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 10/31/2020

For USCIS Use Only
Receipt

Preference Category:

Action Block

Country Chargeable:
Priority Date:

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Date Form I-693 Completed:
Applicant
Interviewed
Date of
Initial Interview:
Lawful Permanent
Resident as of:

Interview
Waived

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.

Select this box if
Form G-28 is
attached.

Volag Number

Attorney State Bar Number

► START HERE - Type or print in black ink.

Attorney or Accredited Representative
USCIS Online Account Number

A-Number ► A-

NOTE TO ALL APPLICANTS: If you leave any fields blank on this form or fail to submit required documents listed in the
Instructions, U.S. Citizenship and Immigration Services (USCIS) may reject or deny your application.

Part 1. Information About You (individual
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)

1.c. Middle Name

Other Names You Have Used Since Birth
Provide all other names you have ever used, including your
family name at birth, other legal names, nicknames, aliases, and
assumed names. If you have never used another name, write
none or equivalent in the blanks. 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)

Other Information About You

4.

Date of Birth (mm/dd/yyyy)

5.

Other Date of Birth Used (mm/dd/yyyy)

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. If you have never used another date
of birth, write none or equivalent in the blank.
6.

Gender

Male

7.

City or Town of Birth

Female

2.c. Middle Name
Form I-485 Edition 10/15/19

Page 1 of 24

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

Country of Birth

9.

Country of Citizenship or Nationality

Any other Alien Registration Number (A-Number)
assigned to you
► A-

If you have ever had other A-Numbers assigned to you
include any additional A-Numbers in the space provided
in Part 14. Additional Information. If you have never
had other A-numbers assigned to you, write "N/A" in the
blank space.
11.

USCIS Online Account Number
►

U.S. Mailing Address

(USPS ZIP Code Lookup)

13.c.

Apt.

Ste.

Flr.

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

13.f. ZIP Code

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.

14.b.

Ste.

Flr.

12.d. City or Town
12.e. State

13.b. Street Number
and Name

14.a. Street Number
and Name

12.b. Street Number
and Name
Apt.

13.a. In Care Of Name

Physical Address 1 (current address)

12.a. In Care Of Name

12.c.

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

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If you have more than one country of citizenship or nationality,
provide additional countries in the space provided in Part 14.
Additional Information.
10.

Safe or Alternate Mailing Address

Apt.

Flr.

14.c. City or Town
14.d. State

12.f. ZIP Code

Ste.

14.e. ZIP Code

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

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

Form I-485 Edition 10/15/19

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A-Number ► A-

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

Social Security Card
20.

Physical Address 2
16.a. Street Number
and Name
16.b.

Apt.

Ste.

Flr.

Has the Social Security Administration (SSA) ever
officially issued a Social Security card to you?
Yes

If you answered “Yes,” provide the information requested in
Item Number 21. If you answered “No,” write “N/A.”
21.

Provide your U.S. Social Security Number (SSN).

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16.c. City or Town
16.d. State
16.f. Province
16.g. Postal Code
16.h. Country

No

►

16.e. ZIP Code

22.

Do you want the SSA to issue you a Social Security card?
(You must also answer “Yes” to Item Number 23.
Consent for Disclosure, to receive a card).
Yes
No

If you answered “Yes,” you must also answer “Yes” to Item
Number 23. If you answered “No,” answer “No” to Item
Number 23.
23.

Dates of Residence

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

Consent for Disclosure: I authorize disclosure of
information from this application to the SSA as required
for the purpose of assigning me an SSN and issuing me a
Social Security Card.
Yes
No

Provide your most recent address outside the United States where
you lived for more than one year (if not already listed above).

Recent Immigration History

18.a. Street Number
and Name

Provide the information for Item Numbers 24. - 28. if you last
entered the United States using a passport or travel document.
If you have traveled to the United States without a passport or
travel document, write "N/A" in the blank spaces.

18.b.

Apt.

Ste.

Flr.

18.c. City or Town
18.d. State
18.f. Province

24.

Passport or Travel Document Number Used at Last Arrival

25.

Expiration Date of this Passport or Travel Document

18.e. ZIP Code

18.g. Postal Code

(mm/dd/yyyy)

26.

Country that Issued this Passport or Travel Document

27.

Nonimmigrant Visa Number Used During Most Recent
Arrival

28.

Date Nonimmigrant Visa Was Issued (mm/dd/yyyy)

18.h. Country

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

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

29.b. State
30.
Form I-485 Edition 10/15/19

Date of Last Arrival (mm/dd/yyyy)
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Part 1. Information About You (Person applying
for lawful permanent residence) (continued)

38.a. Have you ever landed in the United States as an alien
crewman or been admitted in pursuit of your occupation
as a crewman?
Yes
No

When I last arrived in the United States, I:
31.a.

