I854AB-004-INS-Ext-OMBReview-08262021

Instructions for Inter-Agency Alien Witness and Informant
Record and Adjustment of Status
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-854AB

OMB No. 1615-0049
Expires 11/30/2021

What Is the Purpose of These Forms?
Form I-854A is used by law enforcement agencies (LEAs) to request that an alien witness and/or informant receive
classification as S nonimmigrants. Form I-854B is used by LEAs to request that an alien in S nonimmigrant status be
permitted to apply for adjustment of status to adjust to lawful permanent resident (LPR) status under section 245(j) of the
Immigration and Nationality Act (INA).

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These forms provide the Department of State (DOS) and Department of Homeland Security (DHS) with information
necessary to identify the requesting LEA, the alien witness and/or informant, and others (e.g., the U. S. Attorney needing
the information or testimony of that alien). Forms I-854A and I-854B assist DOS and U.S. Citizenship and Immigration
Services (USCIS) in their joint responsibility to adjudicate requests by LEAs for S classification and adjustment of status
under INA section 245(j).

Who Should Use These Forms?

Federal, state, or local LEAs (the U.S. Attorney’s Office is considered an LEA for purposes of this form) may use these
forms to request that an alien witness and/or informant is:
1. Classified as an S nonimmigrant (Form I-854A); or

2. Allowed to adjust to lawful permanent resident status from the S nonimmigrant classification (Form I-854B).
The LEA must specifically request the following for the alien witness and/or informant and his or her derivatives.
1. S-5 classification

This classification is for an alien who possesses and is willing to provide critical, reliable information to the requesting
LEA on a criminal organization or enterprise, and who otherwise qualifies under INA section 101(a)(15)(S)(i) and
8 CFR 214.2(t)(1).
2. S-6 classification

This classification is for an alien who possesses and is willing to provide information about a terrorist organization;
who will be or is placed in danger as a result; who is eligible for an award under section 36(a) of the DOS Basic
Authorities Act of 1956, 22 U.S.C. 2708; and who otherwise qualifies under INA section 101(a)(15)(S)(ii) and
8 CFR 214.2(t)(2).
3. S-7 classification
This classification is for a spouse, married and unmarried sons and daughters, and parents of an alien witness and/or
informant who otherwise qualify under INA section 101(a)(15)(S) and 8 CFR 214.2(t).
NOTE: A Federal or state LEA may request S-5 classification for an alien witness and/or informant. However, only a
Federal LEA or Federal Court may request an S-6 classification. The LEA sponsoring an S-5 or S-6 may also sponsor an
S-7 derivative.
LEA May Also Make a Request for Derivative Beneficiaries
The LEA may include qualifying relatives (spouse, married and unmarried sons and daughters, and parents) of the alien
witness and/or informant in a request for the S nonimmigrant classification.
The LEA must fill out separate Forms I-854A and I-854B for each derivative. The LEA must also include all required
information for such derivative beneficiaries of this request at the time of filing the nonimmigrant classification request.

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USCIS will consider only qualifying relatives identified at the time of filing as accompanying or following to join the alien
witness or informant. The LEA must attach proof of family relationship, biological data, and grounds of inadmissibility for
each named qualifying relative.
Request for an S Nonimmigrant to File for Adjustment of Status to Lawful Permanent Resident (Form I-854B)
The LEA that originally requested the S classification must submit a request to allow a nonimmigrant in an S classification
to file for adjustment to lawful permanent resident status, pursuant to INA section 245(j) and 8CFR 245.11, and may file the
request until the alien has fulfilled the terms and conditions of his or her S classification.
The sponsoring LEA must attach all relevant documentation establishing that the alien has fulfilled the terms and conditions
of his or her S classification and related recommendations to the request on Form I-854B.

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Only the derivative beneficiaries named on the request for S classification are eligible to adjust status pursuant to
8 CFR 245.11.

General Instructions

USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you should
use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/.
Each form must be properly signed and filed. USCIS will not accept a photocopy of a signed form or a typewritten name in
place of a signature. If you are under 14 years of age, your parent or legal guardian may sign the form on your behalf.
Read the instructions and carefully complete all relevant parts of this form. You must use a separate form for each alien
witness and/or informant requested.
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Required Documentation section of these instructions.
Copies. You may submit a legible photocopy of documents requested, unless the instructions specifically state that you
must submit an original document. If you submit original documents when not required, the documents may remain a part
of the record, and USCIS will not automatically return them to you.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must certify that the English language translation is complete and accurate, and that he or she is
competent to translate from the foreign language into English.
How To Fill Out Forms I-854A and I-854B

