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pdfPetition for a Nonimmigrant Worker:
H-3, P, Q, or R Classifications
USCIS
Form I-129MISC
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0009
Expires 01/31/2022
DRAFT
► START HERE - Type or print in black ink.
Part 1. Petitioner Information
If you are an individual or sole proprietor filing this petition, you must complete Item Numbers 1. - 2. If you are a company or an
organization filing this petition on behalf of a beneficiary, complete Item Number 3. All petitioners should complete Item
Numbers 4. - 14., as applicable.
1.
Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)
Given Name (First Name)
2.
Date of Birth (mm/dd/yyyy)
3.
Name of Petitioning Enterprise
4.
Trade Name or “Doing Business As” Name (if applicable)
5.
Petitioner's Primary U.S. Office Address
Middle Name
Not for
Reproduction
In Care Of Name
6.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code (USPS ZIP Code Lookup)
Is your mailing address different from your Primary U.S. Office Address?
Yes
No
If you answered “Yes” to Item Number 6., provide your mailing address below.
7.
Mailing Address
In Care Of Name
09/27/2019
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
8.
Postal Code
ZIP Code (USPS ZIP Code Lookup)
Country
Petitioner'sContact Information
U.S. Daytime Telephone Number U.S. Mobile Telephone Number (if any) Email Address (if any)
Form I-129MISC 01/31/19
Page 1 of 22
Part 1. Petitioner Information (continued)
9.
DRAFT
Tax Payer Identification Numbers
Provide the following information, as applicable:
A. Employer Identification Number (EIN)
►
B. Individual Tax Identification Number (ITIN)
►
10. U.S. Social Security Number (SSN)
►
11. E-Verify Information
A. Are you a participant in the E-Verify program and filing this petition as an employer?
Yes
No
If you answered “Yes” to Item A. in Item Number 11., provide the information requested in Items B. - C.
Not for
Reproduction
B. Employer's Name as Listed in E-Verify
C. Employer's E-Verify Company Identification Number or a Valid E-Verify Client Company Identification Number
Part 2. Information About This Petition
1.
Requested Nonimmigrant Classification (select only one box):
A.
H-3 Trainee
B.
H-3 Special education exchange visitor program
C.
P-1A Major League Sports
D.
P-1A Internationally Recognized Athlete or Team
E.
P-1A Professional Athlete
F.
P-1A Amateur Athlete or Coach
G.
P-1ATheatrical Ice Skater
H.
P-1B Entertainment Group
I.
P-1S Essential Support Personnel for P-1
J.
P-2 Artist or entertainer for reciprocal exchange program
K.
P-2S Essential Support Personnel for P-2
L.
P-3 Artist/Entertainer coming to the United States to perform, teach, or coach under a program that is culturally unique
M.
P-3S Essential Support Personnel for P-3
N.
Q-1 International Cultural Exchange Alien
O.
R-1 Religious Worker
09/27/2019
Form I-129MISC 01/31/19
Page 2 of 22
Part 2. Information About This Petition (continued)
2.
DRAFT
Basis for Classification select only one box):
A.
New employment.
B.
Continuation of previously approved employment without change with the same employer.
C.
Change in previously approved employment (provide an explanation in Part 9. Additional Information).
D.
New concurrent employment.
E.
Change of employer for a beneficiary already in the requested classification.
F.
Amended petition (provide an explanation in Part 9. Additional Information).
3.
If you selected F. - Amended petition, in Item Number 2., provide the receipt
►
number of the petition you seek to amend.
4.
Requested Action (select only one box)
5.
Not for
Reproduction
A.
Notify the office in Part 4. so that each beneficiary can apply for and obtain a visa or be admitted, if eligible.
B.
Change the status and extend the stay of each beneficiary because the beneficiary(ies) is/are now in the United States in
another status (see the Instructions for limitations). This is available only when you select A. - New Employment in
Item Number 2. above.
C.
Extend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
D.
Amend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
Total number of beneficiaries included in this petition. (You may include up to 25 beneficiaries in a single
I-129MISC petition. See the Information About Form I-129MISC section of the Instructions for more
information.)
►
Part 3. Beneficiary Information
Provide the information requested about the beneficiary(ies) for whom you are filing. Use Attachment 1-Additional Beneficiary for
Form I-129MISC to provide information about each additional beneficiary included in this petition.
1.
If the beneficiary is an entertainment group, provide the group name.
2.
