Pages 3-5, Part 2.
Application Type or Filing Category
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[Page 3]
Part 2. Application Type or
Filing Category
1. I
am filing this Form I-485 as a (select only one box):
Principal
applicant
Derivative
applicant
NOTE: Attach a copy of the
Form I-797 receipt or approval notice for the underlying petition
or application, as appropriate.
I am applying as a principal
or derivative applicant to register lawful permanent residence or
adjust status to that of a lawful permanent resident based on the
following immigrant category (select only one category).
(See the Form I-485 Instructions for more information, including
any Additional Instructions that relate to the immigrant
category you select.):
Family-based
2.a. Immediate relative
spouse of a U.S. citizen, parent of a U.S. citizen if the U.S.
citizen is 21 years of age or older, and unmarried child under 21
years of age of a U.S. citizen, Form I-130
2.b. Other relative of a U.S.
citizen under the family-based preference categories, Form I-130
2.c. 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)
2.d. Widow or widower of a
U.S. citizen, Form I-360
2.e. VAWA self-petitioner,
Form I-360
2.f. Spouse, child, or
parent of a deceased U.S. active duty service member in the armed
forces under the National Defense Authorization Act (NDAA), Form
I-130 or Form I-360
Employment-based
3.a. Alien worker, Form I-140
(if you select this box, you must answer Item Number 9.a.)
3.b. Alien entrepreneur, Form
I-526
Special Immigrant
4.a.
Religious worker, Form I-360
4.b.
Special immigrant juvenile, Form I-360
4.c.
Certain Afghan or Iraqi national, Form I-360
4.d.
Certain international broadcaster, Form I-360
4.e.
Certain G-4 international organization or family member or NATO-6
employee or family member, Form I-360
4.f.
Certain U.S. armed forces member (also known as the Six and Six
program), Form I-360
4.g.
Panama Canal Zone employee, Form I-360
4.h.
Certain physician, Form I-360
4.i.
Certain employee or former employee of the U.S. Government
abroad, Form I-360
Asylee or Refugee
5.a.
Asylum status (INA section 208), Form I-589 or Form I-730
5.b.
Refugee status (INA section 207), Form I-590 or Form I-730
Human Trafficking Victim or Crime
Victim
6.a. Human
trafficking victim (T Nonimmigrant), Form I-914 or derivative
family member, Form I-914A
6.b.
Victim of Qualifying Criminal Activity (U Nonimmigrant), Form
I-918, derivative family member, Form I-918A, or qualifying family
member, Form I-929
[Page 4]
Special Programs Based on Certain
Public Laws
7.a.
Applicant adjusting under the Cuban Adjustment Act
7.b.
Applicant adjusting under the Cuban Adjustment Act for
battered spouses and children
7.c.
Applicant adjusting based on dependent status under the
Haitian Refugee Immigrant Fairness Act
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
Additional Options
8.a.
Diversity Visa program
8.b.
Continuous residence in the United States since before January
1, 1972 ("Registry")
8.c.
Individual born in the United States under diplomatic status
8.d. S
nonimmigrants and qualifying family members (only law enforcement
agencies can file Form I-485 for someone in this category)
8.e. Other
eligibility (see the Form I-485 Instructions, Who May
File Form I-485, Item Number 3. Other Immigrant Categories
for examples) [Fillable Field]
Additional
Alien Worker Information
Answer Item
Number 9.a. only if you selected Item Number 3.a. “Alien
worker, Form I-140.”
9.a.
Did a relative file the associated Form I-140 for you or does a
relative have a significant ownership interest (five percent or
more) in the business that filed Form I-140 for you? (The
relative must be your husband, wife, father, mother, child, adult
son, adult daughter, brother, or sister.)
Yes
No
If you
answered "Yes" to Item Number 9.a., answer Item
Numbers 9.b. - 9.d. If you answered "No," skip to
Item Number 10.
9.b.
How is your relative related to you?
