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pdfPetition for Nonimmigrant Worker:
H-2B Classification
USCIS
Form I-129H2B
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-xxxx
Expires xx/xx/20xx
► START HERE - Type or print in black ink. Answer all questions fully and accurately. If a question does not apply to you (for
example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A”
unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How
many children do you have?” or “How many times have you departed the United States?”), type or print “None” unless otherwise
directed.
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Part 1. Petitioner Information
If you are an individual or sole proprietor filing this petition, complete Item Numbers 1. - 2. If you are a company or an organization
filing this petition, complete Item Number 3. All petitioners should fill out Item Numbers 4. - 17., as applicable.
1.
Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)
Given Name (First Name)
3.
2.
Date of Birth (mm/dd/yyyy)
4.
Trade Name or “Doing Business As” Name
5.
USCIS Online Account Number
►
6.
Primary U.S. Office Address of Petitioner
7.
Middle Name
Petitioning Company or Organization Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
Is your mailing address different from your Primary U.S. Office Address?
(USPS ZIP Code Lookup)
Yes
No
If you answered “Yes” to Item Number 7., provide your mailing address below.
8.
Mailing Address
In Care Of Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
(USPS ZIP Code Lookup)
Country
Petitioner's Contact Information
9.
U.S. Daytime Telephone Number
Form I-129H2B xx/xx/19
10.
U.S. Mobile Telephone Number
Page 1 of 21
Part 1. Petitioner Information (continued)
11.
Email Address
Tax Payer Identification Numbers
Provide the following information, as applicable.
12.
Employer Identification Number (EIN)
►
14.
13.
Individual Taxpayer Identification Number (ITIN)
►
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U.S. Social Security Number
►
E-Verify Information
15.
Are you a participant in the E-Verify program?
Yes
No
If you answered “Yes” to Item Number 15., provide the information requested in Item Numbers 16. - 17.
16.
Employer's Name as Listed in E-Verify
17.
Employer's E-Verify Company Identification Number or an E-Verify Client Company Identification Number
Part 2. Information About This Petition
1.
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 11. 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 11. Additional Information.)
2.
If you selected Item F. Amended petition in Item Number 1., provide the receipt number of the petition you seek to amend.
►
3.
Requested Action (select only one box)
4.
A.
Notify the office in Part 5. so that each beneficiary(ies) 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 Item A. New
Employment in Item Number 1. 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 workers included in this petition. (See instructions relating to when more than one worker can be included.)
►
Form I-129H2B xx/xx/19
Page 2 of 21
Part 3. Beneficiary's Information
Indicate the type of beneficiaries you are requesting in this petition, and list the countries of citizenship for these beneficiaries.
1.
Type of beneficiaries requested (select only one box)
Named Workers
2.
Unnamed Workers
List the countries of citizenship for the workers you are requesting.
Country of Citizenship
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If requesting unnamed workers in Item Number 1., proceed to Part 5. Processing Information. However, you must provide the
name and all of the information requested below for each H-2B worker who is in the United States or who is not from a country that
has been designated as a participating country in accordance with 8 CFR 214.2(h)(6)(i)(E)(1). See www.uscis.gov/h-2b for the list of
participating countries. If you are providing information for more than one named beneficiary, complete a separate copy of the
Named Worker Attachment for Form I-129H2B for each additional beneficiary included in this petition.
3.
Is each H-2B worker you plan to hire from a country designated as a participating country in accordance
with 8 CFR 214.2(h)(6)(i)(E)(1)? (See www.uscis.gov/h-2b for the list of H-2B participating countries.)
Yes
No
If you answered “No” to Item Number 3., you must provide the information requested in Item Number 4.
4.
List each H-2B worker from a non-participating country. If you need more space, use Part 11. Additional Information or
attach an additional sheet of paper.
