Table of Changes (form)

TABLE OF CHANGES – FORM

Form I-817, Application for Family Unity Benefits 


OMB Number: 1615-0005

05/31/2017

Reason for Revision: Limited revision for standard signature language.

Current Page Number and Section	Current Text	Proposed Text
Page 1, To be completed by an attorney or BIA-Accredited representative (if any).	[Page 1] … Attorney or Accredited Representative USCIS ELIS Account Number (if any)	[Page 1] … Attorney or Accredited Representative USCIS Online Account Number (if any)
Page 1-2, Part 1. Information About You (Person Requesting Family Unity Benefits)	[Page 1] Part 1. Information About You (Person Requesting Family Unity Benefits) … Other Names Used Provide any other names you have used since birth, including maiden names, and nicknames. … 7. USCIS ELIS Account Number (if any) 8. Gender Male Female … U.S. Mailing Address 11.a. In Care of Name …	[Page 1] Part 1. Information About You (Person Requesting Family Unity Benefits) … Other Names Used Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. … 7. USCIS Online Account Number (if any) 8. Sex Male Female … U.S. Mailing Address 11.a. In Care Of Name (if any) …
Page 2, Part 1. Information About You (Person Requesting Family Unity Benefits)	[Page 2] Part 1. Information About You (Person Requesting Family Unity Benefits) Biographic Information 13.  Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 14.  Race (Select all applicable boxes) White Asian Black or African American American Indian or Alaska Native Native Hawaiian or Other Pacific Islander 15.  Height  Feet__ Inches __ 16.  Weight    Pounds _ ­_ _ 17.  Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other 18.  Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other	[Page 2] Part 2. Biographic Information [delete] 1.  Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2.  Race (Select all applicable boxes) White Asian Black or African American American Indian or Alaska Native Native Hawaiian or Other Pacific Islander 3.  Height  Feet__ Inches __ 4.  Weight    Pounds _ ­_ _ 5.  Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other 6.  Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other
Page 2, Part 2. Basis for Application	[Page 2] Part 2. Basis for Application I am applying for Family Unity benefits because: (Select only one box) 1.a. On May 5, 1988, I was the spouse of an alien who was legalized under section 245A of the Immigration Nationality Act (INA). 1.b. On May 5, 1988, I was the unmarried child under 21 years of age of an alien who was legalized under section 245A of the INA. 1.c. On December 1, 1988, I was the spouse of an alien who was legalized as a Special Agricultural Worker under section 210 of the INA. 1.d. On December 1, 1988, I was the unmarried child under 21 years of age of an alien who was a legalized alien as a Special Agricultural Worker under section 210 of the INA. … 1.g. I am the spouse of a person who is eligible for and has filed or adjusted status under section 1104 of Public Law (P.L.) 106-5534, the Legal Immigration Family Equality (LIFE) Act. I entered the United States on or before December 1, 1988, and resided in the United States on that date. 1.h. I am the unmarried child under 21 years of age of a person who had filed an adjustment of status application or adjusted status under section 1104 of P. L. 106-5534, the LIFE Act. I entered the United States on or before December 1, 1988, and resided in the United States on that date. …	[Page 2] Part 3. Basis for Application [no change] 1.a. On May 5, 1988, I was the spouse of an alien who was legalized under the Immigration and Nationality Act (INA) section 245A. 1.b. On May 5, 1988, I was the unmarried child under 21 years of age of an alien who was legalized under INA section 245A. 1.c. On December 1, 1988, I was the spouse of an alien who was legalized as a Special Agricultural Worker under INA section 210. 1.d. On December 1, 1988, I was the unmarried child under 21 years of age of an alien who was a legalized alien as a Special Agricultural Worker under INA section 210. … 1.g. I am the spouse of a person who is eligible for and has filed or adjusted status under section 1104 of Public Law (Pub. L.) 106-553, the Legal Immigration Family Equality (LIFE) Act. I entered the United States on or before December 1, 1988, and resided in the United States on that date. 1.h. I am the unmarried child under 21 years of age of a person who had filed an adjustment of status application or adjusted status under section 1104 of Pub. L. 106-553, the LIFE Act. I entered the United States on or before December 1, 1988, and resided in the United States on that date. …
