Form I-485 Application to Register Permanent Residence or Adjust St

Application to Register Permanent Residence
or Adjust Status

USCIS
Form I-485

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0023
Expires 06/30/2019

For USCIS Use Only
Receipt

Preference Category:

Action Block

Country Chargeable:
Priority Date:
Date Form I-693 Received:
Applicant
Interviewed
Date of
Initial Interview:

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Interview
Waived

Lawful Permanent
Resident as of:

Section of Law

INA 209(a)
INA 209(b)
INA 245(a)
INA 245(i)
INA 245(m)

INA 249
Sec. 13, Act of 9/11/57
Cuban Adjustment Act
Other

To be completed by an attorney or accredited representative (if any).

Select this box if
Form G-28 is
attached.

Volag Number
(if any)

Attorney State Bar Number
(if applicable)

► START HERE - Type or print in black ink.

Attorney or Accredited Representative
USCIS Online Account Number (if any)

A-Number ► A-

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.

Part 1. Information About You (Person applying
for lawful permanent residence)

3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)

Your Current Legal Name (do not provide a
nickname)

3.c. Middle Name

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

1.c. Middle Name

4.c. Middle Name

Other Names You Have Used Since Birth (if
applicable)

Other Information About You

NOTE: Provide all other names you have ever used, including
your family name at birth, other legal names, nicknames,
aliases, and assumed names. If you need extra space to
complete this section, use the space provided in Part 14.
Additional Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

5.

Date of Birth (mm/dd/yyyy)
NOTE: In addition to providing your actual date of birth,
include any other dates of birth you have used in
connection with any legal names or non-legal names in
the space provided in Part 14. Additional Information.

6.

Sex

Male

7.

City or Town of Birth

Female

2.c. Middle Name
Form I-485 06/26/17 N

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A-Number ► A-

Part 1. Information About You (Person applying
for lawful permanent residence) (continued)
8.

9.

10.

Provide the information for Item Numbers 15. - 19. if you last
entered the United States using a passport or travel document.

Country of Birth

Passport Number Used at Last Arrival

16.

Travel Document Number Used at Last Arrival

17.

Expiration Date of this Passport or Travel Document

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Alien Registration Number (A-Number) (if any)

NOTE: If you have EVER used other A-Numbers,
include the additional A-Numbers in the space provided
in Part 14. Additional Information.
USCIS Online Account Number (if any)
►
12.

15.
Country of Citizenship or Nationality

► A-

11.

Recent Immigration History

U.S. Social Security Number (if any)
►

(mm/dd/yyyy)

18.

Country that Issued this Passport or Travel Document

19.

Nonimmigrant Visa Number from this Passport (if any)

Place of Last Arrival into the United States
20.a. City or Town

U.S. Mailing Address

20.b. State

13.a. In Care Of Name (if any)

21.

13.b. Street Number
and Name
13.c.

Apt.

When I last arrived in the United States, I:

Ste.

13.d. City or Town
13.e. State

Date of Last Arrival (mm/dd/yyyy)

Flr.

13.f. ZIP Code

22.a.

Was inspected at a port of entry and admitted as (for
example, exchange visitor; visitor, waived through;
temporary worker; student):

22.b.

Was inspected at a port of entry and paroled as (for
example, humanitarian parole, Cuban parole):

22.c.

Came into the United States without admission or
parole.

22.d.

Other:

Alternate and/or Safe Mailing Address
If you are applying based on the Violence Against Women Act
(VAWA) or as a special immigrant juvenile, human trafficking
victim (T nonimmigrant), or victim of a qualifying crime (U
nonimmigrant) and you do not want USCIS to send notices
about this application to your home, you may provide an
alternative and/or safe mailing address.

If you were issued a Form I-94 Arrival-Departure Record Number:

14.a. In Care Of Name (if any)

23.a. Form I-94 Arrival-Departure Record Number
►

14.b. Street Number
and Name
14.c.

Apt.

23.b. Expiration Date of Authorized Stay Shown on Form I-94
Ste.

Flr.

23.c. Status on Form I-94 (for example, class of admission, or
paroled, if paroled)

14.d. City or Town
14.e. State

(mm/dd/yyyy)

14.f. ZIP Code

Form I-485 06/26/17 N

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A-Number ► A-

Part 1. Information About You (Person applying
for lawful permanent residence) (continued)
24.

What is your current immigration status (if it has changed
since your arrival)?

Provide your name exactly as it appears on your Form I-94 (if
any)
25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
25.c. Middle Name

Employment-based
3.a.

Alien worker, Form I-140 (if you select this box
AND you are a principal Form I-485 applicant, you
must answer Item Number 9.a.)

3.b.

Alien entrepreneur, Form I-526

Special Immigrant

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4.a.

Religious worker, Form I-360

4.b.

Special immigrant juvenile, Form I-360

4.c.

Certain Afghan or Iraqi national, Form I-360

4.d.

Certain international broadcaster, Form I-360

4.e.

Certain G-4 international organization or family
member or NATO-6 employee or family member,
Form I-360

4.f.

Certain U.S. armed forces member (also known as
the Six and Six program), Form I-360

4.g.

Panama Canal Zone employee, Form I-360

4.h.

Certain physician, Form I-360

4.i.

Certain employee or former employee of the U.S.
Government abroad, Form I-360

Part 2. Application Type or Filing Category
1.

