Form I-539 (e-file) I-539 (e-file) Application to Extend/Change Nonimmigrant Status

Application to Extend/Change Nonimmigrant Status

I-539-021-Copy Deck-PC Rule Rescission

Application to Extend/Change Nonimmigrant Status (efile)

OMB: 1615-0003

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1615-0003 can be found here:

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myUSCIS copy deck
I-539 Application to Change/Extend Nonimmigrant Status
OMB control number 1615-0003
Edits in support of: PC Rule Rescission

Copy Deck Version Info

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
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Heading

Sub-Heading

Application to Extend/Change
Nonimmigrant Status

Before you start your application

Current Body Text

Revised Body Text

You should refer to Instructions for Form I-539 to see if you can use this online form for your nonimmigrant status.

Eligibility

You may be eligible to apply for an extension of your authorized stay if:
・You were lawfully admitted into the United States with a nonimmigrant visa
・Your nonimmigrant visa status remains valid
・You have not committed any crimes that make you ineligible for a visa
・You have not violated the conditions of your admission
・Your passport is valid and will remain valid for the duration of your stay
・Since obtaining the nonimmigrant status you seek to extend or change, you have not received public benefits for more than
12 months within any 36 month period (unless you qualify for any of the exemptions below):
PUBLIC BENEFITS:
1. Any Federal, state, local, or tribal cash assistance for income maintenance including:
a. Supplemental Security Income (SSI);
b. Temporary Assistance for Needy Families (TANF); or
c. Federal, state, or local cash benefit programs for income maintenance (often called “General Assistance” in the state
context, but which may exist under other names);
2. Supplemental Nutrition Assistance Program (SNAP, formerly called “Food Stamps”);
3. Section 8 Housing Assistance under the Housing Choice Voucher Program;
4. Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation);
5. Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.; and
6. Federally-funded Medicaid.

CTA
Learn more about extending or changing your nonimmigrant status

Currently, you may file an Application to Extend/Change Nonimmigrant Status (I-539) online if you are filing for yourself.

[Exemption accordion - see last tab in spreadsheet]
If your nonimmigrant status is based on the fact that you are a family member or dependent of an individual who has already
been granted nonimmigrant status, then you must file your application while that individual continues to maintain a valid
nonimmigrant status. Family members and dependents are limited to the same period of authorized stay as the principal
immigrant.
You may NOT be granted an extension or change of status if you were admitted under the Visa Waiver Program or if your
current status is:
・An alien in transit (C) or in transit without a visa (TWOV)
・A crewman (D)
・A fiancé(e) or dependent of a fiancé(e) (K-1 or K-2)
EXCEPTION: A K-3 and K-4 are eligible to apply for an extension of status. They should file for an extension during the processing
of Form I-130 filed on their behalf and up to completion of their adjustment-of-status application.

Fee

We will automatically calculate the cost for you when you submit your application.

Refund Policy

The application fee is $370. An additional biometrics services fee of $85 is required for you and for each person included
on a Form I-539A.
USCIS does not refund fees, regardless of any action we take on your application, petition, or request.

Learn more about filing a fee waiver.

By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying
the fees for a government service. You further agree that the filing fee, biometric fee, and any other paid costs related
to this financial transaction are final and not refundable.

Filing online
Documents you may need

Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS
Contact Center at 800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf
or hard of hearing) 800-767-1833.
Submitting your application online is the same as mailing in a completed paper form. They both gather the same
information and cost the same.
Most applicants will be required to submit:
・Nonimmigrant Arrival-Departure Record (I-94) for all applicants
・Passport and travel document numbers
・A valid passport
Several other documents will be required depending on your current nonimmigrant status. We will automatically
determine which documents you should provide us as you fill out your application.

After you submit your application

Track your case online
Respond to requests for
information
Provide your biometrics

Completing your form online

After you submit your form, you can track its status through your USCIS account. Sign in to your account often to check
your case status and read any important messages from USCIS.
If we need more information from you, we will send you a Request for Evidence (RFE) or Request for Information (RFI).
You can respond to our request and upload your documents through your USCIS account.
If necessary, we will contact you to schedule an appointment at an Application Support Center near you. At the
appointment, we will get your fingerprints, photograph, and signature.

Provide as many responses as You should provide as many responses as you can. Incomplete fields or sections and missing information can slow down the
process after you submit your form. If you do not finish your form in one session, you can sign in to your account to continue
you can
where you left off.

Application Overview

Sub-Heading

Current Body Text

We will automatically save
your responses

We will automatically save your information when you select next to go to a new page or navigate to another section of
the form. Your responses will be saved for 30 days. You can sign in to your account at anytime to continue where you
left off.

DHS Privacy Notice

AUTHORITIES: The information requested on this application, and the associated evidence, is collected pursuant to the
U.S. Code sections 1103 and 1184 and Title 8 of the Code of Federal Regulations parts 103, 214 and 248.

Revised Body Text

CTA

PURPOSE: The primary purpose for providing the requested information on this application is to apply for an extension
of stay or a change from one nonimmigrant category to another nonimmigrant category. DHS will use the information
you provide to grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in
denial of your application.
ROUTINE USES: DHS may share the information you provide on this application and any additional requested evidence
with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved
routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index,
and National File Tracking System, DHS/USCIS-007 Benefits Information System] and the published privacy impact
assessment [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System and Associated
Systems], which can be found at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law
enforcement purposes or in the interest of national security.
USCIS Compliance Review and By signing this application, you have stated under penalty of perjury (28 U.S.C. section 1746) that all information and
Monitoring
documentation submitted with this application are complete, true, and correct. You also authorize the release of any
information from your records that USCIS may need to determine your eligibility for the immigration benefit you are
seeking and consent to USCIS verifying such information.
DHS has the authority to verify any information you submit to establish eligibility for the immigration benefit you are
seeking at any time. USCIS’ legal authority to verify this information is in 8 U.S.C. sections 1103, 1155, and 1184, and 8
CFR parts 103, 204, 205, and 214. To ensure compliance with applicable laws and authorities, USCIS may verify
information before or after your case is decided.
Agency verification methods may include, but are not limited to: review of public records and information; contact
through written correspondence, the internet, fax, other electronic transmission, or telephone; unannounced physical
site inspections of residences and locations of employment; and interviews. USCIS will use information obtained
through verification to assess your compliance with the laws and to determine your eligibility for an immigration
benefit.
Subject to the restrictions under 8 CFR 103.2(b)(16), USCIS will provide you with an opportunity to address any adverse
or derogatory information that may result from a USCIS compliance review, verification, or site visit after a formal
decision is made on your case or after the agency has initiated an adverse action which may result in revocation or
termination of an approval.
Paperwork Reduction Act

An agency may not conduct or sponsor in information collection, and a person is not required to respond to a collection
of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The public
reporting burden for this collection of information is estimated at 2.38 hours per response, including the time for
reviewing instructions, gathering the required documentation and information, completing the application, preparing
statements, attaching necessary documentation, and submitting the application. The collection of biometrics is
estimated to require 1 hour and 10 minutes. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to:
U.S. Citizenship and Immigration Services, Regulatory Coordination Division
Office of Policy and Strategy
20 Massachusetts Ave NW
Washington, DC 20529-2140
Do not mail your completed Form I-539 to this address.
OMB Number: 1615-0003
Expires: 08/31/2020

Application Overview

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

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Questions/Sub-Questions: Based on the questions from the paper form.
Instructional text: Text that appears directly below a question and provides instructions for answering the question or completing this step/section of the form.
Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.
CTA: copy for button
Page breaks are indicated by a horizontal line (the same sub-navigation can have multiple pages)
Conditional question logic is indicated in ( ) before question
Step

Section

Getting
Started

Basis for eligibility

Paper Form Question
Question #
1.15a What is your current
nonimmigrant status?

