Form I-485, Application to Register Permanent Residence or Adjust Status
OMB No. 1615-0023
Expires 10/31/2020
Edition Date 10/15/2019
[Page 1]
Preference Category:
Country Chargeable:
Priority Date:
Date Form I-693 Completed:
Applicant Interviewed
Interview Waived
Date of Initial Interview:
Lawful Permanent Resident as of:
Receipt
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
Action Block
To be completed by an attorney or accredited representative (if any).
Select this box if Form G-28 is attached.
Volag Number (if any)
Attorney State Bar Number (if applicable)
Attorney or Accredited Representative USCIS Online Account Number (if any)
START HERE - Type or print in black ink.
A-Number [Fillable field that auto-populates at the top of each subsequent page]
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 (Person applying for lawful permanent residence)
Your Current Legal Name (do not provide a nickname)
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)
2.c. Middle Name
3.a. Family Name (Last Name)
3.b. Given Name (First Name)
3.c. Middle 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
Female
7. City or Town of Birth
[Page 2]
8. Country of Birth
9. Country of Citizenship or Nationality
If you have more than one country of citizenship or nationality, provide additional countries in the space provided in Part 14. Additional Information.
10. Any other Alien Registration Number (A-Number) assigned to you
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
12.a. In Care Of Name (if any)
12.b. Street Number and Name
12.c. Apt./Ste./Flr. [Fillable field]
12.d. City or Town
12.e. State
12.f. ZIP Code
Safe or Alternate Mailing Address
If you are applying based on the Violence Against Women Act (VAWA) or as a human trafficking victim (T nonimmigrant), or victim of a qualifying crime (U nonimmigrant) and you do not want USCIS to send notices about this application to your home, you may provide a safe mailing address. If you are applying as a special immigrant juvenile, you may provide an alternate mailing address.
13.a. In Care Of Name (if any)
13.b. Street Number and Name
13.c. Apt./Ste./Flr. [Fillable field]
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.
Physical Address 1 (current address)
14.a. Street Number and Name
14.b. Apt./Ste./Flr. [Fillable field]
14.c. City or Town
14.d. State
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)
[Page 3]
Physical Address 2
16.a. Street Number and Name
16.b. Apt./Ste./Flr. [Fillable field]
16.c. City or Town
16.d. State
16.e. ZIP Code
16.f. Province
16.g. Postal Code
16.h. Country
Dates of Residence
17.a. From (mm/dd/yyyy)
17.b. To (mm/dd/yyyy)
Provide your most recent address outside the United States where you lived for more than one year (if not already listed above).
18.a. Street Number and Name
18.b. Apt./Ste./Flr. [Fillable field]
18.c. City or Town
18.d. State
18.e. ZIP Code
18.f. Province
18.g. Postal Code
18.h. Country
Dates of Residence
19.a. From (mm/dd/yyyy)
19.b. To (mm/dd/yyyy)
Social Security Card
20. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you?
Yes
No
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).
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. 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
Recent Immigration History
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.
24. Passport or Travel Document Number Used at Last Arrival
25. Expiration Date of this Passport or Travel Document (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)
Place of Last Arrival into the United States
29.a. City or Town
29.b. State
30. Date of Last Arrival (mm/dd/yyyy)
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): [Fillable field]
31.b. Was inspected at a port of entry and paroled as (for example, humanitarian parole, Cuban parole): [Fillable field]
31.c. Came into the United States without admission or parole.
31.d. Other: [Fillable field]
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
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)
[Page 3]
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? Y N
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
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
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.”
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)
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 members (also known as the Six and Six program), Form I-360
4.g. [] Panama Canal Zone employees, Form I-360
4.h. [] Certain Physicians, 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 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
[Page 4]
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
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)
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.
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)
[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. 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)
Part 3. Additional Information About You
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
2.a. City
2.b. Country
3. Decision (for example, approved, refused, denied, withdrawn)
4. Date of Decision (mm/dd/yyyy)
5. Have you ever applied for permanent residence while in the U.S.?
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 5., write “N/A” for Item Number 6.