Brother or
sister
Husband,
wife, father, mother, child, adult son, or adult daughter
9.c.
This relative is a:
U.S. citizen
U.S. national
Lawful
permanent resident
None of the
above
10. Regardless of the
immigrant category you are adjusting under, do you hold:
VAWA self-petitioner status
Yes/No
Victim of Qualifying Criminal
Activity (U nonimmigrant) status
Yes/No
Human trafficking victim (T
nonimmigrant) status
Yes/No
INA
Section 245(i)
10. Are you applying for
adjustment based on the Immigration and Nationality Act (INA)
section 245(i)?
Yes
No
NOTE:
If you answered "Yes" to Item Number 10., you
must have selected a family-based, employment-based, special
immigrant, or Diversity Visa immigrant category listed above in
Item Numbers 2.a. - 8.e. as the basis for your application
for adjustment of status. Fill out the rest of this application
AND Supplement A to Form I-485, Adjustment of Status Under
Section 245(i) (Supplement A). For detailed filing instructions,
read the Form I-485 Instructions (including any Additional
Instructions that relate to the immigrant category that you
selected in Item Numbers 2.a. - 8.e.) and Supplement A
Instructions.
Information About Your
Immigrant Category
If you are the principal
applicant, provide the following information.
11.
Receipt Number of Underlying Petition
12.
Priority Date from Underlying Petition (mm/dd/yyyy)
[Page 5]
If you are a
derivative applicant (the spouse or unmarried child under
21 years of age of a principal applicant), provide the following
information for the principal applicant.
Principal
Applicant's Name
13.a.
Family Name (Last Name)
13.b.
Given Name(First Name)
13.c.
Middle Name
14.
Principal Applicant's A-Number
15.
Principal Applicant's Date of Birth (mm/dd/yyyy)
16.
Receipt Number of Principal's Underlying Petition (if any)
17.
Priority Date of Principal Applicant's Underlying Petition (if
any) (mm/dd/yyyy)
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[Page 4]
Part 2. Application Type or
Filing Category
1. I
am filing this Form I-485 as a (select only one box):
Principal
applicant
Derivative
applicant
NOTE: Attach a copy of the
Form I-797 receipt or approval notice for the underlying petition
or application, as appropriate.
I am
applying as a principal or derivative applicant to register
lawful permanent residence or adjust status to that of a lawful
permanent resident based on the following immigrant category
(select only one category). (See the Form I-485
Instructions for more information, including any Additional
Instructions that relate to the immigrant category you
select.):
Family-based
2.a. Immediate relative of a
U.S. citizen, Form I-130 (select your
specific category below):
[] Spouse of a
U.S. citizen
[] 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)
[Page 5]
2.c.
Relative of a lawful permanent
resident under the family-based 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
[]
Unmarried son or daughter of a lawful permanent resident and I am
21 years of age or older
2.d.
[] 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)
2.e.
[] Widow or widower of a U.S. citizen, Form I-360
2.f. 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.
[]
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
Employment-based
3.a. Alien worker, Form I-140
(if you select one of these
categories, you must answer Item Number 9.a.):
[] 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)
[] Any other
worker (requiring less than two years of training or experience)
[] 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)
3.b.
[] Alien
investor, Form I-526
Special Immigrant
4.a. Religious worker, Form
I-360 (select your specific category below):
[] 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)
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)
Human Trafficking Victim or Crime
Victim
6.a. Human trafficking victim
(T Nonimmigrant), Form I-914 or derivative family member, Form
I-914A
6.b. Victim of Qualifying
Criminal Activity (U Nonimmigrant), Form I-918, derivative family
member, Form I-918A, or qualifying family member, Form I-929
[Page 6]
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
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
Additional Options
8.a. Diversity Visa program
If
you selected Diversity Visa program, provide your Diversity Visa
Rank Number:
8.b.
Continuous residence in the United States since before January
1, 1972 (“Registry”)
8.c.
