I-765 Copy Deck - Online Filing

I-765-035-Copy Deck-83C for Online Filing.pdf

Application for Employment Authorization

I-765 Copy Deck - Online Filing

OMB: 1615-0040

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1615-0040 can be found here:

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myUSCIS copy deck
I-765 (c)(3)(A); (c)(3)(B); (c)(3)(C) Application for Employment
OMB control number 1615-0040
Baseline version: 08/25/2020

Copy Deck Version

I-765 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.
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
Heading
Sub-Heading
Application for Employment
Authorization

Body Text
Link
Certain foreign nationals who are in the United States may file Form I-765, Application for Employment Authorization, to request
https://www.uscis.gov/i-765
employment authorization and an Employment Authorization Document (EAD). Other foreign nationals whose immigration status authorizes
them to work in the United States without restrictions may also use Form I-765 to apply for an EAD that shows such authorization.

CTA

Notes
Form I-765 instructions, "What Is
the Purpose of Form I-765" - page
1

Foreign nationals may also apply for a Social Security number and card on Form I-765.
If you are a lawful permanent resident, a conditional permanent resident, or a nonimmigrant only authorized for employment with a specific
employer under 8 CFR 274a.12(b), do not use Form I-765.
Learn more about employment authorization.

Before You Start Your
Application

Eligibility

Only certain F-1 students seeking optional practical training (OPT) may file Form I-765 online. This includes:
- Pre-completion OPT - (c)(3)(A) eligibility category;
- Post-completion OPT - (c)(3)(B) eligibility category; or
- a 24-month extension for STEM students (students sholding a degree in science technology, engineering, or mathematics) (c)(3)(C) elgibility category.

https://www.uscis.gov/i-765

Recommended language to show
online filing is only supported for
(c)(3)(A), (c)(3)(B), and
(c)(3)(C)eligibility categories

For all other eligibility categories, you must submit a paper Form I-765.
(c)(3)(A) eligibility category: Submit your application up to 90 days before being enrolled as an F-1 foreign student for one full
academic year at an educational institution approved by U.S. Immigration and Customs Enforcement and Exchange Visitor
Program (ICE SEVP). Your period of employment should not start before you have completed one full academic year. If you
completed the one-year requirement while in another valid nonimmigrant status and you are now in valid F-1 status, you are still
eligible to apply for OPT

Form I-765 instructions, "Who
May File Form I-765"- pages 7-8

(c)(3)(B) eligibility category: Submit your application up to 90 days before, but no later than 60 days after your program end date.
You must submit your application within 30 days of the date that your designated school official (DSO) enters the
recommendation for OPT into your Student and Exchange Visitory Information System (SEVIS) record. If you fail to do so, we will
deny your OPT request.
(c)(3)(C) eligibility category: Submit your application up to 90 days before your current OPT expires, but you must submit within 60 days
of the DSO's approval of STEM OPT.
Note: If you are an F-1 student filing for initial or extension of OPT, your OPT and your employment authorization will be automatically
terminated if you change educational program levels or transfer to another school. Working in the United States without authorization may
result in your removal from the United States or denial of re-entry. Consult your DSO for additional details.
Fee

Fee: $410.
Refund policy:
USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how long USCIS takes to reach a
decision. 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.

Form I-765 instructions, "What Is
the Filing Fee"- page 6
Previously approved refund policy
language for digital forms

Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-3755283. For TTY (deaf or hard of hearing) 800-767-1833.

Documents you may need

Most applicants must upload:
- A copy of your Form I-94, Nonimmigrant Arrival-Departure Record (front and back), a printout of your electronic Form I-94 from
www.cbp.gov/i94, passport, or other travel document.
- A copy of your last EAD (front and back). If you were not previously issued an EAD, you must submit a copy of a government-issued identity
document (such as a passport) showing your picture, name, and date of birth;
a birth certificate with photo ID; a visa issued by a foreign consulate; or a national ID document with photo
and/or fingerprint. The identity document photocopy must clearly show your facial features and contain your
biographical information.
- Two identical color passport-style photographs of yourself taken recently.

Form I-765 instructions,
"Required Documentation" pages 25-26

We will automatically inform you which documents and additional evidence you may need to provide as you fill out your application. These
recommendations for additional information will be based on the information you provide in the application, such as your personal history
and circumstances.