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

31.b.

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

38.b. If you answered “Yes” to Item Number 38.a., provide
the date of landing as an alien crewman or the date of
admission in pursuit of your occupation as a crewman
(mm/dd/yyyy). If you answered “No” to Item Number
38.a., write “N/A.”

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Part 2. Application Type or Filing Category

1.

31.c.

Came into the United States without admission or
parole.

31.d.

Other:

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.

Provide the information on your Form I-94 Arrival-Departure
Record. If you were not issued a Form I-94, write "N/A" in all
the blank spaces.
32.a. Form I-94 Arrival-Departure Record Number
►

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.):

32.b. Expiration Date of Authorized Stay Shown on Form I-94
(mm/dd/yyyy)

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

Family-based

2.a. Immediate relative of a U.S. citizen, Form I-130 (select
your specific category below):
Spouse of a U.S. citizen

Provide your name exactly as it appears on your Form I-94. If
you were not issued a Form I-94, write "N/A" in all the blanks.
33.a. Family Name
(Last Name)
33.b. Given Name
(First Name)

33.c. Middle Name
34.

Was your last arrival the first time you were physically
present in the United States?
Yes
No

35.

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

36.

Expiration Date of Current Immigration Status
(mm/dd/yyyy)

37.

Are you currently in the United States as an alien crewman
or did you arrive in pursuit of your occupation as a crewman?
Yes
No

Form I-485 Edition 10/15/19

Unmarried child under the age of 21 of a U.S. citizen
Parent of a U.S. citizen (if the citizen is at least
21 years of age)

2.b. Other relative of a U.S. citizen under the family-based
preference categories, Form I-130 (select your specific
category below):
Unmarried son or daughter of a U.S. citizen and
I am 21 years of age or older
Married son or daughter of a U.S. citizen
Brother or sister of a U.S. citizen (if the citizen is
at least 21 years of age)

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An alien applying for a National Interest Waiver
(who IS a member of the professions holding an
advanced degree or an alien of exceptional ability)

Part 2. Application Type or Filing Category
(continued)
2.c. Relative of a lawful permanent resident under the familybased preference categories, Form I-130 (select your
specific category below):
Spouse of a lawful permanent resident
Unmarried child under the age of 21 of a lawful
permanent resident

2.e.
2.f.

Individual 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)
Widow or widower of a U.S. citizen, Form I-360
VAWA self-petitioner (victim of battery or extreme
cruelty), Form I-360 (select your specific category
below):

VAWA self-petitioning spouse of U.S. citizen or
lawful permanent resident
VAWA self-petitioning child (unmarried and
under 21 years old) of a U.S. citizen or lawful
permanent resident

VAWA self-petitioning parent of a U.S. citizen
(if the citizen is at least 21 years of age)
2.g.

Alien investor, Form I-526

Special Immigrant
4.a. Religious worker, Form I-360 (select your specific
category below):

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Unmarried son or daughter of a lawful permanent
resident and I am 21 years of age or older
2.d.

3.b.

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

Minister of religion

Other religious worker

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

Asylee or Refugee

5.a.

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

If you selected asylum, date you were granted asylum
(mm/dd/yyyy)

Employment-based

3.a. Alien worker, Form I-140 (if you select one of these
categories, you must answer Item Number 9.a.):

5.b.

Refugee status (INA section 207), Form I-590 or
Form I-730
If you selected refugee, date of initial admission as
refugee (mm/dd/yyyy)

Alien of extraordinary ability
Outstanding professor or researcher
Multinational executive or manager
Member of the professions holding an advanced
degree or alien of exceptional ability (who is
NOT seeking a National Interest Waiver)
A professional (at a minimum, requiring a
bachelor's degree or a foreign degree equivalent
to a U.S. bachelor's degree)
A skilled worker (requiring at least two years of
specialized training or experience)

Human Trafficking Victim or Victim of Qualifying
Criminal Activity
6.a.

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

6.b.

Victim of Qualifying Criminal Activity (U
Nonimmigrant), Form I-918, derivative family
member, Form I-918A, or qualifying family member,
Form I-929

Any other worker (requiring less than two years
of training or experience)

Form I-485 Edition 10/15/19

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A-Number ► A-

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

Applicant adjusting under the Cuban Adjustment Act

7.b.

A victim of battery or extreme cruelty as a spouse or
child under the Cuban Adjustment Act

7.c.