Individual born in the United States under diplomatic status
8.d. S
nonimmigrants and qualifying family members (only law enforcement
agencies can file Form I-485 for someone in this category)
8.e. Other
eligibility (see the Form I-485 Instructions, Who May
File Form I-485, Item Number 3. Other Immigrant Categories
for examples) [Fillable Field]
Additional Information
[deleted]
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.
Yes
No
N/A (I am adjusting on the basis of a Form
I-140 self-petition or on a basis other than Form I-140)
[deleted]
9.b.
How is the relative related
to the principal applicant?
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
U.S. national
Lawful
permanent resident
None of the
above
N/A
(I answered “No” or “N/A” to Item
Number 9.a.)
10. Regardless of the
immigrant category you are adjusting under, do you hold:
VAWA self-petitioner status?
Yes/No
Victim of Qualifying Criminal
Activity (U nonimmigrant) status?
Yes/No
Human trafficking victim (T
nonimmigrant) status?
Yes/No
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.
[Page 7]
Information About Your
Immigrant Category
[deleted]
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)
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 14.a. - 16.
Principal Applicant's Name
14.a.
Family Name (Last Name)
14.b. Given
Name (First Name)
14.c.
Middle Name
15.
Principal Applicant's A-Number
16.
Principal Applicant's Date of Birth (mm/dd/yyyy)
[delete]
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Pages 10-16, Part 8.
General Eligibility and Inadmissibility Grounds
|
[Page 10]
Part 8. General Eligibility and
Inadmissibility Grounds
1. Have you EVER been
a member of, involved in, or in any way associated with any
organization, association, fund, foundation, party, club, society,
or similar group in the United States or in any other location in
the world including any military service?
Yes
No
If you answered "Yes" to
Item Number 1., complete Item Numbers 2. - 13.b.
below. If you need extra space to complete this section, use the
space provided in Part 14. Additional Information. If
you answered "No," but are unsure of your answer,
provide an explanation of the events and circumstances in the
space provided in Part 14. Additional Information.
Organization 1
2. Name of Organization
3.a. City or Town
3.b. State or Province
3.c. Country
4. Nature of Group
Dates of Membership or Dates of
Involvement
5.a. From (mm/dd/yyyy)
5.b. To (mm/dd/yyyy)
Organization 2
6. Name of Organization
7.a. City or Town
7.b. State or Province
7.c. Country
8. Nature of Group
Dates of Membership or Dates of
Involvement
9.a. From (mm/dd/yyyy)
9.b. To (mm/dd/yyyy)
Organization 3
10. Name of Organization
11.a. City or Town
11.b. State or Province
11.c. Country
12. Nature of Group
Dates of Membership or Dates of
Involvement
13.a. From (mm/dd/yyyy)
13.b. To (mm/dd/yyyy)
[Page 11]
Answer Item Numbers 14. - 80.b.
Choose the answer that you think is correct. If you answer “Yes”
to any questions (or if you answer "No," but are
unsure of your answer), provide an explanation of the events
and circumstances in the space provided in Part 14. Additional
Information.
14. Have you EVER been
denied admission to the United States?
Yes
No
15. Have you EVER been
denied a visa to the United States?
Yes
No
16. Have you EVER
worked in the United States without authorization?
Yes
No
17. Have you EVER
violated the terms or conditions of your nonimmigrant status?
Yes
No
18. Are you presently or have
you EVER been in removal, exclusion, rescission, or
deportation proceedings?
Yes
No
19. Have you EVER been
issued a final order of exclusion, deportation, or removal?
Yes
No
20. Have you EVER had
a prior final order of exclusion, deportation, or removal
reinstated?
Yes
No
21. Have you EVER held
lawful permanent resident status which was later rescinded?
Yes
No
22. Have you EVER been
granted voluntary departure by an immigration officer or an
immigration judge but failed to depart within the allotted time?
Yes
No
23. Have you EVER
applied for any kind of relief or protection from removal,
exclusion, or deportation?