Sub-Question

1.15b When does your current
nonimmigrant status expire?
2.1

What are you applying for?

Instructional Text

Help Text

Dropdown

1.16 Were you granted Duration of Yes/No
Status (D/S)?

Reason for request

Field Type

Radio

Date

Reinstatement to student
status

checkbox

2.2

An extension of stay in my
current status

checkbox

2.3.a

A change of status

checkbox

2.3.c

(IF CHANGE OF STATUS) What is
the change of status you are
requesting?

dropdown

2.3.b

(IF CHANGE OF STATUS) What is month/day/year
the effective date of change?

date

Notation on certain nonimmigrant
Form I-94 indicating that the individual,
such as an F-1 nonimmigrant student, is
authorized to remain in the U.S. as long
as he or she maintains a valid status.

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Section

Paper Form
Question #
3.1

Preparer and interpreter
information

Preparer information
8.1.b
8.1.a

Question

Field Type

What date are you requesting month/day/year
your current or requested
status be extended until?

date

Is someone assisting you with Yes/No
completing this application?

Radio

(IF YES) Is a preparer assisting Yes/No
you with completing this
application?

Radio

(IF YES) Is an interpreter
Yes/No
assisting you with completing
this application?

Radio

(IF YES TO PREPARER) What is Given name (first name)
your preparer's full name?

Text

Family name (last name)

Text
Text

What is your preparer's
business or organization
8.2 name?

What is your preparer's

8.3.h mailing address?
8.3.a
8.3.b
8.3.c
8.3.d/8.3.f

Sub-Question

Instructional Text

A preparer is anyone who
completes or helps you complete
all or part of your application using
information and answers that you
provide.

My preparer is not part of a Checkbox
business or organization.
Country

Text

Address line 1
Address line 2
City or town
State/Province (FOR
FOREIGN ADDRESS)

Text
Text

Text
Dropdown

Street number and name
Apartment, suite, unit, or floor

Help Text

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Section

Paper Form
Question #
8.3.e/8.3.g

Question

Sub-Question

What is your preparer's

ZIP code/Postal code (FOR Text
FOREIGN ADDRESS)
Daytime telephone number Text

8.4 contact information?
8.5

8.6

Interpreter information
7.1.b
7.1.a

7.2

7.3.h
7.3.a
7.3.b
7.3.c
7.3.d/f
7.3.e/g
7.4
7.5

Field Type

Instructional Text

Mobile telephone number Text

My preparer does not have
a mobile telephone
number.
Email address
My preparer does not have
an email address.
(IF YES TO INTERPRETER) What Given name (first name)
is your interpreter's full
name?
Family name (last name)
What is your interpreter's
business or organization
name?
My interpreter is not part
of a business or
organization.
What is your interpreter's
Country
mailing address?
Address line 1
Address line 2
City or town
State/Province (FOR
FOREIGN ADDRESS)
ZIP code/Postal code (FOR
FOREIGN ADDRESS)
What is your interpreter's
Daytime telephone number
contact information?
Mobile telephone number

Checkbox
Text

Text
Text

Checkbox
Text

Text
Text

Text
Dropdown

Text
Text

Street number and name
Apartment, suite, unit, or floor

Help Text

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Section

Paper Form
Question #

Question

7.6

6.1.b

What language is your
interpreter using to interpret
this application for you?

Sub-Question
My interpreter does not
have a mobile telephone
number.
Email address
My interpreter does not
have an email address.

Field Type

Text
Checkbox
Text

Instructional Text

Help Text

Section

Your
Application

Information about request

Paper Form Question
Question #

Field Type

3.2.a.

Is this application based on an extension yes/no
or change of status already granted to
your spouse, child, or parent?

radio

3.2.b

(IF YES) Provide the USCIS receipt
number for the extension or change
already granted to your spouse, child, or
parent.

number

3.3.a

Is this application based on a separate
petition or application to give your
spouse, child, or parent an extension or
change if status?

3.3.b

(IF YES PENDING) Provide the USCIS
receipt number for the pending case.

3.4

(IF YES PENDING) What is the name of
the petitioner or applicant for the
pending application?

3.5
Additional information about
request

Sub-Question

4.3

4.4

Yes, filed with this I- checkbox
539

Instructional Text

Help Text

The USCIS receipt number is a unique 13character identifier that consists of three capital
letters followed by 10 numbers (for example,
ABC1234567890). You can find it on notices of
action USCIS has sent your spouse, child or
parent.

Yes, filed previously checkbox
and pending with
USCIS
No

checkbox
number

Given name (first
name)

Text

Family name (last Text
name)

What date was the petition or
Month/day/year
application filed?
Are you, or any other person included on Yes/No
the application, an applicant for an
immigrant visa?
(IF YES) Provide an explanation.
Has an immigrant petition EVER been
yes/no
filed for you or for any other person
included in this application?

date
radio

text area
radio

Your Application

Section

Paper Form Question
Question #

4.5

4.6

4.14

4.15

Sub-Question

Field Type

(IF YES) Provide an explanation.
Has an Application to Register
yes/no
Permanent Resident or Adjust Status (I485), EVER been filed by you or by any
other person included in this application?

text area
radio

(IF YES) Provide an explanation.
Have you, or any other person included yes/no
in this application, EVER been arrested or
convicted of any criminal offense since
last entering the United States?

text area
radio

(IF YES) Provide an explanation.
Have you, or any other person included yes/no
in this application, been employed in the
United States since last admitted or
granted an extension or change of
status?
(IF YES)Describe the employment and
include the name of the person
employed, name and address of the
employer, weekly income, and whether
the employment was specifically
authorized by USCIS.
(IF NO)Describe how you are supporting
yourself. Include any documentary
evidence of the source, amount, and
basis for any income.

text area
radio

Are you, or any other person included on yes/no
the application, currently or have you
ever been a J-1 exchange visitor or a J2 dependent of a J-1 exchange
visitor?

Instructional Text

Help Text

text area

text area
Such evidence may include, but is not limited to:
• complete bank statements for checking and/or
savings accounts showing all transactions,
• other cash assets, or
• affidavits of support from a sponsor.
radio

Your Application

Section

Co-Applicants

Paper Form Question
Question #

2.4/2.5.a
2.5.b

Sub-Question

(IF YES)Provide the dates you maintained
status as a J-1 exchange visitor or J-2
dependent.
Are you the only applicant applying with Yes/No
this form?
(IF NO) What is the total number of
people (including yourself) in this
application?

Field Type

Instructional Text

Help Text

text area

Radio button
Textfield

Your Application

Section

About You Your Name

Paper Form Question
Question #

Sub-Question

Field Type

Instructional Text

1.1.b What is your current legal

Given name (first name)

Text

1.1.c

Middle name (if applicable) Text

Your current legal name is the name on your birth certificate, unless it changed after
birth by a legal action such as marriage or court order. Do not provide any nicknames
here.

name?

Your Contact
Information

1.1.a
Family name (last name)
1.4.a What is your current mailing In care of name (if any)
1.4.b

address?

1.4.c
1.4.d
1.4.e
1.4.f
Where do you live now?