Family Name (Last Name)
Given Name (First Name)
Middle Name
NOTE: If any of the H-2B workers you are requesting are nationals of a country that is not designated as a participating country,
you must also provide evidence showing: (1) that workers with the required skills are not available among foreign workers from
countries currently on the eligible countries list; (2) whether the beneficiaries have been admitted previously to the United States
in H-2B status; (3) that there is no potential for abuse, fraud, or other harm to the integrity of the H-2B visa programs through the
potential admission of the intended workers; and (4) any other factors that may serve the United States interest.
Information About the Beneficiary
5.
Beneficiary's Full Name
Family Name (Last Name)
6.
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. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.
Family Name (Last Name)
Form I-129H2B xx/xx/19
Given Name (First Name)
Middle Name
Page 3 of 21
Part 3. Beneficiary's Information (continued)
Other Information
7.
Date of Birth (mm/dd/yyyy)
8.
Gender
Male
10.
Alien Registration Number (A-Number)
►
9.
Female
11.
U.S. Social Security Number
►
USCIS Online Account Number
►
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12.
City or Town of Birth
13.
Province of Birth
14.
Country of Birth
15.
Country of Citizenship or Nationality
16.
Beneficiary's Foreign Address
Street Number and Name
City or Town
Province
17.
Apt. Ste. Flr. Number
Postal Code
Country
If the beneficiary is in the United States, complete the following:
Date of Last Arrival
Form I-94 Arrival-Departure Record Number
(mm/dd/yyyy)
►
Passport or Travel Document Number
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 Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)
(mm/dd/yyyy)
Student and Exchange Visitor Information System (SEVIS)
Number
18.
Employment Authorization Document (EAD)
Number
Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 18., you must provide the beneficiary's U.S. residential address information in Item Number 19.
19.
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 (CNMI).)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Form I-129H2B xx/xx/19
ZIP Code
Page 4 of 21
Part 3. Beneficiary's Information (continued)
20.
Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►
21.
Have you ever filed an immigrant petition for this beneficiary?
Yes
No
Yes
No
Yes
No
If you answered "Yes" to Item Number 21., identify the classification sought and the receipt number
for those petitions in Part 11. Additional Information.
22.
Have you ever filed a nonimmigrant petition for this beneficiary?
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If you answered "Yes" to Item Number 22., identify the classification sought and the receipt number
for those petitions in Part 11. Additional Information.
23.
Has this beneficiary ever been denied H-2B classification on any prior petition you filed on behalf of
this beneficiary?
If you answered "Yes" to Item Number 23., identify the receipt number for the petition and the date of
the decision in Part 11. Additional Information.
24.
List the beneficiary's prior periods of stay in H or L classification in the United States for the last three years. Be sure to only
list those periods in which the 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 11.
Additional Information or attach an additional sheet of paper.
NOTE: Submit copies of any available Form I-94, Form I-797, and/or other USCIS issued documents noting these periods of
stay in the H or L classification.
Employer's Name
25.
Period of Stay
From (mm/dd/yyyy) To (mm/dd/yyyy)
Has this beneficiary experienced an interrupted stay associated with their entry in H or L classification?
(See form Instructions for more information on interrupted stays.)
Yes
No
If you answered “Yes” to Item Number 25., identify the classification sought and the receipt numbers for
those petitions in Part 11. Additional Information.
Part 4. Information About The Beneficiary's Public Benefits
Part 4. only applies to petitions that also seek a change of a beneficiary's status or an extension of a beneficiary's nonimmigrant stay
in the United States. If you are filing this petition without a request for the beneficiary's change of status or extension of stay, you
may skip Part 4.
For the beneficiary named above in Part 3. Beneficiary Information, provide the requested information and submit documentation as
outlined in the Instructions. For each additional beneficiary, please respond to the questions in a separate copy of the Named Worker
Attachment for Form I-129H2B.
1.
Has the beneficiary received, since obtaining the nonimmigrant status that you seek to extend or that you seek to change on
behalf of the beneficiary, or is the beneficiary currently certified to receive, the following public benefits? (select all that apply).