Yes
No
[New]
24.a. Have you EVER
been a J nonimmigrant exchange visitor who was subject to the
two-year foreign residence requirement?
Yes
No
If you answered "Yes" to
Item Number 24.a., complete Item Numbers 24.b. - 24.c.
If you answered "No" to Item Number 24.a., skip
to Item Number 25.
24.b. Have you complied with
the foreign residence requirement?
Yes
No
24.c. Have you been granted a
waiver or has Department of State issued a favorable waiver
recommendation letter for you?
Yes
No
Criminal Acts and Violations
For Item Numbers 25. - 45.,
you must answer "Yes" to any question that applies to
you, even if your records were sealed or otherwise cleared, or
even if anyone, including a judge, law enforcement officer, or
attorney, told you that you no longer have a record. You must
also answer "Yes" to the following questions whether the
action or offense occurred here in the United States or anywhere
else in the world. If you answer "Yes" to Item
Numbers 25. - 45., use the space provided in Part 14.
Additional Information to provide an explanation that includes
why you were arrested, cited, detained, or charged; where you were
arrested, cited, detained, or charged; when (date) the event
occurred; and the outcome or disposition (for example, no charges
filed, charges dismissed, jail, probation, community service).
25. Have you
EVER been arrested, cited, charged, or detained for any
reason by any law enforcement official (including but not limited
to any U.S. immigration official or any official of the U.S. armed
forces or U.S. Coast Guard)?
Yes
No
26. Have you
EVER committed a crime of any kind (even if you were not
arrested, cited, charged with, or tried for that crime)?
Yes
No
27. Have you
EVER pled guilty to or been convicted of a crime or offense
(even if the violation was subsequently expunged or sealed by a
court, or if you were granted a pardon, amnesty, a rehabilitation
decree, or other act of clemency)?
Yes
No
NOTE: If you were the
beneficiary of a pardon, amnesty, a rehabilitation decree, or
other act of clemency, provide documentation of that
post-conviction action.
28. Have you
EVER been ordered punished by a judge or had conditions
imposed on you that restrained your liberty (such as a prison
sentence, suspended sentence, house arrest, parole, alternative
sentencing, drug or alcohol treatment, rehabilitative programs or
classes, probation, or community service)?
Yes
No
29. Have you
EVER been a defendant or the accused in a criminal
proceeding (including pre-trial diversion, deferred prosecution,
deferred adjudication, or any withheld adjudication)?
Yes
No
30. Have you
EVER violated (or attempted or conspired to violate) any
controlled substance law or regulation of a state, the United
States, or a foreign country?
Yes
No
[Page 11]
32. Have you EVER
illicitly (illegally) trafficked or benefited from the trafficking
of any controlled substances, such as chemicals, illegal drugs, or
narcotics?
Yes
No
33. Have you EVER
knowingly aided, abetted, assisted, conspired, or colluded in the
illicit trafficking of any illegal narcotic or other controlled
substances?
Yes
No
34. Are you the spouse, son,
or daughter of a foreign national who illicitly trafficked or
aided (or otherwise abetted, assisted, conspired, or colluded) in
the illicit trafficking of a controlled substance, such as
chemicals, illegal drugs, or narcotics and you obtained, within
the last five years, any financial or other benefit from the
illegal activity of your spouse or parent, although you knew or
reasonably should have known that the financial or other benefit
resulted from the illicit activity of your spouse or parent?
Yes
No
[New]
31. Have you EVER been
convicted of two or more offenses (other than purely political
offenses) for which the combined sentences to confinement were
five years or more?
Yes
No
35. Have you EVER
engaged in prostitution or are you coming to the United States to
engage in prostitution?
Yes
No
36. 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
received any proceeds or money from prostitution?
Yes
No
38. 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
39. Have you EVER
exercised immunity (diplomatic or otherwise) to avoid being
prosecuted for a criminal offense in the United States?
Yes
No
40. Have you EVER,
while serving as a foreign government official, been responsible
for or directly carried out violations of religious freedoms?
