I-765 Copy Deck - Online Filing

I-765-041-CopyDeck-OPT+TPS Categories.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⚠️ Notice: This form may be outdated.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 Application for Employment Authorization
Eligibility Categories: OPT, TPS
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

Heading
Sub-Heading
Application for
Employment Authorization

Body Text
Revised Body Text
Certain foreign nationals who are in the United States may file Form I-765, Application for Employment Authorization, to request
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.

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

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.
For all other eligibility categories, you must submit a paper Form I-765.

You may apply online if your eligibility category is:
(c)(3)(A) - F-1 student, pre-completion OPT
(c)(3)(B) - F-1 student, post-completion OPT
(c)(3)(C) - F-1 student, 24-month extentions for STEM students (students holding a degree in science, technology, engineering, or
mathematics);
(a)(12) - Temporary Protected Status (You are submitting an initial Form I-821 or you have an approved Form I-821); or
(c)(19) - Temporary Protected Status (You have a pending Form I-821)
Note: You may submit Form I-765 online as an (a) (12) or (c) (19) applicant only if you are:
A national of Burma, Haiti, Syria or Venezuela, or a person without who last habitually resided in one of these four countries;
Filing an initial application for TPS; and
Applying for an initial request to accept employment or renewing permission to accept employment
All other applicants 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
(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.

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

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

F-1 Students Seeking Optional Practical Training (OPT)
(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
(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.

Temporary Protected Status
(a)(12) and (c)(19) eligibility categories: Submit your application with your Form I-821 application or with evidence that we accepted or
approved your initial Form I-821. Include evidence of your nationality and identity as required by the Form I-821 Instructions. If an EOIR
Immigration Judge (EOIR IJ) or the Board of Immigration Appeals (BIA) granted TPS and you are requesting your first EAD, you must submit a
copy of the order that granted TPS with your Form I-765 (such as a copy of your Form I-821 that the EOIR IJ or BIA approved). you must also
follow the instructions for filing your application as described in the most recent TPS Federal Register Notice regarding a TPS designation, redesignation, or extension for your country.
Note: You may submit this form with Form I-821 online if you are applying under the (a)(12) eligiblity category and applying for an initial
request to accept employment.

Fee

Fee: $410.

Fee: $410. If you are requesting an EAD as an initial TPS applicant, you must pay the Form I-765 filing fee, unless you are younger than 14 or
older than 65.
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
Note: if you are submitting this form with Form I-812, your total application fee will reflect the fees for Form I-821, Form I-765, and Biometric
decision. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for Services (if required). You will pay for all three at the end of this form.
a government service.
Refund policy:
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- 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
5283. For TTY (deaf or hard of hearing) 800-767-1833.
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

After You Submit Your
Application

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.

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.
- A color passport-style photograph of yourself taken recently.

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.

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.

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

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

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.

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

Application Overview

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

Heading

Completing Your Form
Online

Sub-Heading

Body Text

Revised Body Text

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.

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.
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.

Paperwork Reduction Act

Link

CTA

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

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
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

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:

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.
Primary Nav

Secondary Nav

Tertiary Nav

Paper
Form

Question

Sub-Question

Field Type

Instructional Text

Getting Started Basis of eligibility

Revised Instructional Text

Help Text

Notes

(Alert msg) You can file your request online only
for certain eligiblity categories
If your eligiblity category does not appear on the
drop-down list, you must file a paper Form I-765.
If you submit online and are not eligible for one
of the listed categories, your application may be
denied.
2.27

What is your eligibility category?

Eligibility Category

Dropdown

Required field
(only (a)(12) supported for concurrent filing
with Form I-821)
[If A12 selected]
(Alert msg) Only certain TPS applicants may
apply online
To apply under this eligiblity category online,
you must be an eligible national or habitual
resident of Burma, Haiti, Syria, or Venezuela
filing an initial application for TPS. If you do not
meet these requirements, please submit a paper
Form I-765. If you file online and you are not
allowed to, we may deny your application.

Reason for applying

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
Salvadoran or Guatemalan national eligible for benefits
under the ABC settlement agreement?

1.1.a

What is your reason for applying?

1.1.b

1.1.c

a. Initial permission to accept employment.