Yes, the beneficiary has received or is currently certified to receive the following public benefits: (select all that apply)
Any Federal, State, local or tribal cash assistance for income maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
General Assistance (GA)
Form I-129H2B xx/xx/19
Page 5 of 21
Part 4. Information About The Beneficiary's Public Benefits (continued)
Supplemental Nutrition Assistance Program (SNAP, formerly called "Food Stamps")
Section 8 Housing Assistance under the Housing Choice Voucher Program
Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.
Federal-funded Medicaid
No, the beneficiary has not received any of the above listed public benefits.
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No, the beneficiary is not certified to receive any of the above listed public benefits.
2.
If the beneficiary has received or is currently certified to receive any of the above public benefits, provide information about the
public benefits below. If you need additional space to complete any Item Number in this Part, use the space provided in Part 11.
Additional Information. Submit evidence as outlined in the Instructions.
A.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
B.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
C.
Type of Public Benefit
(mm/dd/yyyy)
Type of Public Benefit
3.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
D.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
If you answered “Yes” to Item Number 1., do any of the following apply to the beneficiary? Provide the evidence listed in the
Form I-129 Instructions.
The beneficiary is enlisted in the Armed Forces, or is serving in active duty or in the Ready Reserve Component of the U.S.
Armed Forces.
The beneficiary is the spouse or the child of an individual who is enlisted in the Armed Forces, or who is serving in active
duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary (or the beneficiary's spouse or parent) was enlisted
in the Armed Forces, or was serving in active duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States in a status exempt
from the public charge ground of inadmissibility.
Form I-129H2B xx/xx/19
Page 6 of 21
Part 4. Information About The Beneficiary's Public Benefits (continued)
At the time the beneficiary received the public benefits, the beneficiary was present in the United States after being granted
a waiver of the public charge ground of inadmissibility.
The beneficiary is a child currently residing abroad who entered the United States with a nonimmigrant visa to attend an
N-600K, Application for Citizenship and Issuance of Certificate Under INA Section 322 interview.
None of the above statements apply to the beneficiary.
4.
A.
Has the beneficiary received, applied for, or has been certified to receive federally-funded Medicaid in connection with
any of the following (select all that apply): Submit evidence as outlined in the Instructions.
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An emergency medical condition
For a service under the Individuals with Disabilities Education Act (IDEA)
Other school-based benefits or services available up to the oldest age eligible for secondary education under State law
While under the of age 21
While pregnant or during the 60-day period following the last day of pregnancy
B.
Provide the applicable dates mm/dd/yyyy
to mm/dd/yyyy
Part 5. Processing Information
1.
Indicate the U.S. Consulate or U.S. Customs and Border Protection (CBP) inspection facility you would like notified if the
petition will be approved with consular notification (for example, you requested consular notification or a requested extension of
stay or change of status cannot be granted).
A.
Type of Office (select only one box)
U.S. Consulate
B.
2.
CBP Pre-flight Inspection Facility
City Where Office is Located
C.
U.S. Port of Entry
U.S. State or Foreign Country
Does each beneficiary in this petition have a valid passport?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If you answered “No” to Item Number 2., provide an explanation in Part 11. Additional Information.
3.
Are you filing any other petitions with this one?
If you answered “Yes” to Item Number 3., how many? ►
4.
Have you previously filed any other petitions based on the same temporary labor
certification as this petition?
If you answered “Yes” to Item Number 4., provide the previous receipt number(s). ►
5.
Are you filing any applications for dependents with this petition?
If you answered “Yes” to Item Number 5., how many? ►
6.
Is any beneficiary in this petition in removal proceedings?
If you answered “Yes” to Item Number 6., list the beneficiary's(ies) name(s) in Part 11. Additional Information.
Form I-129H2B xx/xx/19
Page 7 of 21
Part 5. Processing Information (continued)
7.
Has any beneficiary in this petition ever been a J-1 exchange visitor or J-2 dependent of a J-1
exchange visitor?
8.
If you answered “Yes” to Item Number 7., 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.
9.
Are you requesting substitution of beneficiaries who were approved and/or admitted based on
a prior H-2B petition?
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Yes
No
Yes
No
Yes
No
If you answered “Yes” to Item Number 9., provide an explanation in Item Number 10.