1.5.a
1.5.b
1.5.c
1.5.d
1.5.e
4.2.a What is your physical address
abroad?
4.2.b
4.2.c
4.2.d
4.2.e
4.2.f
6.3 How can we contact you?
6.4

Help Text

Text
Text

Address line 1

Text

Street number and name

Address line 2
City or town
State
ZIP code
I live at my current mailing
address

Text
Text
Text
Text
Checkbox

Apartment, suite, unit, or floor

Address line 1
Address line 2
City or town
State
ZIP code
Address line 1

Text
Text
Text
Text
Text
Text

Street number and name
Apartment, suite, unit, or floor

Address line 2
City or town
Province
Postal Code
Country
Daytime telephone number

Text
Text
Text
Text
Dropdown

Apartment, suite, unit, or floor

Text

Mobile telephone number

Text

We will use your current mailing
address to contact you throughout the
application process. We may not be
able to contact you if you do not
provide a complete and valid address.
Please provide a U.S. address only.

Street number and name

About You

Section

Paper Form Question
Question #

Sub-Question

Field Type

Instructional Text

Help Text

Checkbox
This is the same as my
mobile telephone number.

Additional
Information

6.5
1.2 What is your A-Number?

1.3 What is your USCIS Online

Account Number?

Email address

Text

I do not have or know my A- Checkbox
number
I do not have an USCIS
Checkbox
Online Account Number

You can find your USCIS Online Account Number by signing in to your account
and going to your profile page.
If you previously filed an application, petition, or request using the USCIS online
filing system, provide the USCIS Online Account Number you were issued.
If you previously filed certain applications, petitions, or requests on a paper
form via a USCIS Lockbox facility, you may have received a USCIS Online
Account Access Notice issuing you a USCIS Online Account Number. You can
find this number at the top of the notice.
The USCIS Online Account Number is not the same as an A-Number. The USCIS
Online Account Number was previously called the USCIS Electronic Immigration
System (USCIS ELIS) Number.

1.8 What is your date of birth?

month/date/year

1.9 What is your U.S. Social

Date
Text

Security number?

What is your current

I do not have a U.S. Social
Secuirity Number

4.1.a passport number?
4.1.b What country issued your

passport?

4.1.c What date does your passport
expire?
Your Immigration
Information

1.6

What is your country of birth?

Checkbox

Dropdown
Country
month/date/year

date

If you are the Principal Applicant, provide your current passport information.

Dropdown

About You

Section

Paper Form Question
Question #

Sub-Question

Field Type

1.7 What is your country of
citizenship or nationality?

Instructional Text

Help Text

Provide the name of the country as it currently exists, where you are currently a citizen
or national. If the country no longer exists, use the current name of the country.
If you are a citizen or national of more than one country, provide the name of the
foreign country that issued your last passport.

1.10

What is your date of last arrival
into the United States?
1.11 What is your I-94 ArrivalDeparture Record Number?
1.12 What is the passport number
listed on your I-94?
1.13 What is your travel document
number?
1.14.a
What country issued your
passport or travel document?
1.14.b What is the expiration date for
your passport or travel
document?

Text

If you are stateless, enter the name of the current country where you were last a
citizen or national.
Provide information about your most recent entry into the United States

This information may be found on your
Nonimmigrant Arrival/Departure Record (I94) issued by U.S. Customs and Border
Protection (CBP) or USCIS upon arrival to
the United States. If you were admitted to
the United States by CBP at an airport or
seaport after April 30, 2013, you may have
been issued an electronic I-94 by CBP,
instead of a paper form. Visit CBP
[https://www.cbp.gov/travel/internationalvisitors/i-94] to obtain a paper version of
your I-94.
If you are unable to obtain a copy of your I94 from CBP, go to the USCIS I-102
[https://www.uscis.gov/i-102] to find
additional I-94 Replacement Information.

Text
Text

Text

Dropdown

date

About You

Section

Moral
Party and group
Character affiliations

Paper Form Question
Question #
4.7.a

4.7.b

4.7.c

4.7.d

4.7.e

Have you, or any other person included on this
application, EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise
participated in acts involving torture or genocide?
(IF YES) Provide an explanation.
Have you, or any other person included on this
application, EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise
participated in killing any person?
(IF YES) Provide an explanation.
Have you, or any other person included on this
application, EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise
participated in intentionally and severely injuring any
person?
(IF YES) Provide an explanation.

Sub-Question

Field Type

Yes/No

Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

Have you, or any other person included on this
application, EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise
participated in 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?
(IF YES) Provide an explanation.
Have you, or any other person included on this
Yes/No
application, EVER ordered, incited, called for,
committed, assisted, helped with, or otherwise
participated in limiting or denying any person's ability to
exercise religious beliefs?
(IF YES) Provide an explanation.

Instructional Text

Help Text

Textarea
Radio

Textarea

Moral Character

Section

Paper Form Question
Question #

Sub-Question

Field Type

4.8.a

Yes/No

Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

Yes/No

Textarea
Radio

4.8.b

4.9

4.10

4.11

Immigration
Proceedings

4.12

Have you, or any person included on the application,
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,
guerrilla group, militia, insurgent organization, or any
other armed group?
(IF YES) Provide an explanation.
Have you, or any person included in this application,
EVER worked, volunteered, or otherwise served in any
prison, jail, prison camp, detention facility, labor camp,
or any other situation that involved detaining persons?
(IF YES) Provide an explanation.
Have you, or any other person included in this
application, 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?
(IF YES) Provide an explanation.
Have you, or any person included in this application,
EVER assisted or participated in selling, providing, or
transporting weapons to any person who, to your
knowledge, used them against another person?
(IF YES) Provide an explanation.
Have you, or any person included in this application
EVER received any type of military, paramilitary, or
weapons training?
(IF YES) Provide an explanation.
Have you, or any person included in this application,
done anything that violated the terms of the
nonimmigrant status you now hold?
(IF YES) Provide an explanation.

Instructional Text

Help Text

Textarea

Moral Character

Section

Paper Form Question
Question #
4.13

Are you, or any other person included in this
application, now in removal proceedings?
(IF YES) Provide an explanation with the name of the
person in removal proceedings, and information on
jurisdiction, date proceedings began, and status of
proceedings.

Sub-Question

Field Type

Yes/No

Radio

Instructional Text

Help Text

Textarea

Moral Character

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
Step

Public Benefit

Revised Step

Section

Revised Section

Paper Form Question
Question #

Revised Question

Sub-Question

Revised Sub-Question

Field Type

Revised Field
Type

Instructional Text

Public benefit information

[deleted]

5.1

[deleted]

Yes, I have received or I am currently
certified to receive public benefits.

[deleted]

checkbox

[deleted]

1. Any Federal, state, local, or tribal cash
[deleted]
assistance for income maintenance including:
a. Supplemental Security Income (SSI);
b. Temporary Assistance for Needy Families
(TANF); or
c. Federal, state, or local cash benefit
programs for income maintenance (often
called “General Assistance” in the state
context, but which may exist under other
names);
2. Supplemental Nutrition Assistance Program
(SNAP, formerly called “Food Stamps”);
3. Section 8 Housing Assistance under the
Housing Choice Voucher Program;
4. Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation);
5. Public Housing under the Housing Act of
1937, 42 U.S.C. 1437 et seq.; and
6. Federally-funded Medicaid.