Applicant adjusting based on dependent status under
the Haitian Refugee Immigrant Fairness Act

Additional Information
9.a. Did a relative file the associated Form I-140 for you (or for
the principal applicant if you are a derivative applicant), or
does a relative have a significant ownership interest (five
percent or more) in the business that filed Form I-140 for
you (or for the principal applicant if you are a derivative
applicant)? Note: The relative must be your (or the
principal applicant's, if you are a derivative applicant)
husband, wife, father, mother, child, adult son, adult
daughter, brother, or sister.

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7.d.

Applicant adjusting based on dependent status under
the Haitian Refugee Immigrant Fairness Act for
battered spouses and children

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.

Applicant adjusting under the Indochinese Parole
Adjustment Act of 2000

7.h.

Applicant adjusting under the Amerasian Act
(October 22, 1982), Form I-360

Yes

Brother or sister

Husband, wife, father, mother, child, adult son, or
adult daughter
N/A (I answered “No” or “N/A” to Item Number 9.a.)

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

None of the above

U.S. national

N/A (I answered “No”
or “N/A” to Item
Number 9.a.)

Lawful permanent
resident

Diversity Visa program

If you selected Diversity Visa program, provide your
Diversity Visa Rank Number:

N/A (I am adjusting on the basis
of a Form I-140 self-petition or on
a basis other than Form I-140)

9.b. How is the relative related to the principal applicant?

Additional Options
8.a.

No

10.

Regardless of the immigrant category you are adjusting
under, do you hold:
VAWA self-petitioner status?

Yes

No

8.b.

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

Victim of Qualifying Criminal Activity (U nonimmigrant)
status?
Yes
No

8.c.

Individual born in the United States under diplomatic
status

Human trafficking victim (T nonimmigrant) status?
Yes
No

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)

INA Section 245(i)
11.

Are you applying for adjustment based on the
Immigration and Nationality Act (INA) section 245(i)?
(See Form I-485 Supplement A for more information.)
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.

Form I-485 Edition 10/15/19

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Part 2. Application Type or Filing Category
(continued)
Information About Your Immigrant Category
If you are filing Form I-485 concurrently with an immigrant
petition, write “None” for Item Numbers 12. - 13.
12.

Receipt Number of Underlying Petition

13.

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

5.

Have you ever applied for permanent residence while in
Yes
No
the U.S.?

If you need extra space to complete this section, use the space
provided in Part 14. Additional Information. If you answered
“No” to Item Number 5., write "N/A" for Item Number 6.
6.

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

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Employment and Educational History

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. If you are
not a derivative applicant, write “N/A” for Item Numbers 12. 13.

Provide ALL of your employment and educational history for
the last five years, whether inside or outside the United States.
Provide the most recent employment or school attended first.
Include periods of self-employment or unemployment. For
each period of unemployment, list source of financial support.
If you need extra space to complete this section, use the space
provided in Part 14. Additional Information.

Principal Applicant's Name

Employer or School 1 (current or most recent)

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

7.

14.c. Middle Name

8.a. Street Number
and Name

15.

Address of Employer, Company, or School

Principal Applicant's A-Number
► A-

16.

Name of Employer, Company, or School

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

8.b.

Apt.

1.

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

If you need extra space to complete this section, use the space
provided in Part 14. Additional Information. If you answered
“No” to Item Number 1., write "N/A" for Item Numbers 2.a. 4.
Location of U.S. Embassy or U.S. Consulate

Flr.

8.c. City or Town
8.d. State

Part 3. Additional Information About You

Ste.

8.f.

8.e. ZIP Code

Province

8.g. Postal Code
8.h. Country

9.

Your Occupation (if unemployed, so state)

Dates of Employment, Unemployment, or School Attendance
10.a. From (mm/dd/yyyy)

2.a. City
2.b. Country

10.b. To (mm/dd/yyyy)
10.c. If unemployed, source of financial support

3.

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

4.

Date of Decision (mm/dd/yyyy)

Form I-485 Edition 10/15/19

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Part 3. Additional Information About You
(continued)

Address of Employer or Company, or School

Employer or School 2

16.b.

11.

16.a. Street Number
and Name
Apt.

Ste.

Flr.

Name of Employer, Company, or School
16.c. City or Town

Address of Employer, Company, or School

16.d. State

12.a. Street Number
and Name

16.f. Province

12.b.

Apt.

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Ste.

Flr.

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

16.g. Postal Code
16.h. Country

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

16.e. ZIP Code

12.e. ZIP Code

17.

Your Occupation (if unemployed, so state)

Dates of Employment or Unemployment, or School Attendance
18.a. From (mm/dd/yyyy)
18.b. To (mm/dd/yyyy)

13.

Your Occupation (if unemployed, so state)

18.c. If unemployed, source of financial support.