1. Type or print legibly in black ink. Failure to answer all questions will delay the processing of this form and may result
in its denial.
2. If you need extra space to complete any item within this form, attach a separate sheet of paper; type or print your
name, the name of the alien, and the LEA requestor at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and sign and date each sheet. You should make copies of
these completed forms for your records.
3. Answer all questions fully and accurately. If an item is not applicable or the answer is “none,” type or print “N/A,”
unless otherwise directed.
Provide exact information about the request you are making (e.g., for S classification waivers of grounds of
inadmissibility or adjustment of status) and complete and attach all necessary certifications and documentation.
4. Form I-94 Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or USCIS issued the alien a
Form I-94, Arrival-Departure Record, provide his or her I-94 admission number and date that his or her authorized
period of stay expires or expired (as shown on the Form I-94). The I-94 admission number also is known as the
Departure Number on some versions of Form I-94.

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NOTE: If the alien was admitted to the United States by CBP at an airport or seaport after April 30, 2013, he or she
may have been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. The alien may visit the CBP
Web site at www.cbp.gov/i94 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 Web site without charge. If the alien’s Form I-94 cannot be obtained from the CBP Web
site, 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.
Passport and Travel Document Numbers. If the alien used a passport or travel document to travel to the United
States, enter either the passport or travel document information in the appropriate space on the form, even if the
passport or travel document is currently expired.

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Required Documentation
For S Classification

Requests for the S classification (8 CFR 214.2(t)) are premised on the alien witness and informant’s willingness to provide
critical, reliable information. Contact the Department of Justice (DOJ), Office of Enforcement Operations, Special
Operations Unit for details of specific requirements.
NOTE: LEAs may not make promises for immigration benefits to an alien seeking S classification.
For Ground(s) of Inadmissibility

Form I-854A, Part 1., Item Number 8. You must ascertain and attach all grounds of inadmissibility (i.e., the reasons the
alien may not be admissible to the United States) and a statement of each ground, or suspected ground, to this form.
Review the grounds of inadmissibility carefully with the alien and remind him or her that failure to disclose all grounds
of inadmissibility (conduct or conditions) on this form may result in denial of this request and/or removal from the United
States.
For each ground checked in Part 1., Item Number 8., you must provide a statement of all reasons why you believe USCIS
should exercise discretionary waiver authority favorably for this alien for admission in the S classification.
Be as specific as possible and attach affidavits, statements, memorandums, or other documentation as necessary to explain
circumstances. You should present specific reasons for exercising discretionary waiver authority whenever possible (e.g.,
if the alien has a history of drug abuse, you may present evidence of rehabilitation), such as the affidavits from doctors,
psychiatrists, or other experts.
Documentation. You may submit evidence to verify the basis of the request (i.e., for a waiver, classification, or adjustment
of status) in the form of affidavits, statements, memorandums, or other documentation.
You must also submit the following for each alien named in this request.
1. Two sets of the alien’s fingerprints and signatures on Form FD-258.
2. Two identical color photographs of the alien taken within 30 days of filing this form. The photos must have a white to
off-white background, be printed on thin paper with glossy finish, and be unmounted and unretouched.
Passport-style photos must be 2” x 2.” The photos must be in color with a full face, frontal view. Head height should
measure 1” to 1 3/8” from top of hair to bottom of chin and eye height is between 1 1/8” to 1 3/8” from bottom of
photo. The alien’s head must be bare unless he or she is wearing headwear as required by a religious denomination
of which he or she is a member. Using pencil or felt pen, lightly print the alien’s name and his or her alien’s Alien
Registration Number (A-Number) on the back of each photo.
3. The alien’s A-Number (if any), FBI Number, U.S. Social Security Number (if any), and Form G-325, Biographical
Information.
4.

Copy of the alien’s birth certificate (with translation) or passport.

5.

Evidence of the alien’s current immigration status or legal presence (e.g., parole, deferred action).

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Required Certifications
Alien Certification
The certifications made by the alien and the LEA requestor provide a critical record for the future.
After you have carefully explained the certifications in Part 2. of Form I-854A and reviewed all statements on or attached
to the form for accuracy, read the certifications to the alien and ensure that the alien understands each condition of
admission and continued stay in lawful permanent resident status.
Indicate if the certification is interpreted to ensure the alien’s understanding. Make sure the alien understands that an
adjustment of status is not available until he or she has satisfied the conditions of admission and has continued to stay in
lawful permanent resident status in the S classification.