Radio

If concurrently filed with I-821, selection does
not display

Radio
Radio

Is someone assisting you with completing this application?

Yes/No

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

4.1.b

What is your interpreter's full name?

Mobile telephone number
My preparer does not have a mobile telephone number
Email address
My preparer does not have an email address.
Given name (first name)

Text
Checkbox
Text
Checkbox
Text

4.1.a
4.2

What is your interpreter's business or organization name?

5.4
5.5
5.6

4.3

What is your interpreter's mailing address?

Required field
If concurrently filed with I-821, selection does
not display

Yes/No

5.3.a.5.3.h.

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

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.

c. Renewal of permission to accept employment.

Preparer and
interpreter
information

(IF YES TO
INTERPRETER)
Interpreter
information

Radio

Have you previously filed Form I-765?

2.12

(IF YES TO PREPARER
QUESTION) Preparer
information

Yes/No

Family name (last name)

Text
Text

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

Checkbox
Dropdown

Address line 1
Address line 2
City or town
State/Province

Text
Text
Text
Dropdown/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

Tertiary Nav

Paper
Form
4.4

Question

Sub-Question

Field Type

What is your interpreter's contact information?

ZIP code/Postal code
Daytime telephone number

Text
Text

Instructional Text

Revised Instructional Text

Help Text

Notes

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

4.5

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.
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Paper Form Question
Question

Sub-Question

2.1.b

Given name (first name)

2.1.c
2.1a

Your contact
information

Help Text

Middle name
Family name (last name)
Yes/No

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

Given name (first name)

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

Address line 1

Text

Street number and name

Text
Text
Dropdown
Text
Radio

Apartment, suite, unit, or floor

What is your gender?

Address line 2
City or town
State
ZIP code
Male/Female

2.12

What is your marital status?

Single, Married, Divorced, Widowed Radio

2.19a

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

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

What is your current U.S. mailing
address?

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

(If no) Where in the United States do
you live?

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?

Instructional Text

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?

Field Type

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
Required field
Apartment, suite, unit, or floor
Required field
Required field
Required field

Text

About You

Secondary Nav

Your immigration
information

Tertiary Nav

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

2.21.d
2.25
2.26

Additional
information

Sub-Question

2.8

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

Country

Dropdown
Dropdown

N-

Text

A-

Text (9 digits)

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

About You

Secondary Nav

Tertiary Nav

Paper Form Question
Question

2.9

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

2.13a

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?

Sub-Question

Field Type

Checkbox
Text (12
digits)

2.14

Do you want the SSA to issue you a
Social Security card?

Yes/No

Radio

2.15

(If yes to 2.14) Consent for Disclosure: I Yes/No
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

2.16b

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

Given name (first name)

Text

Family name (last name)
Given name (first name)

Text
Text

Family name (last name)

Text

2.17a

Notes

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.

Radio

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

(If yes to 2.15) What is your mother's
birth name?

Help Text

Checkbox
Yes/No

2.13b

2.16a
2.17b

Instructional Text

Text (9 digits)

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.
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)

College degree

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

College Degree

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.

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

Upload

Evidence

Secondary Nav
Institution accreditation

Proof of TPS

Proof of identity and nationality

Form I-821

Replacement TPS EAD

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

Form I-765 instructions, "Who May File Form I-765" page
6

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

If an EOIR Immigration Judge (EOIR IJ) or the Board of Immigration Appeals (BIA) granted
TPS, and you are requesting your first EAD or are re-registering for the first time, upload a
copy of the EOIR IJ or BIA order that granted TPS (such as a copy of your Form I-821 that
the EOIR IJ or BIA approved).

If (a)(12)

(If concurrently filing, do
not show)

Upload proof of your identity and nationality. Examples of documents you may submit
include copies of your:

If (a)(12)

Instructional Text
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.

