| myUSCIS copy deck | ||||||
| I-821D Consideration for Deferred Action for Childhood Arrivals | ||||||
| OMB control number 1615-0124 | ||||||
| I-821D Expires: 03/31/2023 | ||||||
| I-765 Expires: 01/31/2023 |
| I-821D 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 |
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| Heading | Sub-Heading | Body Text | Revised | Link | CTA | Notes |
| I-821D, Consideration of Deferred Action for Childhood Arrivals | Use this form to request consideration of Renewal of Deferred Action for Childhood Arrivals (DACA). Deferred action is a discretionary determination to defer removal action of an individual as an act of prosecutorial discretion. Anyone who receives deferred action will not be placed into removal proceedings or removed from the United States for a specified period of time, unless the Department of Homeland Security (DHS) chooses to terminate the deferral. USCIS considers deferring action (including renewal of deferred action) on a case-by-case basis. Requesters filing Form I-821D must also file Form I-765, Application for Employment Authorization, and Form I-765 Worksheet, Form I-765WS. You must fill out the paper Form I-765WS and upload the completed copy with your application. Learn more about DACA. |
https://www.uscis.gov/sites/default/files/document/forms/i-765ws.pdf www.uscis.gov/DACA | Form I-821D, Instructions, page 1 | |||
| Before You Start Your Request | Eligibility | You may file online only if you are submitting a renewal request. If you are submitting an initial request for DACA, you must submit a paper Form I-821D. You may be considered for renewal of DACA if you meet all the requirements for initial DACA and: •Did not depart the United States on or after August 15, 2012 without advance parole; •Have continuously resided in the United States since you submitted your most recent request for DACA that was approved up to the present time; and •Have not been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and do not otherwise pose a threat to national security or public safety. We may consider deferring action in your case even if you have been arrested or detained by any law enforcement officer and charges were filed, or if charges were filed against you without an arrest. We will evaluate the totality of the circumstances in reaching a decision on deferred action. If we determine that you have been convicted of a felony, a significant misdemeanor, or three or more misdemeanors not occurring on the same date and not arising out of the same act, omission, or scheme of misconduct, or that you otherwise pose a threat to national security or public safety, we are unlikely to defer action in your case. CAUTION: If you file this request more than 150 days prior to the expiration of your current period of deferred action, USCIS may reject your submission and return it to you with instructions to resubmit your request closer to the expiration date. USCIS encourages renewal requestors to file as early in the 150-day period as possible - ideally, at least 120 days prior to the DACA expiration date. If you are currently in immigration detention, you may not request consideration of Renewal of DACA from USCIS. If you think you meet the guidelines of this process, you should identify yourself to your deportation office. Note: You must submit this form with Form I-765 online. We will add Form I-765 for you to complete after you sign your Form I-821D. |
You may file online only if you are submitting a renewal request. If you are submitting an initial request for DACA, you must submit a paper Form I-821D. You may be considered for renewal of DACA if you meet all the requirements for initial DACA and: •Have continuously resided in the United States since you submitted your most recent request for DACA that was approved up to the present time; and •Have not been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and do not otherwise pose a threat to national security or public safety. We may consider deferring action in your case even if you have been arrested or detained by any law enforcement officer and charges were filed, or if charges were filed against you without an arrest. We will evaluate the totality of the circumstances in reaching a decision on deferred action. If we determine that you have been convicted of a felony, a significant misdemeanor, or three or more misdemeanors not occurring on the same date and not arising out of the same act, omission, or scheme of misconduct, or that you otherwise pose a threat to national security or public safety, we are unlikely to defer action in your case. CAUTION: If you file this request more than 150 days prior to the expiration of your current period of deferred action, USCIS may reject your submission and return it to you with instructions to resubmit your request closer to the expiration date. USCIS encourages renewal requestors to file as early in the 150-day period as possible - ideally, at least 120 days prior to the DACA expiration date. If you are currently in immigration detention, you may request consideration of DACA as an Renewal requestor from USCIS. However, if USCIS determines a favorable exercise of discretion is warranted to grant you DACA, USCIS will not approve your DACA request until you are released from detention. If you are requesting DACA, you should tell your deportation officer. Note: You must submit this form with Form I-765 online. We will add Form I-765 for you to complete after you sign your Form I-821D. |
https://www.uscis.gov/i-821d https://www.uscis.gov/DACA |
Form I-821D, Instructions, page 1-2; 11 | |
| Fee | Fee: $0. All requesters must pay a $410 filing fee for Form I-765 and a $85 biometric services fee. Once you complete and sign Form I-821D and Form I-765, you will pay all fees and submit both forms. 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. Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY (deaf or hard of hearing) 800-767-1833. |
Fee: $85. All requesters must pay a $410 filing fee for Form I-765 and a $85 biometric services fee. Once you complete and sign Form I-821D and Form I-765, you will pay all fees and submit both forms. 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. Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY (deaf or hard of hearing) 800-767-1833. |
Form I-821D, Instructions, page 11 | |||
| Documents you may need | At the end of your request, we will highlight certain documents that you should provide with your request for DACA. At the time of filing, you must submit all evidence and supporting documentation listed. Refer to uscis.gov/i-821d if you need additional information about evidence requirements. | https://www.uscis.gov/i-821d | Specific to digital environment and part of global template previously approved by OMB | |||
| Biometric services appointment | Individuals requesting DACA must submit biometrics. You may receive a notice scheduling you to appear at an Application Support Center (ASC) for biometrics collection. Failure to comply with the notice may result in the denial of your deferred action request. USCIS may, in its discretion, waive the collection of certain biometrics. | 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 request. After USCIS receives your request and ensures it is complete, we will inform you in writing if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support Center (ASC) and the date and time of your appointment. If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that: 1. You provided or authorized all information in the request; 2. You reviewed and understood all of the information contained in, and submitted with, your request; and 3. All of this information was complete, true, and correct at the time of filing. If you fail to attend your biometric services appointment, USCIS may deny your application. Failure to comply with the notice may result in the denial of your deferred action request. USCIS may, in its discretion, waive the collection of certain biometrics. |
Specific to digital environment and part of global template previously approved by OMB | |||
| After You Submit Your Request | 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. | Specific to digital environment and part of global template previously approved by OMB | |||
| 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 | ||||
| Receive your decision | We will review your request to determine whether the exercise of prosecutorial discretion is appropriate in your case. Each case will be considered on an individual, case-by, case basis. Even if you satisfy the threshold criteria for consideration of DACA, we may determine that deferred action is not warranted in your case. You will be notified of the decision in writing. There is no motion to reopen/reconsider the decision and there is no right to appeal. | Form I-821D Instructions, page 12 | ||||
| Completing Your Form Online | Filing online | Submitting your request online is the same as mailing in a completed paper form. They both gather the same information. |
Specific to digital environment and part of global template previously approved by OMB | |||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| Provide as many responses as you can | We encourage you to provide complete responses. Incomplete fields or sections and missing information can slow down the process after you submit your form. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| DHS Privacy Notice | AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, section 101, et seq. | AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, section 101, et seq. and 8 CFR Part 236, Subpart C. | Form I-821D Instructions, page 13 | |||
| PURPOSE: The primary purpose for providing the requested information on this form is to determine if you should be considered for deferred action as a childhood arrival. The information you provide will be used in making a decision whether to defer removal action in your case as an exercise of prosecutorial discretion. | Form I-821D Instructions, page 13 | |||||
| DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information or any requested evidence, may delay a final decision in your case or result in denial of your form. | Form I-821D Instructions, page 13 | |||||
| ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and foreign government agencies and authorized organizations following approved routine uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003(a) Integrated Digitization Document Management Program (IDDMP), DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems, and DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which can be found at www.dhs.gov/privacy. OTHER DISCLOSURE INFORMATION: Information provided in this request is protected from disclosure to U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection (CBP) for the purpose of immigration enforcement proceedings unless the requestor meets the criteria for the issuance of a Notice To Appear or a referral to ICE under the criteria set forth in USCIS’ 2011 Notice to Appear guidance (www.uscis.gov/NTA). The information may be shared with national security and law enforcement agencies, including ICE and CBP, for purposes other than removal, including for assistance in the consideration of deferred action for childhood arrivals request itself, to identify or prevent fraudulent claims, for national security purposes, or for the investigation or prosecution of a criminal offense. The above information sharing clause covers family members and guardians, in addition to the requestor. This policy is not intended to, does not, and may not be relied upon to create any right or benefit, substantive or procedural, enforceable at law by any party in any administrative, civil, or criminal matter. |
ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and foreign government agencies and authorized organizations following approved routine uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003(a) Integrated Digitization Document Management Program (IDDMP), DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems, and DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which can be found at www.dhs.gov/privacy. OTHER DISCLOSURE INFORMATION: Information provided in this request will not be used by ICE and U.S. Customs and Border Protection (CBP) for the purpose of immigration enforcement proceedings against the requestor, unless DHS is initiating immigration enforcement proceedings against the requestor due to a criminal offense, fraud, a threat to national security, or public safety concerns. Information contained in this request related to the requestor’s family members or guardians will not be used for immigration enforcement purposes against such family members or guardians. Any information may be shared with national security and law enforcement agencies, including ICE and CBP, for purposes other than removal, including for assistance in the consideration of a deferred action for childhood arrivals request itself, to identify or prevent fraudulent claims, for national security purposes, or for the investigation or prosecution of a criminal offense. This policy is not intended to, does not, and may not be relied upon to create any right or benefit, substantive or procedural, enforceable at law by any party in any administrative, civil, or criminal matter. |