Yes
No
[new]
41. Have you EVER
induced by force, fraud, or coercion (or otherwise been involved
in) the trafficking of persons for commercial sex acts?
Yes
No
42. Have you EVER
trafficked a person into involuntary servitude, peonage, debt
bondage, or slavery? Trafficking includes recruiting, harboring,
transporting, providing, or obtaining a person for labor or
services through the use of force, fraud, or coercion.
Yes
No
43. Have you EVER
knowingly aided, abetted, assisted, conspired, or colluded with
others in trafficking persons for commercial sex acts or
involuntary servitude, peonage, debt bondage, or slavery?
Yes
No
44. Are you the spouse, son
or daughter of a foreign national who engaged in the trafficking
of persons and have received or obtained, within the last five
years, any financial or other benefits from the illicit activity
of your spouse or your parent, although you knew or reasonably
should have known that this benefit resulted from the illicit
activity of your spouse or parent?
Yes
No
45. Have you EVER
engaged in money laundering or have you EVER knowingly
aided, assisted, conspired, or colluded with others in money
laundering or do you seek to enter the United States to engage in
such activity?
Yes
No
Security and Related
Do you intend to:
46.a. Engage in any activity
that violates or evades any law relating to espionage (including
spying) or sabotage in the United States?
Yes
No
46.b. Engage in any activity
in the United States that violates or evades any law prohibiting
the export from the United States of goods, technology, or
sensitive information?
Yes
No
46.c. Engage in any activity
whose purpose includes opposing, controlling, or overthrowing the
U.S. Government by force, violence, or other unlawful means while
in the United States?
Yes
No
46.d. Engage in any activity
that could endanger the welfare, safety, or security of the United
States?
Yes
No
46.e. Engage in any other
unlawful activity?
Yes
No
47. 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
[Page 13]
Have you EVER:
[new]
48.a. Committed, threatened
to commit, attempted to commit, conspired to commit, incited,
endorsed, advocated, planned, or prepared any of the following:
hijacking, sabotage, kidnapping, political assassination, or use
of a weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No
[new]
48.b. Participated in, or
been a member of, a group or organization that did any of the
activities described in Item Number 48.a.?
Yes
No
48.c. Recruited members or
asked for money or things of value for a group or organization
that did any of the activities described in Item Number 48.a.?
Yes
No
48.d. Provided money, a thing
of value, services or labor, or any other assistance or support
for any of the activities described in Item Number 48.a.?
Yes
No
48.e. Provided money, a thing
of value, services or labor, or any other assistance or support
for an individual, group, or organization who did any of the
activities described in Item Number 48.a.?
Yes
No
49. Have you EVER
received any type of military, paramilitary, or weapons training?
Yes
No
50. Do you intend to engage
in any of the activities listed in any part of Item Numbers
48.a. - 49.?
Yes
No
NOTE: If you answered “Yes”
to any part of Item Numbers 46.a. - 50., explain what you
did, including the dates and location of the circumstances, or
what you intend to do in the space provided in Part 14.
Additional Information.
Are you the spouse or child of an
individual who EVER:
51.a. Committed, threatened
to commit, attempted to commit, conspired to commit, incited,
endorsed, advocated, planned, or prepared any of the following:
hijacking, sabotage, kidnapping, political assassination, or use
of a weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No
[New]
51.b. Participated in, or
been a member or a representative of a group or organization that
did any of the activities described in Item Number 51.a.?
Yes
No
51.c. Recruited members, or
asked for money or things of value, for a group or organization
that did any of the activities described in Item Number 51.a.?
Yes
No
51.d. Provided money, a thing
of value, services or labor, or any other assistance or support
for any of the activities described in Item Number 51.a.?
Yes
No
51.e. Provided money, a thing
of value, services or labor, or any other assistance or support to
an individual, group, or organization who did any of the
activities described in Item Number 51.a.?