10.
Explanation
11.
Does any beneficiary in this petition have ownership interest in the petitioning organization?
If you answered “Yes” to Item Number 11., provide an explanation of the beneficiary's(ies')
ownership interests in Item Number 12.
12.
Explanation
13.
Are you or the employer currently debarred by the U.S. Department of Labor (DOL)?
Yes
No
14.
Has the temporary labor certification supporting this petition been revoked by DOL?
Yes
No
15.
To the best of your knowledge, have you or the employer ever received a final order of debarment
from DOL in any foreign labor certification program?
Yes
No
16.
If you answered “Yes” to Item Numbers 13., 14., and/or 15., provide an explanation. If you need more space, use Part 11.
Additional Information or attach an additional sheet of paper.
17.
Is this petition exempt from the H-2B numerical limit (or cap)?
Yes
No
If you answered “Yes” to Item Number 17., provide a response to Item Number 18.
Form I-129H2B xx/xx/19
Page 8 of 21
Part 5. Processing Information (continued)
18.
The basis for cap exemption is:
A.
I am requesting an extension of stay or amendment of stay for the beneficiary(ies) who currently holds H-2B status.
B.
The beneficiary(ies) will work as fish roe processors, fish roe technicians, or supervisors of fish roe processing.
C.
The beneficiary(ies) will work exclusively on Guam.
D.
The beneficiary(ies) will work exclusively in the Commonwealth of the Northern Mariana Islands (CNMI).
E.
The beneficiary(ies) has been previously counted against the H-2B cap in the same fiscal year. Provide receipt number.
►
F.
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Other reason not identified above. Provide an explanation.
19.
Are you requesting consideration of this petition under the National Defense Authorization Act (NDAA)
exemption from the requirement that the services or labor be temporary because it is directly connected
to, or directly associated with, the military realignment on Guam or in the CNMI?
Yes
No
20.
Are you requesting consideration of this petition under the NDAA exemption from the requirement
that the services or labor be temporary because it is for health care workers on Guam or in the CNMI?
Yes
No
Part 6. Basic Information About the Proposed Employment and Employer
Temporary Labor Certification ETA Case Number
1.
Job Title
3.
The nature of your need for the services or labor is: (select only one box)
4.
2.
A.
Seasonal
B.
Peakload
C.
Intermittent
D.
One-time occurrence
If you indicated your need is Seasonal in Item Number 3., is your need for additional worker(s) to
perform services or labor traditionally tied to a season of the year by an event or pattern, and of a
recurring nature?
Yes
No
If you answered “Yes” to Item Number 4., explain the basis on which the need recurs and specify the period(s) of time during
each year in which you do not need the services or labor.
5.
If you indicated your need is Peakload in Item Number 3., do you regularly employ permanent
workers to perform the services or labor at the place of employment?
Yes
No
If you answered “Yes” to Item Number 5., explain why you need to supplement your permanent staff at the place of
employment on a temporary basis due to a seasonal or short-term demand, and why the temporary additional workers you are
seeking will not become a part of your regular operation.
Form I-129H2B xx/xx/19
Page 9 of 21
Part 6. Basic Information About the Proposed Employment and Employer (continued)
6.
If you indicated your need is Intermittent in Item Number 3., have you employed permanent or full-time
workers to perform the services or labor.
Yes
No
If you answered “Yes” to Item Number 6., explain why you occasionally or intermittently need temporary workers to perform
services or labor for short periods and why you have not employed permanent or full-time workers to perform the services or
labor.
7.
A.
Explain why you have not employed workers to perform the services or labor in the past and why you will not need
workers to perform the services or labor in the future.
OR
B.
8.
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If you indicated your need is a One-Time Occurrence in Item Number 3., provide a response to Item Number 7.A. or 7.B., as
applicable.
Explain the temporary event of short duration that has created your one-time need, even though the need for the services
or labor is otherwise permanent.
Will the beneficiary(ies) be working at multiple worksites?