Beneficiary's Full Name
09/27/2019
Family Name (Last Name)
3.
Given Name (First Name)
Middle Name
Provide all other names the beneficiary has used. Include nicknames, aliases, maiden name, and names from all previous marriages.
Family Name (Last Name)
Form I-129MISC 01/31/19
Given Name (First Name)
Middle Name
Page 3 of 22
Part 3. Beneficiary Information (continued)
DRAFT
Other Information
4.
Date of Birth
5.
(mm/dd/yyyy)
7.
Male
Alien Registration Number (A-Number) 8.
6.
Female
U.S. Social Security Number (if any)
►
USCIS Online Account Number (if any)
►
► A9.
Gender
10. Province of Birth
City or Town of Birth
12. Country of Citizenship or Nationality
11. Country of Birth
13. Beneficiary's Foreign Address (if any)
Not for
Reproduction
Street Number and Name
Apt. Ste. Flr. Number
City or Town Province
Postal Code
Country
14. If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy) I-94 Arrival-Departure Record Number
►
Date Passport or Travel Document
Issued (mm/dd/yyyy)
Date Passport or Travel Document
Expires (mm/dd/yyyy)
Passport or Travel Document Number
Passport or Travel Document Country
of Issuance
Current Nonimmigrant Status
09/27/2019
Date Status Expires or D/S (mm/dd/yyyy) (see Form I-94 Arrival/Departure Document)
Student and Exchange Visitor Information System (SEVIS)
Number (if any)
Employment Authorization Document (EAD)
Number (if any)
15. Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 15., you must provide the beneficiary's U.S. residential address information in Item
Number 16.
16. Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the Commonwealth of the
Northern Mariana Islands (CMNI).)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Form I-129MISC 01/31/19
ZIP Code (USPS ZIP Code Lookup)
Page 4 of 22
Part 3. Beneficiary Information (continued)
17. Provide the most recent petition/application receipt number for the
beneficiary. If none exists, write "None."
►
DRAFT
18. Have you ever filed an immigrant petition for this beneficiary?
Yes
No
If you answered "Yes" to Item Number 18., provide the receipt number for each petition you have filed for this beneficiary in
Part 9. Additional Information.
19. Have you ever filed a nonimmigrant petition for this beneficiary?
Yes
No
If you answered "Yes" to Item Number 19., identify the classification requested and the receipt number for each petition in
Part 9. Additional Information.
Part 4. Processing Information
1.
If the beneficiary(ies) named in Part 3. or in any Attachment 1-Additional Beneficiary for Form I-129MISC is/are requesting
new employment, a continuation of previously approved employment without change with the same employer, a change of
employer for a beneficiary already in the requested classification, or an amended petition, state the U.S. Consulate or CBP
inspection facility you want notified if this petition is approved.
Not for
Reproduction
A. Type of Office (select only one box):
U.S. Consulate
B. City Where Office is Located
CBP Pre-flight Inspection Facility
U.S. Port-of-Entry
C. U.S. State or Foreign Country
2.
Are you filing any other petitions with this one?
3.
If yes, how many?
4.
Are you filing any applications for replacement/initial I-94, Arrival-Departure Records with this petition? (If the beneficiary(ies)
was/were issued an electronic Form I-94 by CBP when admitted to the United States at an air or sea port, they may be able to
obtain the Form I-94 from the CBP website at www.cbp.gov/i94 instead of filing an application for a replacement/initial I-94.)
Yes
No
5.
If yes, how many?
6.
Are you filing any applications for dependents with this petition?
7.
If yes, how many?
8.
Is any beneficiary in this petition in removal proceedings?
Yes
No
►
►
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
►
09/27/2019
If you answered "Yes" to Item Number 8., list the beneficiary's(ies) name(s) in Part 9. Additional Information.
9.
Has any beneficiary in this petition ever been given the classification you are now requesting?
If you answered "Yes" to Item Number 9., provide an explanation in Part 9. Additional Information.
10. Has any beneficiary in this petition ever been denied the classification you are now requesting?
If you answered "Yes" to Item Number 10., provide an explanation in Part 9. Additional Information.
11. If you are filing for an entertainment group, has any beneficiary in this petition not been with the group
for at least one year?
If you answered "Yes" to Item Number 11., provide an explanation in Part 9. Additional Information.
12. Has any beneficiary in this petitionever been a J-1 exchange visitor or J-2 dependent of a J-1 exchange
visitor?