Form I-821D Instructions, page 13 | ||||
| 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 2.5 hours per response, 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 Do not mail your completed Form I-821D to this address. OMB No. 1615-0124 Expires: 03/31/2023 |
Form I-821D Instructions, page 13-14 | ||||
| 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 | |||
| I-821D 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 |
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| Heading | Sub-Heading | Body Text | Revised | Link | CTA | Notes |
| I-821D, Consideration of Deferred Action for Childhood Arrivals | Use this form to request that USCIS exercise prosecutorial discretion in your favor under the Deferred Action for Childhood Arrivals (DACA) process. You may also use this form to request renewal of deferred action. Anyone who receives deferred action will not be placed into removal proceedings or removed from the United States for a specified period of time, unless the Department of Homeland Security (DHS) chooses to terminate the deferral. USCIS considers deferring action (including renewal of deferred action) on a case-by-case basis. Requesters filing Form I-821D must also file Form I-765, Application for Employment Authorization, and Form I-765 Worksheet, Form I-765WS. You must fill out the paper Form I-765WS and upload the completed copy with your application. Learn more about DACA. |
https://www.uscis.gov/sites/default/files/document/forms/i-765ws.pdf www.uscis.gov/DACA | Form I-821D, Instructions, page 1 | |||
| Before You Start Your Request | Eligibility | To request DACA, you must be at least 15 years old, unless you are currently in removal proceedings or have a final removal or voluntary departure order. You may be considered for initial deferred action if you: •Were under the age of 31 as of June 15, 2012; •Came to the United States before reaching your 16th birthday; •Have continuously resided in the United States since June 15, 2007, up to the present time; •Were physically present in the United States on June 15, 2012, and at the time of making your request for consideration of deferred action with USCIS; •Had no lawful status on June 15, 2012, meaning that you never had a lawful immigration status on or before June 15, 2012, or any lawful immigration status or parole that you obtained prior to June 15, 2012, had expired as of June 15, 2012; •Are currently in school, have graduated or obtained a certificate of completion from high school, have obtained a general education - development (GED) certificate, or are an honorably discharged veteran of the Coast Guard or Armed Forces of the United States; and •Have not been convicted of a felony, significant misdemeanor, or three or more other misdemeanors, and do not otherwise pose a threat to national security or public safety. You may be considered for renewal of DACA if you meet all the requirements for initial DACA and: •Did not depart the United States on or after August 15, 2012 without advance parole; •Have continuously resided in the United States since you submitted your most recent request for DACA that was approved up to the present time; and •Have not been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and do not otherwise pose a threat to national security or public safety. We may consider deferring action in your case even if you have been arrested or detained by any law enforcement officer and charges were filed, or if charges were filed against you without an arrest. We will evaluate the totality of the circumstances in reaching a decision on deferred action. If we determine that you have been convicted of a felony, a significant misdemeanor, or three or more misdemeanors not occurring on the same date and not arising out of the same act, omission, or scheme of misconduct, or that you otherwise pose a threat to national security or public safety, we are unlikely to defer action in your case. CAUTION: If you file this request more than 150 days prior to the expiration of your current period of deferred action, USCIS may reject your submission and return it to you with instructions to resubmit your request closer to the expiration date. USCIS encourages renewal requestors to file as early in the 150-day period as possible - ideally, at least 120 days prior to the DACA expiration date. If you are currently in immigration detention, you may not request consideration of Renewal of DACA from USCIS. If you think you meet the guidelines of this process, you should identify yourself to your deportation office. Note: You must submit this form with Form I-765 online. We will add Form I-765 for you to complete after you sign your Form I-821D. |
To request DACA, you must be at least 15 years old, unless you are currently in removal proceedings or have a final removal or voluntary departure order. You may be considered for initial deferred action if you: •Were under the age of 31 as of June 15, 2012; •Came to the United States before reaching your 16th birthday; •Have continuously resided in the United States since June 15, 2007, up to the present time; •Were physically present in the United States on June 15, 2012, and at the time of making your request for consideration of deferred action with USCIS; •Had no lawful status on June 15, 2012, meaning that you never had a lawful immigration status on or before June 15, 2012, or any lawful immigration status or parole that you obtained prior to June 15, 2012, had expired as of June 15, 2012; •Are currently in school, have graduated or obtained a certificate of completion from high school, have obtained a general education - development (GED) certificate, or are an honorably discharged veteran of the Coast Guard or Armed Forces of the United States; and •Have not been convicted of a felony, significant misdemeanor, or three or more other misdemeanors, and do not otherwise pose a threat to national security or public safety. You may be considered for renewal of DACA if you meet all the requirements for initial DACA and: •Have continuously resided in the United States since you submitted your most recent request for DACA that was approved up to the present time; and •Have not been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and do not otherwise pose a threat to national security or public safety. We may consider deferring action in your case even if you have been arrested or detained by any law enforcement officer and charges were filed, or if charges were filed against you without an arrest. We will evaluate the totality of the circumstances in reaching a decision on deferred action. If we determine that you have been convicted of a felony, a significant misdemeanor, or three or more misdemeanors not occurring on the same date and not arising out of the same act, omission, or scheme of misconduct, or that you otherwise pose a threat to national security or public safety, we are unlikely to defer action in your case. CAUTION: If you file this request more than 150 days prior to the expiration of your current period of deferred action, USCIS may reject your submission and return it to you with instructions to resubmit your request closer to the expiration date. USCIS encourages renewal requestors to file as early in the 150-day period as possible - ideally, at least 120 days prior to the DACA expiration date. If you are currently in immigration detention, you may request consideration of DACA as an Initial or Renewal requestor from USCIS. However, if USCIS determines a favorable exercise of discretion is warranted to grant you DACA, USCIS will not approve your DACA request until you are released from detention. If you are requesting DACA, you should tell your deportation officer. Note: You must submit this form with Form I-765 online. We will add Form I-765 for you to complete after you sign your Form I-821D. |
https://www.uscis.gov/i-821d https://www.uscis.gov/DACA |
Form I-821D, Instructions, page 1-2; 11 | |
| Fee | Fee: $0. All requesters must pay a $410 filing fee for Form I-765 and a $85 biometric services fee. Once you complete and sign Form I-821D and Form I-765, you will pay all fees and submit both 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 800-375-5283. For TTY (deaf or hard of hearing) 800-767-1833. |
Form I-821D, Instructions, page 11 | ||||
| Documents you may need | At the end of your request, we will highlight certain documents that you should provide with your request for DACA. At the time of filing, you must submit all evidence and supporting documentation listed. Refer to uscis.gov/i-821d if you need additional information about evidence requirements. | https://www.uscis.gov/i-821d | Specific to digital environment and part of global template previously approved by OMB | |||
| Biometric services appointment | Individuals requesting DACA must submit biometrics. You may receive a notice scheduling you to appear at an Application Support Center (ASC) for biometrics collection. Failure to comply with the notice may result in the denial of your deferred action request. USCIS may, in its discretion, waive the collection of certain biometrics. | 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 request. After USCIS receives your request and ensures it is complete, we will inform you in writing if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support Center (ASC) and the date and time of your appointment. If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that: 1. You provided or authorized all information in the request; 2. You reviewed and understood all of the information contained in, and submitted with, your request; and 3. All of this information was complete, true, and correct at the time of filing. If you fail to attend your biometric services appointment, USCIS may deny your application. Failure to comply with the notice may result in the denial of your deferred action request. USCIS may, in its discretion, waive the collection of certain biometrics. |
Specific to digital environment and part of global template previously approved by OMB | |||
| After You Submit Your Request | 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. | Specific to digital environment and part of global template previously approved by OMB | |||
| 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 | ||||
| Receive your decision | We will review your request to determine whether the exercise of prosecutorial discretion is appropriate in your case. Each case will be considered on an individual, case-by, case basis. Even if you satisfy the threshold criteria for consideration of DACA, we may determine that deferred action is not warranted in your case. You will be notified of the decision in writing. There is no motion to reopen/reconsider the decision and there is no right to appeal. | Form I-821D Instructions, page 12 | ||||
| Completing Your Form Online | Filing online | Submitting your request online is the same as mailing in a completed paper form. They both gather the same information. |
Specific to digital environment and part of global template previously approved by OMB | |||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| Provide as many responses as you can | We encourage you to provide complete responses. Incomplete fields or sections and missing information can slow down the process after you submit your form | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| DHS Privacy Notice | AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, section 101, et seq. | AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, section 101, et seq. and 8 CFR Part 236, Subpart C. | Form I-821D Instructions, page 13 | |||
| PURPOSE: The primary purpose for providing the requested information on this form is to determine if you should be considered for deferred action as a childhood arrival. The information you provide will be used in making a decision whether to defer removal action in your case as an exercise of prosecutorial discretion. | Form I-821D Instructions, page 13 | |||||
| DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information or any requested evidence, may delay a final decision in your case or result in denial of your form. | Form I-821D Instructions, page 13 | |||||
| ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and foreign government agencies and authorized organizations following approved routine uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003(a) Integrated Digitization Document Management Program (IDDMP), DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems, and DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which can be found at www.dhs.gov/privacy. OTHER DISCLOSURE INFORMATION: Information provided in this request is protected from disclosure to U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection (CBP) for the purpose of immigration enforcement proceedings unless the requestor meets the criteria for the issuance of a Notice To Appear or a referral to ICE under the criteria set forth in USCIS’ 2011 Notice to Appear guidance (www.uscis.gov/NTA). The information may be shared with national security and law enforcement agencies, including ICE and CBP, for purposes other than removal, including for assistance in the consideration of deferred action for childhood arrivals request itself, to identify or prevent fraudulent claims, for national security purposes, or for the investigation or prosecution of a criminal offense. The above information sharing clause covers family members and guardians, in addition to the requestor. This policy is not intended to, does not, and may not be relied upon to create any right or benefit, substantive or procedural, enforceable at law by any party in any administrative, civil, or criminal matter. |
ROUTINE USES: The information you provide on this form may be shared with other federal, state, local, and foreign government agencies and authorized organizations following approved routine uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-003(a) Integrated Digitization Document Management Program (IDDMP), DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems, and DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which can be found at www.dhs.gov/privacy. OTHER DISCLOSURE INFORMATION: Information provided in this request will not be used by ICE and U.S. Customs and Border Protection (CBP) for the purpose of immigration enforcement proceedings against the requestor, unless DHS is initiating immigration enforcement proceedings against the requestor due to a criminal offense, fraud, a threat to national security, or public safety concerns. Information contained in this request related to the requestor’s family members or guardians will not be used for immigration enforcement purposes against such family members or guardians. Any information may be shared with national security and law enforcement agencies, including ICE and CBP, for purposes other than removal, including for assistance in the consideration of a deferred action for childhood arrivals request itself, to identify or prevent fraudulent claims, for national security purposes, or for the investigation or prosecution of a criminal offense. This policy is not intended to, does not, and may not be relied upon to create any right or benefit, substantive or procedural, enforceable at law by any party in any administrative, civil, or criminal matter. |
Form I-821D Instructions, page 13 | ||||
| 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 2.5 hours per response, 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 Do not mail your completed Form I-821D to this address. OMB No. 1615-0124 Expires: 03/31/2023 |
Form I-821D Instructions, page 13-14 | ||||
| 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 | |||
| I-821D: 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. About You should be the THIRD TAB when creating a new copydeck. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Revised | Paper Form Question | Question | Sub-Question | Field Type | Instructional Text | Help Text | Notes | Lockbox Required Field | ||||
| About You | Your name | 1.3.b | What is your current legal name? | Given name (first name) | 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. | ||||||||||
| 1.3.c | Middle name | ||||||||||||||
| 1.3.a | Family name (last name) | Required | |||||||||||||
| Have you used any other names since birth? | Yes/No | Other names used may include nicknames, aliases, and maiden names. | |||||||||||||
| 1.14.b | (If yes) | Given name (first name) | Provide the other names you have used. | ||||||||||||
| 1.14.c | Middle name | ||||||||||||||
| 1.14.a | Family name (last name) | ||||||||||||||
| Your contact information | 5.3 | How may we contact you? | Daytime telephone number | Text (9 digits) | |||||||||||
| 5.4 | Mobile telephone number | Text (9 digits) | |||||||||||||
| This is the same as my daytime telephone number. | Checkbox | ||||||||||||||
| 5.5 | Email address | Text | |||||||||||||
| 1.4.a | What is your current U.S. mailing address? | In care of name (if any) | Text | We will use your current mailing address to contact you while your request is under consideration. 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. | |||||||||||
| 1.4.b | Address line 1 | Text | Street number and name | Required | |||||||||||
| 1.4.c | Address line 2 | Text | Apartment, suite, unit, or floor | ||||||||||||
| 1.4.d | City or town | Text | Required | ||||||||||||
| 1.4.e | State | Dropdown | Required | ||||||||||||
| 1.4.f | ZIP code | Text | Required | ||||||||||||
| When and where you were born | 1.8. | What is your date of birth? | (mm/dd/yyyy) | Date | Required | ||||||||||
| 1.10.a | What is your city, town, or village of birth? | Text | |||||||||||||
| 1.10.b | What is your country of birth? | Dropdown | |||||||||||||
| Describe yourself | 1.9. | What is your gender? | Male/Female | Radio | |||||||||||
| 1.13 | What is your current marital status? | Single/Married/Divorced/Widowed | Radio | ||||||||||||
| 1.15 | What is your ethnicity? | Hispanic or Latino Not Hispanic or Latino |
Radio | Hispanic or Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. | |||||||||||
| 1.16 | What is your race? | White | Checkbox | Select all that apply. Your race is different from your ethnicity and should reflect your geographical origins. | White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. |
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| Asian | Checkbox | Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. |
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| Black or African American | Checkbox | Black or African American A person having origins in any of the black racial groups of Africa. |
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| American Indian or Alaska Native | Checkbox | American Indian or Alaska Native A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. |
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| Native Hawaiian or Other Pacific Islander | Checkbox | Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. |
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| 1.17 | What is your height? | Feet/Inches | Dropdown | ||||||||||||
| 1.18 | What is your weight? | Pounds | Text | ||||||||||||
| 1.19 | What is the color of your eyes? | Black/Blue/Brown/Gray/Green/Hazel/Maroon/Pink/ Unknown/other | Dropdown | ||||||||||||
| 1.20 | What is the color of your hair? | Bald/Black/Blonde/Brown/Gray/Red/Sandy/White/[Unknow/other] | Dropdown | ||||||||||||
| Where you have lived | 1.11 | What is your current country of residence? | Dropdown | ||||||||||||
| Where in the United States do you live? | Address line 1 | Text | |||||||||||||
| Address line 2 | Text | ||||||||||||||
| City or town | Text | ||||||||||||||
| State | Dropdown | ||||||||||||||
| ZIP code | Text | ||||||||||||||
| When did you move here? | mm/dd/yyyy | Date | |||||||||||||
| Where you have lived page 2 | 2.3.a-2.4.f | Where else have you lived? | For initial requestors or renewal requestors who were initially granted DACA by ICE: List any other addresses where you lived since the date of your initial entry into the United States. For renewal requestors: List any other addresses where you lived since you submitted your last Form I-821D that was approved. |
large table | |||||||||||
| Add address | CTA button | ||||||||||||||
| Address line 1 | Text | ||||||||||||||
| Address line 2 | Text | ||||||||||||||
| City or town | Text | ||||||||||||||
| State | Dropdown | ||||||||||||||
| ZIP code | Text | ||||||||||||||
| From | Date | ||||||||||||||
| To | Date | ||||||||||||||
| Travel outside the United States | 2.6.a-2.7.c | List your absences from the United States (if any). | For initial requestors or renewal requestors who were initially granted DACA by ICE: List all of your absences from the United States since June 15, 2007. For renewal requestors: List only your absences from the United States since you submitted your last Form I-821D that was approved. |
Large table | |||||||||||
| Add absence | CTA button | ||||||||||||||
| Date you left | mm/dd/yyyy | Date | |||||||||||||
| Date you returned | mm/dd/yyyy | Date | |||||||||||||
| Reason for absence | Text | ||||||||||||||
| 2.8 | Have you left the United States without advance parole on or after August 15, 2012? | Yes/No | Radio | ||||||||||||
| Your immigration information | 2.12 | What is your country of citizenship or nationality? | Dropdown | ||||||||||||
| 2.9.b | What is the passport number of your most recently issued passport? | Text | |||||||||||||
| 2.9.a | What country issued your most recent passport? | Dropdown | |||||||||||||
| 2.9.c | What is the expiration date of your most recent passport? | (mm/dd/yyyy) | Date | ||||||||||||
| 2.10. | What is your Border Crossing Card number (if any)? | Text | |||||||||||||
| (If 1.1 or DACA initially granted by ICE) Your immigration information page 2 | (If 1.1) Your immigration information page 2 | 3.2 | What is the date of your initial entry into the United States (on or about)? | Date | |||||||||||
| 3.3 | Where did you initially enter the United States? | Text | |||||||||||||
| 3.5.a | Were you ever issued an Arrival-Departure Record (Form I-94, I-94W, or I-95)? | Yes/No | Radio | ||||||||||||
| (If Yes to 3.5a) 3.5.b | What is your Form I-94, I-94W, or I-95 number, if available? | Text | |||||||||||||
| (If Yes to 3.5a) 3.5.c | What is the expiration date of your authorized period of stay as shown on your Form I-94? | Date | |||||||||||||
| Other information | 1.5 | Are you now or have you ever been in removal proceedings, or do you have a removal order issued in any other context (for example, at the border or within the United States by an immigration agent)? | Yes/No | Radio | The term "removal proceedings" includes exclusion or deportation proceedings initiated before April 1, 1997; an Immigration and Nationality Act (INA) section 240 removal proceeding; expedited removal; reinstatement of a final order of exclusion, deportation, or removal; an INA section 217 removal after admission under the Visa Waiver Program; or removal as a criminal alien under INA section 238. | ||||||||||
| (If Yes to 1.5) 1.5.a | What is your current status or outcome of your removal proceedings? | Still in Progress | Radio | ||||||||||||
| (If Yes to 1.5) 1.5.b | Terminated | Radio | |||||||||||||
| (If Yes to 1.5) 1.5.c | Administratively Closed | Radio | |||||||||||||
| (If Yes to 1.5) 1.5.d | Subject to Final Order | Radio | |||||||||||||
| (If Yes to 1.5) 1.5.e | Other | Radio | |||||||||||||
| (If 1.5.e) 1.5.e | Provide an explanation. | Text | |||||||||||||
| (If Yes to 1.5) 1.5.f | What is the most recent date of the proceedings? | Date | |||||||||||||
| (If Yes to 1.5) 1.5.g | What is the location of the proceedings? | Text | |||||||||||||
| 1.6. | What is your A-Number? | A- | Text (9 digits) | Conditionally required if Renewal selected | |||||||||||
| I do not have an A-Number. | Checkbox | ||||||||||||||
| 1.7. | What is your U.S. Social Security number? | Text (9 digits) | |||||||||||||
| I do not have or know my U.S. Social Security number. | Checkbox | ||||||||||||||
| I-821D: MORAL CHARACTER | ||||||||||
Step: Indicates the form navigation element. In this case, these questions would appear in the Moral Character 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Paper Form Question | Question | Sub-Question | Field Type | Instructional Text | Help Text | Notes | Lockbox Required Field |
| Moral character | Crimes and offenses | 4.1 | Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor, including incidents handled in juvenile court, in the United States? | Yes/No | Radio | Do not include minor traffic violations unless they were alcohol-related or drug-related. | Conditionally required | |||