No, I have not received any of the public [deleted]
benefits listed above

checkbox

[deleted]

No, I am not certified to receive any of
the public benefits listed above
Any federal, state, local or tribal cash
assistance for income maintenance

[deleted]

checkbox

[deleted]

checkbox

[deleted]

Supplemental Security Income (SSI)
Temporary Assistance for Needy Families
(TANF)
General Assistance (GA)
Supplemental Nutrition Assistance
Program (SNAP, formerly called “Food
Stamps”)
Section 8 Housing Assistance under the
Housing Choice Voucher Program
Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation)

[deleted]
[deleted]

checkbox
checkbox

[deleted]
[deleted]

checkbox
checkbox

[deleted]
[deleted]

[deleted]

checkbox

[deleted]

checkbox

[deleted]

Public Housing under the Housing Act of
1937, 42 U.S.C. 1437 et seq.
Federally-funded Medicaid

[deleted]

checkbox

[deleted]

checkbox

[deleted]

dropdown

[deleted]

[deleted]
[deleted]

text area
date

[deleted]
[deleted]

date

[deleted]

text area

[deleted]

[deleted]
[deleted]

checkbox
checkbox

[deleted]
[deleted]

Other school-based benefits or services [deleted]
available up to the oldest age eligible for
secondary education under state law.

checkbox

[deleted]

While you were under the age of 21.
While you were pregnant or during the
60-day period following the last day of
pregnancy.
None of the above statements apply to
me.
From

[deleted]
[deleted]

checkbox
checkbox

[deleted]
[deleted]

[deleted]

checkbox

[deleted]

date

[deleted]

To
[deleted]
I am enlisted in the Armed Forces, or am [deleted]
serving in active duty or in the Ready
Reserve Component of the U.S. Armed
Forces.
I am the spouse or the child of an
[deleted]
individual who is enlisted in the Armed
Forces, or who is serving in active duty or
in the Ready Reserve Component of the
U.S. Armed Forces.

date
checkbox

[deleted]
[deleted]

checkbox

[deleted]

At the time I received the public benefits, [deleted]
I (or my spouse or parent) was enlisted in
the Armed Forces, or was serving in
active duty or in the Ready Reserve
Component of the U.S. Armed Forces.

checkbox

[deleted]

At the time I received the public benefits, [deleted]
I was present in the United States in a
status exempt from the public charge
ground of inadmissibility.

checkbox

[deleted]

At the time I received the public benefits, [deleted]
I was present in the United States after
being granted a waiver off the public
charge ground of inadmissibility.

checkbox

[deleted]

I am a child currently residing abroad
who entered the United States with a
nonimmigrant visa to attend an N-600K,
Application for Citizenship and Issuance
of Certificate under INA Section 322
interview.
None of the above statements apply to
me.

[deleted]

checkbox

[deleted]

checkbox

[deleted]

(IF 5.1 = Yes) Public benefit
information to

(IF 5.1 = Yes) Public benefit
history

[deleted]

Since obtaining the nonimmigrant status
that you seek to extend or from which you
seek to change, have you ever received, or
are you currently certified to receive in the
future any of the following public benefits?
(See below and select all that apply)

(if Yes) Select all of the public benefits which
you received or are currently certified to
receive:

[deleted]

Your public benefits
5.2.a-d What type of public benefit have you
received?

What Agency Granted You the Benefit?
What date did you start receiving the
benefit?

Public benefit additional
information

[deleted]

5.4.a.

5.4.b.

5.3

[deleted]

What date did the benefit or coverage end [deleted]
or what is the date it expires?
Have you received, applied for, or have been [deleted]
certified to receive federally-funded
Medicaid in connection with any of the
following? (Select all that apply)

(IF 5.4.a ≠ None of the above) Provide the
applicable start and end dates for federallyfunded Medicaid.

[deleted]

(If Yes to 5.1) Do any of the following apply
to you?

[deleted]

An emergency medical condition.
For a service under the Individuals with
Disabilities Education Act (IDEA).

Revised Instructional Text

List all of the public benefits which you
received or are set to receive below.
This dropdown list is based on the public
benefits you indicated you are currently
receiving or certified to receive. Select from
the public benefits listed in the dropdown
menu to provide the additional information
about that public benefit.

[deleted]

Date You Started Receiving the Benefit or if
Certified, Date You Will Start Receiving the
Benefit or Date Your Coverage Starts

[deleted]

Help Text

Revised Help Text

Add Public Benefit History Information

[deleted]

Public Benefit

I-539 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
Copy in gray boxes is approved copy from previous forms and should not be edited
Step: Indicates the form navigation element.
Section: Indicates the form sub-navigation element. Copy for questions should be grouped by appropriate section.
Questions/Sub-Questions: Based on the questions from the paper form.
Instructional text: Text that appears directly below a question and provides instructions for answering the question or completing this step/section of the
form.
Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying
information about a question.
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Page breaks are indicated by a horizontal line (the same sub-navigation can have multiple pages)
Conditional question logic is indicated in ( ) before question
Step

Section

Paper Form Question
Question #

Sub-Question

Field Type

Instructional Text

Additional
Explanation

Additional
explanation

9.1.a-9.7.d

Additional
information

Textbox

If you need to provide any additional
information for any of your answers to the
questions in this form, enter it into the
space below. You should include the
questions that you are referencing.

You may provide additional information
for your application

Help
Text

Notes

If you do not need to provide any
additional information, you may leave this
section blank.

Additional Explanation

Section

Evidence Title

Evidence

Required
evidence

Your Nonimmigrant Arrival/Departure Record (I-94)

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type
Upload

Upload an image or copy of both sides of your Nonimmigrant Arrival/Departure Record
(I-94).

Revised Instructional Text

Logic
Required for all applicants (exclude T and U nonimmigrants)

If you were admitted to the United States by U.S. Customs and Border Protection (CBP)
at an airport or seaport after April 30, 2013, you may have been issued an electronic I94 by CBP, instead of a paper form. Visit CBP
to obtain a copy of your I-94.

Additional applicants' Nonimmigrant Arrival/Departure Record
(I-94)

Upload

If you are unable to obtain a copy of your I-94 from CBP, go to USCIS I-102 to find additional I-94
Replacement Information.
Upload an image or copy of both sides of the Nonimmigrant Arrival/Departure Record (I94) for each person included in your application.

Required for all additional applicants (exclude T and U
nonimmigrants)

If they were admitted to the United States by CBP at an airport or seaport after April 30,
2013, they may have been issued an electronic Nonimmigrant Arrival/Departure Record
by CBP, instead of a paper form. Visit the CBP
website to obtain a paper version of their Nonimmigrant Arrival/Departure Record.
If you are unable to obtain a copy of their I-94 from CBP, go to the USCIS I-102 page to find additional I-94
Replacement Information.
Your Nonimmigrant Arrival/Departure Record (I-94) or
Approval Notice (I-797)

Upload

Upload an image or copy of both sides of your Nonimmigrant Arrival/Departure Record
(I-94). If you do not have your Nonimmigrant Arrival/Departure Record, you can upload
a copy of your Approval Notice (I-797) or an image of your passport that shows you
have already been granted status.

If nonimmigrant status = T (law enforcement OR exceptional
circumstances), T derivative (T-2, T-3, T-4, T-5, T-6), U (law
enforcement OR exceptional circumstances), U-1, U-2, U-3, U-4,
U-5

If you were admitted to the United States by CBP at an airport or seaport after April 30,
2013, you may have been issued an electronic Nonimmigrant Arrival/Departure Record
by CBP, instead of a paper form. Visit the CBP
website to obtain a paper version of your Nonimmigrant Arrival/Departure Record.
If you are unable to obtain a copy of your I-94 from CBP, go to the USCIS I-102 page to find additional I-94
Replacement Information.