I am filing this Form I-485 as a (select only one box):
Principal applicant

Derivative applicant

NOTE: Attach a copy of the Form I-797 receipt or approval
notice for the underlying petition or application, as appropriate.

I am applying as a principal or derivative applicant to register
lawful permanent residence or adjust status to that of a lawful
permanent resident based on the following immigrant category
(select only one category). (See the Form I-485 Instructions for
more information, including any Additional Instructions that
relate to the immigrant category you select.):

Family-based
2.a.

Immediate relative of a U.S. citizen, Form I-130

2.b.

Other relative of a U.S. citizen or relative of a lawful
permanent resident under the family-based preference
categories, Form I-130

2.c.

Person admitted to the United States as a fiancé(e) or
child of a fiancé(e) of a U.S. citizen, Form I-129F
(K-1/K-2 Nonimmigrant)

2.d.

Widow or widower of a U.S. citizen, Form I-360

2.e.

VAWA self-petitioner, Form I-360

2.f.

Spouse, child, or parent of a deceased U.S. active
duty service member in the armed forces under the
National Defense Authorization Act (NDAA), Form
I-130 or Form I-360

Form I-485 06/26/17 N

Asylee or Refugee

5.a.

Asylum status (INA section 208), Form I-589 or
Form I-730

5.b.

Refugee status (INA section 207), Form I-590 or
Form I-730

Human Trafficking Victim or Crime Victim
6.a.

Human trafficking victim (T Nonimmigrant), Form
I-914 or derivative family member, Form I-914A

6.b.

Crime victim (U Nonimmigrant), Form I-918,
derivative family member, Form I-918A, or
qualifying family member, Form I-929

Page 3 of 20

A-Number ► AIf you answered "Yes" to Item Number 9.a., answer
Item Numbers 9.b. - 9.c. If you answered "No," skip to
Item Number 10.

Part 2. Application Type or Filing Category
(continued)
Special Programs Based on Certain Public Laws
7.a.

The Cuban Adjustment Act

7.b.

The Cuban Adjustment Act for battered spouses and
children

7.c.

Dependent status under the Haitian Refugee
Immigrant Fairness Act

7.d.

Dependent status under the Haitian Refugee
Immigrant Fairness Act for battered spouses and
children

Brother or sister
Husband, wife, father, mother, child, adult son, or
adult daughter

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7.e.

Lautenberg Parolees

7.f.

Diplomats or high ranking officials unable to return
home (Section 13 of the Act of September 11, 1957)

7.g.

Indochinese Parole Adjustment Act of 2000

7.h.

Amerasian Act (October 22, 1928), Form I-360

Additional Options

9.b. How is your relative related to you?

8.a.

Diversity Visa program

8.b.

Continuous residence in the United States since
before January 1, 1972 ("Registry")

8.c.

Individual born in the United States under diplomatic
status

8.d.

S nonimmigrants and qualifying family members
(only law enforcement agencies can file Form I-485
for someone in this category)

8.e.

Other eligibility (see the Form I-485 Instructions,
Who May Form I-485, Item Number 3. Other
Immigrant Categories for examples)

9.c. This relative is a:
U.S. citizen

U.S. national

Lawful permanent resident
None of the above

INA Section 245(i)

10.

Are you applying for adjustment based on the
Immigration and Nationality Act (INA) section 245(i)?
Yes

No

NOTE: If you answered "Yes" to Item Number 10., you
must have selected a family-based, employment-based,
special immigrant, or Diversity Visa immigrant category
listed above in Item Numbers 2.a. - 8.e. as the basis for
your application for adjustment of status. Fill out the rest
of this application AND Supplement A to Form I-485,
Adjustment of Status Under Section 245(i) (Supplement
A). For detailed filing instructions, read the Form I-485
Instructions (including any Additional Instructions that
relate to the immigrant category that you selected in Item
Numbers 2.a. - 8.e.) and Supplement A Instructions.

Information About Your Immigrant Category
If you are the principal applicant, provide the following
information.
11.

Receipt Number of Underlying Petition (if any)

12.

Priority Date from Underlying Petition (if any)
(mm/dd/yyyy)

Additional Alien Worker Information
Answer Item Number 9.a. only if you selected Item Number
3.a. (Alien worker AND you are a principal Form I-485
employment-based adjustment applicant).
9.a. Did a relative file the associated Form I-140 for you or
does a relative have a significant ownership interest (five
percent or more) in the business that filed Form I-140 for
you? (The relative must be your husband, wife, father,
mother, child, adult son, adult daughter, brother, or sister.)
Yes
No

If you are a derivative applicant (the spouse or unmarried
child under 21 years of age of a principal applicant), provide the
following information for the principal applicant.
Principal Applicant's Name
13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)
13.c. Middle Name

Form I-485 06/26/17 N

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A-Number ► A-

Part 2. Application Type or Filing Category
(continued)
14.

Principal Applicant's A-Number (if any)
► A-

15.

Principal Applicant's Date of Birth (mm/dd/yyyy)

Address History
Provide physical addresses for everywhere you have lived
during the last five years, whether inside or outside the United
States. Provide your current address first. If you need extra
space to complete this section, use the space provided in
Part 14. Additional Information.
Physical Address 1 (current address)

16.

►
17.

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Receipt Number of Principal's Underlying Petition (if any)

Priority Date of Principal Applicant's Underlying Petition
(if any) (mm/dd/yyyy)

5.a. Street Number
and Name

5.b.

