/HQ SACT Visa Office (Subject filed under Section 13. Advise USCIS of findings.) 3. Adjustment or Change of Status Granted Denied Date of Decision (mm/dd/yyyy) If change of status granted, print new status 4. Request for Employment Authorization Granted Denied Date of Decision (mm/dd/yyyy) Date Valid Until (mm/dd/yyy) Classification 5. DOS, USUN, NATO/HQ SACT, OR Visa Office Office Notified Yes No Date of Notification (mm/dd/yyyy)	Part 10. USCIS USE ONLY 1. From [no change] [no change] [no change] [no change] 2. To DOS Protocol USUN DOS OFM NATO/HQ SACT DOS Visa Office (Subject filed under Section 13. Advise USCIS of findings.) 3. [no change] [no change] [no change] [no change] [no change] 4. [no change] [no change] [no change] [no change] [no change] [no change] 5. DOS OFM, USUN, NATO/HQ SACT, or DOS Visa Office [no change] [no change] [no change] [no change]

1