Yes
No
51.f. Received any type of
military, paramilitary, or weapons training from a group or
organization that did any of the activities described in Item
Number 51.a.?
Yes
No
NOTE: If you answered “Yes”
to any part of Item Number 51., explain the relationship
and what occurred, including the dates and location of the
circumstances, in the space provided in Part 14. Additional
Information.
52. Have you EVER
assisted or participated in selling, providing, or transporting
weapons to any person who, to your knowledge, used them against
another person?
Yes
No
53. Have you EVER
worked, volunteered, or otherwise served in any prison, jail,
prison camp, detention facility, labor camp, or any other
situation that involved detaining persons?
Yes
No
54. Have you EVER been
a member of, assisted, or participated in any group, unit, or
organization of any kind in which you or other persons used any
type of weapon against any person or threatened to do so?
Yes
No
55. 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
56. 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
No
57. 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
[Page 14]
Have you EVER ordered,
incited, called for, committed, assisted, helped with, or
otherwise participated in any of the following:
58.a. Acts involving torture
or genocide?
Yes
No
58.b. Killing any person?
Yes
No
58.c. Intentionally and
severely injuring any person?
Yes
No
58.d. Engaging in any kind of
sexual contact or relations with any person who did not consent or
was unable to consent, or was being forced or threatened?
Yes
No
58.e. Limiting or denying any
person's ability to exercise religious beliefs?
Yes
No
59. Have you EVER
recruited, enlisted, conscripted, or used any person under 15
years of age to serve in or help an armed force or group?
Yes
No
60. Have you EVER used
any person under 15 years of age to take part in hostilities, or
to help or provide services to people in combat?
Yes
No
NOTE: If you answered “Yes”
to any part of Item Numbers 52. - 60., explain what
occurred, including the dates and location of the circumstances,
in the space provided in Part 14. Additional Information.
Public
Charge
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.
Declaration of
Self-Sufficiency (Form I-944)
61.
Are you exempt from the public charge ground of inadmissibility?
Yes
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 Self-Sufficiency (Form I-944) and Affidavit of
Support Under Section 213A of the INA (Form I-864). If you
answered “Yes” to Item Number 61., proceed to
Item Number 63.a. If you answered “No,”
complete Form I-944 and include it with your Form I-485 filing,
and proceed to Item Number 62.a.
Affidavit
of Support Under Section 213A of the INA (Form I-864)
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 Self-Sufficiency (Form I-944) and
Affidavit of Support Under INA section 213A (Form I-864).
[New]
I am EXEMPT
from filing Form I-864 because:
62.a.
I have earned or can receive credit for 40 qualifying quarters
(credits) of work in the United States (as defined by the Social
Security Act (SSA)). (Attach your SSA earnings statements. Do
not count any quarters during which you received a means-tested
public benefit).
62.b.
I am under 18 years of age, unmarried, immigrating as the child of
a U.S. citizen, am not likely to become a public charge and will
automatically become a U.S. citizen under INA section 320 upon my
admission to the United States.
62.c.
I am applying under the widow or widower of a U.S. citizen (Form
I-360) immigrant category.
[New]
62.d.
I am applying under an alien worker (Form I-140) employment-based
preference immigrant category and both of the following apply:
(1)
I am not a relative of the Form I-140 petitioner; and
(2)
I do not have a relative with a significant ownership interest (at
least five percent) in the business that filed Form I-140.
62.e.
I am applying under the alien entrepreneur (Form I-526) immigrant
category.
62.f.
I am applying under the human trafficking victim (T nonimmigrant)
immigrant category (INA section 245(l)).
62.g.
I am applying under a category other than the human trafficking
victim (T nonimmigrant) category (INA section 245(l)), or 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, and
I either have a pending application for T nonimmigrant status or I
am an individual who is in valid T nonimmigrant status.
NOTE: If, when USCIS
adjudicates your adjustment application, your Form I-914 is no
longer pending a decision or you are no longer in valid T
nonimmigrant status, you may have to submit a Form I-944 and Form
I-864.