Yes
No
If you answered "Yes" to Item Number 8., you must submit a detailed itinerary with the dates and
locations where the services or labor is to be performed.
9.
If you answered “No” to Item Number 8., provide the address where the beneficiary(ies) will work if different from the address
in Part 1. Provide the name of the person or organization associated with the address, if different from the individual employer,
sole proprietor, or company or organization name listed in Part 1.
Name of Person or Organization
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
10.
Will the beneficiary(ies) work for you off-site at another company or organization's location?
Yes
No
11.
Have you or a corporate parent, subsidiary, or affiliate filed an application for permanent labor
certification for this same position?
Yes
No
12.
Is this a full-time position?
Yes
No
13.
If you answered “No” to Item Number 12., how many hours per week for the position? ►
14.
Wages (in U.S. dollars)
Form I-129H2B xx/xx/19
$
per (Specify hour, week, month, or year)
Page 10 of 21
Part 6. Basic Information About the Proposed Employment and Employer (continued)
15.
Other Compensation (Explain)
16.
Dates of Intended Employment
From (mm/dd/yyyy)
To (mm/dd/yyyy)
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17.
Type of Business
19.
Current Number of Employees in the United States ►
20.
Gross Annual Income
$
18.
21.
Year Established
Net Annual Income
$
Part 7. Petitioner and Employer Obligations
1.
Did you or do you plan to use a staffing, recruiting, or similar placement service or agent to locate the
H-2B workers that you intend to hire by filing this petition?
Yes
No
Yes
No
If you answered “Yes” to Item Number 1., provide the name and address of the service or agent used
in Item Numbers 2. and 3. If you need to include the name and address of more than one service or
agent, use the space provided in Part 11. Additional Information.
2.
Name of Service or Agent
3.
Address of Service or Agent
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
4.
Postal Code
ZIP Code
Country
Did any of the H-2B workers that you are requesting pay you or an agent, a job placement fee or other
form of compensation (either direct or indirect) as a condition of the employment, or do they have an
agreement to pay you or the service such fees at a later date?
NOTE: The phrase "fee or other form of compensation" includes, but is not limited to, petition fees, attorney fees, recruitment
costs, and any other fees that are a condition of a beneficiary's employment that the employer is prohibited from passing to the
H-2B worker under law. This phrase does not include reasonable travel expenses and certain government-mandated fees (such
as passport fees) that are not prohibited from being passed to the H-2B worker by statute, regulations, or any laws.
Form I-129H2B xx/xx/19
Page 11 of 21
Part 7. Petitioner and Employer Obligations (continued)
5.
If you answered "Yes" to Item Number 4., list the types and amounts of fees that the worker(s) paid or have agreed to pay. If
you need to include information about more than three fees, use the space provided in Part 11. Additional Information.
Type of Fee
Amount
$
$
$
6.
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If the workers paid any fee or compensation, were they reimbursed?
Yes
No
Yes
No
Yes
No
Yes
No
If you answered “Yes” to Item Number 6., submit evidence of reimbursement with this petition.
7.
If the workers agreed to pay a fee, was that agreement terminated before the workers paid the fee?
(Submit evidence of termination or reimbursement with this petition.)
If you answered “Yes” to Item Number 7., submit evidence of termination with this petition
8.
If you answered “Yes” to Item Number 1., have you made inquiries to determine that the
recruiter, facilitator, agent, or similar employment service that you used or plan to use has not
collected, and will not collect, directly or indirectly, any fees or other compensation from the
H-2B workers requested in this petition as a condition of the H-2B workers' employment?
NOTE: If USCIS determines that you knew, or should have known, that the workers requested in
connection with this petition paid any fees or other compensation at any time as a condition of
employment, your petition may be denied or revoked.
9.
Have you ever had an H-2B petition denied or revoked because an employee paid a job placement
fee or other similar compensation as a condition of the job offer or employment?
10.
If you answered “Yes” to Item Number 9., when was the petition denied or revoked?
(mm/dd/yyyy)
11.
Receipt Number of denied or revoked H-2B petition:
►
12.