Apt.

Ste.

Flr.

5.c. City or Town
5.d. State

5.e. ZIP Code

Part 3. Additional Information About You

5.f.

1.

Province

Have you ever applied for an immigrant visa to obtain
permanent resident status at a U.S. Embassy or U.S.
Consulate abroad?
Yes
No

5.g. Postal Code

If you answered "Yes" to Item Number 1., complete
Item Numbers 2.a. - 4. below. If you need extra space to
complete this section, use the space provided in Part 14.
Additional Information.

Dates of Residence

5.h. Country

6.a. From (mm/dd/yyyy)

Location of U.S. Embassy or U.S. Consulate

6.b. To (mm/dd/yyyy)

2.a. City
2.b. Country

Physical Address 2

7.a. Street Number
and Name

3.

Decision (for example, approved, refused, denied,
withdrawn)

7.b.

Apt.

Ste.

Flr.

7.c. City or Town
4.

Date of Decision (mm/dd/yyyy)

7.d. State
7.f.

7.e. ZIP Code

Province

7.g. Postal Code
7.h. Country

Dates of Residence
8.a. From (mm/dd/yyyy)
8.b. To (mm/dd/yyyy)

Form I-485 06/26/17 N

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A-Number ► A-

Part 3. Additional Information About You
(continued)
Provide your most recent address outside the United States
where you lived for more than one year (if not already listed
above).

Apt.

Dates of Employment
14.a. From (mm/dd/yyyy)

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Ste.

Flr.

Employer 2
15.

9.c. City or Town
9.d. State
9.f.

Your Occupation

14.b. To (mm/dd/yyyy)

9.a. Street Number
and Name
9.b.

13.

9.e. ZIP Code

Name of Employer or Company

Address of Employer or Company
16.a. Street Number
and Name

Province

9.g. Postal Code

16.b.

9.h. Country

Apt.

Ste.

Flr.

16.c. City or Town
16.d. State

Dates of Residence

16.f. Province

10.a. From (mm/dd/yyyy)
10.b. To (mm/dd/yyyy)

16.e. ZIP Code

16.g. Postal Code
16.h. Country

Employment History

Provide your employment history for the last five years,
whether inside or outside the United States. Provide the most
recent employment first. If you need extra space to complete
this section, use the space provided in Part 14. Additional
Information.
Employer 1 (current or most recent)
11.

Name of Employer or Company

17.

Your Occupation

Dates of Employment

18.a. From (mm/dd/yyyy)
18.b. To (mm/dd/yyyy)

Provide your most recent employment outside of the United
States (if not already listed above).
Address of Employer or Company

19.

Name of Employer or Company

12.a. Street Number
and Name
12.b.

Apt.

Ste.

Flr.

12.c. City or Town
12.d. State

12.e. ZIP Code

12.f. Province
12.g. Postal Code
12.h. Country

Form I-485 06/26/17 N

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A-Number ► A-

Part 3. Additional Information About You
(continued)

4.

Sex

Male

Female

5.

City or Town of Birth

6.

Country of Birth

7.

Current City or Town of Residence (if living)

8.

Current Country of Residence (if living)

Address of Employer or Company
20.a. Street Number
and Name
20.b.

Apt.

Ste.

20.c. City or Town
20.d. State

Flr.

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20.e. ZIP Code

20.f. Province

Information About Your Parent 2

20.g. Postal Code
20.h. Country

21.

Your Occupation

Parent 2's Legal Name
9.a. Family Name
(Last Name)
9.b. Given Name
(First Name)

9.c. Middle Name

Dates of Employment

22.a. From (mm/dd/yyyy)
22.b. To (mm/dd/yyyy)

Part 4. Information About Your Parents

Parent 2's Name at Birth (if different than above)

10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)

10.c. Middle Name
11.

Date of Birth (mm/dd/yyyy)

12.

Sex

13.

City or Town of Birth

14.

Country of Birth

15.

Current City or Town of Residence (if living)

16.

Current Country of Residence (if living)

Information About Your Parent 1
Parent 1's Legal Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

Male

Female

1.c. Middle Name
Parent 1's Name at Birth (if different than above)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
3.

Date of Birth (mm/dd/yyyy)

Form I-485 06/26/17 N

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A-Number ► A-

Part 5. Information About Your Marital History
1.

9.a. City or Town

What is your current marital status?
Single, Never Married
Widowed

Married

Place of Marriage to Current Spouse

Divorced

Marriage Annulled

9.b. State or Province

Legally Separated
2.

3.

If you are married, is your spouse a current member of the
U.S. armed forces or U.S. Coast Guard?
N/A
Yes
No

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How many times have you been married (including
annulled marriages and marriages to the same person)?

Information About Your Current Marriage
(including if you are legally separated)

If you are currently married, provide the following information
about your current spouse.
Current Spouse's Legal Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
4.c. Middle Name
5.

9.c. Country

10.

Is your current spouse applying with you?
Yes

No

Information About Prior Marriages (if any)

If you have been married before, whether in the United States or
in any other country, provide the following information about
your prior spouse. If you have had more than one previous
marriage, use the space provided in Part 14. Additional
Information to provide the information below.

Prior Spouse's Legal Name (provide family name before
marriage)
11.a. Family Name
(Last Name)
11.b. Given Name
(First Name)

11.c. Middle Name

A-Number (if any)

► A-

6.