62.h. I am applying under
the victim of qualifying criminal activity (U nonimmigrant)
immigrant category (INA section 245(m)).
[Page 15]
62.i. I am applying under a
category other than the victim of qualifying criminal activity (U
nonimmigrant) category under INA section 245(m) or 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, but I
either have a pending petition for U nonimmigrant status or I am
an individual who is granted U nonimmigrant status.
NOTE: If, at the time of the
adjudication of the 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 be required to submit Form I-944 and Form I-864.
62.j. 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.
62.k. I am a law enforcement
officer filing this Form I-485 for an S nonimmigrant immigrant (or
a qualifying family member).
62.l. [ ] I am applying under
the Diversity Visa program immigrant category.
62.m. [ ] 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
[ ] Certain broadcasters
[ ] 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
62.n. [ ] I am applying under
the Amerasian Act (October 22, 1982)
[new]
Illegal Entries and Other
Immigration Violations
63.a. Have you EVER
failed or refused to attend or to remain in attendance at any
removal proceeding filed against you on or after April 1, 1997?
Yes
No
63.b. If your answer to Item
Number 63.a. is "Yes," do you believe you had
reasonable cause?
Yes
No
63.c. If your answer to Item
Number 63.b. is "Yes," attach a written statement
explaining why you had reasonable cause.
64. Have you EVER
submitted fraudulent or counterfeit documentation to any U.S.
Government official to obtain or attempt to obtain any immigration
benefit, including a visa or entry into the United States?
Yes
No
65. Have you EVER lied
about, concealed, or misrepresented any information on an
application or petition to obtain a visa, other documentation
required for entry into the United States, admission to the United
States, or any other kind of immigration benefit?
Yes
No
66. Have you EVER
falsely claimed to be a U.S. citizen (in writing or any other
way)?
Yes
No
67. Have you EVER been
a stowaway on a vessel or aircraft arriving in the United States?
Yes
No
68. Have you EVER
knowingly encouraged, induced, assisted, abetted, or aided any
foreign national to enter or to try to enter the United States
illegally (alien smuggling)?
Yes
No
69. Are you under a final
order of civil penalty for violating INA section 274C for use of
fraudulent documents?
Yes
No
Removal, Unlawful Presence, or
Illegal Reentry After Previous Immigration Violations
70. 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
71. Have you EVER
entered the United States without being inspected and admitted or
paroled?
Yes
No
Since April 1, 1997, have you been
unlawfully present in the United States:
72.a. For more than 180 days
but less than a year, and then departed the United States?
Yes
No
72.b. For one year or more
and then departed the United States?
Yes
No
NOTE: You were unlawfully
present in the United States if you entered the United States
without being inspected and admitted or inspected and paroled, or
if you legally entered the United States but you stayed longer
than permitted.
[Page 16]
Since April 1, 1997, have you EVER
reentered or attempted to reenter the United States without
being inspected and admitted or paroled after:
73.a. Having been unlawfully
present in the United States for more than one year in the
aggregate?
Yes
No
73.b. Having been deported,
excluded, or removed from the United States?
Yes
No
[New]
Miscellaneous Conduct
74. Do you plan to practice
polygamy in the United States?
Yes
No
75. Are you accompanying
another foreign national who requires your protection or
guardianship but who is inadmissible after being certified by a
medical officer as being helpless from sickness, physical or
mental disability, or infancy, as described in INA section 232(c)?
Yes
No
76. 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
[New]
77. Have you EVER
voted in violation of any Federal, state, or local constitutional
provision, statute, ordinance, or regulation in the United States?
Yes
No
78. Have you EVER
renounced U.S. citizenship to avoid being taxed by the United
States?
Yes
No
Have you EVER:
79.a. Applied for exemption
or discharge from training or service in the U.S. armed forces or
in the U.S. National Security Training Corps on the ground that
you are a foreign national?