Describe the types and amounts of fees the workers paid or agreed to pay in connection with the denied or revoked petition. If
you need to include information about more than three fees, use the space provided in Part 11. Additional Information.
Type of Fee
Amount
$
$
$
13.
Were the workers reimbursed for such fees and compensation that they paid in connection with the denied
or revoked petition?
Yes
No
If you answered “Yes” to Item Number 13., submit evidence of reimbursement. If you answered “No” to Item Number 13.,
because you were unable to locate the workers, include evidence of your efforts to locate the workers.
Form I-129H2B xx/xx/19
Page 12 of 21
Part 7. Petitioner and Employer Obligations (continued)
14.
The H-2B petitioner and each employer consent to allow Government access to the site where the labor is being performed for
the purpose of determining compliance with H-2B requirements. The petitioner further agrees to notify DHS within 2 workdays
if:
A.
An H-2B worker fails to report for work within 5 workdays after the employment start date stated on the petition;
B.
The agricultural labor or services for which H-2B workers were hired is completed more than 30 days early;
C.
The H-2B worker absconds from the worksite by failing to report for work for 5 consecutive workdays without the
consent of the employer; or
D.
The H-2B worker is terminated prior to the completion of labor or services for which he or she was hired.
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Yes
No
See www.uscis.gov/h-2b for the appropriate manner of notifying DHS as specified in a notice published in the Federal Register.
NOTE: "Workday" means the period between the time on any particular day when such employee commences his or her
principal activity and the time on that day at which he or she ceases such principal activity or activities.
15.
The petitioner agrees to retain evidence of such notification and make it available for inspection by
DHS officers for a one-year period.
Yes
No
Petitioner's or Employer's Agreement
The petitioner must complete and sign the statement in Item Number 16. If the petitioner is the employer's agent, the employer must
complete and sign Item Number 17.
16.
Petitioner
By filing this petition, I agree to the conditions of H-2B employment and agree to the notification requirements.
Signature of Petitioner
Date (mm/dd/yyyy)
Name of Petitioner
17.
Employer Who is Not the Petitioner
I certify that I have authorized the party filing this petition to act as my agent in this regard. I assume full responsibility for all
representations made by this agent on my behalf and agree to the conditions of H-2B eligibility.
Name of Employer
Signature of Employer
Date (mm/dd/yyyy)
Part 8. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory
NOTE: Read the Penalties section of the Form I-129H2B Instructions before completing this section.
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.
Form I-129H2B xx/xx/19
Page 13 of 21
Part 8. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory (continued)
B.
The interpreter named in Part 9. 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.
2.
Petitioner's or Authorized Signatory's Statement Regarding the Preparer
At my request, the preparer named in Part 10.,
,
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prepared this petition for me based only upon information I provided or authorized.
Petitioner's or Authorized Signatory's Certification
Copies of any documents 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 that the petitioner 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.
I certify, under penalty of perjury, that all of the information in my petition 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 petition and that all of
this information is complete, true, and correct.
Petitioner's or Authorized Signatory's Signature
3.
Petitioner's or Authorized Signatory's Signature
Date of Signature (mm/dd/yyyy)
If Part 8. is being completed by an Authorized Signatory, provide the name and title of the Authorized Signatory.
Name and Title of Authorized Signatory
4.
Family Name (Last Name)
5.
Title
Given Name (First Name)
Authorized Signatory's Contact Information
6.
Daytime Telephone Number
8.
Email Address (if any)
7.
Mobile Telephone Number (if any)
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.
Form I-129H2B xx/xx/19
Page 14 of 21
Part 9. 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)
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
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Interpreter's Mailing Address
3.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
ZIP Code
Country
Postal Code
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)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 8.,
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
Form I-129H2B xx/xx/19
Date of Signature (mm/dd/yyyy)
Page 15 of 21
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner or Authorized Signatory
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
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Preparer's Mailing Address
3.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Preparer's Contact Information
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.
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.
B.
I am an attorney or accredited representative and my representation of the petitioner in this case
extends
does not extend beyond the preparation of this supplement.