Specific to digital environment
and part of global template
previously approved by OMB

Any document containing foreign language submitted to USCIS must be accompanied by a full English language translation that the translator
has certified as complete and accurate, and by the translator's certification that he or she is competent to translate from the foreign language
into English.

Application Overview

I-765 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

After You Submit Your
Application

Completing Your Form
Online

Sub-Heading

Body Text

Biometric services appointment

USCIS may require that you appear for an interview or provide biometrics (fingerprints, photograph, and/or signature) at any time to verify
your identity, obtain additional information, and conduct background and security checks, including a check of criminal history records
maintained by the Federal Bureau of Investigation (FBI), before making a decision on your application or petition. After USCIS receives your
application and ensures it is complete, we will inform you in writing if you need to attend a biometric services appointment.

Link

CTA

Notes
Specific to digital environment
and part of global template
previously approved by OMB

Track your case 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.

Respond to requests for information

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.

Specific to digital environment
and part of global template
previously approved by OMB
Specific to digital environment
and part of global template
previously approved by OMB

Receive your decision

The decision on Form I-765 involves a determination of whether you have established eligibility for the immigration benefit you are seeking.
USCIS will notify you of the decision in writing. If your application is approved, we will either mail your EAD to you or we may require you to
visit your local USCIS office to pick it up.

Form I-765 instructions,
"Processing Information" - page
29

Filing online

Submitting your application online is the same as mailing in a completed paper form. They both gather the same information.

Complete the Getting Started section first

You should answer all questions in the Getting Started section first so we can best customize the rest of your online form experience.

Provide as many responses as you can

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.

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. We will
save your information for 30 days from today, or from the last time you worked on the form.

How to continue filling out your form

After you start your form, you can sign in to your account to continue where you left off.

DHS Privacy Notice

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the Immigration and Nationality
Act, 8 U.S.C. section 1324a, and 8 CFR 274a.13.
PURPOSE: The primary purpose for providing the requested information on this application is to determine eligibility for certain aliens who
are temporarily in the United States requesting an Employment Authorization Document. DHS uses the information you provide to grant or
deny the benefit you are seeking.

Specific to digital environment
and part of global template
previously approved by OMB
Specific to digital environment
and part of global template
previously approved by OMB
Specific to digital environment
and part of global template
previously approved by OMB
Specific to digital environment
and part of global template
previously approved by OMB
Specific to digital environment
and part of global template
previously approved by OMB
Form I-765 instructions, "DHS
Privacy Notice" - page 30
Form I-765 instructions, "DHS
Privacy Notice" - page 30

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security
number, and any requested evidence may delay a final decision or result in a rejection or denial of your application.

Form I-765 instructions, "DHS
Privacy Notice" - page 30

ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, 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, as 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 Benefit Information System; DHS/USCIS-010
Asylum Information and Pre-Screening; and, DHS/USCIS-017 Refugee Case Processing and Security Screening Information System; DHS/USCIS018 Immigration Biometric and Background Check] and the published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked
Application Information Management System and Associated Systems; DHS/USCIS/PIA-027 Asylum Division; DHS/USCIS/PIA-056 USCIS
Electronic Immigration System; and DHS/USCIS/PIA-068 Refugee Case Processing and Security Vetting], which can be found at
www.dhs.gov/privacy [https://www.dhs.gov/topic/privacy]. DHS may also share this information as appropriate for law enforcement
purposes or in the interest of national security.

Form I-765 instructions, "DHS
Privacy Notice" - page 31

Application Overview

I-765 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Sub-Heading

Body Text

Paperwork Reduction Act

An agency may not conduct or sponsor an 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 4 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. The public reporting burden for the collection of information for Form
I-765WS is estimated at 30 minutes 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. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,
to:

Link

CTA

Notes
Form I-765 instructions,
"Paperwork Reduction Act" page 31

U.S. Citizenship and Immigration Services
Office of Policy and Strategy, Regulatory Coordination Division
5900 Capital Gateway Drive, Mail Stop #2140
Camp Springs, MD 20588-0009
Do not mail your completed Form I-765 to this address.
OMB No. 1615-0040
Expires: 07/31/2022

Security reminder

If you do not work on your application for more than 30 days, we will delete your data in order to prevent storing personal information
indefinitely.