Dates of Employment, Unemployment, or School Attendance
14.a. From (mm/dd/yyyy)
14.b. To (mm/dd/yyyy)

14.c. If unemployed, source of financial support

Provide your most recent employment outside of the United
States (if not already listed above).
15.

Name of Employer or Company, or School

Part 4. Information About Your Parents

Information About Your Parent 1

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

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

Form I-485 Edition 10/15/19

3.

Date of Birth (mm/dd/yyyy)

4.

Gender

5.

City or Town of Birth

Male

Female

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Part 4. Information About Your Parents
(Continued)
6.

Part 5. Information About Your Marital History
1.

Country of Birth

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

7.

8.

Current City or Town of Residence (if living; write “N/A”
if deceased)

Married

Divorced

Marriage Annulled

Legally Separated
2.

If you are married, is your spouse a current member of the
U.S. armed forces or U.S. Coast Guard?

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Current Country of Residence (if living; write “N/A” if
deceased)

N/A

3.

Information About Your Parent 2
Parent 2's Legal Name

Yes

No

How many times have you been married (including your
current marriage, marriages abroad, annulled marriages
and marriages to the same individual)?
►

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

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

If you are currently married, provide the following information
about your current spouse. If you are currently not married,
write “N/A” for Item Numbers 4.a. - 12.

9.c. Middle Name

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

Current Spouse's Legal Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

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

4.c. Middle Name

10.c. Middle Name
11.

Date of Birth (mm/dd/yyyy)

12.

Gender

13.

City or Town of Birth

14.

Country of Birth

15.

Current City or Town of Residence (if living; write “N/A”
if deceased)

Male

► A-

5.

A-Number

6.

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

7.

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

Female

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

8.b. State or Province
16.

Current Country of Residence (if living; write “N/A” if
deceased)

8.c. Country

9.

Spouse's Country of Citizenship or Nationality

If your spouse has more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 14. Additional Information.

Form I-485 Edition 10/15/19

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Part 5. Information About Your Marital History
(continued)

If your prior spouse has more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 14. Additional Information.

Current Spouse's Current Physical Address

17.

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

10.a. City or Town
Place of Marriage to Prior Spouse
10.b. State or Province

18.a. City or Town

10.c. Country

18.b. State or Province

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18.c. Country

Place of Marriage to Current Spouse
11.a. City or Town

19.

11.b. State or Province

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

Place Where Marriage with Prior Spouse Legally Ended

11.c. Country

12.

20.a. City or Town

Is your current spouse applying with you?

20.b. State or Province

Yes

No

Information About Prior Marriages

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. If you have
never been married before, write “N/A” for Item Numbers
13.a. - 21.

20.c. Country

21.

Annulled
Divorced

Spouse Deceased
Other (Explain):

Prior Spouse's Legal Name (provide family name before
marriage)
13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)
13.c. Middle Name
14.

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

15.

Prior Spouse's Country of Birth

16.

Prior Spouse's Country of Citizenship or Nationality

Form I-485 Edition 10/15/19

How Marriage Ended with My Prior Spouse (select one):

Part 6. Information About Your Children
1.

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

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Part 6. Information About Your Children
(continued)
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. If you do not have any
children, write “N/A” for Item Numbers 2.a. - 22.
Child 1

12.

Country of Birth

13.

Country of Citizenship or Nationality

If your child has more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 14. Additional Information.

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Current Legal Name

14.

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

What is your child's relationship to you? (for example,
biological child, stepchild, legally adopted child)

15.

Is this child also applying now on a separate Form I-485?
Yes
No

2.c. Middle Name

► A-

Child 3

3.

A-Number

4.

Date of Birth (mm/dd/yyyy)

5.

Country of Birth

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

6.

Country of Citizenship or Nationality

16.c. Middle Name

Current Legal Name

If your child has more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 14. Additional Information.
7.

8.

What is your child's relationship to you? (for example,
biological child, stepchild, legally adopted child)

Is this child also applying now on a separate Form I-485?
Yes
No

► A-

17.

A-Number

18.

Date of Birth (mm/dd/yyyy)

19.

Country of Birth

20.

Country of Citizenship or Nationality

Child 2

If your child has more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 14. Additional Information.

Current Legal Name

21.

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

What is your child's relationship to you? (for example,
biological child, stepchild, legally adopted child)

22.

Is this child also applying now on a separate Form I-485?
Yes
No

9.c. Middle Name
► A-

10.

A-Number

11.

Date of Birth (mm/dd/yyyy)

Form I-485 Edition 10/15/19

Page 11 of 24

A-Number ► A-

3.a. City or Town

Part 7. Biographic Information
1.