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 has reviewed this completed petition, including the Petitioner's or Authorized Signatory's
Certification, and informed me that all of the information in the petition and in the supporting documents is complete, true, and
correct.
Preparer's Signature
8.
Preparer's Signature
Form I-129H2B xx/xx/19
Date of Signature (mm/dd/yyyy)
Page 16 of 21
Part 11. Additional Information
If you need extra space to provide any additional information within this petition, 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 petition or attach a separate sheet of paper. Type or
print your company or organization name 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.
Individual Petitioner or Company Name
2.
A.
Page Number
B. Part Number
C. Item Number
Page Number
B. Part Number
C. Item Number
Page Number
B. Part Number
C. Item Number
Page Number
B. Part Number
C. Item Number
Page Number
B. Part Number
C. Item Number
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D.
3.
A.
D.
4.
A.
D.
5.
A.
D.
6.
A.
D.
Form I-129H2B xx/xx/19
Page 17 of 21
Named Worker Attachment for Form I-129H2B
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129H2B
OMB No. 1615-xxxx
Expires xx/xx/20xx
Attach to Form I-129H2B when more than one person is included in the petition. A single H-2B petition may be filed on behalf of no
more than 25 named workers. Therefore, do not include more than 24 Named Worker Attachments with a single I-129H2B petition.
Complete a separate copy of this attachment for each additional beneficiary included in this petition. (Do not complete a copy of this
Attachment for the beneficiary you already named in Part 3. of Form I-129H2B.)
Petitioner's Information
Provide the same petitioner name information that was provided in Part 1. of Form I-129H2B, as applicable.
1.
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Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)
2.
Given Name (First Name)
Middle Name
Given Name (First Name)
Middle Name
Petitioning Company or Organization Name
Beneficiary Information
3.
Beneficiary's Full Name
Family Name (Last Name)
4.
Provide all other names the beneficiary has used. Include nicknames, aliases, maiden name, and names from all previous
marriages.
Family Name (Last Name)
Other Information
5.
Date of Birth (mm/dd/yyyy)
Given Name (First Name)
6.
Gender
Male
8.
Alien Registration Number (A-Number)
►
7.
U.S. Social Security Number
►
Female
9.
Middle Name
USCIS Online Account Number
►
A-
10.
City or Town of Birth
11.
Province of Birth
12.
Country of Birth
13.
Country of Citizenship or Nationality
14.
Beneficiary's Foreign Address
Street Number and Name
Apt. Ste. Flr. Number
City or Town
Province
Form I-129H2B xx/xx/19
Postal Code
Country
Page 18 of 21
15.
If the beneficiary is in the United States, complete the following:
Date of Last Arrival
Form I-94 Arrival-Departure Record Number
(mm/dd/yyyy)
►
Passport or Travel Document Number
Date Passport or Travel Document Issued
(mm/dd/yyyy)
Passport or Travel Document Country of Issuance
Date Passport or Travel Document Expires
(mm/dd/yyyy)
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Current Nonimmigrant
Status
Date Status Expires or Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)
(mm/dd/yyyy)
Student and Exchange Visitor Information System (SEVIS)
Number
16.
Employment Authorization Document (EAD)
Number
Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 16., you must provide the beneficiary's U.S. residential address
information in Item Number 17.
17.
18.
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 (CNMI).)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►
19.
ZIP Code
Have you ever filed an immigrant petition for this beneficiary?
Yes
No
Yes
No
Yes
No
If you answered "Yes" to Item Number 19., identify the classification sought and the receipt number
for those petitions in Part 11. Additional Information.
20.
Have you ever filed a nonimmigrant petition for this beneficiary?
If you answered "Yes" to Item Number 20., identify the classification sought and the receipt number
for those petitions in Part 11. Additional Information.
21.
Has this beneficiary ever been denied H-2B classification on any prior petition you filed on behalf of
this beneficiary?
If you answered "Yes" to Item Number 21., identify the classification sought and the receipt number
for those petitions in Part 11. Additional Information.
