[Page 13]
…
If
you answered “Yes” to Item
Number 22.,
identify the classification sought and the receipt number for
those petitions in Part
11. Additional Information.
…
If
you answered “Yes” to Item
Number 23.,
identify the classification sought and the receipt number for
those petitions in Part
11. Additional Information.
…
If
you answered “Yes” to Item
Number 24.,
identify the receipt number for the petition and the date of the
decision in Part 11.
Additional Information.
Provide
the worker’s prior periods of stay in CW-1 classification in
the United States for the last three years in Item
Numbers 25.a. - 27.c.
Be sure to only provide those periods in which the worker was
actually in the CNMI in CW-1 status. Do not include periods in
which the worker was in a dependent status (for example, CW-2
status). If you need extra space to complete this section, use
the space provided in Part
11. Additional Information.
…
Period
of Stay 3
27.a.
Employer’s Name
27.b.
Period of Stay From (mm/dd/yyyy)
27.c. To (mm/dd/yyyy)
[Page 14]
Information about the
Additional Beneficiary’s Public Benefits
28. Has the beneficiary,
since obtaining the nonimmigrant status that you seek to extend or
that you seek to change on behalf of the beneficiary, received, or
is the beneficiary currently certified to receive, any of the
following public benefits (select all that apply)?
Yes, the beneficiary
has received or is currently certified to receive the following
benefits:
Any Federal, State, Local, or
Tribal Cash Assistance For Income Maintenance
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)
Public
Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.
Federally-Funded
Medicaid
No,
the beneficiary has not received any of the above listed public
benefits.
No,
the beneficiary is not certified to receive any of the above
listed public benefits.
29. If the beneficiary has
received or is currently certified to receive any of the above
public benefits, provide information about the public benefits,
below. If you need additional space to complete any Item
Number in this Part, use the space provided in Part
11. Additional Information. Submit evidence as outlined in
the Instructions.
A. Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started
Receiving the Benefit or if Certified, Date the Beneficiary Will
Start Receiving the Benefit (mm/dd/yyyy)
Date Benefit or Coverage Ended or
Expires (mm/dd/yyyy)
B. Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started
Receiving the Benefit or if Certified, Date the Beneficiary Will
Start Receiving the Benefit (mm/dd/yyyy)
Date Benefit or Coverage Ended or
Expires (mm/dd/yyyy)
C. Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started
Receiving the Benefit or if Certified, Date the Beneficiary Will
Start Receiving the Benefit (mm/dd/yyyy)
Date Benefit or Coverage Ended or
Expires (mm/dd/yyyy)
D. Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started
Receiving the Benefit or if Certified, Date the Beneficiary Will
Start Receiving the Benefit (mm/dd/yyyy) Date Benefit or Coverage
Ended or Expires (mm/dd/yyyy)
[Page 15]
30. If you answered “Yes”
to Item Number 1., do any of the following apply to the
beneficiary? Provide the evidence listed in the Form I-129CW
Instructions.
The beneficiary is enlisted in the
U.S. Armed Forces, or is serving in active duty or in the Ready
Reserve Component of the U.S. Armed Forces.
The beneficiary is the spouse or the
child of an individual who is enlisted in the U.S. Armed Forces,
or who is serving in active duty or in the Ready Reserve Component
of the U.S. Armed Forces.
At the time the beneficiary received
the public benefits, the beneficiary (or the beneficiary’s
spouse or parent) was enlisted in the U.S. Armed Forces, or was
serving in active duty or in the Ready Reserve Component of the
U.S. Armed Forces.
At the time the beneficiary received
the public benefits, the beneficiary was present in the United
States in a status exempt from the public charge ground of
inadmissibility.
At the time the beneficiary received
the public benefits, the beneficiary was previously present in the
United States after being granted a waiver of the public charge
ground of inadmissibility.
The beneficiary is 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 the beneficiary.
31.a. Has the beneficiary
received, applied for, or has been certified to receive
federally-funded Medicaid in connection with any of the following
(select all that apply):
NOTE: Submit evidence as
outlined in the Instructions.
An Emergency Medical Condition
For a Service Under the Individuals
with Disabilities Education Act (IDEA)
Other School-based Benefits or
Services Available Up to the Oldest Age Eligible for Secondary
Education Under State Law
While Under 21 Years of Age
While Pregnant or During the 60-day
Period Following the Last Day of Pregnancy
31.b. Provide the Applicable
Dates
Start Date (mm/dd/yyyy)
End Date (mm/dd/yyyy)
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