Ethnicity (Select only one box)
3.b. State or Province

Hispanic or Latino
Not Hispanic or Latino
2.

3.c. Country

Race (Select all applicable boxes)
White
Asian

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4.

Nature of Organization

5.

Nature of involvement in organization, including role or
position(s) held

Black or African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander
3.

Height

Feet

Inches

Dates of Membership or Dates of Involvement

Pounds

4.

Weight

5.

Eye Color (Select only one box)
Black
Gray
Maroon

6.

Blue

Brown

Green

Hazel

Pink

Unknown/Other

6.b. To (mm/dd/yyyy)
Organization 2
7.

Name of Organization

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

Black

Blond

Brown

Gray

Red

White

Unknown/Other

Sandy

Part 8. General Eligibility and Inadmissibility
Grounds
1.

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

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?
Yes
No

If you answered “Yes” to Item Number 1., complete Item
Numbers 2. - 16.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.

8.a. City or Town

8.b. State or Province

8.c. Country

9.

Nature of Organization

10.

Nature of involvement in organization, including role or
position(s) held

Dates of Membership or Dates of Involvement
11.a. From (mm/dd/yyyy)
11.b. To (mm/dd/yyyy)

Organization 1
2.

Name of Organization

Form I-485 Edition 10/15/19

Page 12 of 24

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

23.

Are you presently or have you EVER been in removal,
exclusion, rescission, or deportation proceedings?
Yes
No

Organization 3

24.

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

25.

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

26.

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

27.

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

28.

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

29.

Have you EVER worked in a country other than the
United States without employment authorization (or the
equivalent)?
Yes
No

30.

Have you EVER entered a country other than the United
States in violation of that country's immigration laws?
Yes
No

31.

Have you EVER been unlawfully present (or the
equivalent) in a country other than the United States?
Yes
No

32.

Have you EVER been in removal, deportation, or
exclusion proceedings (or the equivalent) in a country
other than the United States?
Yes
No

33.

Have you EVER been ordered removed, deported, or
excluded (or the equivalent) from a country other than the
United States?
Yes
No

12.

Name of Organization

13.a. City or Town

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13.b. State or Province

13.c. Country

14.

15.

Nature of Organization

Nature of involvement in organization, including role or
position(s) held

Dates of Membership or Dates of Involvement
16.a. From (mm/dd/yyyy)
16.b. To (mm/dd/yyyy)
17.

18.

Are you now or have you EVER been a member of, or
associated with, a group of three or more persons who
acted together in the United States or elsewhere with the
aim of committing any crime?
Yes
No
Are you now or have you EVER been a member of, or
associated with, a group of three or more persons who
acted together to commit and/or to attempt to commit a
crime involving more than one country?
Yes
No

Answer Item Numbers 19. - 86.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.
19.

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

20.

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

21.

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

22.

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

Form I-485 Edition 10/15/19

34.a. Have you EVER been a J nonimmigrant exchange visitor
who was subject to the two-year foreign residence
requirement?
Yes
No
34.b. Have you complied with the foreign residence
requirement? If you answered “No” for Item Number
34.a., select “No”.
Yes
No
34.c. Have you been granted a waiver or has Department of
State issued a favorable waiver recommendation letter for
you? If you answered “No” for Item Number 34.a.,
select “No”.
Yes
No

Page 13 of 24

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

41.

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

42.

Have you EVER knowingly aided, abetted, assisted,
conspired, or colluded in the illicit trafficking of any
illegal narcotic or other controlled substances?
Yes
No

Criminal Acts and Violations
For Item Numbers 35. - 55., 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 35. - 55., 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).
35.

43.a. 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 this activity of your spouse
or parent?
Yes
No

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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 or by a similar official of a country other than the
United States)?
Yes
No

43.b. If your answer to Item Number 43.a. is “Yes,” did you
know or reasonably should have known that this benefit
resulted from this activity of your spouse or parent?
Yes
No
N/A
44.

Have you EVER been convicted of two or more offenses
for which the combined sentences to confinement were
five years or more?
Yes
No

45.

Have you EVER engaged in prostitution or are you
coming to the United States to engage in prostitution?
Yes
No

36.

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

46.

Have you EVER directly or indirectly procured or
attempted to procure, or imported prostitutes or persons
for the purpose of prostitution?
Yes
No

37.

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

47.

Have you EVER received any proceeds or money from
prostitution?
Yes
No

48.

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

49.

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

50.

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

If you were the beneficiary of a pardon, amnesty, a
rehabilitation decree, or other act of clemency, provide
documentation of that post-conviction action.
38.

Have you EVER been ordered punished by a judge or
magistrate 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

39.

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

40.

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?
Yes
No

Form I-485 Edition 10/15/19

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
51.

52.

53.

Have you EVER engaged in sex trafficking? Sex
trafficking involves inducing or causing an adult to
engage in a commercial sex act (any sex act performed for
anything of value) through fraud, force, or coercion, or
inducing or causing any person under 18 years of age to
engage in a commercial sex act. Sex trafficking may
include recruiting, enticing, harboring, transporting,
providing, obtaining, advertising, maintaining,
patronizing or soliciting by any means a person to engage
in the commercial sex act knowing (or, in the case of
advertising, with reckless disregard of the fact) that the
person is under 18 years of age or that force, fraud, or
coercion was used to induce or cause the person to engage
in the commercial sex act. Sex trafficking may also
include knowingly benefitting financially or by receiving
anything of value, from participation in a venture
involved in sex trafficking.
Yes
No

56.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

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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
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

54.a. 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 this activity of your
spouse or your parent?
Yes
No

54.b. If your answer to Item Number 54.a. is “Yes,” did you
know or reasonably should have known that this benefit
resulted from this activity of your spouse or parent?
Yes
No
N/A
55.

56.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

Have you EVER engaged in money laundering or have
you EVER knowingly aided, assisted, abetted, conspired,
or colluded with others in money laundering or do you
seek to enter the United States to engage in such activity?
Yes
No

Security and Related Questions
Do you intend to:
56.a. Engage in any activity that violates or evades any law
relating to espionage (including spying) or sabotage in the
United States?
Yes
No

Form I-485 Edition 10/15/19

56.d. Engage in any activity that could endanger the welfare,
safety, or security of the United States?
Yes
No
56.e. Engage in any other unlawful activity?
57.

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:
58.

Received any weapons training, paramilitary training, or
other military-type training?
Yes
No

59.a. Committed kidnapping, assassination, or hijacking or
sabotage of a conveyance (including an aircraft, vessel,
vehicle, or train)?
Yes
No
59.b. Used a weapon or explosive or any dangerous device with
the intent to endanger the safety of another person or
people or cause damage to property?
Yes
No

59.c. Threatened, attempted, conspired, prepared, or planned to
do any of the things described in Item Number 59.a. or
59.b.?
Yes
No
59.d. Incited, under circumstances indicating an intention to
cause death or serious bodily harm/injury, any of the
things in Item Number 59.a. or 59.b.?
Yes
No
59.e. Participated in, or been a member of, a group or
organization that did any of the activities described in
Item Numbers 59.a. - 59.d.?
Yes
No
59.f. Recruited members or asked for money or things of value
for a group or organization that did any of the activities
described in Item Numbers 59.a. - 59.d.?
Yes
No
59.g. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Numbers 59.a. - 59.d.?
Yes
No
59.h. 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 Numbers 59.a. - 59.d.?
Yes
No

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
60.

Do you intend to engage in any of the activities listed in
any part of Item Numbers 59.a. - 59.h.?
Yes
No

If you answered “Yes” to any part of Item Numbers 59.a. - 60.,
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.

If you answered “Yes” to any part of Item Number 61., explain
the relationship and what occurred, including the dates and
location of the circumstances, in the space provided in Part 14.
Additional Information.
62.

Have you EVER sold, provided, or transported weapons,
or assisted any person in selling, providing, or
transporting weapons, which you knew or believed would
be used against another person?
Yes
No

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63.

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

64.

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?
Yes
No

65.

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

66.

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

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

61.a. Committed kidnapping, assassination, or hijacking or
sabotage of a conveyance (including an aircraft, vessel, or
vehicle)?
Yes
No
61.b. Used a weapon or explosive, or any dangerous device
with the intent to endanger the safety of another person or
people or cause damage to property?
Yes
No
61.c. Threatened, attempted, conspired, prepared or planned to
do any of the activities described in Item Number 61.a.
or 61.b.?
Yes
No
61.d. Incited, under circumstances indicating an intention to
cause death or serious bodily harm/injury, any of the
things in Item Number 61.a. or 61.b.?
Yes
No

61.e. Participated in, or been a member or a representative of a
group or organization that did any of the activities
described in Item Numbers 61.a. - 61.d?
Yes
No

61.f. Recruited members, or asked for money or things of value,
for a group or organization that did any of the activities
described in Item Numbers 61.a. - 61.d?
Yes
No
61.g. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Numbers 61.a. - 61.d?
Yes
No
61.h. 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 Numbers 61.a. - 61.d?
Yes
No
61.i. Received any weapons training, paramilitary training, or
other military-type training?
Yes
No

67.