Current Spouse's Date of Birth (mm/dd/yyyy)

7.

Date of Marriage to Current Spouse (mm/dd/yyyy)

12.

Prior Spouse's Date of Birth (mm/dd/yyyy)

13.

Date of Marriage to Prior Spouse (mm/dd/yyyy)

Place of Marriage to Prior Spouse
14.a. City or Town

Current Spouse's Place of Birth
8.a. City or Town

8.b. State or Province

8.c. Country

Form I-485 06/26/17 N

14.b. State or Province

14.c. Country

15.

Date Marriage with Prior Spouse Legally Ended
(mm/dd/yyyy)

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A-Number ► A-

Part 5. Information About Your Marital History
(continued)

Current Legal Name
7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)

Place Where Marriage with Prior Spouse Legally Ended
16.a. City or Town

16.b. State or Province

Child 2

7.c. Middle Name

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8.

16.c. Country

A-Number (if any)

► A-

9.

Date of Birth (mm/dd/yyyy)

10.

Country of Birth

Indicate the total number of ALL living children
(including adult sons and daughters) that you have.

11.

Is this child applying with you?

NOTE: The term “children” includes all biological or
legally adopted children, as well as current stepchildren,
of any age, whether born in the United States or other
countries, married or unmarried, living with you or
elsewhere and includes any missing children and those
born to you outside of marriage.

Child 3

Part 6. Information About Your Children
1.

Provide the following information for each of your children.
If you have more than three children, use the space provided in
Part 14. Additional Information.
Child 1
Current Legal Name
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

No

Yes

No

Current Legal Name
12.a. Family Name
(Last Name)
12.b. Given Name
(First Name)

12.c. Middle Name
13.

A-Number (if any)

► A-

2.c. Middle Name
3.

Yes

14.

Date of Birth (mm/dd/yyyy)

15.

Country of Birth

16.

Is this child applying with you?

A-Number (if any)
► A-

4.

Date of Birth (mm/dd/yyyy)

5.

Country of Birth

6.

Is this child applying with you?

Form I-485 06/26/17 N

Yes

No

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A-Number ► A3.b. State or Province

Part 7. Biographic Information
1.

Ethnicity (Select only one box)

3.c. Country

Hispanic or Latino
Not Hispanic or Latino
2.

4.

Nature of Group

Race (Select all applicable boxes)
White
Asian

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Dates of Membership or Dates of Involvement

5.a. From (mm/dd/yyyy)

Black or African American

American Indian or Alaska Native

5.b. To (mm/dd/yyyy)

Native Hawaiian or Other Pacific Islander
3.

Height

4.

Weight

5.

Eye Color (Select only one box)
Black
Gray
Maroon

6.

Feet

Inches

Brown
Sandy

6.

Name of Organization

Pounds

7.a. City or Town

Blue

Brown

Green

Hazel

Pink

Unknown/Other

7.b. State or Province

7.c. Country

Hair Color (Select only one box)
Bald (No hair)

Organization 2

Black

Blond

Gray

Red

White

Unknown/Other

8.

Nature of Group

Dates of Membership or Dates of Involvement

Part 8. General Eligibility and Inadmissibility
Grounds
1.

Have you EVER been a member of, involved in, or in
any way associated with any organization, association,
fund, foundation, party, club, society, or similar group in
the United States or in any other location in the world
including any military service?
Yes
No

If you answered "Yes" to Item Number 1., complete Item
Numbers 2. - 13.b. below. If you need extra space to complete
this section, use the space provided in Part 14. Additional
Information. If you answered "No," but are unsure of your
answer, provide an explanation of the events and circumstances
in the space provided in Part 14. Additional Information.

9.a. From (mm/dd/yyyy)
9.b. To (mm/dd/yyyy)
Organization 3
10.

Name of Organization

11.a. City or Town

11.b. State or Province

11.c. Country
Organization 1
2.

Name of Organization

12.

Nature of Group

3.a. City or Town

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

If you answered "Yes" to Item Number 24.a., complete Item
Numbers 24.b. - 24.c. If you answered "No" to Item Number
24.a., skip to Item Number 25.

Dates of Membership or Dates of Involvement

24.b. Have you complied with the foreign residence
requirement?
Yes

13.a. From (mm/dd/yyyy)
13.b. To (mm/dd/yyyy)

No

24.c. Have you been granted a waiver or has Department of
State issued a favorable waiver recommendation letter
for you?
Yes
No

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Answer Item Numbers 14. - 80.b. Choose the answer that you
think is correct. If you answer “Yes” to any questions (or if
you answer "No," but are unsure of your answer), provide
an explanation of the events and circumstances in the space
provided in Part 14. Additional Information.
14.

Have you EVER been denied admission to the United
States?
Yes
No

15.

Have you EVER been denied a visa to the United States?
Yes
No

16.

Have you EVER worked in the United States without
authorization?
Yes
No

17.

Have you EVER violated the terms or conditions of your
nonimmigrant status?
Yes
No

18.