| (If Yes to 4.1) Provide an explanation. | Text | |||||||||
| 4.2 | Have you ever been arrested for, charged with, or convicted of any crime in a country other than the United States? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.2) Provide an explanation. | Text | |||||||||
| 4.3 | Have you ever engaged in, do you continue to engage in, or do you plan to engage in terrorist activities? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.3) Provide an explanation. | Text | |||||||||
| 4.5.a | Have you ever engaged in, ordered, incited, assisted, or otherwise participated in acts involving torture, genocide, or human trafficking? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.5.a) Provide an explanation. | Text | |||||||||
| 4.5.b | Have you ever engaged in, ordered, incited, assisted, or otherwise participated in killing any person? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.5.b) Provide an explanation. | Text | |||||||||
| 4.5.c | Have you ever engaged in, ordered, incited, assisted, or otherwise participated in severely injuring any person? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.5.c) Provide an explanation. | Text | |||||||||
| 4.5.d | Have you ever engaged in, ordered, incited, assisted, or otherwise participated in any kind of sexual contact or relations with any person who was being forced or threatened? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.5.d) Provide an explanation. | Text | |||||||||
| Affiliations | 4.4 | Are you now or have you ever been a member of a gang? | Yes/No | Radio | Conditionally required | |||||
| (If Yes to 4.4) Provide an explanation. | Text | |||||||||
| 4.6 | Have you ever recruited, enlisted, conscripted, or used any person to serve in or help an armed force or group while such person was under the age of 15? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.6) Provide an explanation. | Text | |||||||||
| 4.7 | Have you ever used any person under the age of 15 to take part in hostilities, or to help or provide services to people in combat? | Yes/No | Radio | Conditionally required | ||||||
| (If Yes to 4.7) Provide an explanation. | Text | |||||||||
| I-821D: 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. Evidence should be a separate tab when creating a new copydeck for forms that collect this information. Types of evidence should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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 |
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| Primary Nav | Secondary Nav | Paper Form | Evidence Title | Instructional Text | Document type | Field Type | Links | File requirements | Logic | Revised |
| Evidence | Proof of identity | Form I-821 D Instructions, page 5 | Proof of Identity | Upload proof of your identity. Examples of documents you may submit include copies of your: - Passport; - Birth certificate accompanied by photo identification; - Any national identity document from your country of origin that includes your photo and/or fingerprint; - Any U.S. government immigration or other document bearing your name and photograph (e.g., EADs, visas, driver’s licenses, non-driver cards); - Any school-issued form of identification with photo; - Military identification document with photo; - State-issued photo ID showing date of birth; or - Any other document with photo that you believe is relevant. Note: Expired documents are acceptable. |
Birth Certificate; EAD; Government ID; Military ID; Other Documents; Passport - All Pages, Passport (ID Page); Photo School ID; Visa | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | |
| Proof of arrival | Form I-821 D Instructions, page 6 | Proof of Arrival | Upload evidence that shows that you came to the United States before your 16th birthday. Examples of documents you may submit include copies of your: - Passport with an admission stamp indicating when you entered the United States; - Form I-94, I-94W, or I-95 Arrival-Departure Record; - Any Immigration and Naturalization Service (INS) or DHS document stating your date of entry (e.g., Form I-862, Notice to Appear); - Travel records, such as transportation tickets showing your dates of travel to the United States; - School records (e.g., transcripts, report cards) from the schools that you have attended in the United States, showing the names of the schools and periods of school attendance; - Hospital or medical records concerning treatment or hospitalization, showing the names of the medical facilities or physicians and the dates of the treatment or hospitalization; - Official records from a religious entity in the United States confirming your participation in a religious ceremony, rite, or passage (e.g., baptism, first communion, wedding); or - Any other document that you believe is relevant. |
I-94;I-94W; I-95; I-862; Medical Records; Official Religious Records; Other Documents; Passport - All Pages, Passport (ID Page); School Records; Travel Records | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Established residency | Form I-821 D Instructions, page 6 | Established Residency | Upload documents that show you established residence before your 16th birthday if you left the United States for some period of time before your 16th birthday and returned on or after your 16th birthday to begin your current period of continuous residence. Examples of documents you may submit include copies of your: - School records (e.g., transcripts, report cards) from the schools that you have attended in the United States, showing the names of the schools and periods of school attendance; - Employment records (e.g., pay stubs, W-2 Forms, certification of the filing of Federal income tax returns, state verification of the filing of state income tax returns, letters from employers, or, if you are self employed, letters from banks and other firms with whom you have done business); - Documents evidencing that you were physically present in the United States for multiple years prior to your 16th birthday; or - Any other relevant document. |
Employment Records; School Records; Other Documents; W-2 | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Continuous residence | Form I-821 D Instructions, page 6- 7 | Continuous Residence | Upload evidence that shows that you continuously resided in the United States since June 15, 2007, up to the present date. Examples of documents you may submit include copies of your: - Rent receipts, utility bills (e.g., gas, electric, phone), or receipts or letters from companies showing the dates during which you received service. You may submit this documentation even if it only has the name of your parents or legal guardians, as long as you also submit other evidence (e.g., third party documentation) that connects you to your residence at that address; - Employment records (e.g., pay stubs, W-2 Forms, certification of the filing of federal income tax returns, state verification of the filing of state income tax returns, letters from employers, or, if you are self-employed, letters from banks and other firms with whom you have done business) NOTE: In all of these documents, your name and the name of the employer or other interested organization must appear on the form or letter, as well as relevant dates. Letters must include: your address at the time of employment, exact periods of employment, periods of layoff, and duties with the employer. Letters must also be signed by the employer and include the employer’s contact information. - School records (e.g., transcripts, report cards) from the schools that you have attended in the United States, showing the names of the schools and periods of school attendance; - Military records (e.g., Form DD-214, Certificate of Release or Discharge from Active Duty; NGB Form 22, National Guard Report of Separation and Record of Service; military personnel records; or military health records); - Hospital or medical records concerning treatment or hospitalization, showing the names of the medical facilities or physicians and the dates of the treatment or hospitalization; - Official records from a religious entity in the United States confirming your participation in a religious ceremony, rite, or passage (e.g., baptism, first communion, wedding); - Money order receipts for money sent in or out of the country; passport entries; birth certificates of children born in the United States; dated records of bank transactions; correspondence between you and another person or organization; automobile license receipts, title, vehicle registration, etc.; deeds, mortgages, rental agreements, contracts to which you have been a party; tax receipts; insurance policies; receipts; postmarked letters; or - Any other relevant document. |
Birth Certificates; Employment Records; I-94; Medical Records; Military Records; Official Religious Records; Other Documents; Passport - All Pages, Passport (ID Page); Rent Receipt; School Records; Utility Bill; W-2 | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Proof of presence | Form I-821 D Instructions, page 7-8 | Proof of Presence | Upload evidence that proves that you were present in the United States on June 15, 2012. Examples of documents you may submit include copies of your: - Rent receipts, utility bills (e.g., gas, electric, phone), or receipts or letters from companies showing the dates during which you received service. You may submit this documentation even if it only has the name of your parents or legal guardians, as long as you also submit other evidence (e.g., third party documentation) that connects you to your residence at that address; - Employment records (e.g., pay stubs, W-2 Forms, certification of the filing of Federal income tax returns, state verification of the filing of state income tax returns, letters from employers, or, if you are self employed, letters from banks and other firms with whom you have done business) NOTE: In all of these documents, your name and the name of the employer or other interested organization must appear on the form or letter, as well as relevant dates. Letters must include: your address at the time of employment, exact periods of employment, periods of layoff, and duties with the employer. Letters must also be signed by the employer and include the employer’s contact information. - School records (e.g., transcripts, report cards) from the schools that you have attended in the United States, showing the names of the schools and periods of school attendance; - Military records (e.g., Form DD-214, Certificate of Release or Discharge from Active Duty; NGB Form 22, National Guard Report of Separation and Record of Service; military personnel records; or military health records); - Hospital or medical records concerning treatment or hospitalization, showing the names of the medical facilities or physicians and the dates of the treatment or hospitalization; - Official records from a religious entity in the United States confirming your participation in a religious ceremony, rite, or passage (e.g., baptism, first communion, wedding); - Money order receipts for money sent in or out of the country; passport entries; birth certificates of children born in the United States; dated records of bank transactions; correspondence between you and another person or organization; automobile license receipts, title, vehicle registration, etc.; deeds, mortgages, rental agreements, contracts to which you have been a party; tax receipts; insurance policies; receipts; postmarked letters; or - Any other relevant document. |
Birth Certificates; Employment Records; I-94; Medical Records; Military Records; Official Religious Records; Other Documents; Passport - All Pages, Passport (ID Page); Rent Receipt; School Records; Utility Bill; W-2 | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Status | Form I-821 D Instructions, page 8 | Evidence of No Lawful Status | Upload evidence if you were admitted or paroled, or otherwise obtained a lawful immigration status, on or before June 15, 2012, or you were or are in removal proceedings. Examples of documents you may submit include copies of: - Form I-94, I-94W, or I-95 Arrival/Departure Record showing the date your authorized stay expired; - A final order of exclusion, deportation, or removal issued as of June 15, 2012, along with the related charging documents, if available; - An INS or DHS charging document placing you into removal proceedings, if available; or - Any other document that you believe is relevant to show that on June 15, 2012, you had no lawful status. |