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:
68.a. Acts involving torture or genocide?

Yes

No

68.b. Killing any person?

Yes

No

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

No

68.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
68.e. Limiting or denying any person's ability to exercise
religious beliefs?
Yes
No

Form I-485 Edition 10/15/19

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
69.

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

70.

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

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).

72.c.

I am under 18 years of age, unmarried, immigrating
as the child of a U.S. citizen, am not likely to become
a public charge and will automatically become a U.S.
citizen under INA section 320, as amended by the
Child Citizenship Act of 2000, upon my admission to
the United States.

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If you answered “Yes” to any part of Item Numbers 62. - 70.,
explain what occurred, including the dates and location of the
circumstances, in the space provided in Part 14. Additional
Information.

Public Charge

72.b.

Those who are subject to the public charge ground of
inadmissibility under INA section 212(a)(4) must complete
Form I-944, Declaration of Self-Sufficiency, and may also have
to submit Form I-864, Affidavit of Support Under Section 213A
of the INA. Answer the questions below to determine whether
you need to submit these forms together with this Form I-485.

72.d.

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

72.e.

I am applying as a VAWA self-petitioner.

72.f.

I am applying under an alien worker (Form I-140)
employment-based preference immigrant category
and:
(1) (a) The Form I-140 petitioner is not my (or the
principal applicant's) relative; and
(1) (b) My (or the principal applicant's) relative
does not have a significant ownership
interest (at least five percent) in the business
that filed Form I-140; or

Declaration of Self-Sufficiency (Form I-944)
71.

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

(2) The Form I-140 filed is a self-petition.

No

To determine if you are exempt from the public charge ground
of inadmissibility, and therefore exempt from filing Form I-944,
read 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
Section 213A of the INA (Form I-864).

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

72.g.

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

72.h.

I am applying under the human trafficking victim
(T nonimmigrant) immigrant category (INA section
245(l)).

72.i.

I have a pending application for T nonimmigrant
status that sets forth a prima facie case for eligibility
or I am in valid T nonimmigrant status, and I am
applying under a category other than the human
trafficking victim (T nonimmigrant) category (INA
section 245(l)), but not as an alien worker under the
employment-based preference categories where a
relative filed Form I-140 for me or has a five percent
or more ownership interest in the business that filed
Form I-140.

You may need to file Form I-864. For more information, read
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).
72.a.

I am NOT EXEMPT from filing Form I-864

If you selected Item Number 72.a., proceed to Item Number
73. If not, you must select one of Item Numbers 72b.
through 72q.
I am EXEMPT from filing Form I-864 because (select one of
the following Item Numbers 72b. through 72q.):

Form I-485 Edition 10/15/19

NOTE: If, at the time USCIS adjudicates your Form I-485,
your Form I-914 is no longer pending or you are no longer in
valid T nonimmigrant status, you may have to file Form I-944
and Form I-864.
72.j.

I am applying under the victim of qualifying criminal
activity (U nonimmigrant) immigrant category (INA
section 245(m)).

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

73.b. If your answer to Item Number 73.a. is “Yes” do you
believe you had reasonable cause?
Yes
No
N/A

72.k.

73.c. If your answer to Item Number 73.b. is “Yes,” attach a
written statement explaining why you had reasonable cause.

I am in valid U nonimmigrant status and am applying
under a category other than the victim of qualifying
criminal activity (U nonimmigrant) category (INA
section 245(m)) but not as an alien worker under the
employment-based preference categories where a
relative filed Form I-140 for me or has a five percent
or more ownership interest in the business that filed
Form I-140.

74.

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75.

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
immigration benefit?
Yes
No

76.

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

77.

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

78.

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

79.

Are you under a final order of civil penalty for violating
INA section 274C for use of fraudulent documents?
Yes
No

NOTE: If, at the time USCIS adjudicates your Form I-485,
your Form I-918 is no longer pending a decision or you are no
longer in valid U nonimmigrant status, you may have to file
Form I-944 and Form I-864.
72.l.

72.m.

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

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.

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

72.n.

I am applying under the Diversity Visa program
immigrant category.

72.o.

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

Armed forces (also known as the Six and Six
program)
Panama Canal Zone

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

Certain broadcasters

80.

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

81.

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

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

International employees of the U.S. Government
abroad
Religious workers
Certain physicians
Employed by or on behalf of the U.S.
Government
72.p.

I am applying under the Amerasian Act (October 22,
1982)

72.q.

I answered “Yes” to Item Number 71. and the
checkboxes above do not apply to me.