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LEA Certification (Form I-854A)

The LEA certification is necessary to provide a signatory witness to the alien’s signature and stated understanding of his or
her certification. LEA headquarters level certification is required to ensure that no promises were made other than those
afforded by section 101(a)(15)(S) of the INA, and that full assumption of the responsibilities outlined in the request are
authorized. The name of the LEA agency contact on this case, who is available by telephone for questions and verification
of information, is also necessary.
LEA Certification (Form I-854B)

The LEA certification for Form I-854B is the formal request by the LEA that the Department of Justice, Criminal Division
recommends that alien is allowed to apply for adjustment of status under INA section 245(j).
United States Attorney Certification

The U.S. Attorney’s certification is necessary if the alien witness and/or informant will participate in a prosecution or
investigation that falls within the jurisdictional authority of a United States Attorney or if a state or local LEA will submit
this form.
In some cases, the U.S. Attorney can defer their certification to the Assistant Attorney General for the Department of
Justice, Criminal Division.

What is The Filing Fee?

There are no filing fees for processing Forms I-854A or I-854B.

Where to File
Submit requests for S nonimmigrant classification or for S nonimmigrants to file for adjustment of status to:
U.S. Department of Justice
Criminal Division, Office of Enforcement Operations
Special Operations Unit
1301 New York Avenue NW, 9th floor
Washington, D.C. 20530-0001
NOTE: The Criminal Division, will forward certified requests on Forms I-854A and I-854B for processing to USCIS.
USCIS will not adjudicate any request made on Forms I-854A and I-854B without the certification of the Criminal
Division.

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Other Information
Employment Authorization
Alien witnesses and/or informants who have received S nonimmigrant classification are eligible to receive an Employment
Authorization Document (EAD) enabling them to seek employment in the United States. Alien witnesses and/or informants
may request an EAD by filing Form I-765, Application for Employment Authorization, under the C21 eligibility category.
Instructions for Form I-765 are available on the USCIS Web site at www.uscis.gov/I-765. You may not file Form I-765
with Forms I-854A and I-854B. You must file Form I-765 separately.
Authority for Collecting This Information

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You can find the authority that requires you to file Form I-854A, when requesting to classify an alien witness and/or
informant as an S nonimmigrant, at INA section 101(a)(15)(S). You can find the authority to require you to file Form
I-854B, when requesting that an S nonimmigrant is permitted to apply for adjustment of status, under INA section 245(j).
Information you provide on Forms I-854A and I-854B is used to determine eligibility for the requested benefit/authorization
to record the numbers of requests and determinations made on this form, track and monitor the alien, and provide Congress
with a required annual report on the admission of alien witnesses and/or informants.
Failure to provide all information as required may result in the denial or rejection of this form. USCIS, DOS, and DOJ
may also disclose the information you provide to other Federal, state, local, and foreign law enforcement, intelligence, and
regulatory agencies.

USCIS Forms and Information

To ensure you are using the latest versions of these forms, visit the USCIS Web site at www.uscis.gov where you can obtain
the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order USCIS
forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling the USCIS
National Customer Service Center at 1-800-375-5283. For TDD (deaf or hard of hearing) call: 1-800-767-1833.

Penalties

All statements made in response to questions on this form are declared to be true and correct under penalty of perjury
18 U.S.C. 1546, which provides in part:
Whoever knowingly makes under oath, or as permitted under penalty under 28 U.S.C. 1746, knowingly subscribes
as true, any false statement with respect to a material fact in any application, affidavit, or other document required
by the immigration laws or regulations prescribed thereunder, or knowingly presents any such application, affidavit,
or other document containing any such false statement - shall be fined in accordance with this title or imprisoned
for not more than five years, or both.
The knowing placement of false information on this form may subject the alien and/or the preparer of this form to criminal
penalties under Title 18 U.S.C. 1546(a). The knowing placement of false information on this form may also subject the
alien and/or the preparer to civil penalties under section 274C of the Act, 8 U.S.C. 1324c. Under 8 U.S.C. 1324c, a person
subject to a final order for civil document fraud is removable from the United States and may be subject to fines.

DHS Privacy Notice
AUTHORITIES: The information requested on these forms, and the associated evidence, is collected under 8 U.S.C.
section 1101(a)(15)(S).
PURPOSE: The primary purpose for providing the requested information on these forms are to obtain either S nonimmigrant
status or adjustment of status after assisting a law enforcement agency as a witness or informant. DHS uses the information
you provide to grant or deny the immigration benefit you are seeking.

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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 form.
ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide
on these forms 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 of Records] and published
privacy impact assessment [DHS/USCIS/PIA-013-01 Fraud Detection and National Security Directorate] which you can
find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the
interest of national security.

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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 OMB control number. The public reporting burden for this collection of
information is estimated at 3 hours per response on Form I-854A and 1 hour per response on Form I-854B, including the
time for reviewing instructions and completing and submitting the form. 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail
Stop #2140, Camp Springs, MD 20588-0009; OMB No. 1615-0046. Do not mail your completed form to this address.

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