6. Decision (for example, approved, refused, denied, withdrawn)
Employment and Educational History
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.
Employer 1 (current or most recent)
Employer or School 1 (current or most recent)
7. Name of Employer, Company, or School
Address of Employer, Company, or School
8.a. Street Number and Name
8.b. Apt./Ste./Flr. [Fillable field]
8.c. City or Town
8.d. State
8.e. ZIP Code
8.f. 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)
10.b. To (mm/dd/yyyy)
10.c. If unemployed, source of financial support
Employer or School 2
11. Name of Employer, Company, or School
Address of Employer, Company, or School
12.a. Street Number and Name
12.b. Apt./Ste./Flr. [Fillable field]
12.c. City or Town
12.d. State
12.e. ZIP Code
12.f. Province
12.g. Postal Code
12.h. Country
13. Your Occupation (if unemployed, so state)
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
[Page 7]
Provide your most recent employment outside of the United States (if not already listed above).
15. Name of Employer, Company, or School
Address of Employer, Company, or School
16.a. Street Number and Name
16.b. Apt./Ste./Flr. [Fillable field]
16.c. City or Town
16.d. State
16.e. ZIP Code
16.f. Province
16.g. Postal Code
16.h. Country
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)
18.c. If unemployed, source of financial support.
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
3. Date of Birth (mm/dd/yyyy)
4. Gender
Male/Female
5. City or Town of Birth
6. Country of Birth
7. Current City or Town of Residence (if living; write “N/A” if deceased)
8. Current Country of Residence (if living; write “N/A” if deceased)
Information About Your Parent 2
Parent 2's Legal Name
9.a. Family Name (Last Name)
9.b. Given Name (First Name)
9.c. Middle Name
Parent 2's Name at Birth (if different than above)
10.a. Family Name (Last Name)
10.b. Given Name (First Name)
10.c. Middle Name
11. Date of Birth (mm/dd/yyyy)
12. Gender
Male/Female
13. City or Town of Birth
14. Country of Birth
15. Current City or Town of Residence (if living; write “N/A” if deceased)
16. Current Country of Residence (if living; write “N/A” if deceased)
[Page 8]
Part 5. Information About Your Marital History
1. What is your current marital status?
Single, Never Married
Married
Divorced
Widowed
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?
N/A
Yes
No
3. 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)
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.
Current Spouse's Legal Name
4.a. Family Name (Last Name)
4.b. Given Name (First Name)
4.c. Middle Name
5. A-Number (if any)
6. Current Spouse's Date of Birth (mm/dd/yyyy)
7. Date of Marriage to Current Spouse (mm/dd/yyyy)
Current Spouse's Place of Birth
8.a. City or Town
8.b. State or Province
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.
Current Spouse’s Current Physical Address
10.a. City or Town
10.b. State or Province
10.c. Country
Place of Marriage to Current Spouse
11.a. City or Town
11.b. State or Province
11.c. Country
12. Is your current spouse applying with you?
Yes
No
Information About Prior Marriages (if any)
If you have been married before, whether in the United States or in any other country, provide the following information about your prior spouse. If you have had more than one previous marriage, use the space provided in Part 14. Additional Information to provide the information below. If you have never been married before, write “N/A” for Item Numbers 13.a. - 21.
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
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.
17. Date of Marriage to Prior Spouse (mm/dd/yyyy)
Place of Marriage to Prior Spouse
18.a. City or Town
18.b. State or Province
18.c. Country
19. Date Marriage with Prior Spouse Legally Ended (mm/dd/yyyy)
[Page 9]
Place Where Marriage with Prior Spouse Legally Ended
20.a. City or Town
20.b. State or Province
20.c. Country
21. How Marriage Ended with My Prior Spouse (select one):
[] Annulled
[] Divorced
[] Spouse Deceased
[] Other (Explain):
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.
NOTE: The term “children” includes all biological or legally adopted children, as well as current stepchildren, of any age, whether born in the United States or other countries, married or unmarried, living with you or elsewhere and includes any missing children and those born to you outside of marriage. [Fillable field]
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
Current Legal Name
2.a. Family Name (Last Name)
2.b. Given Name (First Name)
2.c. Middle Name
4. Date of Birth (mm/dd/yyyy)
5. Country of Birth
6. 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.