Are you presently or have you EVER been in removal,
exclusion, rescission, or deportation proceedings?
Yes

For Item Numbers 25. - 45., you must answer "Yes" to any
question that applies to you, even if your records were sealed or
otherwise cleared, or even if anyone, including a judge, law
enforcement officer, or attorney, told you that you no longer
have a record. You must also answer "Yes" to the following
questions whether the action or offense occurred here in the
United States or anywhere else in the world. If you answer
"Yes" to Item Numbers 25. - 45., use the space provided in
Part 14. Additional Information to provide an explanation
that includes why you were arrested, cited, detained, or charged;
where you were arrested, cited, detained, or charged; when
(date) the event occurred; and the outcome or disposition (for
example, no charges filed, charges dismissed, jail, probation,
community service).
25.

Have you EVER been arrested, cited, charged, or
detained for any reason by any law enforcement official
(including but not limited to any U.S. immigration
official or any official of the U.S. armed forces or U.S.
Coast Guard)?
Yes
No

26.

Have you EVER committed a crime of any kind (even if
you were not arrested, cited, charged with, or tried for that
crime)?
Yes
No

27.

Have you EVER pled guilty to or been convicted of a
crime or offense (even if the violation was subsequently
expunged or sealed by a court, or if you were granted a
pardon, amnesty, a rehabilitation decree, or other act of
clemency)?
Yes
No

No

19.

Have you EVER been issued a final order of exclusion,
deportation, or removal?
Yes
No

20.

Have you EVER had a prior final order of exclusion,
deportation, or removal reinstated?
Yes
No

21.

Have you EVER held lawful permanent resident status
which was later rescinded?
Yes
No

22.

Have you EVER been granted voluntary departure by an
immigration officer or an immigration judge but failed to
depart within the allotted time?
Yes
No

23.

Have you EVER applied for any kind of relief or
protection from removal, exclusion, or deportation?
Yes
No

24.a. Have you EVER been a J nonimmigrant exchange visitor
who was subject to the two-year foreign residence
requirement?
Yes
No

Form I-485 06/26/17 N

Criminal Acts and Violations

NOTE: If you were the beneficiary of a pardon, amnesty,
a rehabilitation decree, or other act of clemency, provide
documentation of that post-conviction action.
28.

Have you EVER been ordered punished by a judge or had
conditions imposed on you that restrained your liberty
(such as a prison sentence, suspended sentence, house
arrest, parole, alternative sentencing, drug or alcohol
treatment, rehabilitative programs or classes, probation, or
community service)?
Yes
No

Page 11 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
29.

Have you EVER been a defendant or the accused in a
criminal proceeding (including pre-trial diversion,
deferred prosecution, deferred adjudication, or any
withheld adjudication)?
Yes
No

30.

Have you EVER violated (or attempted or conspired to
violate) any controlled substance law or regulation of a
state, the United States, or a foreign country?

No

31.

Have you EVER been convicted of two or more offenses
(other than purely political offenses) for which the
combined sentences to confinement were five years or
more?
Yes
No

32.

Have you EVER illicitly (illegally) trafficked or benefited
from the trafficking of any controlled substances, such as
chemicals, illegal drugs, or narcotics?
Yes
No

33.

Have you EVER knowingly aided, abetted, assisted,
conspired, or colluded in the illicit trafficking of any
illegal narcotic or other controlled substances?
Yes

37.

38.

No

Have you EVER engaged in prostitution or are you
coming to the United States to engage in prostitution?
Yes

36.

40.

Have you EVER, while serving as a foreign government
official, been responsible for or directly carried out
violations of religious freedoms?
Yes
No

41.

Have you EVER induced by force, fraud, or coercion (or
otherwise been involved in) the trafficking of persons for
commercial sex acts?
Yes
No

42.

Have you EVER trafficked a person into involuntary
servitude, peonage, debt bondage, or slavery? Trafficking
includes recruiting, harboring, transporting, providing, or
obtaining a person for labor or services through the use of
force, fraud, or coercion.
Yes
No

43.

Have you EVER knowingly aided, abetted, assisted,
conspired, or colluded with others in trafficking persons
for commercial sex acts or involuntary servitude,
peonage, debt bondage, or slavery?
Yes
No

44.

Are you the spouse, son or daughter of a foreign national
who engaged in the trafficking of persons and have
received or obtained, within the last five years, any
financial or other benefits from the illicit activity of your
spouse or your parent, although you knew or reasonably
should have known that this benefit resulted from the illicit
activity of your spouse or parent?
Yes
No

45.

Have you EVER engaged in money laundering or have
you EVER knowingly aided, assisted, conspired, or
colluded with others in money laundering or do you seek
to enter the United States to engage in such activity?

No

Are you the spouse, son, or daughter of a foreign national
who illicitly trafficked or aided (or otherwise abetted,
assisted, conspired, or colluded) in the illicit trafficking of
a controlled substance, such as chemicals, illegal drugs, or
narcotics and you obtained, within the last five years, any
financial or other benefit from the illegal activity of your
spouse or parent, although you knew or reasonably should
have known that the financial or other benefit resulted
from the illicit activity of your spouse or parent?
Yes

35.

Have you EVER exercised immunity (diplomatic or
otherwise) to avoid being prosecuted for a criminal
offense in the United States?
Yes
No

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Yes

34.

39.