Form I-129H2B xx/xx/19
Named Worker Attachment
Page 19 of 21
22.
List the beneficiary's prior periods of stay in H or L classification in the United States for the last three years. Be sure to only
list those periods in which the beneficiary was physically present 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 11.
Additional Information or attach an additional sheet of paper.
NOTE: Submit copies of any available Forms I-94, I-797, and/or other USCIS issued documents noting these periods of stay in
the H or L classification.
Period of Stay
From (mm/dd/yyyy) To (mm/dd/yyyy)
Employer's Name
23.
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Has this beneficiary experienced an interrupted stay associated with their entry in H or L classification?
(See form instructions for more information on interrupted stays.)
Yes
No
If you answered “Yes” to Item Number 23., submit evidence of each entry and each exit as evidence of
the interrupted stays.
Information About the Additional Beneficiary's Public Charge
Item Numbers 24. - 27.B. only apply to petitions that also seek a change of a beneficiary's status or an extension of a beneficiary's
nonimmigrant stay in the United States. If you are filing this petition without a request for the beneficiary's change of status or
extension of stay, you may skip Item Numbers 24. - 27.B.
24.
Has the beneficiary, since obtaining the nonimmigrant status that you seek to extend or that you seek to change on behalf of the
beneficiary, received, or is the beneficiary currently certified to receive, any of the following public benefits? (select all that apply).
Yes, the beneficiary has received or is currently certified to receive the following public benefits:
Any Federal, State, local or tribal cash assistance for income maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
General Assistance (GA)
Supplemental Nutrition Assistance Program (SNAP, formerly called "Food Stamps")
Section 8 Housing Assistance under the Housing Choice Voucher Program
Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.
Federal-funded Medicaid
No, the beneficiary has not received any of the above listed public benefits.
No, the beneficiary is not certified to receive any of the above listed public benefits.
25.
If the beneficiary has received or is currently certified to receive any of the above public benefits, provide information about the
public benefits below. If you need additional space to complete any Item Number in this Part, use the space provided in Part 11.
Additional Information. Submit evidence as outlined in the Instructions.
A.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
Form I-129H2B xx/xx/19
Named Worker Attachment
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Page 20 of 21
Information About the Additional Beneficiary's Public Charge (continued)
B.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
C.
Type of Public Benefit
Agency that Granted the Public Benefit
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Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
D.
Type of Public Benefit
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
26.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
If you answered “Yes” to Item Number 24., do any of the following apply to the beneficiary? Provide the evidence listed in the
Form I-129 Instructions.
The beneficiary is enlisted in the Armed Forces, or is serving in active duty or in the Ready Reserve Component of the U.S.
Armed Forces.
The beneficiary is the spouse or the child of an individual who is enlisted in the Armed Forces, or is serving in active duty
or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary (or the beneficiary's spouse or parent) was enlisted
in the Armed Forces, or was serving in active duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States in a status exempt
from the public charge ground of inadmissibility.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States after being granted
a waiver of the public charge ground of inadmissibility.
The beneficiary is a child currently residing abroad who entered the United States with a nonimmigrant visa to attend an
N-600K, Application for Citizenship and Issuance of Certificate Under INA Section 322 interview.
None of the above statements apply to the beneficiary.
27.
A.
Has the beneficiary received, applied for, or has been certified to receive federally-funded Medicaid in connection with
any of the following (select all that apply): Submit evidence as outlined in the Instructions.
An emergency medical condition
For a service under the Individuals with Disabilities Education Act (IDEA)
Other school-based benefits or services available up to the oldest age eligible for secondary education under State law
While under the of age 21
While pregnant or during the 60-day period following the last day of pregnancy
B.
Provide the applicable dates mm/dd/yyyy
Form I-129H2B xx/xx/19
to mm/dd/yyyy
Named Worker Attachment
Page 21 of 21
| File Type | application/pdf |
| File Title | Form I-129H2B, Petition for Nonimmigrant Worker: H2B Classification |
| Author | USCIS |
| File Modified | 2020-08-18 |
| File Created | 2020-08-18 |