I-94;I-94W; I-95; Charging Document; Final Order; Other Documents | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Brief departures | Form I-821 D Instructions, page 7 | Brief Departures | If you were absent from the United States for any period of time since June 15, 2007, upload documents showing the absence was brief, casual and innocent. Your absence will be considered brief, casual, and innocent, if it was on or after June 15, 2007, and before August 15, 2012, and: - The absence was short and reasonably calculated to accomplish the purpose for the absence; - The absence was not because of an order of exclusion, deportation, or removal; - The absence was not because of an order of voluntary departure or an administrative grant of voluntary departure before you were placed in exclusion, deportation, or removal proceedings; and - The purpose of the absence and/or your actions while outside of the United States were not contrary to law. Examples of documents you may submit include copies of: - Plane or other transportation tickets or itinerary showing the travel dates; - Passport entries; - Hotel receipts showing the dates you were abroad; - Evidence of the purpose of the travel (e.g., you attended a wedding or funeral); - Copy of Advance Parole Document issued by USCIS; and - Any other evidence that could support a brief, casual, and innocent absence. |
Advanced Parole Document; Other Documents; Passport - All Pages, Passport (ID Page); Receipts; Travel Documents | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Education | Form I-821 D Instructions, page 8-9 | Education | Upload documents that show that you: - Are currently in school in the United States at the time of filing; - Have graduated or received a certificate of completion or a certificate of attendance from a U.S. high school or a U.S. public or private college or university, including community college; or - Have obtained a GED certificate or other equivalent state-authorized exam in the United States. Requestors who are currently in school (enrolled) Evidence of enrollment may include, but is not limited to: school registration cards, acceptance or other letters showing enrollment or attendance, current transcripts, report cards, progress reports, or other documents issued by a school district, state education agency, school, or program. These documents should show your name; the name of the school district or state educational agency, school, or program issuing the record; the dates or periods of enrollment you are seeking to establish; and your current educational or grade level. If you have been accepted for enrollment and your classes have not yet begun, you may submit an acceptance letter with evidence that you have registered for classes or any other relevant evidence showing you have committed to starting classes on a certain date, including, for example, a copy of your tuition bill, your class schedule, or your Individualized Educational Program. If you are enrolled in an educational, literacy, or career training program (including vocational training or an ESL course), include evidence that the program is funded in whole or in part by federal, state, local, or municipal funds includes a letter or other documentation from an authorized representative of the program that includes information such as: your name and date of enrollment, the duration of the program and expected completion date, the program’s source of public funding, and the program’s authorized representative’s contact information. If you are enrolled in an education, literacy, or career training program that is not publicly funded, include evidence that the program is of demonstrated effectiveness may include information from an authorized school representative relating to: the duration of the program’s existence; the program’s track record in placing students in employment, job training, or post-secondary education; receipt of awards or special achievement or recognition that indicate the program’s overall quality; and/or any other information indicating the program’s overall quality. Reqestors who graduated from school or obtained a GED or equivalent state-authorized exam Evidence to show that you meet the educational guideline because you have “graduated from school” or “obtained a GED certificate” or other equivalent state-authorized exam in the United States includes, but is not limited to: •A high school diploma from a U.S. public or private high school or secondary school; •A recognized equivalent of a U.S. high school diploma under state law, including a GED certificate or other equivalent state-authorized exam, a certificate of completion, or a certificate of attendance; •A transcript that identifies the date of graduation or program completion; •An enrollment history that shows the date of graduation or program completion; •A degree from a public or private college or university or a community college; or •An alternate award from a U.S. public or private high school or secondary school. These documents should show your name; the name of the school district, or state educational agency, school, or program issuing the record; the dates or time periods of enrollment you are seeking to establish; and your date of graduation or completion. |
Acceptance Letter; GED; Class Schedule; College Degree; High School Diploma; Other Documents; Progress Reports; Report Cards; Tuition Bill | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE | If Yes to 1.1 | ||
| Military service | Form I-82 D Instructions, page 9-10 | Military Service | Upload evidence that proves you are an honorably discharged veteran of the U.S. Armed Forces or U.S. Coast Guard (if applicable). Examples of documents you may submit include copies of your: - Form DD-214, Certificate of Release or Discharge from Active Duty; - NGB Form 22, National Guard Report of Separation and Record of Service; - Military personnel records; - Military health records; or - Any other relevant document. |
DD-214; NGB Form 22; Military Records; Military Health Records; Other Documents | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If Yes to 1.1 or initially granted DACA by ICE AND 3.9 = Yes | If Yes to 1.1 AND 3.9 = Yes | ||
| Criminal history | Form I-82 D Instructions, page 10 | Criminal History | If you have been arrested for or charged with any felony (i.e., a Federal, state, or local criminal offense punishable by imprisonment for a term exceeding one year) or misdemeanor (i.e., a Federal, state, or local criminal offense for which the maximum term of imprisonment authorized is one year or less but greater than five days) in the United States, or a crime in any country other than the United States, you must upload evidence demonstrating the results of the arrest or charges brought against you. If the charges against you were handled in juvenile court, and the records are from a state with laws prohibiting their disclosure, this evidence is not required. If you have ever been arrested for any felony or misdemeanor in the United States, or a crime in any country other than the United States, and no charges were filed, upload an original official statement by the arresting agency or applicable court order confirming that no charges were filed for each arrest. If you have ever been charged with or convicted of a felony or misdemeanor in the United States, or a crime in any country other than the United States, upload an original or court-certified copy of the complete arrest record and disposition for each incident (e.g., dismissal order, conviction and sentencing record, acquittal order). If you have ever had any arrest or conviction vacated, set aside, sealed, expunged, or otherwise removed from your record upload: - An original or court-certified copy of the court order vacating, setting aside, sealing, expunging, or otherwise removing the arrest or conviction; or - An original statement from the court that no record exists of your arrest or conviction. If you are submitting a renewal request, you only need to submit any new documents pertaining to criminal history that you have not already submitted to USCISn However, you should submit new documents if you have been charged with, or convicted of, a felony or misdemeanor (please note, you do not need to submit these documents if you already submitted them with a previous DACA request). If you are unable to provide documentation or if it is not available, upload an explanation, including a description of your efforts to obtain this evidence. NOTE: You do not need to submit documentation concerning minor traffic violations such as driving without a license unless they were alcohol- or drug-related. |
Court Records, Court Petition/Motion; Court/Custodian Order; Other Supporting Documents, Photographs, Police/Arrest Records, Sentencing Documents; Written Statement | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If 4.1 or 4.2 = Yes | If 4.1 or 4.2 = Yes | ||
| Removal proceedings | Form I-821 D Instructions, page 10-11 | Upload a copy of the removal order, any document issued by the immigration judge, or the final decision of the Board of Immigration Appeals (BIA), if available. If you are submitting a renewal request, you only need to submit any new documents pertaining to removal proceedings that you have not already submitted to USCIS. However, you should submit new documents if you are currently in exclusion, deportation, or removal proceedings (please note, you do not need to submit these documents if your case was administratively closed). |
Final Decision; Other Document; Removal Order; | Upload | • Clear and readable • Accepted file formats: JPG, JPEG, PDF, TIF or TIFF • No encrypted or password-protected files • If your documents are in a foreign language, upload a full English translation and the translator’s certification with each original document • Upload no more than five documents at a time • Accepted file name characters: English letters, numbers, spaces, periods, hyphens, underscores, and parentheses • Maximum size: 6MB per file |
If 1. 5 = Yes | If 1. 5 = Yes | |||
| I-821D: ADDITIONAL INFORMATION | |||||||||
| Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary | Secondary | Paper Form Question | Question | Sub-Question | Field Type | Required? | Instructional Text | Help Text | Notes |
| Additional Information | Additional information | 8.1.a.-8.5.d | You may provide additional information for your application | Additional information | Textbox | No | 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. |
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| I-821D: 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. Review and Submit should be the LAST TAB when creating a new copydeck for a form. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Paper Form | Question | Sub-Question | Revised | Field Type | Instructional Text | Help Text | CTA | Notes | Lockbox Required Field |
| Review and Submit | Review your request | Check your request before you submit | Please review your request and check it for accuracy and completeness before you submit it. We encourage you to provide as many responses as you can throughout the request, to the best of your knowledge. Missing information can slow down the review process after you submit your request. You can return to this page to review your request as many times as you want before you submit it. |
Specific to digital environment and part of global template previously approved by OMB. | ||||||||
| Your fee | Your form filing fee is: [$XXX} 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. |
Exact fee will be pulled from ELIS | ||||||||||
| Alerts and warnings | You have one or more alerts and warnings based on the information you provided in your application. A red alert means you have incomplete responses or inconsistent data. You cannot submit your application with any alerts. |
Specific to digital environment and part of global template previously approved by OMB. | ||||||||||
| Your request summary | Review the I-821D form information | Here is a summary of all the information you provided in your request. Make sure you have provided responses for everything that applies to you before you submit your request. You can edit your responses by going to each request section using the site navigation. We also prepared a draft case snapshot with your responses, which you can download below. |
Next | Specific to digital environment and part of global template previously approved by OMB. | ||||||||
| (IF PREPARER) Preparer declaration | Preparer's statement | |||||||||||
| 7.7 | Preparer's declaration and signature | I declare that I prepared this Form I-821D at the requestor's behest, and it is based on all the information of which I have knowledge. | Your preparer must read and agree to the certification below. | |||||||||