7. What is your child’s relationship to you? (for example, biological child, stepchild, legally adopted child)
8. Is this child also applying now on a separate Form I-485?
Yes
No
Child 2
Current Legal Name
9.a. Family Name (Last Name)
9.b. Given Name (First Name)
9.c. Middle Name
11. Date of Birth (mm/dd/yyyy)
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.
14. 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
Child 3
Current Legal Name
16.a. Family Name (Last Name)
16.b. Given Name (First Name)
16.c. Middle Name
18. Date of Birth (mm/dd/yyyy)
19. Country of Birth
20. 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.
21. 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
Part 7. Biographic Information
1. Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
2. Race (Select all applicable boxes)
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
[Page 10]
3. Height
Feet
Inches
4. Weight
Pounds
5. Eye Color (Select only one box)
Black
Blue
Brown
Gray
Green
Hazel
Maroon
Pink
Unknown/Other
6. Hair Color (Select only one box)
Bald (No hair)
Black
Blond
Brown
Gray
Red
Sandy
White
Unknown/Other
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?
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
[Page 11]
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
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
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
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
[Page 13]
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
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
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 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]
Part 9. Accommodations for Individuals With Disabilities and/or Impairments
NOTE: Read the information in the Form I-485 Instructions before completing this part.
1. Are you requesting an accommodation because of your disabilities and/or impairments? Yes/No
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).):
[Fillable field]
2.b. I am blind or have low vision and request the following accommodation:
[Fillable field]
2.c. I have another type of disability and/or impairment. (Describe the nature of your disability and/or impairment and the accommodation you are requesting.)
[Fillable field]
Part 10. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-485 Instructions before completing this part. You must file Form I-485 while in the United States.
[Page 17]
Applicant's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
1.a. 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 [Fillable field], a language in which I am fluent, and I understood everything.
2. At my request, the preparer named in Part 12., [Fillable field], prepared this application for me based only upon information I provided or authorized.
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)
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.
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. law.
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:
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
3) 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)
6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.
Part 11. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
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)
[Page 18]
Interpreter's Mailing Address
3.a. Street Number and Name
3.b. Apt./Ste./Flr. [Fillable field]
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f. Province
3.g. Postal Code
3.h. Country
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
5. Interpreter's Mobile Telephone Number (if any)
6. Interpreter's Email Address (if any)
Interpreter's Certification
I certify, under penalty of perjury, that: I am fluent in English and [Fillable field], which is the same language specified in Part 10., Item Number 1.b., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant's Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.a. Interpreter's Signature (sign in ink)
7.b. Date of Signature (mm/dd/yyyy)
Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
2. Preparer's Business or Organization Name (if any)
Preparer's Mailing Address
3.a. Street Number and Name
3.b. Apt./Ste./Flr. [Fillable field]
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f. Province
3.g. Postal Code
3.h. Country
Preparer's Contact Information
4. Preparer's Daytime Telephone Number
5. Preparer's Mobile Telephone Number (if any)
6. Preparer's Email Address (if any)
[Page 19]
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.
NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.
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)
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 changes made to this application, numbered [Blank field] through [Blank field], are complete, true, and correct. All information on additional pages submitted by me with this Form I-485, on numbered pages [Blank field] through [Blank field] 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)
[Page 20]
Part 14. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. A-Number (if any)
3.a. Page Number
3.b. Part Number
3.c. Item Number
3.d. [Fillable field]
4.a. Page Number
4.b. Part Number
4.c. Item Number
4.d. [Fillable field]
5.a. Page Number
5.b. Part Number
5.c. Item Number
5.d. [Fillable field]
6.a. Page Number
6.b. Part Number
6.c. Item Number
6.d. [Fillable field]
7.a. Page Number
7.b. Part Number
7.c. Item Number
7.d. [Fillable field]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | I-485 |
| Author | Hallstrom, Samantha M |
| File Modified | 0000-00-00 |
| File Created | 2021-03-05 |