Additional applicants' Nonimmigrant Arrival/Departure Record
(I-94) or Approval Notice (I-797)

Upload

Upload an image or copy of both sides of the Nonimmigrant Arrival/Departure Record (I94) for each person included in your application. If you do not have your Nonimmigrant
Arrival/Departure Record, you can upload a copy of your Approval Notice (I-797) or an
image of your passport that shows you have already been granted status.

If nonimmigrant status = T (law enforcement OR exceptional
circumstances), T derivative (T-2, T-3, T-4, T-5, T-6), U (law
enforcement OR exceptional circumstances), U-1, U-2, U-3, U-4,
U-5

Your Interagency Record of Request - A, G, or NATO
Dependent Employment, Authorization, or
Change/Adjustment to/from A, G, or NATO Status (I-566)

Upload

Upload an image or copy of the Iteragency Record of Request - A, G, or NATO
Dependent Employment, Authorization, or Change/Adjustment to/from A, G, or NATO
Status (I-566) that is certified by the Department of State and indicates your accredited
status.

If nonimmigrant status = A, G

Evidence

Section

Evidence Title

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type

Revised Instructional Text

Logic

Upload

Upload an image or copy of your employer's Nonimmigrant Arrival/Departure Record (I94) or an approval notice demonstrating their A status.

If nonimmigrant status = A-3

Upload

Upload an image or copy of your employer's Nonimmigrant Arrival/Departure Record (I94) or an approval notice demonstrating their G status.

If nonimmigrant status = G-5

Upload

Upload an image or copy of a letter from your employer stating:
・Your duties
・That the employer intends to personally employ you for the entirety of your contract
・Arrangements you have made to depart from the United States

If nonimmigrant status = A-3, G-5

Your employer's Interagency Record of Request - A, G, or
NATO Dependent Employment, Authorization, or
Change/Adjustment to/from A, G, or NATO Status (I-566)

Upload

Upload an image or copy of your employer's Interagency Record of Request - A, G, or
NATO Dependent Employment, Authorization, or Change/Adjustment to/from A, G, or
NATO Status (I-566) that is certified by the Department of State and indicates your
employer's continuing accredited status.

If nonimmigrant status = A-3, G-5

Your written statement

Upload

Upload a written statement explaining in detail:
・The reasons for your request for an extension or change
・The reasons why your extended stay would be temporary, including what
arrangements you have made to depart from the United States
・Any effect the extended stay may have on your foreign employment or residency

If nonimmigrant status = B-1 or B-2

Evidence of your lawful residence in Commonwealth of
Northern Mariana Islands

Upload

Upload an image or copy of proof of your lawful presence in the Commonwealth of the
Northern Mariana Islands (CNMI) as defined in 8 CFR 214.2(w)(l)(v).

If nonimmigrant status = CW-2 (Dependent of CW-1)

Evidence of your relationship with the CW-1 transitional
worker

Upload

Upload an image or copy of any evidence that shows each applicant's relationship to
the CW-1 transitional worker. This may include a birth certificate, marriage certificate,
or proof of termination of any prior marriages.

If nonimmigrant status = CW-2

Additional evidence for CW-2 applicants

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker in the CNMI (I-129CW) that was filed on behalf
of the CW-1 transitional worker
2. A copy of the Receipt Notice (I-797) related to the transitional worker's already
pending petition
3. A copy of the front and back of the transitional worker's most recent Nonimmigrant
Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the transitional worker has already
been granted status for the period requested on your application
Upload an image or copy of any evidence that shows each applicant's relationship to
the principal E nonimmigrant. This may include a birth certificate, marriage certificate,
or proof of termination of any prior marriages.

If nonimmigrant status = CW-2

Your employer's Nonimmigrant Arrival/Departure Record (I94)
Your employer's Nonimmigrant Arrival/Departure Record (I94)
Letter from your employer

Evidence of your relationship with the principal E
nonimmigrant

If nonimmigrant status = E-1 Treaty Traders, E-1 employees, E-2
Treaty Investors, E-2 employees, E-2 CNMI Investors, E-3
Australian Specialty Occupation Professionals

Evidence

Section

Evidence Title

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type

Revised Instructional Text

Logic

Additional evidence for dependents of principal E
nonimmigrants

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the principal E
nonimmigrant
2. A copy of the Receipt Notice (I-797) related to the principal E nonimmigrant's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the principal E nonimmigrant's most recent
Nonimmigrant Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the principal E nonimmigrant has
already been granted status for the period requested on your application.

If nonimmigrant status = E-1 Treaty Traders, E-1 employees, E-2
Treaty Investors, E-2 employees, E-2 CNMI Investors, E-3
Australian Specialty Occupation Professionals

Your Certificate of Eligibility for Nonimmigrant Student (I-20)

Upload

Proof of ability to pay

Upload

If nonimmigrant status = F-1 (and requesting change or
reinstatement), M-1
If nonimmigrant status = F-1 (and requesting change or
reinstatement), M-1

Evidence for reinstatement

Upload

Upload an image or copy of your Certificate of Eligibility for Nonimmigrant Student (I20), issued by the school where you will study.
Upload an image or copy of any documentation that demonstrates your ability to pay
for your studies and support yourself, and any accompanying dependent family
members, while you are in the United States.
Upload an image or copy of any documentation that shows that your violation of status
resulted from circumstances beyond your control or that your violation relates to a
reduction in your course load that would have been within a Designated Schools
Official's (DSO's) power to authorize, and that failure to approve reinstatement would
result in extreme hardship for you.

If nonimmigrant status = F-1 (requesting reinstatement), M-1
(requesting reinstatement)

If you have been out of status for more than 5 months at the time of filing your request
for reinstatement, you must also provide evidence that your failure to file within the 5
month period was the result of exceptional circumstances and that you filed your
request for reinstatement as promptly as possible under these exceptional
circumstances.
Evidence of your relationship with the H temporary worker

Upload

Additional evidence for dependents of an H temporary worker

Upload

Letter from your employer

Upload

Upload an image or copy of any evidence that shows each applicant's relationship to
the H temporary worker. This may include a birth certificate, marriage certificate, or
proof of termination of any prior marriages.
Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the H
temporary worker
2. A copy of the Receipt Notice (I-797) related to the H temporary worker's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the H temporary worker's most recent Nonimmigrant
Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the H temporary worker has already
been granted status for the period requested on your application.
Upload an image or copy of a letter from the employing media organization that:
・Verifies your employment
・Establishes that you are a representative of that media organization
・Describes your compensation and work to be performed

If nonimmigrant status = H-4

If nonimmigrant status = I

Evidence

Section

Evidence Title

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type

Revised Instructional Text

Logic

Evidence of your relationship with the principal nonimmigrant

Upload

Upload an image or copy of any evidence that shows each applicant's relationship to
the principal nonimmigrant. This may include a birth certificate, marriage certificate, or
proof of termination of any prior marriages.

If nonimmigrant status = I (dependent)

Your Certificate of Eligibility for Exchange Visitor Status (DS2019)
Evidence of your relationship with the L intracompany
transferee

Upload

Upload an image or copy of your Certificate of Eligibility for Exchange Visitor Status (DS2019).
Upload an image or copy of any evidence that shows each applicant's relationship to
the L intracompany transferee. This may include a birth certificate, marriage certificate,
or proof of termination of any prior marriages.

If nonimmigrant status = J-1 (changing to J-1)

Additional evidence for dependents of an L intracompany
transferee

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the L
intracompany transferee
2. A copy of the Receipt Notice (I-797) related to the L intracompany transferee's
already pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the L intracompany transferee's most recent
Nonimmigrant Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the L intracompany transferee has
already been granted status for the period requested on your application.