No

Have you EVER directly or indirectly procured (or
attempted to procure) or imported prostitutes or persons
for the purpose of prostitution?
Yes
No
Have you EVER received any proceeds or money from
prostitution?
Yes
No
Do you intend to engage in illegal gambling or any other
form of commercialized vice, such as prostitution,
bootlegging, or the sale of child pornography, while in the
United States?
Yes
No

Form I-485 06/26/17 N

Yes

No

Security and Related
Do you intend to:
46.a. Engage in any activity that violates or evades any law
relating to espionage (including spying) or sabotage in the
United States?
Yes
No
46.b. Engage in any activity in the United States that violates or
evades any law prohibiting the export from the United
States of goods, technology, or sensitive information?
Yes

No

46.c. Engage in any activity whose purpose includes opposing,
controlling, or overthrowing the U.S. Government by
force, violence, or other unlawful means while in the
United States?
Yes
No

Page 12 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
46.d. Engage in any activity that could endanger the welfare,
safety, or security of the United States?
Yes
Yes

No

Are you engaged in or, upon your entry into the United
States, do you intend to engage in any activity that could
have potentially serious adverse foreign policy
consequences for the United States?
Yes
No

Have you EVER:

48.a. Committed, threatened to commit, attempted to commit,
conspired to commit, incited, endorsed, advocated,
planned, or prepared any of the following: hijacking,
sabotage, kidnapping, political assassination, or use of a
weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No
48.b. Participated in, or been a member of, a group or
organization that did any of the activities described in
Item Number 48.a.?
Yes
No

48.c. Recruited members or asked for money or things of value
for a group or organization that did any of the activities
described in Item Number 48.a.?
Yes
No
48.d. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Number 48.a.?
Yes
No

48.e. Provided money, a thing of value, services or labor, or
any other assistance or support for an individual, group,
or organization who did any of the activities described in
Item Number 48.a.?
Yes
No
49.

50.

Have you EVER received any type of military,
paramilitary, or weapons training?
Yes

51.b. Participated in, or been a member or a representative of a
group or organization that did any of the activities
described in Item Number 51.a.?
Yes
No
51.c. Recruited members, or asked for money or things of value,
for a group or organization that did any of the activities
described in Item Number 51.a.?
Yes
No
51.d. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Number 51.a.?
Yes
No
51.e. Provided money, a thing of value, services or labor, or
any other assistance or support to an individual, group, or
organization who did any of the activities described in
Item Number 51.a.?
Yes
No
51.f. Received any type of military, paramilitary, or weapons
training from a group or organization that did any of the
activities described in Item Number 51.a.?
Yes
No
NOTE: If you answered “Yes” to any part of Item Number
51., explain the relationship and what occurred, including the
dates and location of the circumstances, in the space provided
in Part 14. Additional Information.
52.

NOTE: If you answered “Yes” to any part of Item Numbers
46.a. - 50., explain what you did, including the dates and
location of the circumstances, or what you intend to do in the
space provided in Part 14. Additional Information.

Have you EVER assisted or participated in selling,
providing, or transporting weapons to any person who,
to your knowledge, used them against another person?
Yes

No

53.

Have you EVER worked, volunteered, or otherwise
served in any prison, jail, prison camp, detention facility,
labor camp, or any other situation that involved detaining
persons?
Yes
No

54.

Have you EVER been a member of, assisted, or
participated in any group, unit, or organization of any
kind in which you or other persons used any type of
weapon against any person or threatened to do so?

No

Do you intend to engage in any of the activities listed in
any part of Item Numbers 48.a. - 49.?
Yes
No

Form I-485 06/26/17 N

51.a. Committed, threatened to commit, attempted to commit,
conspired to commit, incited, endorsed, advocated,
planned, or prepared any of the following: hijacking,
sabotage, kidnapping, political assassination, or use of a
weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No

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46.e. Engage in any other unlawful activity?
47.

No

Are you the spouse or child of an individual who EVER:

Yes

No

Page 13 of 20

A-Number ► A-

Public Charge

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
55.

56.

Have you EVER served in, been a member of, assisted,
or participated in any military unit, paramilitary unit,
police unit, self-defense unit, vigilante unit, rebel group,
guerilla group, militia, insurgent organization, or any
other armed group?
Yes
No

Are you exempt from the public charge ground of
inadmissibility?
Yes

No

To see if you are exempt from filing Form I-944, read the Form
I-485 Instructions, What Evidence Must You Submit, Item
Number 9. Public Charge: Declaration of Self-Sufficiency
(Form I-944) and Affidavit of Support Under Section 213A
of the INA (Form I-864). If you answered "Yes" to Item
Number 61., skip to Item Number 63.a. If you answered
"No," proceed to Item Number 62.a.

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Have you EVER been a member of, or in any way
affiliated with, the Communist Party or any other
totalitarian party (in the United States or abroad)?
Yes

57.

61.

No

During the period from March 23, 1933 to May 8, 1945,
did you ever order, incite, assist, or otherwise participate
in the persecution of any person because of race, religion,
national origin, or political opinion, in association with
either the Nazi government of Germany or any
organization or government associated or allied with the
Nazi government of Germany?
Yes
No

Have you EVER ordered, incited, called for, committed, assisted,
helped with, or otherwise participated in any of the following:
58.a. Acts involving torture or genocide?

Yes

No

58.b. Killing any person?

Yes

No

58.c. Intentionally and severely injuring any person?
Yes

You may need to file Form I-864. For more information, go to
the Form I-485 Instructions, What Evidence Must You
Submit, Item Number 9. Public Charge: Declaration of SelfSufficiency (Form I-944) and Affidavit of Support Under
INA section 213A (Form I-864).
I am EXEMPT from filing Form I-864 because:
62.a.