Proof of Temporary Protected
Status Granted by EOIR Immigration
Judge or Board of Immigration
Appeals

Form I-765 instructions, "Who May File Form I-765" page
6
Proof of identity and nationality
I-821, Application for Temporary
Protect Status
Form I-765 instructions, "Who May File Form I-765" page
6
Replacement for Temporary
Protected Status Employment
Authorization Document
Form I-765 instructions, "Who May File Form I-765" page
7

Links

Evidence Title
Institution Accreditation

Field Type
Upload

- Passport (cover to cover);
- Birth certificate accompanied by photo identification; or
- Any national identity document from your country of origin that includes your photo
and/or fingerprint.
If you previously filed Form I-821, upload evidence that we accepted or approved your
initial Form I-821.

If your non-expired TPS EAD is lost, stolen, or damaged, upload a copy of your approval
notice for TPS (if you have been approved) or a copy of your previous Form I-797 Notice for
Form I-821 if your TPS application is still pending.

If (a)(12) or (c)(19)

(c)(19) not supported for
concurrent filing. (If
concurrently filing, do not
show)
If (a)(12) or (c)(19) AND 1.1b If (a)(12) or (c)(19) AND 1.1b
(c19 not supported for
concurrent filing) (If
concurrently filing, do not
show)

Evidence

I-765 INTERACTIVE FORM COPY: ADDITIONAL INFORMATION
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.
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
Content specific to digital environment

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: [$XXX}

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.
Alerts and warnings

Your application summary

You have one or more alerts and warnings based on the information you provided in your
application.
A red alert means you have incomplete or incorrect responses to certain questions. You
cannot submit your application with any alerts.
Here is a summary of all the information you provided in your application.

Review the I-765 form information

Content specific to digital environment

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.
We also prepared a draft case snapshot with your responses, which you can download
below.
(IF PREPARER) Preparer
statement

5.7a

Preparer's statement

5.7b
5.7b
5.8a

Preparer's certification and signature

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

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

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.

Your preparer must read and agree to the certification below.

Content specific to digital environment

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

Preparer's signature upload
4.7a

Interpreter's certification and signature

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:

Content specific to digital environment

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

(If "Your Statement" is
complete) Your signature

Interpreter's signature upload
3.1a

Applicant's statement

3.2

Applicant's statement regarding the preparer

3.1b

Applicant's statement regarding the interpreter

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

Applicant's Declaration and Certification

Upload

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

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

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.

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.

You must read and agree to the statement below.
You must read and agree to the statement below.

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.

3.7a

Your signature

I have read and agree to the applicant's statement

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.

Content specific to digital environment
Required field

Review & Submit

Secondary Nav

Tertiary Nav

Paper Form

Question

Sub-Question
[Date of signature]
Pay for and submit your application

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

Field Type

Instructional Text

Help Text

CTA

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

Notes
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

Content specific to digital environment

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.
(If concurrently filed with I821) Finish and continue
to pay and submit

Finish and continue to pay and submit

(If Representative
completing form on behalf
of client) Finish and
continue to G-28

Finish the Form I-765 and continue to the G-28

By finishing this form, your Form I-765 will be locked and no further changes can be made. Please make sure that the information
on your Form I-765 is complete and accurate before continuing. If you need to make any edits after finishing, you will need to create
both a new Form I-821 and a new Form I-765.
Next, you will continue to the pay and submit page where you can pay for and submit both your Form I-821 and Form I-765 at the
same time.
By finishing this form, your Form I-765 will be locked and no further changes can be made. Please make sure that the information
on your Form I-765 is complete and accurate before continuing. If you need to make any edits after finishing, you will need to create
both a new Form I-821 and a new Form I-765.
We will prepare a draft Form I-821 and Form I-765 for your client to review and sign. If your client does not approve the information
provided in the Form I-821 or Form I-765, you will need to edit the information in the form, and resubmit it for your client's review.
Next, you will continue to the G-28. When you submit the G-28, we will give you a passcode for your client to add you as his or her
representative in his or her USCSIS online account. Once you are added, your client will have access to review the draft Form I-821,
the draft Form I-765, and the draft G-28.

(No nav)

Pay for and submit your applications

The final step to submit your Form I-821, Application for Temporary Protected Status (TPS) and your Form I-765, Application for
Employment Authorization is to pay the required fee.
Form I-821: [$XXX]
Form I-765: [$XXX]
Biometrics: [$XXX]
Your total 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.

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

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	2021-06-23
File Created	2021-06-23