Page 3-5, Information About Your Relationship	[Page 3] Part 3. Information About Your Relationship If you need extra space to complete Part 3., use the space provided in Part 9. Additional Information. Other Names Used (Including maiden name, nicknames, etc.) … 6. USCIS ELIS Account Number (if any) … 8. Gender Male/Female … [Page 4] 17.k. Reason for Termination Divorce/Death/Annulment/Other (Provide an explanation if there are any other reasons for termination. If you need extra space to provide an explanation, use the space provided in Part 9. Additional Information.) … 19.k. Reason for Termination Divorce/Death/Annulment/Other (Provide an explanation if there are any other reasons for termination. If you need extra space to provide an explanation, use the space provided in Part 9. Additional Information.) NOTE: If you were previously married, you must complete Part 3., Item Numbers 13. - 19.k. of this application; complete all requested information about your prior marriages; and select the box in Item Number 20. Indicating that it is complete. 20. I have completed Part 3., Item Numbers 13. - 19.k. , information about my prior marriages (if any). …	[Page 3] Part 4. Information About Your Relationship If you need extra space to complete Part 4., use the space provided in Part 10. Additional Information. Other Names Used Provide all other names the legalized alien has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. … 6. USCIS Online Account Number (if any) … 8. Sex Male/Female … [Page 4] 17.k. Reason for Termination Divorce/Death/Annulment/Other (Provide an explanation if there are any other reasons for termination. If you need extra space to provide an explanation, use the space provided in Part 10. Additional Information.) … 19.k. Reason for Termination Divorce/Death/Annulment/Other (Provide an explanation if there are any other reasons for termination. If you need extra space to provide an explanation, use the space provided in Part 10. Additional Information.) NOTE: If you were previously married, you must complete Part 4., Item Numbers 13. - 19.k. of this application; complete all requested information about your prior marriages; and select the box in Item Number 20. Indicating that it is complete. 20. I have completed Part 4., Item Numbers 13. - 19.k. , information about my prior marriages (if any). …
Page 5-9, Part 4. Other Information	[Page 6] Part 4. Other Information ... Provide the U.S. address where you lived on May 5, 1988 (INA 245Aor or Cuban Haitian Adjustment Act) or December 1, 1988 (INA section 210 or LIFE Act). … NOTE: If you need more space to complete an answer in Item Numbers 5.a. - 24.f., use Part 9. Additional Information. … [Page 8] NOTE: If you need more space to complete an answer in Item Numbers 5.a. – 24.f., use Part 9. Additional Information. Answer Item Number 25.a. - 38. If you answer “Yes” to ANY of the questions, use the space provided in Part 9. Additional Information to provide an explanation. …	[Page 6] Part 5. Other Information ... Provide the U.S. address where you lived on May 5, 1988 (INA section 245A or Cuban Haitian Adjustment Act) or December 1, 1988 (INA section 210 or LIFE Act). … NOTE: If you need extra space to complete an answer in Item Numbers 5.a. - 24.f., use the space provided in Part 10. Additional Information. … [Page 8] NOTE: If you need extra space to complete an answer in Item Numbers 5.a. - 24.f., use the space provided in Part 10. Additional Information. Answer Item Number 25.a. - 38. If you answer “Yes” to ANY of the questions, use the space provided in Part 10. Additional Information to provide an explanation. …
Page 9-10, Part 5.  Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature	[Page 9] Part 5.  Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature NOTE: Read the information on penalties in the Penalties section of the Form I-817 Instructions before completing this part. Applicant's Statement NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. I can read and understand English, and have read and understand every question and instruction on this application, as well as my answer to every question. I have read and understand the Acknowledgement of Appointment at USCIS Application Support Center. 1.b. The interpreter named in Part 6. has also read to me every question and instruction on this application, as well as my answer to every question, in [fillable field], a language in which I am fluent.  I understand every question and instruction on this application as translated to me by my interpreter, and have provided complete, true, and correct responses in the language indicated above. The interpreter named in Part 6. has also read the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter. 2. I have requested the services of and consented to [fillable field], who is/is not an attorney or accredited representative, preparing this application for me. This person who assisted me in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center with me, and I understand the ASC Acknowledgement. Applicant's Contact Information 3. Applicant's Daytime Telephone Number 4. Applicant's Mobile Telephone Number (if any) 5. Applicant's Email Address (if any) Acknowledgement of Appointment at USCIS Application Support Center I, [fillable field], understand that the purpose of a USCIS ASC appointment is for me to provide my fingerprints, photograph, and/or signature and to re-affirm that all of the information in my application is complete, true, and correct and was provided by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC appointment. By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct. I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center with me. [page 10] Applicant's Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I certify, under penalty of perjury, that the information in my application and any document submitted with my application were provided by me and are complete, true, and correct. Applicant's Signature 6.a. Applicant's Signature 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, your application may be denied.	[Page 9] Part 6. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature NOTE: Read the Penalties section of the Form I-817 Instructions before completing this part. [no change] [no change] 1.a. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question. 1.b. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything. 2. At my request, the preparer named in Part 8., [Fillable Filed], prepared this application for me based only upon information I provided or authorized. [no change] [Delete] [Delete] [Delete] [Delete] Applicant’s Declaration and Certification [no change] I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1) I reviewed and understood all of the information contained in, and submitted with, my application; and 2) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that all of the information in my application and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my application and that all of this information is complete, true, and correct. [no change] [no change] [no change] NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.
Page 10, Part 6.  Interpreter's Contact Information, Certification, and Signature	[Page 10] Part 6.  Interpreter's Contact Information, Certification, and Signature Provide the following information concerning the interpreter. Interpreter's Full Name 1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) Interpreter's Mailing Address 3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter's Email Address (if any) Interpreter's Certification I certify that: I am fluent in English and [fillable field], which is the same language provided in Part 5., Item Number 1.b.; I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language provided in Part 5., Item Number 1.b.; and I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant in the same language provided in Part 5., Item Number 1.b. The applicant has informed me that he or she understands every instruction and question on the application, as well as the answer to every question, and the applicant verified the accuracy of every answer; and The applicant has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the contents of this application and all supporting documentation are complete, true, and correct. Interpreter's Signature 6.a. Interpreter's Signature 6.b. Date of Signature (mm/dd/yyyy)	[Page 10] Part 7.  Interpreter's Contact Information, Certification, and Signature Provide the following information about the interpreter. [no change] [no change] [no change] [no change] [Page 10] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] 5. Interpreter’s Mobile Telephone Number (if any) 6. Interpreter’s Email Address (if any) [no change] I certify, under penalty of perjury, that: I am fluent in English and [Fillable Field], which is the same language specified in Part 6., Item Number 1.b., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant’s Declaration and Certification, and has verified the accuracy of every answer. [Delete] [Delete] [no change] 7.a. Interpreter's Signature 7.b. Date of Signature (mm/dd/yyyy)
Page 11, Part 7.  Contact Information, Statement, Certification, and Signature of the Person Preparing This Application, If Other Than the Applicant	[Page 11] Part 7.  Contact Information, Statement, Certification, and Signature of the Person Preparing This Application, If Other Than the Applicant Provide the following information concerning the preparer. Preparer's Full Name 1.a. Preparer's Family Name (Last Name) 1.b. Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) Preparer's Mailing Address 3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number (if any) 6. Preparer's Email Address (if any) Preparer's Statement 7.a. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent. 7.b. I am an attorney or accredited representative and my representation of the applicant in this case extends/does not extend beyond the preparation of this application. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application. Preparer's Certification By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this application on behalf of, at the request of, and with the express consent of the applicant. I completed this application based only on responses the applicant provided to me. After completing the application, I reviewed it and all of the applicant's responses with the applicant, who agreed with every answer on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and the applicant has informed me that he or she understands the ASC Acknowledgement. Preparer's Signature 8.a. Preparer's Signature 8.b. Date of Signature (mm/dd/yyyy)	[Page 10] Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant Provide the following information about the preparer. [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] [no change] 5. Preparer’s Mobile Telephone Number (if any) [no change] [no change] [no change] [no change] NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application. [no change] By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant’s Declaration and Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use. [no change] [no change] [no change]
Page 11, Part 8. Signature for Placement On Employment Authorization Document	[Page 11] Part 8. Signature for Placement On Employment Authorization Document …	[Page 11] Part 9. Signature for Placement On Employment Authorization Document …
Page 12, Additional Information	[Page 12] Part 9. Additional Information If your need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. …	[Page 12] Part 10. Additional Information If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. …

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