I have earned or can receive credit for 40 qualifying
quarters (credits) of work in the United States (as
defined by the Social Security Act (SSA)). (Attach
your SSA earnings statements. Do not count any
quarters during which you received a means-tested
public benefit.)

62.b.

I am under 18 years of age, unmarried, immigrating
as the child of a U.S. citizen, and will automatically
become a U.S. citizen under the Child Citizenship
Act of 2000 upon my admission to the United States.

62.c.

I am applying under the widow or widower of a U.S.
citizen (Form I-360) immigrant category.

62.d.

I am applying under an alien worker (Form I-140)
employment-based preference immigrant category
and both of the following apply:

No

58.d. Engaging in any kind of sexual contact or relations with
any person who did not consent or was unable to consent,
or was being forced or threatened?
Yes
No
58.e. Limiting or denying any person's ability to exercise
religious beliefs?
Yes
No
59.

Have you EVER recruited, enlisted, conscripted, or used
any person under 15 years of age to serve in or help an
armed force or group?
Yes
No

60.

Have you EVER used any person under 15 years of age
to take part in hostilities, or to help or provide services to
people in combat?
Yes
No

NOTE: If you answered “Yes” to any part of Item Numbers
52. - 60., explain what occurred, including the dates and
location of the circumstances, in the space provided in Part 14.
Additional Information.

Form I-485 06/26/17 N

Affidavit of Support Under Section 213A of the
INA (Form I-864)

(1) I am not a relative of the Form I-140 petitioner;
and
(2) I do not have a relative with a significant
ownership interest (at least five percent) in the
business that filed Form I-140.
62.e.

I am applying under the alien entrepreneur (Form
I-526) immigrant category.

62.f.

I am applying under the human trafficking victim (T
nonimmigrant, Form I-914) immigrant category.

62.g.

I am applying under the diplomat or high ranking
official unable to return home (Section 13 of the Act
of September 11, 1957) immigrant category.

Page 14 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
62.h.

I am a law enforcement officer filing this Form I-485
for an S nonimmigrant immigrant (or a qualifying
family member).

62.i.

I am applying under the Diversity Visa program
immigrant category.

62.j.

I am applying under one of the following special
immigrant categories (select one):

Have you EVER been a stowaway on a vessel or aircraft
arriving in the United States?
Yes
No

68.

Have you EVER knowingly encouraged, induced,
assisted, abetted, or aided any foreign national to enter or
to try to enter the United States illegally (alien
smuggling)?
Yes
No

69.

Are you under a final order of civil penalty for violating
INA section 274C for use of fraudulent documents?

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Yes

No

(1)

Armed forces (also known as the Six and
Six program)

Removal, Unlawful Presence, or Illegal Reentry
After Previous Immigration Violations

(2)

Panama Canal Zone

70.

(3)

Certain brodcasters

(4)

G-4 or NATO-6 employees and their family
members

(5)

International employees of the U.S.
Government abroad

(6)

Religious workers

(7)

Certain physicians

(8)

Employed by or on behalf of the U.S.
Government

Illegal Entries and Other Immigration Violations

63.a. Have you EVER failed or refused to attend or to remain
in attendance at any removal proceeding filed against you
on or after April 1, 1997?
Yes
No
63.b. If your answer to Item Number 63.a. is "Yes," do you
believe you had reasonable cause?
Yes
No
63.c. If your answer to Item Number 63.b. is "Yes," attach a
written statement explaining why you had reasonable
cause.
64.

67.

Have you EVER submitted fraudulent or counterfeit
documentation to any U.S. Government official to obtain
or attempt to obtain any immigration benefit, including a
visa or entry into the United States?
Yes
No

65.

Have you EVER lied about, concealed, or misrepresented
any information on an application or petition to obtain a
visa, other documentation required for entry into the
United States, admission to the United States, or any other
kind of immigration benefit?
Yes
No

66.

Have you EVER falsely claimed to be a U.S. citizen (in
writing or any other way)?
Yes
No

Form I-485 06/26/17 N

71.

Have you EVER been excluded, deported, or removed
from the United States or have you ever departed the
United States on your own after having been ordered
excluded, deported, or removed from the United States?
Yes

No

Have you EVER entered the United States without being
inspected and admitted or paroled?
Yes
No

Since April 1, 1997, have you been unlawfully present in the
United States:
72.a. For more than 180 days but less than a year, and then
departed the United States?
Yes
No

72.b. For one year or more and then departed the United States?
Yes
No
NOTE: You were unlawfully present in the United States if
you entered the United States without being inspected and
admitted or inspected and paroled, or if you legally entered the
United States but you stayed longer than permitted.
Since April 1, 1997, have you EVER reentered or attempted to
reenter the United States without being inspected and admitted
or paroled after:
73.a. Having been unlawfully present in the United States for
more than one year in the aggregate?
Yes
No

73.b. Having been deported, excluded, or removed from the
United States?
Yes
No

Page 15 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

Part 9. Accommodations for Individuals With
Disabilities and/or Impairments

Miscellaneous Conduct

NOTE: Read the information in the Form I-485 Instructions
before completing this part.

74.

Do you plan to practice polygamy in the United States?
Yes
No

75.

Are you accompanying another foreign national who
requires your protection or guardianship but who is
inadmissible after being certified by a medical officer as
being helpless from sickness, physical or mental
disability, or infancy, as described in INA section 232(c)?

If you answered "Yes" to Item Number 1., select any
applicable box in Item Numbers 2.a. - 2.c. and provide
an answer.

2.a.

I am deaf or hard of hearing and request the
following accommodation. (If you are requesting a
sign-language interpreter, indicate for which
language (for example, American Sign Language).):

2.b.

I am blind or have low vision and request the
following accommodation:

2.c.

I have another type of disability and/or impairment.
(Describe the nature of your disability and/or
impairment and the accommodation you are
requesting.)

No

Have you EVER assisted in detaining, retaining, or
withholding custody of a U.S. citizen child outside the
United States from a U.S. citizen who has been granted
custody of the child?
Yes
No

77.

Have you EVER voted in violation of any Federal, state,
or local constitutional provision, statute, ordinance, or
regulation in the United States?
Yes
No

78.

Have you EVER renounced U.S. citizenship to avoid
being taxed by the United States?
Yes
No

Have you EVER:

Are you requesting an accommodation because of your
disabilities and/or impairments?
Yes
No

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Yes

76.

1.

79.a. Applied for exemption or discharge from training or
service in the U.S. armed forces or in the U.S. National
Security Training Corps on the ground that you are a
foreign national?
Yes
No

79.b. Been relieved or discharged from such training or service
on the ground that you are a foreign national?
Yes
No
79.c. Been convicted of desertion from the U.S. armed forces?
Yes

No

80.a. Have you EVER left or remained outside the United
States to avoid or evade training or service in the U.S.
armed forces in time of war or a period declared by the
President to be a national emergency?
Yes
No
80.b. If your answer to Item Number 80.a. is “Yes,” what was
your nationality or immigration status immediately before
you left (for example, U.S. citizen or national, lawful
permanent resident, nonimmigrant, parolee, present
without admission or parole, or any other status)?

Form I-485 06/26/17 N

Page 16 of 20

A-Number ► AI 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.

Part 10. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature
NOTE: Read the Penalties section of the Form I-485
Instructions before completing this part. You must file Form
I-485 while in the United States.

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:

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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.

1.b.

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.
The interpreter named in Part 11. read to me every
question and instruction on this application and my
answer to every question in

,

a language in which I am fluent, and I understood
everything.
2.

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.

Applicant's Signature

At my request, the preparer named in Part 12.,

6.a. Applicant's Signature (sign in ink)

,

prepared this application for me based only upon
information I provided or authorized.

Applicant's Contact Information

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, USCIS may deny your application.

3.

Applicant's Daytime Telephone Number

4.

Applicant's Mobile Telephone Number (if any)

Part 11. Interpreter's Contact Information,
Certification, and Signature

5.

Applicant's Email Address (if any)

Provide the following information about the interpreter.

Interpreter's Full Name
Applicant's Declaration and 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.

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)

I understand that if I am a male who is 18 to 26 years of age,
submitting this application will automatically register me with
the Selective Service System as required by the Military
Selective Service Act.

Form I-485 06/26/17 N

Page 17 of 20

A-Number ► A-

Part 11. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

3.f.

Provide the following information about the preparer.

Preparer's Full Name

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Ste.

3.c. City or Town
3.d. State

Part 12. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant

Flr.

3.e. ZIP Code

Province

1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2.

3.g. Postal Code
3.h. Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

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

5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

3.d. State
3.f.

3.e. ZIP Code

Province

3.g. Postal Code

Interpreter's Certification

I certify, under penalty of perjury, that: I am fluent in English
and [Fillable field], which is the same language specified in
Part 10., 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.

3.h. Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

Interpreter's Signature
7.a. Interpreter's Signature (sign in ink)

7.b. Date of Signature (mm/dd/yyyy)

Form I-485 06/26/17 N

Page 18 of 20

A-Number ► A-

Part 12. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Preparer's Statement
7.a.

7.b.

I am not an attorney or accredited representative
but have prepared this application on behalf of
the applicant and with the applicant's consent.

NOTE: Do not complete Part 13. until the USCIS Officer
instructs you to do so at the interview.

Part 13. Signature at Interview
I swear (affirm) and certify under penalty of perjury under the
laws of the United States of America that I know that the
contents of this Form I-485, Application to Register Permanent
Residence or Adjust Status, subscribed by me, including the

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corrections made to this application, numbered

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.

through

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.

true, and correct. All documents submitted at this interview
were provided by me and are complete, true, and correct.

, are complete, true, and correct. All

additional pages submitted by me with this Form I-485, on
numbered pages

through

are complete,

Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp

Preparer's Certification

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.

Date of Signature (mm/dd/yyyy)

Applicant's Signature (sign in ink)

USCIS Officer's Signature (sign in ink)

Preparer's Signature

8.a. Preparer's Signature (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)

Form I-485 06/26/17 N

Page 19 of 20

A-Number ► A5.a. Page Number

Part 14. 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.

1.c. Middle Name

5.c. Item Number

5.d.

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1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

2.

5.b. Part Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

A-Number (if any) ► A-

6.d.

3.a. Page Number

3.b. Part Number

3.d.

3.c. Item Number

7.a. Page Number

7.d.
4.a. Page Number

4.b. Part Number

4.c. Item Number

4.d.

Form I-485 06/26/17 N

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