If you answered "Yes" to Item Number 12., provide a response to Item Number 13.
Form I-129MISC 01/31/19
Page 5 of 22
Part 4. Processing Information (continued)
DRAFT
13. If you selected yes in Item Number 12., provide the dates the beneficiary(ies) maintained status as a J-1 exchange visitor or J-2
dependent. Also, provide evidence of this status by attaching a copy of either a DS-2019, Certificate of Eligibility for Exchange
Visitor (J-1) Status, a Form IAP-66, or a copy of the passport that includes the J visa stamp. Additionally, if applicable, provide
evidence that the beneficiary(ies) fulfilled the two-year foreign residence requirement or had such residence requirement waived.
Part 5. Basic Information About the Proposed Employment and Employer
Attach the Form I-129MISC Supplement relevant to the classification you are requesting.
1.
Job Title
2.
Did you include an itinerary with this petition?
Yes
No
3.
Will the beneficiary(ies) work for you off-site at another company or organization's location?
Yes
No
4.
Will the beneficiary(ies) work exclusively in the CNMI?
Yes
No
5.
Is this a full-time position?
Yes
No
6.
If the answered "No" to Item Number 5., how many hours per week for the position?
►
7.
Wages (in U.S. dollars): $
►
8.
Other Compensation (Explain)
9.
Dates of intended employment
Not for
Reproduction
per (Specify hour, week, month, or year)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
10. Type of Business
11. Year Established
12. Current Number of Employees in the United States
13. Gross Annual Income
14. Net Annual Income
09/27/2019
Part 6. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory
NOTE: Read the Penalties section of the Form I-129MISC Instructions before completing this part.
Petitioner's or Authorized Signatory's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.
Petitioner's or Authorized Signatory's Statement Regarding the Interpreter
A.
I can read and understand English, and I have read and understand every question and instruction on this petition and
my answer to every question.
B.
The interpreter named in Part 7. has read to me every question and instruction on this petition and my answer to every
question in
, a language in which I am fluent, and I understood all of this
information as interpreted.
Form I-129MISC 01/31/19
Page 6 of 22
Part 6. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory (continued)
2.
DRAFT
Petitioner's or Authorized Signatory's Statement Regarding the Preparer
At my request, the preparer named in Part 8.,
prepared this petition for me based only upon information I provided or authorized.
,
Authorized Signatory's Contact Information
3.
Authorized Signatory's Family Name (Last Name)
4.
Authorized Signatory's Title
6.
Authorized Signatory's Mobile Telephone Number (if any)
Authorized Signatory's Given Name (First Name)
5.
Authorized Signatory's Daytime Telephone Number
Not for
Reproduction
7.
Authorized Signatory's Email Address (if any)
Petitioner's or Authorized Signatory's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that, as the
petitioner or authorized signatory, I may be required to submit original documents to USCIS at a later date.
I authorize the release of any information contained in this petition, in supporting documents, in my USCIS records, and in the
petitioning organization's USCIS records, to USCIS or other entities and persons where necessary to determine eligibility for the
immigration benefit sought or where authorized by law. I recognize the authority of USCIS to conduct audits of this petition using
publicly available open source information. I also recognize that any supporting evidence submitted in support of this petition may be
verified by USCIS through any means determined appropriate by USCIS, including but not limited to, on-site compliance reviews.
If filing this petition on behalf of an organization, I certify that I am authorized to do so by the organization.
I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the
information contained in, and submitted with, my petition, and that all of this information is complete, true, and correct.
Petitioner's or Authorized Signatory's Signature
8.
Petitioner's or Authorized Signatory's Signature
Date of Signature (mm/dd/yyyy)
09/27/2019
NOTE TO ALL PETITIONERS AND AUTHORIZED SIGNATORIES: If you do not completely fill out this petition or fail to
submit required documents listed in the Instructions, USCIS may deny your petition.
Part 7. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
2.
Interpreter's Business or Organization Name (if any)
Form I-129MISC 01/31/19
Interpreter's Given Name (First Name)
Page 7 of 22
Part 7. Interpreter's Contact Information, Certification, and Signature (continued)
DRAFT
Interpreter's Mailing Address
3.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
(USPS ZIP Code Lookup)
Country
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
6.
Interpreter's Email Address (if any)
5.