Yes
No
79.b. Been relieved or
discharged from such training or service on the ground that you
are a foreign national?
Yes
No
79.c. Been convicted of
desertion from the U.S. armed forces?
Yes
No
80.a. Have you EVER
left or remained outside the United States to avoid or evade
training or service in the U.S. armed forces in time of war or a
period declared by the President to be a national emergency?
Yes
No
80.b. If your answer to Item
Number 80.a. is “Yes,” what was your
nationality or immigration status immediately before you left (for
example, U.S. citizen or national, lawful permanent resident,
nonimmigrant, parolee, present without admission or parole, or any
other status)?
[Fillable field]
|
[Page 12]
Part 8. General Eligibility and
Inadmissibility Grounds
1.
Have you EVER been a member of, involved in, or in any
way associated with any organization, association, fund,
foundation, party, club, society, or other 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.
Organization 1
2. Name of Organization
3.a. City or Town
3.b. State or Province
3.c. Country
4. Nature of Organization
5.
Nature of involvement in organization, including role or
position(s) held
Dates of Membership or Dates of
Involvement
6.a. From
(mm/dd/yyyy)
6.b. To
(mm/dd/yyyy)
Organization 2
7. Name
of Organization
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)
[Page 13]
Organization 3
12. Name
of Organization
13.a. City
or Town
13.b. State
or Province
13.c.
Country
14. Nature
of Organization
15.
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. 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
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 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
employment authorization?
Yes
No
22.
Have you EVER violated the terms or conditions of your
nonimmigrant status?
Yes
No
23.
Are you presently or have you EVER been in exclusion,
deportation, removal, or rescission proceedings?
Yes
No
24.
Have you EVER been issued a final order of exclusion,
deportation, or removal?
Yes
No
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 exclusion, deportation, or removal?
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
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 14]
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.
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
36.
Have you EVER committed a crime of any kind
(even if you were not arrested, cited, charged with, tried for
that crime, or convicted)?
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
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
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
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
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
46. Have
you EVER directly or indirectly procured or attempted to
procure, or imported prostitutes or
persons for the purpose of prostitution?
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
[Page 15]
51. 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
[deleted]
52. 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
53.
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. 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
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
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
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?
Yes
No
57. 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 54.a. or 54.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
[Page 16]
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
[deleted]
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.
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
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
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
No
67.
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
[Page
17]
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
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
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
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.
Declaration of
Self-Sufficiency (Form I-944)
71.
Are you exempt from the public charge ground of
inadmissibility?
Yes
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 Self-Sufficiency
(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)
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 Self-Sufficiency (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.):
72.b.
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.
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
(2)
The Form I-140 filed is a self-petition.
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.
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.
[Page 18]
72.j.
I am applying under the victim of qualifying criminal
activity (U nonimmigrant) immigrant category (INA section 245(m)).
72.k. 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.
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.
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.
72.m.
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
[ ] Certain broadcasters
[ ] 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
73.b.
If your answer to Item Number 73.a.
is “Yes,” do you believe you had reasonable
cause?
Yes
No
N/A
73.c. If
your answer to Item Number 73.b.
is “Yes,” attach a written statement
explaining why you had reasonable cause.
74. 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
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
Removal, Unlawful Presence, or
Illegal Reentry After Previous Immigration Violations
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
inspected and admitted or paroled?
Yes
No
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.
[Page 19]
Since April 1, 1997, have you EVER
reentered or attempted to reenter the United States without
being inspected, and admitted or paroled after:
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
83.b.
Having been deported, excluded, or removed from the
United States?
Yes
No
84.
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
Miscellaneous Conduct
85. Do
you plan to practice polygamy in the United States?
Yes
No
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
87. Have
you EVER intentionally assisted
in detaining, retaining, or withholding custody of a U.S. citizen
child outside the United States from a person
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
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
90. Have
you EVER renounced U.S. citizenship to avoid being taxed by
the United States?
Yes
No
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
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
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)?
[Fillable
field]
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