Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

Instructions for Application for T Nonimmigrant Status
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-914

OMB No. 1615-0099
Expires 07/31/2016

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.

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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:

(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
(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;
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:
(1) You are under 18 years of age;

(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 21 years of age, eligible family members for whom you are filing are your:
(1) Spouse;

(2) Unmarried child(ren) under 21 years of age;
(3) Parent(s); or
(4) Unmarried sibling(s) under 18 years of age.
B. If you are over 21 years of age, eligible family members for whom you are filing are your:
(1) Spouse; or
(2) Unmarried child(ren) under 21 years of age.

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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 18 years of age; or
(3) An adult or minor child of your derivative (your grandchild, your spouse’s child, your niece or nephew, or
your sibling).

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General Instructions

Fill Out Form I-914, Form I-914, Supplement A, and Form I-914, Supplement B (optional)
1. Type or print legibly in black ink.

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.
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.”

Completing Form I-914

You, as the principal applicant, must file Form I-914 for yourself.

This form is divided into Parts A. - H. 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.
2. Other Names Used. Provide all the names you have used, including maiden name if applicable, married names,
nicknames, etc.
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.
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.
5. Home Telephone Number. Give the phone number with area code. If you live outside the United States, give the
country and city code.

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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 e-mail 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.

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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.
17. Current Immigration Status. Give your current status, regardless of how you entered the United States (visitor,
student, entry without inspection, etc.).
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.
Complete Question 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 Question 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 members to the United States, you must provide the requested
information about your spouse and children, if any.

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Part F. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist
you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further,
you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any),
and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if
applicable). A stamped or typewritten name in place of a signature is not acceptable.
Part G. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the instructions and questions on this application to you in a language in
which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her
business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and
his or her email address (if any). The interpreter must sign and date the application.

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Part H. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
This section must contain the signature of the person who completed your application, if other than you, the applicant. If
the same individual acted as your interpreter and your preparer, that person should complete both Part G. and Part H.
If the person who completed this application is associated with a business or organization, that person should complete
the business or organization name and address information. Anyone who helped you complete this application MUST
sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person
who helped you prepare your application is an attorney or accredited representative, he or she may be obliged to also
submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your
application.

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 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 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.).
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 grandchild, your spouse’s 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 (the principal)
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.

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2. Date of Birth. Use eight numbers to show your date of birth (example: May 1, 1979, should be written 05/01/1979).
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.
4. Status of your Form I-914, Application for T Nonimmigrant Status. Check the appropriate box.
Part D. Information About Your Family Member (the derivative)
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.

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

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

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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.).
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.

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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.
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. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature

Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist
you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further,
you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any),
and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if
applicable). A stamped or typewritten name in place of a signature is not acceptable.
NOTE: If the family member for whom you are filing is in the United States, he or she must sign and date the
application. If he or she does not sign or date the application, then Form I-914, Supplement A, will be returned as
incomplete.
Part G. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the instructions and questions on this application to you in a language in
which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her
business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and
his or her email address (if any). The interpreter must sign and date the application.

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Part H. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
This section must contain the signature of the person who completed your application, if other than you, the applicant. If
the same individual acted as your interpreter and your preparer, that person should complete both Part G. and Part H.
If the person who completed this application is associated with a business or organization, that person should complete
the business or organization name and address information. Anyone who helped you complete this application MUST
sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person
who helped you prepare your application is an attorney or accredited representative, he or she may be obliged to also
submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your
application.

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Completing Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking
in Persons
Form I-914, Supplement B, is completed by Federal, State, or local law enforcement authorities and is then given to you
to submit to USCIS.
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.

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.
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 F.; 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.

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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.
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;

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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 of age, 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
have been a victim of either:
1. Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced
to perform such act is under 18 years of age; or
2. The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of
force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

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.
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.
Personal Statement
A personal narrative statement is required. That statement should describe, to the best of your recollection, 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;
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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;
8. What you have been doing since you were separated from the traffickers;
9. Why you were unable to leave the United States after you were separated from the traffickers;

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10. What harm or mistreatment you fear if you are removed from the United States; and
11. Why you fear you would be harmed or mistreated.

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 21 years of age, eligible family members for whom you are filing must be your:
1. Spouse;

2. Unmarried child(ren) under 21 years of age;
3. Parent(s); or

4. Unmarried sibling(s) under 18 years of age.

If you are over 21 years of age, eligible family members for whom you are filing are your:
1. Spouse; or

2. Unmarried child(ren) under 21 years of age.

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 18 years of age; or

3. Adult or minor child of your derivative (your grandchild, your spouse’s child, your neice or nephew, or your sibling).
You must include:
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.
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.

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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.

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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 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.
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 two 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 two-year legal custody requirement.
I. Your unmarried sibling under 18 years of age. 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.
3. If you are filing for your parents, unmarried siblings under 18 years of age, 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:
A. A description of the danger the family member faces and how the danger is linked to your escape or cooperation
with law enforcement;
B. Documentation of a previous grant of advance parole to a family member, if available; and
C. 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 individuals.

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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.
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.

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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.
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.

Where to File?
Mail your complete application to the following address:
USCIS
Vermont Service Center
75 Lower Welden Street
St. Albans, VT 05479-0001
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What Is the Filing Fee?
There is no filing fee for Form I-914.
No biometrics services fee is required.

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 website at www.uscis.gov/addresschange or contact the USCIS National Customer Service
Center at 1-800-375-5283.

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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
Question 10 in Part C. As the principal applicant you do not need to file 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.
Decision
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 concerning T nonimmigrant status applicants and derivatives is protected under 8 USC section 1367. The
disclosure of information relating to an individual with a pending or approved application for T nonimmigrant status is
prohibited except in certain limited circumstances.

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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 website at www.uscis.gov.
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 website. 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.

Penalties

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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

AUTHORITIES: The information requested on this benefit application, and the associated evidence, is collected
pursuant to Public Law 106 - 386, sections 107(e) and 1513(c) and 8 USC 1101(a)(15)(T).
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.
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, 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 DHS/
USCIS-001 - Alien File, Index, and National File Tracking System], 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.

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;

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C. I am cooperating with Federal, State, or local law enforcement authorities in the investigation or
prosecution of the trafficker(s) (unless under 18 years of age 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;

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).

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