Interpreter's Mobile Telephone Number (if any)
Not for
Reproduction
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
which is the same language specified in Part 6.,
Item B. in Item Number 1., and I have read to this petitioner or the authorized signatory in the identified language every question and
instruction on this petition and his or her answer to every question. The petitioner or authorized signatory informed me that he or she
understands every instruction, question, and answer on the petition, including the Petitioner's or Authorized Signatory's
Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
09/27/2019
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
2.
Preparer's Business or Organization Name (if any)
Form I-129MISC 01/31/19
Preparer's Given Name (First Name)
Page 8 of 22
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner
Preparer's Mailing Address
3.
Street Number and Name
DRAFT
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
(USPS ZIP Code Lookup)
Country
Preparer's Contact Information
Not for
Reproduction
4.
Preparer's Daytime Telephone Number
6.
Preparer's Email Address (if any)
5.
Preparer's Mobile Telephone Number (if any)
Preparer's Statement
7.
A.
B.
I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the
petitioner's or authorized signatory's consent.
I am an attorney or accredited representative and my representation of the petitioner or authorized signatory in this case
extends
does not extend beyond the preparation of this request.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as Attorney In Matters Outside
the Geographical Confines of the United States, with this petition.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner or authorized signatory.
The petitioner or authorized signatory then reviewed this completed petition and informed me that he or she understands all of the
information contained in, and submitted with, his or her petition, including the Petitioner's or Authorized Signatory's Certification,
and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner or
authorized signatory provided to me or authorized me to obtain or use.
09/27/2019
Preparer's Signature
8.
Preparer's Signature
Form I-129MISC 01/31/19
Date of Signature (mm/dd/yyyy)
Page 9 of 22
Part 9. Additional Information
DRAFT
If you require more space to provide any additional information within this petition, use the space below. If you require more space
than what is provided to complete this petition, you may make a copy of Part 9. to complete and file with this petition. In order to
assist us in reviewing your response, you must identify the Page Number, Part Number, and Item Number corresponding to the
additional information.
1.
Individual Petitioner or Company Name (same as Part 1.)
2.
Page Number
Part Number
Item Number
Not for
Reproduction
3.
Page Number
4.
Page Number
Form I-129MISC 01/31/19
Part Number
Item Number
09/27/2019
Part Number
Item Number
Page 10 of 22
H-3 Classification Supplement to Form I-129MISC
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129MISC
OMB No. 1615-0009
Expires 01/31/2022
DRAFT
Provide the same petitioner name information that was provided in Part 1. of Form I-129MISC.
1. Legal Name of Individual Petitioner
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Name of Petitioning Enterprise
3. Address where the beneficiary(ies) will receive training or participate in the special education program, if different from the
address in Part 1. of Form I-129MISC.
4.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Not for
Reproduction
ZIP Code
(USPS ZIP Code Lookup)
List each beneficiary's prior periods of stay in H or L classification in the United States for the last 6 years (beneficiaries
requesting H-2A or H-2B classification need to list only the last 3 years). Only list those periods in which each beneficiary was
actually in the United States in an H or L classification. Do not include periods in which the beneficiary was in a dependent
status, for example, H-4 or L-2 status. If you need more space, use Part 9. Additional Information of Form I-129MISC or
attach an additional sheet of paper.
NOTE: Submit photocopies of Forms I-94, I-797, and/or other USCIS issued documents noting these periods of stay in the H or
L classification.
Beneficiary's Name
Period of Stay (mm/dd/yyyy)
From
To
09/27/2019
5.
Does any beneficiary in this petition have an ownership interest in the petitioning organization?
6.
If you answered "Yes" to Item Number 5., provide an explanation.
Yes
No
If you answer "Yes" to any of the questions in Item Numbers 7. - 13., provide an explanation in Part 9. Additional Information of
form I-129MISC or attach an additional sheet of paper.
7.
Is the training you intend to provide, or similar training, available in the beneficiary's country?
Yes
No
8.
Will the training benefit the beneficiary in pursuing a career abroad?
Yes
No
If "No," provide an explanation in Part 9. Additional Information of Form I-129MISC.
Form I-129MISC 01/31/19
H-3 Classification Supplement
Page 11 of 22
9.
Does the training involve productive employment incidental to the training?
Yes
No
If you answered “Yes” to Item Number 9., explain the amount of compensation employment versus the classroom in Part 9.
Additional Information.
DRAFT
10.
Does the beneficiary already have skills related to the training?
Yes
No
11.