Illegal Entries and Other Immigration Violations
73.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

Form I-485 Edition 10/15/19

Since April 1, 1997, have you been unlawfully present in the
United States:
82.a. For more than 180 days but less than a year and then
departed the United States?
Yes
No
82.b. For one year or more and then departed the United States?
Yes
No
You were unlawfully present in the United States if you were
present in the United States without having been inspected and
admitted or inspected and paroled, or if you were present in the
United States after the period of stay authorized by DHS
expired.
Since April 1, 1997, have you EVER reentered or attempted to
reenter the United States without being inspected and admitted
or paroled after:
Page 18 of 24

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
83.a. Having been unlawfully present in the United States for
more than one year in total, counting together all days
which you were unlawfully present in the United States
during all of your stays on or after April 1, 1997?
Yes
No

92.b. If your answer to Item Number 92.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)?

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83.b. Having been deported, excluded, or removed from the
United States?
Yes
No
84.

92.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

If you answered “Yes” to any of Item Numbers
83.a. - 83.b.,was a severe form of trafficking in persons at
least one central reason for your unlawful presence in the
United States?
Yes
No
N/A

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.

85.

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

1.

86.

Are you accompanying a foreign national who is
inadmissible and who has been certified by a medical
officer as helpless from sickness, mental or physical
disability, or infancy, and who requires your protection or
guardianship, as described in INA section 232(c)?
Yes
No

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

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).):

87.

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

88.

Have you EVER intentionally provided material support
or safe haven to an alien who detained, retained, or
withheld custody of a U.S. citizen child outside the
United States from a person who has been granted
custody of the child?
Yes
No

2.b.

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

89.

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

2.c.

90.

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

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

Have you EVER:
91.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
91.b. Been relieved or discharged from such training or service
on the ground that you are a foreign national?
Yes
No
91.c. Been convicted of desertion from the U.S. armed forces?
Yes
No

Form I-485 Edition 10/15/19

Page 19 of 24

A-Number ► A-

Part 10. Applicant's Statement, Contact
Information, Certification, and Signature
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, I will be required to sign an
oath reaffirming that:

Applicant's Statement

1)

I reviewed and provided or authorized all of the
information in my application;

2)

I understood all of the information contained in, and
submitted with, my application; and

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Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.

3)

1.a.

I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.

1.b.

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

All of this information was complete, true, and
correct at the time of filing.

I certify, under penalty of perjury, that I provided or authorized
all of the information in my application, I 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

,

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

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

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

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

,

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

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.

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

4.

Applicant's Mobile Telephone Number (if any)

5.

Applicant's Email Address (if any)

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

Provide the following information about the interpreter.

Interpreter's Full Name

Applicant's Certification
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any and all of my records that USCIS may need to
determine my eligibility for the immigration benefit that I seek.

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 and
my application is approved, USCIS will share my information
with the Selective Service System so that they may register me
as required by the Military Selective Service Act.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of any U.S. immigration law.
Form I-485 Edition 10/15/19

Page 20 of 24

A-Number ► A-

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

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

Interpreter's Mailing Address

Provide the following information about the preparer.

3.a. Street Number
and Name
3.b.

Apt.

Preparer's Full Name
Ste.

Flr.

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

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

Province

3.g. Postal Code
3.h. Country

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

3.e. ZIP Code

2.

Preparer's Mailing Address

3.a. Street Number
and Name

Interpreter's Contact Information
4.

Preparer's Business or Organization Name (if any)

3.b.

Interpreter's Daytime Telephone Number

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
3.h. Country

Interpreter's Certification

I certify, under penalty of perjury, that:
I am fluent in English and

,

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
Certification, and has verified the accuracy of every answer.

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 Edition 10/15/19

Page 21 of 24

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.

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

7.b.

I am an attorney or accredited representative and my
representation of the applicant in this case
extends
does not extend beyond the preparation
of this application.

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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.

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 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.

Preparer's Signature

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

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

Form I-485 Edition 10/15/19

Page 22 of 24

A-Number ► A-

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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changes made to this application, numbered
through

, are complete, true, and correct. All

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

through

are complete, true, and correct. All documents submitted at
this interview were provided by me and are complete, true, and
correct.
Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp

Date of Signature (mm/dd/yyyy)

Applicant's Signature (sign in ink)

USCIS Officer's Signature (sign in ink)

Form I-485 Edition 10/15/19

Page 23 of 24

A-Number ► A-

5.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 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.

5.b. Part Number

5.c. Item Number

5.d.

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

1.c. Middle Name
2.

A-Number

3.a. Page Number

3.d.

4.a. Page Number

► A-

3.b. Part Number

3.c. Item Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.d.

Form I-485 Edition 10/15/19

4.c. Item Number

7.a. Page Number

7.d.

Page 24 of 24