| As the requester's preparer, you must sign on paper and provide your signature page to the applicant. Follow these steps: 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 requester The requester will need to scan and upload your completed signature page on the next screen. |
Specific to digital environment and part of global template previously approved by OMB. | |||||||||||
| (IF PREPARER) Preparer signature | 7.7.a-b | Preparer's signature upload | Upload | Scan and upload your preparer's completed signature page below. | ||||||||
| (IF INTERPRETER) Interpreter certification | 6.6 | Interpreter's certification and signature | I certify, under penalty of perjury, that: I am fluent in English and the language provided in the Getting Started section of this request, and I have read to this requestor in the identified language every question and instruction on this form and his or her answer to every question. The requestor informed me that he or she understands every instruction, question, and answer on the form, as well as the answer to each question. |
Your interpreter must read and agree to the certification below. | ||||||||
| As the requester's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these steps: 1. Download the Interpreter Signature page 2. Print the Interpreter Signature page 3. Read and sign the Interpreter Signature page 4. Give the signed Interpreter Signature page to the requester The requester will need to scan and upload your completed signature page on the next screen. |
Specific to digital environment and part of global template previously approved by OMB. | |||||||||||
| (IF INTERPRETER) Interpreter signature | 6.6.a | Interpreter's signature upload | Upload | Scan and upload your interpreter's completed signature page below. | ||||||||
| Your statement | 5.1.a | (If no interpreter) Requestor's statement | I can read and understand English, and have read and understand every question and instruction on this form, as well as my answer to every question. | Checkbox | You must read and agree to the statement below. | |||||||
| 5.1.b | (if interepreter) Requestor'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 form 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. | ||||||||
| (If "Your Statement" is complete) Your signature | 5.1 | Requestor's Declaration and Certification | I certify, under penalty of perjury under the laws of the United States of America, that foregoing is true and correct and that copies of documents submitted are exact photocopies of unaltered original documents. I understand that I may be required to submit original documents to U.S. Citizenship and Immigration Services (USCIS) at a later date. I also understand that knowingly and willfully providing materially false information on this form is a federal felony punishable by a fine, imprisonment up to 5 years, or both, under 18 U.S.C. section 1001. Furthermore, I authorize the release of any information from my record that USCIS may need to reach a determination on my deferred action request. |
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 request that I seek. I furthermore authorize release of information contained in this request, 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 provided or authorized all of the information in my request; 2. I understood all of the information contained in, and submitted with, my request; and 3. All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury under the laws of the United States of America, that foregoing is true and correct and that copies of documents submitted are exact photocopies of unaltered original documents. I understand that I may be required to submit original documents to U.S. Citizenship and Immigration Services (USCIS) at a later date. I also understand that knowingly and willfully providing materially false information on this form is a federal felony punishable by a fine, imprisonment up to 5 years, or both, under 18 U.S.C. section 1001. Furthermore, I authorize the release of any information from my record that USCIS may need to reach a determination on my deferred action request. |
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 request, we can deny your request and may deny any other immigration benefit. You may also face criminal prosecution and penalties provided by the law. | |||||||
| I have read and agree to the requestor's statement | Checkbox | Specific to digital environment and part of global template previously approved by OMB. | ||||||||||
| 5.1 | Requestor's signature | You must provide your digital signature below by typing your full legal name. If you do not completely fill out this request, or if you do not submit the required documents listed in the Instructions, we may deny your request. We will record the date of your signature with your request. | Sign | Required field | Required | |||||||
| Finish and continue to I-765 | Finish the I-821D and continue to the I-765 By finishing this form, your Form I-821D will be locked and no further changes can be made. Please make sure that the information on your Form I-821D is complete and accurate before continuing. If you need to make any edits after finishing, you will need to create a new Form I-821D. Next, you will continue to Form I-765. Once you complete Form I-765, you can pay for and submit both forms at the same time. |
Finish and continue | ||||||||||
| I-821D: Alerts | |||||
| Number | Section | Type | Logic | Message | Notes |
| 1 | Review and Submit | Red alert | If user has not answered required field | h2. There are errors in (Section): (Sub section) Edit my response |
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| 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 |
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| Heading | Sub-Heading | Body Text (Re-registration) | REVISED | Link | CTA | Notes |
| I-765, Application for Employment Authorization | 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. 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. |
https://www.uscis.gov/i-765 | Form I-765 instructions, "What Is the Purpose of Form I-765" - page 1 | |||
| Before You Start Your Application | Eligibility | 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 extension 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); -(c)(19) - Temporary Protected Status (You have a pending Form I-821); -(c)(8) - Pending Asylum and Withholding of Removal Applicants and Applicants for Asylum under the ABC Settlement Agreement; or -(c)(33) - Consideration of Deferred Action for Childhood Arrivals (DACA). All other applicants must submit a paper Form I-765. |
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 |
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F-1 Students Seeking Optional Practical Training (OPT) (c)(3)(A) eligibility category: Submit Form I-765 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 (ICE) and Student and Exchange Visitor Program (SEVP). Your period of employment will 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 Form I-765 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 Visitor Information System (SEVIS) record. If you fail to do so, we will deny your OPT request. (c)(3)(C) eligibility category: Submit Form I-765 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 (TPS) (a)(12) and (c)(19) eligibility categories: Submit Form I-765 with your Form I-821 application or with evidence that we accepted or approved your initial Form I-821. You must also follow the instructions for filing your application as described in the most recent TPS Federal Register notice regarding a TPS designation, re-designation, or extension for your country. Consideration of Deferred Action for Childhood Arrivals (c)(33) eligibility category: You must submit Form I-765 with Form I-821D. |
Form I-765 instructions, "Who May File Form I-765"- pages 6-8 | |||||
| Fee | Fee: $410. TPS applicants: You must pay the Form I-765 filing fee if you are requesting an EAD as an initial TPS applicant, unless you are younger than 14 or older than 65. If you are re-registering for TPS and requesting an EAD, you must pay the Form I-765 filing fee. Note: Your total filing fee will be shown at the end of this form. The total will include the application fee for Form I-765, the biometric services fee (if required), and the fee for any other form you are submitting with this application. Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY (deaf or hard of hearing) 800-767-1833. |
Form I-765 instructions, "What Is the Filing Fee"- page 6 Previously approved refund policy language for digital forms |
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| 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. - 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 |
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| 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, petition, or request. 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. If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that: 1. You provided or authorized all information in the application; 2. You reviewed and understood all of the information contained in, and submitted with, your application; and 3. All of the declared information was complete, true, and correct at the time of filing. If you fail to attend your biometric services appointment, USCIS may deny your application. |
Specific to digital environment and part of global template previously approved by OMB | ||||
| After You Submit Your Application | 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. | Specific to digital environment and part of global template previously approved by OMB | |||
| 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 | ||||
| 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. If USCIS cannot approve your application, you will receive a written notice explaining the basis of your denial. | Form I-765 instructions, "Processing Information" - page 29 |
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| Completing Your Form Online | Filing online | Submitting your application online is the same as mailing in a completed paper form. They both gather the same information. |
Specific to digital environment and part of global template previously approved by OMB | |||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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. | Specific to digital environment and part of global template previously approved by OMB | ||||
| 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, 8 CFR 274a.12, and 8 CFR 274a.13. | Form I-765 instructions, "DHS Privacy Notice" - page 30 |
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| 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. | Form I-765 instructions, "DHS Privacy Notice" - page 30 |
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| 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 |
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| 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 of Records; DHS/USCIS-007 Benefits Information System; DHS/USCIS-010 Asylum Information and Pre-Screening System of Records; DHS/USCIS-017 Refugee Case Processing and Security Screening Information System of Records; and DHS/USCIS-018 Immigration Biometric and Background Check (IBBC) System of Records], and the published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems; DHS/USCIS/PIA-027 USCIS Asylum Division; DHS/USCIS/PIA-056 USCIS Electronic Immigration System (USCIS ELIS); and DHS/USCIS/PIA-068 Refugee Case Processing and Security Vetting], which can be found at www.dhs.gov/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 |
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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 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: 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 |
Expires: 01/31/2023 | Form I-765 instructions, "Paperwork Reduction Act" - page 31 |
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| 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 | |||
| I-765: 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. Getting Started should be the SECOND TAB when creating a new copydeck. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Paper Form Question (Re-registration) | Question | Sub-Question | Field Type | Instructional Text | Help Text | Notes |
| Getting Started | Basis of eligibility | 2.27 | What is your eligibility category? | Eligibility Category | Dropdown | Required field | |||
| 2.28.a | [If you entered the eligibility category (c)(3)C] What STEM field did you receive your degree in? | 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 | |||||||
| Reason for applying | 1.1.a | What is your reason for applying? | [If (c)(3)(A), (c)(3)(B), (c)(3)(C), OR (a)(12)]a. Initial permission to accept employment. |
Radio | Required field | ||||