Is this training an effort to overcome a labor shortage?
Yes
No
12.
Do you intend to employ the beneficiary abroad at the end of this training?
Yes
No
13. If you do not intend to employ the beneficiary abroad at the end of this training, explain why you wish to incur the cost of
providing this training and your expected return from this training.
Not for
Reproduction
09/27/2019
Form I-129MISC 01/31/19
H-3 Classification Supplement
Page 12 of 22
P Classification Supplement to Form I-129MISC
USCIS
Form I-129MISC
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0009
Expires 01/31/2022
DRAFT
Provide the same petitioner name information that was provided in Part 1. of Form I-129MISC.
1. Legal Name of Individual Petitioner
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Name of Petitioning Enterprise
3. Address where the beneficiary(ies) will work if different from the address in Part 1. of form I-129MISC. (If the beneficiary(ies)
will work at more than one address, you must include the additional addresses in the itinerary information submitted with your
petition.)
Name
Not for
Reproduction
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
(USPS ZIP Code Lookup)
4.
Explain the nature of the event.
5.
Describe the duties to be performed.
6.
If filing for any P support classification, list the dates of the beneficiary's prior work experience under the principal P alien. For
Major League Sports support personnel, please see the Information About Form I-129MISC section of the Instructions.
7.
Does an appropriate labor organization exist for the petition?
09/27/2019
Yes
No
If you answered “No” to Item Number 7., provide an explanation in Part 9. Additional Information of Form I-129MISC.
8.
Is the required consultation or written advisory opinion being submitted with this petition?
Yes
No. A copy of the request is attached.
N/A
If you answered “No” to Item Number 8., provide the following information about the organization(s) to which you have sent a
duplicate of this petition.
Form I-129MISC 01/31/19
P Classification Supplement
Page 13 of 22
9. Name of Labor Organization
10. Labor Organization's Address
Street Number and Name
DRAFT
Apt. Ste. Flr. Number
State
City or Town
11. Labor Organization's Daytime Telephone Number
ZIP Code
(USPS ZIP Code Lookup)
12. Date Request Sent (mm/dd/yyyy)
P Nonimmigrant Classification Petitioner's or Authorized Signatory's Statement
Not for
Reproduction
I certify that I, the petitioner or authorized signatory, and the employer whose offer of employment formed the basis of status (if
different from the petitioner) will be jointly and severally liable for the reasonable costs of return transportation of the beneficiary
abroad if the beneficiary is dismissed from employment by the employer before the end of the period of authorized stay.
1. Petitioner's Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Signature and Date
Signature of Petitioner
Date of Signature (mm/dd/yyyy)
09/27/2019
Form I-129MISC 01/31/19
P Classification Supplement
Page 14 of 22
Q-1 International Cultural Exchange Alien Supplement
to Form I-129
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129MISC
OMB No. 1615-0009
Expires 01/31/2022
DRAFT
Provide the same petitioner name information that was provided in Part 1. of Form I-129MISC.
1.
Legal Name of Individual Petitioner
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Name of Petitioning Enterprise
3. Address where the beneficiary(ies) will work if different from the address in Part 1. of Form I-129MICSC. If you need to
provide more than one additional address, use Part 9. Additional Information of Form I-129MISC.
4.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Not for
Reproduction
ZIP Code
(USPS ZIP Code Lookup)
I hereby certify that the beneficiary(ies) of this petition:
A. Is/are at least 18 years of age;
B. Is/are qualified to perform the service or labor or receive the type of training stated in the petition;
C. Has/have the ability to communicate effectively about the cultural attributes of their country of nationality to the American
public; and
D. Has/have resided and been physically present outside the United States for the 12 months immediately prior to the filing of
this petition. (Applies only if the beneficiary was previously admitted as a Q-1).
I also certify that I will offer the beneficiary(ies) wages and working conditions comparable to those accorded to local domestic
workers who are similarly employed.
5.
Petitioner's Full Name
Family Name (Last Name)
6. Signature and Date
Given Name (First Name)
09/27/2019
Signature of Petitioner
Form I-129MISC 01/31/19
Middle Name
Date of Signature (mm/dd/yyyy)
Q-1 Classification Supplement
Page 15 of 22
R-1 Classification Supplement to Form I-129MISC
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129MISC
OMB No. 1615-0009
Expires 01/31/2022
DRAFT
Provide the same petitioner name information that was provided in Part 1. of Form I-129MISC.
1.
Legal Name of Individual Petitioner
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Name of Petitioning Enterprise
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker
3.
Not for
Reproduction
Has the beneficiary or any of the beneficiary's dependent family members previously been admitted
to the United States for a period of stay in the R visa classification in the last five years?
Yes
No
If you answered “Yes” to Item Number 3., complete the table below. List the beneficiary and any dependent family member's
prior periods of stay in the R visa classification in the United States in the last five years. Be sure to list only those periods in
which the beneficiary and/or family members were actually in the United States in an R classification.
NOTE: Submit photocopies of Forms I-94 (Arrival-Departure Record), I-797 (Notice of Action), and/or other USCIS
documents identifying these periods of stay in the R visa classification(s). If you need more space, use Part 9. Additional
Information of Form I-129MISC or attach an additional sheet of paper.
Alien or Dependent Family Member's Name
Period of Stay (mm/dd/yyyy)
From
To
09/27/2019
4.
Describe the relationship, if any, between the religious organization in the United States and the organization abroad of which the
beneficiary is a member.
5.
The beneficiary will be working (select one of the following):
As a minister
Form I-129MISC 01/31/19
In a religious vocation
In a religious occupation
R-1 Classification Supplement
Page 16 of 22
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker (continued)
DRAFT
Petitioner Attestations
If you answer “No” to any of the questions in Item Numbers 6. - 14, provide an explanation in Part 9. Additional Information of
Form I-129MISC.
6.
The prospective employer is a bona fide non-profit religious organization or a bona fide organization which
is affiliated with the religious denomination and is exempt from taxation.
Yes
No
7.
The alien has been a member of the denomination for at least two years and is otherwise qualified for the
position offered.
Yes
No
8.
The number of members of the perspective employer's organization is:
►
9.
The number of employees who work at the same location where the beneficiary will be employed is:
►
10. Provide a summary of those employees' responsibilities. (At our discretion, USCIS may additionally request a list of all
employees, their titles, and a brief description of their duties.)
Not for
Reproduction
Position
Summary of the Type of Responsibilities for That Position
09/27/2019
11. The number of aliens holding special immigrant or nonimmigrant religious worker status who are currently
employed or have been employed within the past five years by the prospective employer's organization is:
►
12. The number of special immigrant religious worker and nonimmigrant religious worker petitions and
applications filed by or on behalf of any aliens for employment by the prospective employer in the past five
years is:
►
13. Provide the title of the position offered to the beneficiary and a detailed description of the beneficiary's proposed daily duties.
14. The beneficiary will receive (select only one box):
Salaried Compensation
Form I-129MISC 01/31/19
Non-Salaried Compensation
R-1 Classification Supplement
Page 17 of 22
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker (continued)
DRAFT
15. Provide the details of the beneficiary's compensation indicated in Item Number 14.
16. The beneficiary will be employed at least 20 hours per week.
Yes
No
17. Provide the specific locations(s) of the proposed employment. If you need to provide information about more than two locations,
use Part 9. Additional Information of Form I-129MISC or attach an additional sheet of paper.
Location or Address 1
Name
Not for
Reproduction
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
(USPS ZIP Code Lookup)
Location or Address 2
Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
18. The beneficiary will be employed only in a religious worker position and will not be engaged in secular
employment.
09/27/2019
(USPS ZIP Code Lookup)
Yes
No
If you answered “No” to Item Number 18., provide an explanation in Part 9. Additional Information of I-129 MISC or attach an
additional sheet of paper.
19. The petitioner will notify USCIS within fourteen days if an R-1 alien is working less than the required
number of hours, or has been released from or has otherwise terminated employment before the expiration of
a period of authorized R-1 stay.
Yes
No
If you answered “No” to Item Number 19., provide an explanation in Part 9. Additional Information of I-129MISC or attach an
additional sheet of paper.
Form I-129MISC 01/31/19
R-1 Classification Supplement
Page 18 of 22
Attestation
DRAFT
I certify, under penalty of perjury, that the information in this Supplement, the evidence submitted with it, and the contents of
this attestation are true and correct.
1.
Petitioner's Full Name
Family Name (Last Name)
2.
Petitioner's Title
3.
Signature of Petitioner
Given Name (First Name)
Middle Name
Date of Signature (mm/dd/yyyy)
Not for
Reproduction
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker (continued)
4.
5.