If nonimmigrant status = L-2

Evidence supporting your reason for an extension

Upload

Upload an image or copy of any evidence supporting your reason for requesting an
extension. You may request an extension if:
・Compelling educational or medical reasons have resulted in a delay of your course of
study
・You are applying for a post-completion optional practical training
・You are transferring to a different school

if nonimmigrant status = M-1 (extension)

Upload

If nonimmigrant status = L-2

If you are transferring schools 6 months, or more, after the date you first admitted, you
will need to upload evidence showing you are unable to remain at the school you were
initially admitted to attend due to circumstances beyond your control.
Evidence of your relationship with the O nonimmigrant worker

Upload

Upload an image or copy of any evidence that shows each applicant's relationship to
the O nonimmigrant worker. This may include a birth certificate, marriage certificate, or
proof of termination of any prior marriages.

If nonimmigrant status = O-3

Additional evidence for dependents of an O nonimmigrant
worker

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the O
nonimmigrant worker
2. A copy of the Receipt Notice (I-797) related to the O nonimmigrant worker's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the O nonimmigrant worker's most recent
Nonimmigrant Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the O nonimmigrant worker has
already been granted status for the period requested on your application.

If nonimmigrant status = O-3

Evidence of your relationship with the P nonimmigrant worker

Upload

Upload an image or copy of any evidence that shows each applicant's relationship to
the P nonimmigrant worker. This may include a birth certificate, marriage certificate, or
proof of termination of any prior marriages.

If nonimmigrant status = P-4

Additional evidence for dependents of an P nonimmigrant
worker

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the P
nonimmigrant worker
2. A copy of the Receipt Notice (I-797) related to the P nonimmigrant worker's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the P nonimmigrant worker's most recent
Nonimmigrant Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the P nonimmigrant worker has
already been granted status for the period requested on your application.

If nonimmigrant status = P-4

Evidence

Section

Evidence Title

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type

Evidence of your relationship with the R religious worker

Upload

Additional evidence for dependents of an R religious worker

Upload

Evidence of your relationship with the TN professional worker

Upload

Additional evidence for dependents of a TN professional
worker

Revised Instructional Text

Logic

Upload an image or copy of any evidence that shows each applicant's relationship to
the R religious worker. This may include a birth certificate, marriage certificate, or proof
of termination of any prior marriages.
Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the R religious
worker
2. A copy of the Receipt Notice (I-797) related to the R religious worker's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the R religious worker's most recent Nonimmigrant
Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the R religious worker has already
been granted status for the period requested on your application.
Upload an image or copy of any evidence that shows each applicant's relationship to
the TN professional worker. This may include a birth certificate, marriage certificate, or
proof of termination of any prior marriages.

If nonimmigrant status = R-2

Upload

Upload an image or copy of one of the following:
1. Petition for a Nonimmigrant Worker (I-129) that was filed on behalf of the TN
professional worker
2. A copy of the Receipt Notice (I-797) related to the TN professional worker's already
pending Petition for a Nonimmigrant Worker (I-129)
3. A copy of the front and back of the TN professional worker's most recent
Nonimmigrant Arrival/Departure Record (I-94)
4. A copy of the Approval Notice (I-797) showing the TN professional worker has already
been granted status for the period requested on your application.

If nonimmigrant status = TD

Evidence demonstrating law enforcement need

Upload

Upload an image or copy of any evidence demonstrating law enforcement need. This
may include a Declaration of Law Enforcement Officer for Victims or Trafficking in
Persons (I-914, Supplement B) or other evidence from law enforcement explaining that
your presence is necessary, and any other credible evidence.

If nonimmigrant status = T (law enforcement need)

Evidence demonstrating exceptional circumstances

Upload

If nonimmigrant status = T (exceptional circumstances), U
(exceptional circumstances)

Evidence supporting your reason for an extension

Upload

Evidence of your relationship with the T-1 nonimmigrant
principal

Upload

Upload an image or copy of any evidence that demonstrates your exceptional
circumstances. This may include an affirmative statement or any other credible
evidence.
Upload a written statement explaining the need and reason for your request for an
extension.
Upload an image or copy of any evidence that shows each applicant's relationship to
the T-1 nonimmigrant principal. This may include a birth certificate, marriage
certificate, or proof of termination of any prior marriages.

Evidence demonstrating law enforcement need

Upload

If nonimmigrant status = U (law enforcement need)

Evidence of your relationship with the U-1 nonimmigrant
principal

Upload

Upload an image or copy of any evidence demonstrating law enforcement need. This
may include a U Nonimmigrant Status Certification (I-918, Supplement B) or other
evidence from law enforcement explaining that your presence is necessary, and any
other credible evidence.
Upload an image or copy of any evidence that shows each applicant's relationship to
the U-1 nonimmigrant principal. This may include a birth certificate, marriage
certificate, or proof of termination of any prior marriages.

Evidence you received any public benefits.

[deleted]

Upload

[deleted]

Evidence of public benefit disenrollment request.

[deleted]

Upload

[deleted]

Upload evidence in the form of a letter, notice, certification, or other agency
documents that contain the following:
1. Your name;
2. Name and contact information for the public benefit granting agency;
3. Type of benefit;
4. Date you started receiving the benefit or if certified, date you will start receiving the
benefit; and
5. Date benefit or coverage ended or expires (mm/dd/yyyy) (if applicable)
Upload evidence of your request to disenroll if the public benefit-granting agency has
not processed your request (if applicable).

If nonimmigrant status = R-2

If nonimmigrant status = TD

If nonimmigrant status = T-2, T-3, T-4, T-5, T-6, U-2, U-3, U-4, U-5
If nonimmigrant status = T-2, T-3, T-4, T-5, T-6

If nonimmigrant status = U-2, U-3, U-4, U-5

[deleted]

If selected 5.1: “Yes, I have received or I am currently certified
to receive public benefits."

[deleted]

If selected 5.1: "Yes, I have received or I am currently certified
to receive public benefits."

Evidence

Section

Additional
evidence

Evidence Title

Revised Evidence Title

Field Type Revised
Instructional Text
Field Type

Evidence your enlistment in the U.S. Armed Forces, serving in
active duty or in the Ready Reserve component of the U.S.
Armed forces.

[deleted]

Upload

[deleted]

Upload certified evidence of alien’s enlistment/service issued by the authorizing official [deleted]
of the executive department in which service member is serving.

Evidence of your relationship to a service member of the U.S.
Armed forces.

[deleted]

Upload

[deleted]

Upload a copy of Form DD-1173, United States Uniformed Services Identification and
Privilege Card (Dependent).

Evidence of receiving Federal-Funded Medicaid by a child
under 21 years of age.

[deleted]

Upload

[deleted]

Upload a copy of the following (if applicable):
[deleted]
1. A statement with information regarding the "emergency medical condition"
determination (if applicable);
2. Documentation of these payments under the IDEA or school-based service; and
3. Pregnancy verification letter from medical professional including estimated duration
of pregnancy.

Proof of child's N-600K interview notice.

[deleted]

Upload

[deleted]

Upload a copy of the N-600K interview notice.

[deleted]

Evidence you received public benefits while in a category that [deleted]
is exempt from public charge.

Upload

[deleted]

If 5.3 = "At the time I received the public benefits, I was present
in the United States in a status exempt from the public charge
ground of inadmissibility."

Evidence you received public benefits while in a category
which had received a waiver for public charge.

Upload

[deleted]

Upload information that evidences of your status or that you
received a waiver for the public charge ground of inadmissibility, such as
1. Approval notice (such as Form I-797, Notice of
Action); or
2. Form I-94, Arrival/Departure Record.
Upload information that evidences of your status or that you
received a waiver for the public charge ground of
inadmissibility, such as
1. Approval notice (such as Form I-797, Notice of
Action); or
2. Form I-94, Arrival/Departure Record.

[deleted]

If 5.3 = "At the time I received the public benefits, I was present
in the United States after being granted a waiver off the public
charge ground of inadmissibility."

Additional evidence you want to provide

[deleted]

Upload

You can provide additional documents that support your application and help explain
any of your answers on the application. If you want to provide additional evidence now,
upload any documents below.

Revised Instructional Text

[deleted]

Logic
If 5.3 = "I am enlisted in the Armed Forces, or am serving in
active duty or in the Ready Reserve Component of the U.S.
Armed Forces"
OR;
"At the time I received the public benefits, I (or my spouse or
parent) was enlisted in the Armed Forces, or was serving in
active duty or in the Ready Reserve Component of the U.S.
Armed Forces."
If 5.3 = "I am the spouse or the child of an individual who is
enlisted in the Armed Forces, or who is serving in active duty or
in the Ready Reserve Component of the U.S. Armed Forces."
OR;
"At the time I received the public benefits, I (or my spouse or
parent) was enlisted in the Armed Forces, or was serving in
active duty or in the Ready Reserve Component of the U.S.
Armed Forces."
If 5.4.a. = "While you were under the age of 21."OR;
"An emergency medical condition." OR;
"For a service under the Individuals with Disabilities Education
Act (IDEA)." OR;
"Other school-based benefits or services available up to the
oldest age eligible for secondary education under state law."
OR;
"While you were pregnant or during the 60-day period following
the last day of pregnancy."
If 5.3 = "I am a child currently residing abroad who entered the
United States with a nonimmigrant visa to attend an N-600K,
Application for Citizenship and Issuance of Certificate Under INA
Section 322 interview."

All applicants

Evidence

Section

Review and Submit

Review your
application

Paper Form Question
Question #

Sub-Question

Revised Sub-Question

Field Type

Check your
application before
you submit

Current Instructional Text

We will review your application to check for accuracy and completeness
before you submit it.

Help Text

Primary CTA

Review my
application

We encourage you to provide as many responses as you can
throughout the application, to the best of your knowledge. Missing
information can slow down the review process after you submit your
application.
You can return to this page to review your application as many times as
you want before you submit it.

Your fee

Your form filing fee is: $370
Refund Policy: USCIS does not refund fees, regardless of any action we
take on your application, petition, or request. By continuing this
transaction, you acknowledge that you must submit fees in the exact
amount and that you are paying the fees for a government service.

You have one or more alerts and warnings based on the information
you provided in your application.

Alerts and warnings

A red alert means you have incomplete or incorrect responses to
certain questions. You cannot submit your application with any alerts.
A yellow warning means you may be missing information or may need
to follow-up with us about your responses. You can still submit your
application, but some warnings may slow down the review process
after you submit your application.
Your application
summary

Here is a summary of all the information you provided in your
application.

Make sure you have provided responses for everything that applies to
you before you submit your application. You can edit your responses by
going to each application section using the site navigation.
Preparer signature

8.7.a

Preparer's
statement

8.7.b
8.7.b
8

Preparer's
certification

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

I am an attorney or accredited representative and my representation of the applicant in this case does
not extend beyond the preparation of this application.
I am an attorney or accredited representative and my representation of the applicant in this case
extends beyond the preparation of this application.
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 Declaration and 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.
As the applicant's preparer, you must sign on paper and provide your signature page to the applicant.
Follow these steps:

Radio

Your preparer must read the statements below and select the
statement that applies to him or her.
If your preparer is an attorney or accredited representative whose
representation extends beyond preparation of this application, he or
she may be obliged to submit a completed Notice of Entry of
Appearance as Attorney or Accredited Representative (G-28) with your
application

Radio
Checkbox

Your preparer must read and agree to the certification below.

Upload

Scan and upload your preparer's completed signature page below.

Checkbox

Your interpreter must read and agree to the certification below.

1. Download the Preparer Signature page
2. Print the Preparer Signature page
3. Read and sign the Preparer Signature page
4. Give the signed Preparer Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.

Interpreter
signature

8.8.a/b Preparer's signature
upload
Interpreter's
I certify, under penalty of perjury, that: I am fluent in English and the language provided in the Getting
certification
Started section of this application, 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 Declaration and Certification, and has verified the accuracy of every answer.
As the applicant's interpreter, you must sign on paper and provide your signature page to the
applicant. Follow these steps:
1. Download the Interpreter Signature page
2. Print the Interpreter Signature page
3. Read and sign the Interpreter Signature page
4. Give the signed Interpreter Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.

Review and Submit

Section

Paper Form Question
Question #

Your signature

6.1.a

6.2

6.1.b

7.7.a/b Interpreter's
signature upload
Applicant's
statement
Applicant's
statement
regarding the
preparer
Applicant's
statement
regarding the
interpreter
Applicant's
declaration,
certification and
signature

Sub-Question

Revised Sub-Question

Field Type

Current Instructional Text

Upload

Scan and upload your interpreter's completed signature page below.

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.

Checkbox

You must read and agree to the statement below.

At my request, the preparer named in the Getting Started section of this application/[preparer name]
prepared this application for me based only upon information I provided or authorized.

Checkbox

You must read and agree to the statement below.

The interpreter named in the Getting Started section of this application read to me every question and
instruction on this application and my answer to every question in the language I specified in the
Getting Started section, a language in which I am fluent, and I understood everything.

Checkbox

You must read and agree to the statement below.

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.

Help Text

Primary CTA

Read the Penalties section of the Form I539 Instructions before completing this
section.

You must read and agree to the certification below. If you knowingly
and willfully falsify or conceal a material fact or submit a false
document with your application, we can deny your application and may
deny any other immigration benefit. You may also face criminal
prosecution and penalties provided by the law.

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 U.S. immigration law.
I understand that USCIS willrequire 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 understood all of the information contained in, and submitted with, my application;
and
2) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my application and any document
submitted with it were provided or authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my application and that all of this information is
complete, true, and correct.

Federal Agency
Disclosure and
Authorizations

I authorize, as applicable, the Social Security Administration (SSA) to verify my Social Security number
(to match my name, Social Security number, and date of birth with information in SSA records and
provide the results of the match) to USCIS. I authorize SSA to provide explanatory information to USCIS
as necessary.

I authorize, as applicable, the SSA, U.S. Department of Agriculture (USDA), U.S. Department of Health [deleted]
and Human Services (HHS), U.S. Department of Housing and Urban Development (HUD), and any other
U.S. Government agency that has received and/or adjudicated a request for a public benefit, as
defined in 8CFR 212.21(b), submitted by me or on my behalf, and/or granted one or more public
benefits to me, to disclose to USCIS that I have applied for, received, or have been certified to receive,
a public benefit from such agency, including the type and amount of benefits, dates of receipt, and any
other relevant information provided to the agency for the purpose of obtaining such as public benefit,
to the extent permitted by law. I also authorize SSA, USDA, HHS, HUD, and any other US. Government
agency to provide any additional data and information to USCIS, to the extent permitted by law.
I authorize, as applicable, custodians of records and other sources of information pertaining to my
request for or receipt of public benefits to release information regarding my request for and/or receipt
of public benefits, upon the request of the investigator, special agents, or other duly accredited
representative of any Federal agency authorized above, regardless of any previous agreement to the
contrary.
I understand that the information released by records custodians and sources of information is for
official use by the Federal Government, that the U.S. Government will use it only to review if I have
received public benefits in regards to my eligibility for immigration benefits and to enforce immigration
laws, and that the U.S. Government may disclose the information only as authorized by law.
6.6.a

6.6.b
Pay and submit

I have read and agree to the applicant's statement
Your signature

Checkbox
You must provide your digital signature below by typing your full legal
name. We may deny your application if you do not completely fill out
this application or fail to submit required documents. We will record
the date of your signature with your application.

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.

[Date of signature]
The final step to submit your Application to Extend/Change
Nonimmigrant Status (I-539) is to pay the required fee.
Your application fee is: $370
Refund Policy: USCIS does not refund fees, regardless of any action we
take on your application, petition, or request. By continuing this
transaction, you acknowledge that you must submit fees in the exact
amount and that you are paying the fees for a government service.

Review and Submit

Section

Paper Form Question
Question #
Pay for and submit
your application

Sub-Question

Revised Sub-Question

Field Type

Current Instructional Text

If you have a form fee, we will send you to Pay.gov — our safe, secure
payment website — to make your payment and submit your application
online.

Help Text

Primary CTA

Pay and submit

Here are the steps in the payment and submission process:
1. Provide your billing information on Pay.gov
2. Provide your information for one of two billing options: credit card or
U.S. bank account
3. Submit your payment
When you have paid your fee, your application will be submitted.
Pay.gov will redirect you to an application confirmation screen. You can
track the status of your application through your USCIS online account.

Review and Submit

I-539 FORM COPY: WARNINGS, ALERTS, NOTICES, AND ERRORS
Copy in gray boxes is approved copy from the N600 and should not be edited

Alert: Appears in red box; indicates missing required information or lack of eligibility; user cannot submit application

Number Type
Logic
1 Yellow alert This alert will show up
during Beta - Beta 2.1

Revised Logic

Message
h3. You can file an individual extension request online only for certain
statuses

Revised Message

Where the alert exists
https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/overview

Revised Where the alert exists

Link goes to: https://www.uscis.gov/i539

1.1 Yellow alert This alert will show up
during Beta 4.

At this time, you cannot file online if you:
* Need to extend your status and your nonimmigrant status is not listed
above,
* Want to reinstate or change your nonimmigrant status, or
* Have additional applicants.
* Have an A, G, NATO, V, T or U nonimmigrant status
* Require a lawyer or accredited representative
You will need to file a paper Form I-539
h3. You can file an individual extension request online only for certain
statuses

https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/overview

Link goes to: https://www.uscis.gov/i539

1.1 Yellow alert This alert will show up
during Beta 5.

At this time, you cannot file online if you:
* Need to extend your status and your nonimmigrant status is not listed
above,
* Have additional applicants.
* Have an A, G, NATO, V, T or U nonimmigrant status
* Require a lawyer or accredited representative
You will need to file a paper Form I-539
h3. You can file an individual extension request online only for certain
statuses

https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/overview

Link goes to: https://www.uscis.gov/i539

https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/2497/basis-for-eligibility

Link goes to: https://www.uscis.gov/i539

https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/2497/reason-for-request

Link goes to: https://www.uscis.gov/i539

At this time, you cannot file online if you:
* Need to extend your status and your nonimmigrant status is not listed
above,
* Have additional applicants.
* Have an A, G, NATO, V, T or U nonimmigrant status
You will need to file a paper Form I-539
h3. You can file your extension request online only for certain statuses.

2 Yellow alert This alert will show up
during Beta - Beta 2.1

You can complete this online form if your current nonimmigrant status is
listed above and you are requesting an extension of status. You should
submit the paper Form I-539 if your current nonimmigrant status is not
listed above or you want to change or reinstate your nonimmigrant
status.

This alert will show up
during Beta - Beta 3.
This will go away with
Beta 4.

h3. Online filing is available only for extension of status requests.

4 Red alert

This alert will show up
during Beta - Beta 4.
This will go away with
Beta 5.

h3. You can file Form I-539 online only for yourself and no other
applicants at this time.

https://qa-my.uscis.dhs.gov/apply/application-to-extend-changenonimmigrant-status/2497/additional-applicants

5 Red alert

This will show up if I-94
is not uploaded

You can complete the online version of Form I-539 if you are requesting
an extension for only yourself. If you want to include co-applicants, you
must file the paper Form I-539.
h3. You must upload an image or copy of your Nonimmigrant
Arrival/Departure Record (I-94).

https://qa-my.uscis.dhs.gov/apply/application-to-extend-change-nonimmigrantstatus/4870/required-evidence

6 Yellow alert

Will show up if the user
has not answered
question about having
Public Benefits

[deleted]

Will show up on Public
Benefits Additional
Information page

[deleted]

3 Red alert

You can complete this online form only if you are requesting an extension
of your nonimmigrant status. You should file a paper Form I-539 if you
want to change or reinstate your nonimmigrant status.

You cannot submit your application until you upload an image or copy of
your I-94.

h3. There are new question in the form

[deleted]

https://qa-my.uscis.dhs.gov/apply/application-to-extend-change-nonimmigrant- [deleted]
status/4870/review-your-application

[deleted]

https://qa-my.uscis.dhs.gov/apply/application-to-extend-change-nonimmigrant- [deleted]
status/4870/public-benefits-additional-information

On October 15, 2019, the Public Benefits section was added to the I-539. If you
started your I-539 before October 15, 2019, you may not have seen this section.
You should fill out the Public Benefits section before submitting your form.

Link goes to: https://qamy.uscis.dhs.gov/apply/application-toextend-change-nonimmigrantstatus/4870/public-benefits-information

CTA button link: "Go to Public Benefits section"

7 Yellow alert

h3. There is evidence that you should upload for public benefits
Click on Next to go to the Evidence section.

Alerts

I-539 FORM COPY: EXEMPTION ACCORDION
Heading
Sub-Heading
Before you start your Eligibility
application

Body Text
EXEMPTIONS: The following
are exempted from the public
benefits listed above.

Revised Body Text
[deleted]

Accordion Header
Revised Accordion Header
Public benefits received by U.S. Armed [deleted]
Forces;

Accordion Body
Revised Accordion Body
An alien enlisted in the U.S. Armed Forces, serving in active duty or in the Ready Reserve component of the U.S. Armed [deleted]
forces; or the spouse or child of the service member.

Federal-funded Medicaid;

[deleted]

1. Receipt by a child under 21 years of age;
2. The receipt of Medicaid payment(s) for an "emergency medical condition;"
3. The receipt of Medicaid for services provided under the Individuals with Disabilities Education Act (IDEA);
4. The receipt of Medicaid for school-based benefits for children who are of an age eligible for secondary education as
determined under state or local law; or
5. Receipt during pregnancy and during the 60-day period after the last day of pregnancy.

[deleted]

Children who will naturalize under INA [deleted]
322;

Child currently residing abroad who entered the United States with a nonimmigrant visa to attend N-600K, Application
for Citizenship and Issuance of Certificate under INA Section 322 interview.

[deleted]

Public benefits received while in an
immigration category exempt from
public charge;

Received public benefits while in a category that is exempt from public charge; or received public benefits while in a
category had received a waiver for public charge.

[deleted]

Exemption Accordion

File Type	application/pdf
Author	Taylor-Netzband, JoAnn M (CTR)
File Modified	2021-02-17
File Created	2021-02-17