Start

Specific to digital environment
and part of global template
previously approved by OMB

Application Overview

I-765 INTERACTIVE FORM COPY: GETTING STARTED
The Getting Started step is the first part of the form that the applicant will complete. Questions relating to the applicant's basis for eligibility (if applicable) and questions about the applicant's preparer/interpreter (if any) should be grouped in the Getting Started step of the form and should be organized by the appropriate section. This step and section
structure will inform the navigation and sub-navigation for the form.
Step: Indicates the form navigation element. In this case, these questions would appear in the Getting Started step of the form.
Section: Indicates the form sub-navigation element. The following copy for questions is grouped by the section in which they should appear.
Questions/Sub-Questions: Based on the questions from the paper 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.
Instructional text: Text that appears directly below a question and provides instructions for answering the question.
Question sets are separated by a double-line.
Conditional question logic is indicated in () before question.
Primary Nav

Secondary Nav

Getting Started Basis of eligibility

Reason for applying

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

2.27

What is your eligibility category?

Eligibility Category

Dropdown

2.28.a

[If you entered the eligibility category (c)(3)C]
What is your degree?

Text

2.28.b

[If you entered the eligibility category (c)(3)C]
What is your employer's name as listed in E-Verify?

Text

2.28.c

[If you entered the eligibility category (c)(3)C]
What is your employer's E-Verify company identification
number or a valid E-Verify client company identification
number?

Text

3.6

[If you entered the eligibility category (c)(8)] Are you a Yes/No
Salvadoran or Guatemalan national eligible for benefits
under the ABC settlement agreement?

Radio

Question will not be included in initial release
because we are not supporting the c(8)
category.

1.1.a

What is your reason for applying?

Radio

Required field

1.1.b

c. Renewal of permission to accept employment.

Radio

Have you previously filed Form I-765?
Is someone assisting you with completing this application?

Yes/No
Yes/No

Radio
Radio

(IF YES) Is a preparer assisting you with completing this
application?

Yes/No

Radio

(IF YES) Is an interpreter assisting you with completing this
application?

Yes/No

Radio

5.1.b

What is your preparer's full name?

Given name (first name)

Text

5.1.a
5.2

What is your preparer's business or organization name?

Family name (last name)

Text
Text

What is your preparer's mailing address?

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

Checkbox
Dropdown

What is your preparer's contact information?

Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime phone number

Text
Text
Text
Dropdown/Text
Text
Text

Mobile telephone number
My preparer does not have a mobile telephone number
Email address
My preparer does not have an email address.

Text
Checkbox
Text
Checkbox

2.12
Preparer and
interpreter information

5.3.a.5.3.h.

5.4
5.5
5.6

Help Text

Notes
Required field

b. Replacement of lost, stolen, or damaged employment Radio
authorization document, or correction of my employment
authorization document NOT DUE to U.S. Citizenship and
Immigration Services (USCIS) error.

1.1.c

(IF YES TO PREPARER
QUESTION) Preparer
information

a. Initial permission to accept employment.

Instructional Text

Specific to digital environment and part of
global template previously approved by OMB.

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

Specific to digital environment and part of
global template previously approved by OMB.

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

Getting Started

Secondary Nav
(IF YES TO
INTERPRETER)
Interpreter information

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

4.1.b

What is your interpreter's full name?

Given name (first name)

Text

4.1.a
4.2

What is your interpreter's business or organization name?

Family name (last name)

Text
Text

4.3

What is your interpreter's mailing address?

My interpreter is not part of a business or organization.
Country

Checkbox
Dropdown

What is your interpreter's contact information?

Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime telephone number

Text
Text
Text
Dropdown/Text
Text
Text

4.4
4.5

Instructional Text

Help Text

Notes

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

Mobile telephone number
Text
My interpreter does not have a mobile telephone number Checkbox

4.6
What language is your interpreter using to interpret this
application for you?

Email address
My interpreter does not have an email address.

Text
Checkbox
Text

Getting Started

I-765 INTERACTIVE FORM COPY: ABOUT YOU

The About You step is the second part of the paper form that the applicant will complete. Questions relating to the applicant's personal information should be grouped in the About you step of the form and should be organized by the appropriate section. This step and section structure will inform the navigation
and sub-navigation for the form. Personal information questions include questions about the applicant's name, contact information, immigration information, demographics, school and employment, military service, requests for accommodations, etc.
Step: Indicates the form navigation element. In this case, these questions would appear in the About You step of the form.
Section: Indicates the form sub-navigation element. The following copy for questions is grouped by the section in which they should appear.
Questions/Sub-Questions: Based on the questions from the paper 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.
Instructional text: Text that appears directly below a question and provides instructions for answering the question.
Question sets are separated by a double-line.
Conditional question logic is indicated in () before question.
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Paper Form Question
Question
2.1.b

2.1.c
2.1a

Your contact
information

Given name (first name)

Middle name
Family name (last name)
Yes/No

2.2c
2.2a
3.3

How may we contact you?

Middle name
Family name (last name)
Daytime telephone number

Text (9 digits)

3.4

Mobile telephone number (if any)

Text (9 digits)
Checkbox

3.5
2.5.a

This is the same as my daytime
telephone number.
Email address
In care of name (if any)

Address line 1
Address line 2
City or town
State
ZIP code
Yes/No

Text
Text
Text
Dropdown
Text
Radio

Is your current mailing address the
same as your physical address?

2.7.b
2.7.c
2.7.d
2.7.e
2.10

(If no) Where in the United States do Address line 1
you live?
Address line 2
City or town
State
ZIP code
What is your gender?
Male/Female

2.12

What is your marital status?

2.19a

What is your city, town, or village of
birth?

Help Text

Other names used may include nicknames,
aliases, and maiden names.

Given name (first name)

What is your current U.S. mailing
address?

Instructional Text

Notes

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.

(If yes)

2.7.a

When and where
you were born

Have you used any other names
since birth?

Field Type

2.2b

2.5.b
2.5.c
2.5.d
2.5.e
2.5.f
2.6

Describe yourself

What is your current legal name?

Sub-Question

Required field

Provide the other names you have used.

Text
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
Apartment, suite, unit, or floor

Required field
Required field
Required field
Required field

Text

Street number and name

Text
Text
Dropdown
Text
Radio

Apartment, suite, unit, or floor

Single, Married, Divorced, Widowed Radio

Text

About You

I-765 INTERACTIVE FORM COPY: ABOUT YOU

Secondary Nav

Your immigration
information

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

2.19b

What is your state or province of
birth?

2.19c
2.20

What is your country of birth?
What is your date of birth?

2.18

What is your country of citizenship or
nationality?

Dropdown

2.21.a

What is your Form I-94 ArrivalDeparture Record Number (if any)?

11 character
restricted
text

2.22
2.23

2.24
2.21.b

When did you last arrive in the United
States?

What is the passport number of your
most recently issued passport?

2.21c

What is your travel document number
(if any)?

2.21.e

What is the expiration date of your
passport or travel document?

Instructional Text

Help Text

Notes

Text

(mm/dd/yyyy)

Dropdown
Date

Date of arrival
Place of arrival

Date
Dropdown

Status at last arrival

Dropdown
Text

Required field

List all countries where you are currently
a citizen or national.

List your arrival date, place of arrival, and
status at arrival.

User will be able to input multiple
countries (at least two based on paper
form). It will be a table or list.

mm/dd/yy

Text

(mm/dd/yyyy)

Date

About You

I-765 INTERACTIVE FORM COPY: ABOUT YOU

Secondary Nav

Tertiary Nav

Paper Form Question
Question
2.21.d
2.25
2.26

Additional
information

2.8

2.9

2.13a

Sub-Question

Field Type

What country issued your passport or Country
travel document?
What is your current immigration status
or category?
What is your Student and Exchange
NVisitor Information System (SEVIS)
Number (if any) ?
What is your A-Number?
A-

Dropdown

I do not have or know my A-Number.
What is your USCIS Online Account
Number?

Checkbox
Text (12
digits)

I do not have or know my USCIS Online
Account Number.
Has the Social Security
Administration (SSA) ever officially
issued a Social Security card to
you?

Instructional Text

Help Text

Notes

Dropdown
Text

Text (9 digits)

Use the "Additional Information"section
to include all previously used SEVIS
numbers.

Providing your unique USCIS Online
The phrase "certain paper forms" would have a
Account Number (OAN) helps us manage tooltip that would list the forms: "I-90, I-130, I-485, Iyour account. You may already have an 821, I-821D, N-336, N-400, N-565, N-600, N-600K"
OAN if you previously filed certain paper
forms and received an Account Access
Notice in the mail. You can find the OAN
at the top of the notice; it is not the
same as an A-Number.

Checkbox
Yes/No

Radio

2.13b

(If yes to 2.13a) What is your Social
Security number (if known)?

Text (9 digits)

2.14

Do you want the SSA to issue you a Yes/No
Social Security card?

Radio

2.15

(If yes to 2.14) Consent for
Yes/No
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.

Radio

About You

I-765 INTERACTIVE FORM COPY: ABOUT YOU

Secondary Nav

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

2.16b

(If yes to 2.15) What is your father's Given name (first name)
birth name?

Text

2.16a
2.17b

Family name (last name)
(If yes to 2.15) What is your mother's Given name (first name)
birth name?

Text
Text

2.17a

Family name (last name)

Text

Instructional Text

Help Text

Notes

About You

I-765 INTERACTIVE FORM COPY: EVIDENCE

The Evidence step is for forms that require the applicant to submit evidence to USCIS. As the applicant completes the form, the form's logic will dictate which pieces of evidence a particular applicant should be prompted to submit.
Step: Indicates the form navigation element. In this case, these questions would appear in the Evidence step of the form.
Section: Indicates the form sub-navigation element. The following copy for questions is grouped by the section in which they should appear.
Evidence title: Type of evidence being requested
Instructional text: Clarifying information about what type of evidence an applicant should submit. Copy for evidence is created using the form's paper instructions.
Evidence types are separated by a double-line.
Field type is the universal upload pattern
Primary Nav
Evidence

Secondary Nav
2 x 2 Photo of you

Paper Form
Form I-765 instructions, "Required Documentation" pages 25-26

Evidence Title
2 x 2 Photo of You

Instructional Text
Upload 2 identical recent color photographs of yourself that measure 2 inches by 2 inches,
with your face measuring 1 inch to 1 3/8 inch from your chin to the top of your head. Your
eyes should be between 1 1/8 inch and 1 3/8 inch from the bottom of the photo.

Field Type
Upload

Make sure your whole face is visible, you are facing the camera directly, and the
background is white or off-white. Your head must be bare, unless contrary to your religious
beliefs.

Logic
Links
https://travel.state.gov/cont
ent/travel/en/us-visas/visainformationresources/photos.html

If you need help understanding the photo requirements or want to resize, rotate, or crop
your photo, you can use to the Department of State's photo composition tools. Please
note that we cannot approve your application without your photos.

Form I-94

Form I-765 instructions, "Required Documentation" page 25

I-94, Arrival and Departure
Record

Upload a copy of one of the following:
- Your Form I-94, Arrival-Departure Record (front and back);
- A printout of your electronic Form I-94 ; or
- Your passport or other travel document.

Upload

https://www.cbp.gov/travel
/international-visitors/i-94
www.uscis.gov/i-102

If you were admitted to the United States by CBP at an airport or seaport after April 30,
2013, CBP may have issued you an electronic Form I-94 instead of a paper Form I-94. You
may visit the CBP website to obtain a paper version of an electronic Form I-94. CBP does
not charge a fee for this service. Some travelers admitted to the United States at a land
border, airport, or seaport, after April 30, 2013, with a passport or travel document, who
were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form I-94
from the CBP website without charge.
If your Form I-94 cannot be obtained from the CBP website, it may be obtained by filing
Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record,
with USCIS. USCIS does charge a fee for this service.

Employment Authorization Document

Form I-765 instructions, "Required Documentation" page 25

Employment Authorization
Document or Government ID

Upload a copy of your last Employment Authorization document (EAD) (front and back). If
you were not previously issued an EAD, you must upload a copy of a government-issued
identity document (such as a passport) showing your picture, name, and date of birth; a
birth certificate with photo ID; a visa issued by a foreign consulate; or a national ID
document with photo and/or fingerprint. The identity document photocopy must clearly
show your facial features and contain your biographical information.

Proof of enrollment

Form I-765 instructions, "Who May File Form I-765"page 7

Proof of Enrollment

Upload evidence of having been lawfully enrolled on a full-time basis for one full academic
year at a college, university, conservatory, or seminary approved by the U.S. Immigration
and Customs Enforcement (ICE) Student and Exchange Visitor Program (SEVP) for
attendance by F-1 foreign students.

If eligibility category is
(c)(3)(A)

Post Completion CPT or OPT

Form I-765 instructions, "Who May File Form I-765"pages 7-8

Post Completion CPT or OPT

Upload evidence of any previously authorized CPT or OPT and the academic level at which it
was authorized.

If eligibility category is
(c)(3)(A) or (c)(3)(B

Form I-20

Form I-765 instructions, "Who May File Form I-765"pages 7-8

I-20, Certificate of Eligibility for
Nonimmigrant Student Status

Upload a copy of the Form I-20, Certificate of Eligibility for Nonimmigrant Student Status
Upload
endorsed by the Designated School Official (DSO). For the (c)(3)(B) eligibility category, your
DSO must have entered the recommendation for OPT into your SEVIS record within 30 days
of you submitting Form I-765. If you fail to do so, we will deny your OPT request. For the
(c)(3)(C) elgibility category, the Form I-20 must have been endorsed by the DSO within 60
days of submitting Form I-765.

If eligibility category is
(c)(3)(A) or (c)(3)(B or
(c)(3)(C)

Upload

Evidence

I-765 INTERACTIVE FORM COPY: EVIDENCE

Secondary Nav
College degree

Paper Form
Form I-765 instructions, "Who May File Form I-765"page 8

Evidence Title
College Degree

Instructional Text
Field Type
Upload evidence that the degree that is the basis for the STEM OPT extension is in one of
Upload
the degree programs currently listed on the STEM Designated Degree Program List or a copy
of your prior STEM degree.

Institution accreditation

Form I-765 instructions, "Who May File Form I-765"page 8

Institution Accreditation

Upload evidence that the institution that granted your STEM degree is currently accredited
by the U.S. Department of Education and certified by the Student Exchange and Visitor
Program (SEVP), if this STEM OPT extension is based on a previously earned STEM degree.

Upload

Logic
Links
https://studyinthestates.dhs. If eligibility category is
gov/stem-opt-hub/eligible- (c)(3)(C)
cip-codes-for-the-stem-optextension

If eligibility category is
(c)(3)(C)

Evidence

I-765 INTERACTIVE FORM COPY: ADDITIONAL INFORMATION

Step: Indicates the form navigation element. In this case, these questions would appear in the Getting Started step of the form.
Section: Indicates the form sub-navigation element. The following copy for questions is grouped by the section in which they should appear.
Questions/Sub-Questions: Based on the questions from the paper 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.
Instructional text: Text that appears directly below a question and provides instructions for answering the question.
Question sets are separated by a double-line.
Conditional question logic is indicated in () before question.
Primary

Secondary

Additional
Information

Additional information 6.1.a-6.7.d

Paper Form Question Question
You may provide additional information for your application

Sub-Question

Field Type Required? Instructional Text

Additional information Textbox

Help Text Notes

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

Additional Information

I-765 INTERACTIVE FORM COPY: REVIEW AND SUBMIT

The Review and Submit step is the last step that an applicant completes before submitting their form. Sections and Questions in the Review and Submit step should be mostly consistent across all forms but copy should be updated to reflect the statements, certification, and attestations on the paper form. Review and Submit should contain all of the copy relating to reviewing the application, the preparer/interpreter's certification
and signature, the applicant's statements and signature, and paying/submitting the application.
Step: Indicates the form navigation element. In this case, these questions would appear in the Review and Submit step of the form.
Section: Indicates the form sub-navigation element. The following copy for questions is grouped by the section in which they should appear.
Questions/Sub-Questions: Based on the required certifications, statements, and signatures from the paper 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.
Instructional text: Text that appears directly below a question and provides instructions for completing this step/section of the form.
CTA: copy for button
Question sets are separated by a double-line.
Conditional question logic is indicated in () before question.
Primary Nav

Review and Submit

Secondary Nav
Review your application

Tertiary Nav

Paper Form

Question
Check your application before you submit

Sub-Question

Field Type

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

Help Text

CTA

Notes
Specific to digital environment and part of
global template previously approved by OMB.

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 form filing fee is: [$XXX}

Your fee

Exact fee will be pulled from ELIS

Refund Policy: USCIS does not refund fees, regardless of any action we take on your
application, petition or request, or how long USCIS takes to reach a decision. 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

Specific to digital environment and part of
global template previously approved by OMB.