| 1.1b | b. Replacement of lost, stolen, or damaged employment authorization document, or correction of my employment authorization document NOT DUE to U.S. Citizenship and Immigration Services (USCIS) error. | Radio | |||||||
| 1.1.c | c. Renewal of permission to accept employment. | Radio | only renewal should display for (c)(33) if we are only accepting renewal DACA requests | ||||||
| 2.12 | Have you previously filed Form I-765? | Yes/No | Radio | ||||||
| Preparer and interpreter information | Is someone assisting you with completing this application? | Yes/No | Radio | Specific to digital environment and part of global template previously approved by OMB. | |||||
| (IF YES) Is a preparer assisting you with completing this application? | Yes/No | Radio | A preparer is anyone who completes or helps you complete 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. | |||||
| (IF YES) Is an interpreter assisting you with completing this application? | Yes/No | Radio | 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. | |||||
| (IF YES TO PREPARER QUESTION) Preparer information | 5.1.b | What is your preparer's full name? | Given name (first name) | Text | |||||
| 5.1.a | Family name (last name) | Text | |||||||
| 5.2 | What is your preparer's business or organization name? | Text | |||||||
| My preparer is not part of a business or organization. | Checkbox | ||||||||
| 5.3.a.-5.3.h. | What is your preparer's mailing address? | Country | Dropdown | ||||||
| Address line 1 | Text | Street number and name | |||||||
| Address line 2 | Text | Apartment, suite, unit, or floor | |||||||
| City or town | Text | ||||||||
| State/Province | Dropdown/Text | ||||||||
| ZIP code/Postal code | Text | ||||||||
| 5.4 | What is your preparer's contact information? | Daytime phone number | Text | ||||||
| 5.5 | Mobile telephone number | Text | |||||||
| My preparer does not have a mobile telephone number | Checkbox | ||||||||
| 5.6 | Email address | Text | |||||||
| My preparer does not have an email address. | Checkbox | ||||||||
| (IF YES TO INTERPRETER) Interpreter information | 4.1.b | What is your interpreter's full name? | Given name (first name) | Text | |||||
| 4.1.a | Family name (last name) | Text | |||||||
| 4.2 | What is your interpreter's business or organization name? | Text | |||||||
| My interpreter is not part of a business or organization. | Checkbox | ||||||||
| 4.3 | What is your interpreter's mailing address? | Country | Dropdown | ||||||
| Address line 1 | Text | Street number and name | |||||||
| Address line 2 | Text | Apartment, suite, unit, or floor | |||||||
| City or town | Text | ||||||||
| State/Province | Dropdown/Text | ||||||||
| ZIP code/Postal code | Text | ||||||||
| 4.4 | What is your interpreter's contact information? | Daytime telephone number | Text | ||||||
| 4.5 | Mobile telephone number | Text | |||||||
| My interpreter does not have a mobile telephone number | Checkbox | ||||||||
| 4.6 | Email address | Text | |||||||
| My interpreter does not have an email address. | Checkbox | ||||||||
| What language is your interpreter using to interpret this application for you? | Text | ||||||||
| I-765: 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. Getting Started should be the SECOND TAB when creating a new copydeck. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Paper Form Question (Re-registration) | Question | Sub-Question | Field Type | Instructional Text | Help Text | Notes |
| Getting Started | Basis of eligibility | 2.27 | What is your eligibility category? | Eligibility Category | Dropdown | Required field | |||
| 2.28.a | [If you entered the eligibility category (c)(3)C] What STEM field did you receive your degree in? | 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 | |||||||
| Reason for applying | 1.1.a | What is your reason for applying? | [If (c)(3)(A), (c)(3)(B), (c)(3)(C), OR (a)(12)]a. Initial permission to accept employment. |
Radio | Required field. only display for c33 if it is an initial DACA request | ||||
| 1.1b | b. Replacement of lost, stolen, or damaged employment authorization document, or correction of my employment authorization document NOT DUE to U.S. Citizenship and Immigration Services (USCIS) error. | Radio | |||||||
| 1.1.c | c. Renewal of permission to accept employment. | Radio | only display for c33 if it is a renewal DACA request | ||||||
| 2.12 | Have you previously filed Form I-765? | Yes/No | Radio | ||||||
| Preparer and interpreter information | Is someone assisting you with completing this application? | Yes/No | Radio | Specific to digital environment and part of global template previously approved by OMB. | |||||
| (IF YES) Is a preparer assisting you with completing this application? | Yes/No | Radio | A preparer is anyone who completes or helps you complete 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. | |||||
| (IF YES) Is an interpreter assisting you with completing this application? | Yes/No | Radio | 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. | |||||
| (IF YES TO PREPARER QUESTION) Preparer information | 5.1.b | What is your preparer's full name? | Given name (first name) | Text | |||||
| 5.1.a | Family name (last name) | Text | |||||||
| 5.2 | What is your preparer's business or organization name? | Text | |||||||
| My preparer is not part of a business or organization. | Checkbox | ||||||||
| 5.3.a.-5.3.h. | What is your preparer's mailing address? | Country | Dropdown | ||||||
| Address line 1 | Text | Street number and name | |||||||
| Address line 2 | Text | Apartment, suite, unit, or floor | |||||||
| City or town | Text | ||||||||
| State/Province | Dropdown/Text | ||||||||
| ZIP code/Postal code | Text | ||||||||
| 5.4 | What is your preparer's contact information? | Daytime phone number | Text | ||||||
| 5.5 | Mobile telephone number | Text | |||||||
| My preparer does not have a mobile telephone number | Checkbox | ||||||||
| 5.6 | Email address | Text | |||||||
| My preparer does not have an email address. | Checkbox | ||||||||
| (IF YES TO INTERPRETER) Interpreter information | 4.1.b | What is your interpreter's full name? | Given name (first name) | Text | |||||
| 4.1.a | Family name (last name) | Text | |||||||
| 4.2 | What is your interpreter's business or organization name? | Text | |||||||
| My interpreter is not part of a business or organization. | Checkbox | ||||||||
| 4.3 | What is your interpreter's mailing address? | Country | Dropdown | ||||||
| Address line 1 | Text | Street number and name | |||||||
| Address line 2 | Text | Apartment, suite, unit, or floor | |||||||
| City or town | Text | ||||||||
| State/Province | Dropdown/Text | ||||||||
| ZIP code/Postal code | Text | ||||||||
| 4.4 | What is your interpreter's contact information? | Daytime telephone number | Text | ||||||
| 4.5 | Mobile telephone number | Text | |||||||
| My interpreter does not have a mobile telephone number | Checkbox | ||||||||
| 4.6 | Email address | Text | |||||||
| My interpreter does not have an email address. | Checkbox | ||||||||
| What language is your interpreter using to interpret this application for you? | Text | ||||||||
| I-765: 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. About You should be the THIRD TAB when creating a new copydeck. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | Tertiary Nav | Paper Form Question | Question | Sub-Question | Field Type | Instructional Text | Help Text | Notes |
| About You | Your name | 2.1.b | What is your current legal name? | Given name (first name) | 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. | ||||
| 2.1.c | Middle name | ||||||||
| 2.1a | Family name (last name) | Required field | |||||||
| Have you used any other names since birth? | Yes/No | Other names used may include nicknames, aliases, and maiden names. | |||||||
| 2.2b | (If yes) | Given name (first name) | Provide the other names you have used. | ||||||
| 2.2c | Middle name | ||||||||
| 2.2a | Family name (last name) | ||||||||
| Your contact information | 3.3 | How may we contact you? | Daytime telephone number | Text (9 digits) | |||||
| 3.4 | Mobile telephone number (if any) | Text (9 digits) | |||||||
| This is the same as my daytime telephone number. | Checkbox | ||||||||
| 3.5 | Email address | Text | |||||||
| 2.5.a | What is your current U.S. mailing address? | In care of name (if any) | 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. | |||||
| 2.5.b | Address line 1 | Text | Street number and name | Required field | |||||
| 2.5.c | Address line 2 | Text | Apartment, suite, unit, or floor | ||||||
| 2.5.d | City or town | Text | Required field | ||||||
| 2.5.e | State | Dropdown | Required field | ||||||
| 2.5.f | ZIP code | Text | Required field | ||||||
| 2.6 | Is your current mailing address the same as your physical address? | Yes/No | Radio | ||||||
| 2.7.a | (If no) Where in the United States do you live? | Address line 1 | Text | Street number and name | |||||
| 2.7.b | Address line 2 | Text | Apartment, suite, unit, or floor | ||||||
| 2.7.c | City or town | Text | |||||||
| 2.7.d | State | Dropdown | |||||||
| 2.7.e | ZIP code | Text | |||||||
| Describe yourself | 2.10 | What is your gender? | Male/Female | Radio | |||||
| 2.12 | What is your marital status? | Single, Married, Divorced, Widowed | Radio | ||||||
| When and where you were born | 2.19a | What is your city, town, or village of birth? | Text | ||||||
| 2.19b | What is your state or province of birth? | Text | |||||||
| 2.19c | What is your country of birth? | Dropdown | |||||||
| 2.20 | What is your date of birth? | (mm/dd/yyyy) | Date | Required field | |||||
| Your immigration information | 2.18 | What is your country of citizenship or nationality? | Dropdown | List all countries where you are currently a citizen or national. | User will be able to input multiple countries (at least two based on paper form). It will be a table or list. | ||||
| 2.21.a | What is your Form I-94 Arrival-Departure Record Number (if any)? | 11 character restricted text | |||||||
| When did you last arrive in the United States? | List your arrival date, place of arrival, and status at arrival. | ||||||||
| 2.22 | Date of arrival | Date | mm/dd/yy | ||||||
| 2.23 | Place of arrival | Dropdown | |||||||
| 2.24 | Status at last arrival | Dropdown | |||||||
| 2.21.b | What is the passport number of your most recently issued passport? | Text | |||||||
| 2.21c | What is your travel document number (if any)? | Text | |||||||
| 2.21.e | What is the expiration date of your passport or travel document? | (mm/dd/yyyy) | Date | ||||||
| 2.21.d | What country issued your passport or travel document? | Country | Dropdown | ||||||
| 2.25 | What is your current immigration status or category? | Dropdown | |||||||
| 2.26 | What is your Student and Exchange Visitor Information System (SEVIS) Number (if any)? | N- | Text | Use the "Additional Information"section to include all previously used SEVIS numbers. | |||||
| Other informaiton | 2.8 | What is your A-Number? | A- | Text (9 digits) | |||||
| I do not have or know my A-Number. | Checkbox | ||||||||
| 2.9 | What is your USCIS Online Account Number? | Text (12 digits) | Providing your unique USCIS Online Account Number (OAN) helps us manage your account. You may already have an 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. |
The phrase "certain paper forms" would have a tooltip that would list the forms: "I-90, I-130, I-485, I-821, I-821D, N-336, N-400, N-565, N-600, N-600K" | |||||
| I do not have or know my USCIS Online Account Number. | Checkbox | ||||||||
| 2.13a | Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? | 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 Social Security card? | Yes/No | Radio | ||||||
| 2.15 | (If yes to 2.14) Consent for 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. | Yes/No | Radio | ||||||
| 2.16b | (If yes to 2.15) What is your father's birth name? | Given name (first name) | Text | ||||||
| 2.16a | Family name (last name) | Text | |||||||
| 2.17b | (If yes to 2.15) What is your mother's birth name? | Given name (first name) | Text | ||||||
| 2.17a | Family name (last name) | Text | |||||||
| I-765: 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. Evidence should be a separate tab when creating a new copydeck for forms that collect this information. Types of evidence should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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 |
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| Primary Nav | Secondary Nav | DACA and c8 | DACA and c8 | Evidence Title | DACA and c8 | Instructional Text | DACA and c8 | Field Type | Links | Logic | NOTES | |