Employer or Organization Address (Do not use a post office or private mail box)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
Employer or Organization's Contact Information
Daytime Telephone Number
Fax Number
Email Address
Section 2. This Section Is Required For Petitioners Affiliated With The Religious Denomination
Religious Denomination Certification
I certify, under penalty of perjury, that:
Name of Employing Organization
is affiliated with:
09/27/2019
Name of Religious Denomination
and that the attesting organization within the religious denomination is tax-exempt as described in section 501(c)(3) of the Internal
Revenue Code of 1986 (codified at 26 U.S.C. 501(c)(3)), any subsequent amendment(s), subsequent amendment, or equivalent
sections of prior enactments of the Internal Revenue Code. The contents of this certification are true and correct to the best of my
knowledge.
1.
Name of Authorized Representative of Attesting Organization
(The authorized representative of the attesting organization cannot be the petitioner.)
2.
Authorized Representative's Title
3.
Signature of Authorized Representative of Attesting Organization
Form I-129MISC 01/31/19
R-1 Classification Supplement
Date (mm/dd/yyyy)
Page 19 of 22
Attesting Organization's Name and Address (Do not use a post office or private mail box)
4.
Attesting Organization's Name
5.
Street Number and Name
DRAFT
Apt. Ste. Flr. Number
City or Town
6.
State
ZIP Code
Employer or Organization's Contact Information
Daytime Telephone Number
Fax Number
Email Address (if any)
Not for
Reproduction
09/27/2019
Form I-129MISC 01/31/19
R-1 Classification Supplement
Page 20 of 22
Attachment 1 - Additional Beneficiary for Form I-129MISC
Complete a separate copy of this attachment for each additional beneficiary included in this petition. (Do not
complete a copy of Attachment 1 for the beneficiary you already named in Part 3. of Form I-129MISC.)
1.
DRAFT
Legal Name of Individual Petitioner
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Name of Petitioning Enterprise
3. If the beneficiary is an entertainment group, provide the group name.
4.
Beneficiary'S Full Name
Family Name (Last Name)
5.
Given Name (First Name)
Middle Name
Not for
Reproduction
Provide all other names the beneficiary has used. Include nicknames, aliases, maiden name, and names from all previous marriages.
Family Name (Last Name)
Given Name (First Name)
Middle Name
Other Information
6.
Date of Birth
7.
(mm/dd/yyyy)
9.
Gender
Male
8.
Female
U.S. Social Security Number (if any)
►
Alien Registration Number (A-Number) 10. USCIS Online Account Number (if any)
►
► A-
11. City or Town of Birth
12. Province of Birth
13. Country of Birth
14. Country of Citizenship or Nationality
15. Beneficiary's Foreign Address (if any)
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Street Number and Name
Apt. Ste. Flr. Number
City or Town Province
Postal Code
Country
Form I-129MISC 01/31/19
Attachment-1
Page 21 of 22
16. If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy) I-94 Arrival-Departure Record Number
►
Passport or Travel Document Number
DRAFT
Date Passport or Travel Document
Issued (mm/dd/yyyy)
Date Passport or Travel Document
Expires (mm/dd/yyyy)
Passport or Travel Document Country
of Issuance
Current Nonimmigrant Status
Date Status Expires or D/S (mm/dd/yyyy) (see Form I-94 Arrival/Departure Document)
Student and Exchange Visitor Information System (SEVIS)
Number (if any)
Employment Authorization Document (EAD)
Number (if any)
Not for
Reproduction
17. Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 17., you must provide the beneficiary's U.S. residential address information in Item
Number 18.
18. Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the CMNI.)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
19. Provide the most recent petition/application receipt number for the
beneficiary. If none exists, write "None."
ZIP Code
►
20. Have you ever filed an immigrant petition for this beneficiary?
Yes
No
If you answered "Yes" to Item Number 20., provide the receipt number for each petition you have filed for this beneficiary in
Part 9. Additional Information of Form I-129MISC.
21. Have you ever filed a nonimmigrant petition for this beneficiary?
Yes
No
If you answered "Yes" to Item Number 21., identify the classification requested and the receipt number for each petition in
Part 9. Additional Information of Form I-129MISC.
09/27/2019
Form I-129MISC 01/31/19
Attachment-1
Page 22 of 22
| File Type | application/pdf |
| File Title | Petition for Nonimmigrant Worker |
| Author | USCIS |
| File Modified | 2019-09-27 |
| File Created | 2019-09-27 |