A red alert means you have incomplete or incorrect responses to certain questions.
You cannot submit your application with any alerts.
Your application summary

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

Review the I-765 form information

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.

Specific to digital environment and part of
global template previously approved by OMB.

We also prepared a draft case snapshot with your responses, which you can
download below.

(IF PREPARER) Preparer
statement

5.7a

Preparer's statement

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

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.

5.7b
5.7b
5.8a

Preparer's certification and signature

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

Your preparer must read and agree to the certification below.

As the applicant's preparer, you must sign on paper and provide your signature page to the applicant. Follow these steps:

Specific to digital environment and part of
global template previously approved by OMB.

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
(IF PREPARER) Preparer
signature
(IF INTERPRETER)
Interpreter certification

Preparer's signature upload
4.7a

Interpreter's certification and signature

The applicant will need to scan and upload your completed signature page on the next screen.

Upload

I certify, under penalty of perjury, that: I am fluent in English and the language provided in the Getting 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.

Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these steps:

Specific to digital environment and part of
global template previously approved by OMB.

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.

(IF INTERPRETER)
Interpreter signature
Your statement

Interpreter's signature upload
3.1a

Applicant's statement

3.2

Applicant's statement regarding the preparer

Upload
I can read and understand English, and have read and understand every question and instruction on this application, as
Checkbox
well as my answer to every question.
At my request, the preparer named in the Getting Started section of this application prepared this application for me based Checkbox
only upon the information I provided or authorized.

Scan and upload your interpreter's completed signature page below.
You must read and agree to the statement below.
You must read and agree to the statement below.

Review & Submit

I-765 INTERACTIVE FORM COPY: REVIEW AND SUBMIT

Secondary Nav

(If "Your Statement" is
complete) Your signature

Tertiary Nav

Paper Form

Question

Sub-Question

Field Type

Instructional Text

3.1b

Applicant's statement regarding the interpreter

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.

Form I-765, "Applican'ts
Declaration and
Certification" - pages 4-5

Applicant's Declaration and 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.

Help Text

CTA

Notes

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 may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, 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.

I have read and agree to the applicant's statement

3.7a

(If "Your Statement" and
"Your signature" are
complete ) Pay and submit

Your signature
[Date of signature]
Pay for and submit your application

Checkbox

Specific to digital environment and part of
global template previously approved by OMB.
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.

Required field

The final step to submit your Form I-765, Application for Employment Authorization is
to pay the required fee.

Exact fee will be pulled from ELIS

Your application fee is: [$XXX]
Refund policy: By continuing this transaction, you agree that you are paying for a
government service and that the filing fee, biometric services fee and all related
financial transactions are final and not refundable, regardless of any action USCIS
takes on an application, petition or request, or how long USCIS takes to reach a
decision. You must submit all fees in the exact amounts.

We will send you to Pay.gov — our safe, secure payment website — to pay your fees
and submit your application online.

Pay and
submit

Specific to digital environment and part of
global template previously approved by OMB.

Here are the steps in the payment and submission process:
1. Provide your billing information on Pay.gov
2. Provide your credit card or U.S. bank account information
3. Submit your payment
When you have paid your fee, your application will be submitted.
Pay.gov will redirect you to a uscis.gov confirmation screen, which will include your
receipt number. Please keep a copy of your receipt number for your records. You can
track the status of your application through your USCIS online account.

Review & Submit

I-765 INTERACTIVE FORM COPY: Alerts

Number

Section

About You, Additional
1 information

Getting Started,
2 Additional information

3 Review and Submit

Type

Logic

Yellow alert

User selects "No" to consent
statement regarding SSN

Yellow alert

User selects "Yes" to "Do you
want the SSA to issue you a
Social Security card"

Red alert

If user has not answered
required field

Message

Notes

h2. You must agree to the Consent for Disclosure
To receive a Social Security card, you must select "Yes" to the Consent for Disclosure.

h2. You must agree to the Consent for Disclosure
f you answer “Yes”, you must also answer “Yes” to the Consent for Disclosure.
h2. There are errors in (Section): (Sub section)
Edit my response

Alerts

File Type	application/pdf
File Title	Copy of I-130 Form Copydeck 6.18.19- acaOCC 062719
Author	Microsoft Office User
File Modified	2021-02-17
File Created	2021-02-17