| Evidence | 2 x 2 Photo of you | Form I-765 instructions, "Required Documentation" - pages 25-26 | 2 x 2 Photo of You | Upload a recent color photograph of yourself that measures 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. 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. 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 photo. |
Upload | https://travel.state.gov/content/travel/en/us-visas/visa-information-resources/photos.html | ||||||
| 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. 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. |
Upload | https://www.cbp.gov/travel/international-visitors/i-94 www.uscis.gov/i-102 | do not display for c33 if concurrent filing | ||||||
| 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. | Upload | do not display for c33 if concurrent filing an Initial I-821D request | |||||||
| 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) | ||||||||
| Previously authorized CPT or OPT | Form I-765 instructions, "Who May File Form I-765"- pages 7-8 | Previously Authorized 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 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) eligibility category, the Form I-20 must have been endorsed by the DSO within 60 days of submitting Form I-765. | Upload | 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 the degree programs currently listed on the STEM Designated Degree Program List or a copy of your prior STEM degree. | Upload | https://studyinthestates.dhs.gov/stem-opt-hub/eligible-cip-codes-for-the-stem-opt-extension | If eligibility category is (c)(3)(C) | ||||||
| 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 | If eligibility category is (c)(3)(C) | |||||||
| EOIR or BIA order | Form I-765 instructions, "Who May File Form I-765" page 6 | Proof of Temporary Protected Status Granted by EOIR Immigration Judge or Board of Immigration Appeals | If an EOIR Immigration Judge (EOIR IJ) or the Board of Immigration Appeals (BIA) granted TPS, and you are requesting your first EAD or 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) or (c)(19) | display for TPS re-registration | |||||||
| Proof of identity and nationality | Form I-765 instructions, "Who May File Form I-765" page 6 | Proof of identity and nationality | Upload proof of your identity and nationality. Examples of documents you may submit include copies of your: - 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 (a)(12) or (c)(19) | ||||||||
| Form I-821 | Form I-765 instructions, "Who May File Form I-765" page 6 | I-821, Application for Temporary Protect Status | If you previously filed Form I-821, upload evidence that we accepted or approved your initial Form I-821. | If (a)(12) or (c)(19) | ||||||||
| Form I-765WS | Form I-765 instructions, "Consideration of Deferred Action for Childhood. Arrivals. -- (c)(33)" page 17 | I-765WS, Worksheet | Download, complete, and upload Form I-765WS so that we can determine whether you have an economic need for work. | Upload | https://www.uscis.gov/sites/default/files/document/forms/i-765ws.pdf | If (c)(33) | ||||||
| I-765: ADDITIONAL INFORMATION | |||||||||
| Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary | Secondary | Paper Form Question | Question | Sub-Question | Field Type | Required? | Instructional Text | Help Text | Notes |
| Additional Information | Additional information | 6.1.a-6.7.d | You may provide additional information for your application | Additional information | Textbox | No | 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. |
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| I-765: 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. Review and Submit should be the LAST TAB when creating a new copydeck for a form. Questions from the paper form should be identified in the Global Copydeck and the same copy should be used. This copy has been approved for use in its current state. 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. |
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| Primary Nav | Secondary Nav | DACA | Tertiary Nav | Paper Form | Question | DACA | Sub-Question | Field Type | Instructional Text | DACA | Help Text | CTA | DACA | Notes |
| Review and Submit | Review your application | Check your application before you submit | We will review your application to check for accuracy and completeness before you submit it. 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. |
Specific to digital environment and part of global template previously approved by OMB. | ||||||||||
| Your fee | Your form filing fee is: [$XXX} 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. |
Exact fee will be pulled from ELIS | ||||||||||||
| Alerts and warnings | You have one or more alerts and warnings based on the information you provided in your application. A red alert means you have incomplete responses or inconsistent data. You cannot submit your application with any alerts. |
Specific to digital environment and part of global template previously approved by OMB. | ||||||||||||
| Your application summary | Review the I-765 form information | Here is a summary of all the information you provided in your application. Make sure you have provided responses for everything that applies to you before you submit your application. You can edit your responses by going to each application section using the site navigation. We also prepared a draft case snapshot with your responses, which you can download below. |
Next | Specific to digital environment and part of global template previously approved by OMB. | ||||||||||
| (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. |
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| 5.7b | I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application. | Radio | ||||||||||||
| 5.7b | I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application. | Radio | ||||||||||||
| 5.8a | Preparer's certification and signature | 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: 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. |
Specific to digital environment and part of global template previously approved by OMB. | |||||||||||||
| (IF PREPARER) Preparer signature | Preparer's signature upload | Upload | Scan and upload your preparer's completed signature page below. | |||||||||||
| (IF INTERPRETER) Interpreter certification | 4.7a | Interpreter's certification and signature | 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. |
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: 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. |
Specific to digital environment and part of global template previously approved by OMB. | |||||||||||||
| (IF INTERPRETER) Interpreter signature | Interpreter's signature upload | Upload | Scan and upload your interpreter's completed signature page below. | |||||||||||
| Your statement | 3.1a | Applicant's statement | I can read and understand English, and have read and understand every question and instruction on this application, as well as my answer to every question. | Checkbox | You must read and agree to the statement below. | |||||||||
| 3.2 | Applicant's statement regarding the preparer | At my request, the preparer named in the Getting Started section of this application prepared this application for me based only upon the information I provided or authorized. | Checkbox | You must read and agree to the statement below. | ||||||||||
| 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. | ||||||||||
| (If "Your Statement" is complete) Your signature | Form I-765, "Applicant's 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. 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. |
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 have read and agree to the applicant's statement | Checkbox | Specific to digital environment and part of global template previously approved by OMB. | ||||||||||||
| 3.7a | Applicant's signature | You must provide your digital signature below by typing your full legal name. If you do not completely fill out this application, or if you do not submit the required documents listed in the Instructions, we may deny your application. We will record the date of your signature with your application. | Sign | Required field | ||||||||||
| Finish and continue to pay and submit | Finish and continue to pay and submit | 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-821D 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-821D and Form I-765 at the same time. |
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| (If Representative completing form on behalf of client) Finish and continue to G-28 | Finish the 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-821D and a new Form I-765. We will prepare a draft Form I-821D and Form I-765 for your client to review and sign. If your client does not approve the information provided in the Form I-821D 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-821D, the draft Form I-765, and the draft G-28. |
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| (If Your Statement and Your Signature is complete) Pay and submit | Pay for and submit your applications | The final step to submit your Form I-821D, Consideration of Deferred Action for Childhood Arrivals and your Form I-765, Application for Employment Authorization is to pay the required fee. Form I-821D: [$XXX] Form I-765: [$XXX] Biometrics: [$XXX] Your total filling 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. |
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| We will send you to Pay.gov — our safe, secure payment website — to pay your fees and submit your application online. 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(s), your form(s) 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 form(s) through your USCIS online account. |
Pay and submit | Specific to digital environment and part of global template previously approved by OMB. | ||||||||||||
| ( Sucessful subnmission) (No nav) | You have successfully submitted both your Consideration of Deferred Action for Childhood Arrivals (I-821D) and Application for Employment Authorization (I-765) | We will contact you if we have any questions or need additional information. You can track the status of your application through your USCIS online account. | Go to my cases | |||||||||||
| (Unsuccesful card declined) (No nav) | You did not submit your Consideration of Deferred Action for Childhood Arrivals (I-821D) and Application for Employment Authorization (I-765) | Your payment failed because your credit or debit card was declined. You can try again now to sign and submit your applications or save and exit. |
Sign and submit | |||||||||||
| ( Unsucessful subnmission) (No nav) | You did not submit your Consideration of Deferred Action for Childhood Arrivals (I-821D) and Application for Employment Authorization (I-765) | Your payment failed or was canceled before it could be processed on Pay.gov. You can try again now to sign and submit your application or save your application and exit. We will save your application for 30 days from when you started it. |
Sign and submit | |||||||||||
| I-765: Alerts | ||||||||
| Number | Section | Revised | Type | Revised | Logic | Revised | Message | Notes |
| 1 | Eligibility | Orange alert | s | You can file your request online only for certain eligibility categories If your eligibility 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 denied. |
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| 2 | About You, Additional information | Yellow alert | User selects "No" to consent statement regarding SSN | h2. You must agree to the Consent for Disclosure To receive a Social Security card, you must select "Yes" to the Consent for Disclosure. |
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| 3 | Getting Started, Additional information | Yellow alert | User selects "Yes" to "Do you want the SSA to issue you a Social Security card" | h2. You must agree to the Consent for Disclosure If you answer “Yes”, you must also answer “Yes” to the Consent for Disclosure. |
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| 4 | Evidence, 2x2 Photo | Yellow Modal | User navigates away from page before upload complete. | You did not upload your files Your files have not finished uploading. If you leave this page, you will need to upload your files again. Stay on this page | Leave this page |
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| 5 | Evidence, I-765WS | Red alert | User doesn't upload I-765WS when concurrently filing with I-821d | You must provide evidence. | ||||
| 6 | Review and Submit | Red alert | If user has not answered required field | h2. There are errors in (Section): (Sub section) Edit my response |
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |