Form I-918 B I-918 B U Nonimmigrant Status Certification

USCIS
Form I-918

Supplement B, U Nonimmigrant Status Certification
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0104
Expires 02/28/2026

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For Certifying
Agency Use Only
(Certification
Tracking
Information)

For USCIS Use Only

► START HERE - Type or print in black ink.

Answer all questions fully and accurately. If you need extra space to provide additional information for any question, use the space
provided in Part 10. Additional Information.

Part 1. General Information About the Victim
1.

Victim's Full Legal Name

Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

Other Names Used

Family Name (Last Name)

3.

Date of Birth (mm/dd/yyyy)

4.

Alien Registration Number (A-Number) (if any)

5.

► A-

Gender

Male

Female

Another Gender Identity

Part 2. Information About You (Certifying Official)
I am the head of the certifying agency
I have been designated as the certifying official by the head of my agency
I am a judge
1.

Your Name (Certifying Official)
Family Name (Last Name)

2.

Given Name (First Name)

Name of Your Certifying Agency

3.

Middle Name (if applicable)

Your Position Title and Division or Office

If you are not the head of your agency, answer Item Numbers 4. - 5.
NOTE: Judges do not need to fill out Item Numbers 4. - 5.
4.

Name of the Head of Your Certifying Agency
Family Name (Last Name)

5.

Given Name (First Name)

Middle Name (if applicable)

Position Title of the Head of Your Certifying Agency

Form I-918 Sup B Edition 04/01/24

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Part 2. Information About You (Certifying Official) (continued)
6.

Physical Address of Your Agency
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

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Province

Postal Code

ZIP Code

Country

Other Agency Information
7.

Agency Type (select one):
Federal

8.

State

Local

Tribal

Territorial

Certifying Agency Category (select one):
Judge
Law Enforcement
Prosecutor

Other

Part 3. Case Information
1.

Case Status (select one):
Active/Ongoing Investigation

Closed Investigation

2.

Case Number (if any)

4.

State Identification (SID) Number (if applicable)

3.

FBI Universal Control Number (UCN) (if applicable)

Part 4. Qualifying Criminal Activity Perpetuated Against the Victim
If you need extra space to complete this section, use the space provided in Part 10. Additional Information.

Qualifying Criminal Activity Category
NOTE: USCIS is solely responsible for determining whether the crime(s) listed below is a “qualifying criminal activity” for
purposes of eligibility for U nonimmigrant status.
1.

The person listed in Part 1. is a victim of the following crimes (list the statutory citations for the qualifying criminal activity
detected, investigated, or prosecuted) and provide the dates on which the qualifying criminal activity occurred:
Statutory Citations for Qualifying Criminal Activity

Form I-918 Sup B Edition 04/01/24

Dates of Qualifying Criminal Activity

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Part 4. Qualifying Criminal Activity Perpetuated Against the Victim (continued)
2.

3.

4.

Describe the qualifying criminal activity being detected, investigated, and/or prosecuted. Attach copies of all relevant reports
and outcomes.

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The qualifying criminal activity in Part 4., Item Number 1. appears to fall under one or more of the following categories.
(Select all applicable boxes.)
Abduction

Manslaughter

Abusive Sexual Contact

Murder

Attempt to Commit Any of the Named Crimes

Peonage

Being Held Hostage

Perjury

Blackmail

Prostitution

Conspiracy to Commit Any of the Named Crimes

Rape

Domestic Violence

Sexual Assault

Extortion

Sexual Exploitation

False Imprisonment

Slave Trade

Felonious Assault

Solicitation to Commit Any of the Named Crimes

Female Genital Mutilation

Stalking

Fraud in Foreign Labor Contracting

Torture

Incest

Trafficking

Involuntary Servitude

Unlawful Criminal Restraint

Kidnapping

Witness Tampering

If the qualifying criminal activity listed at Part 4., Item Number 1. is similar to one or more of the above selected
categories listed in Part 4., Item Number 3. (for example, felonious assault), please list and provide a detailed description of
the nature and elements of the criminal activities you detected, investigated, or prosecuted.

Culpability in Qualifying Criminal Activity
5.

The victim was culpable in the qualifying criminal activity detected, investigated, or prosecuted. If you
answered “Yes,” provide an explanation in Part 10. Additional Information. Attach copies of all relevant
reports and findings.

Form I-918 Sup B Edition 04/01/24

Yes

No

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Part 4. Qualifying Criminal Activity Perpetuated Against the Victim (continued)
Jurisdiction
6.

Did the qualifying criminal activity occur in the United States (including Indian country and military
installations) or the territories or possessions of the United States? If you answered “Yes,” please indicate
where the qualifying criminal activity occurred.

Yes

No

7.

Did the qualifying criminal activity violate a Federal extraterritorial jurisdiction statute? If you answered
“Yes,” provide the statutory citation providing the authority for extraterritorial jurisdiction.

Yes

No

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Part 5. Known or Documented Injury to the Victim
1.

Provide a description of any known or documented injury to the victim. Attach copies of all relevant reports and findings.

Part 6. Helpfulness of the Victim
For the following questions, if the victim is under 16 years of age, or is incompetent or incapacitated, then a parent, guardian, or next
friend may act on behalf of the victim.
1.

Does the victim possess information concerning the qualifying criminal activity listed in Part 4.?

Yes

No

2.

The victim has been, is being, or is likely to be helpful in the detection, investigation, or prosecution of
the qualifying criminal activity detailed above.

Yes

No

3.

Since the initiation of cooperation, has the victim refused or failed to provide assistance reasonably
requested in the investigation or prosecution of the qualifying criminal activity detailed above?

Yes

No

If you answer “Yes” to Items Numbers 1. - 3., provide an explanation in the space below. If you need extra space to complete
this section, use the space provided in Part 10. Additional Information.

Form I-918 Sup B Edition 04/01/24

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Part 7. Victim's Family Members Culpable In The Qualifying Criminal Activity
If any of the victim's family members are culpable or believed to be culpable or believed to be culpable in the qualifying criminal
activity perpetrated against the victim, list the family members and their criminal involvement.
1.

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Family Member 1

Family Name (Last Name)

2.

Relationship to Victim

4.

Family Member 2

Family Name (Last Name)

5.

Relationship to Victim

Given Name (First Name)

Middle Name (if known)

3. Involvement

Given Name (First Name)

Middle Name (if known)

6. Involvement

Part 8. Supplemental Information
1.

If you would like to share any additional information you think is relevant to this certification, provide specific details. Attach
all relevant documentation and records.

Part 9. Certification
As the head of the agency or the person designated by the head of the agency, or a person otherwise authorized by INA Section
214(p)(1) to sign certifications, I certify, under penalty of perjury, that the foregoing is true and correct.
The individual identified in Part 1. is or was a victim of one or more of the qualifying criminal activities listed in Part 4.
My agency has been or is involved in the detection, investigation, prosecution, conviction, sentencing of one or more of the qualifying
criminal activities listed in Part 4.
The individual has been, is being, or is likely to be helpful in the detection, investigation, prosecution, conviction, sentencing of the
qualifying criminal activity.
NOTE: If you are a designated certifying official and your name and signature has not been provided to USCIS, or if your agency
needs to otherwise update its list certifying official(s), see page 2 of the Form I-918, Supplement B, “Instructions for Certifying
Officials” for further guidance.
1.

Signature of Certifying Official

3.

Daytime Telephone Number

5.

Fax Number

Form I-918 Sup B Edition 04/01/24

2.

4.

Date of Signature (mm/dd/yyyy)

Email Address

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Part 10. Additional Information
If you need extra space to provide additional information within this supplement, use the space below. If you need more space than
what is provided, you may make copies of this page and file with this supplement or attach a separate sheet of paper. Type or print the
agency's name, victim's name, and the A-Number at the top of each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each sheet.

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1.

Page Number

Part Number Item Number

2.

Page Number

Part Number Item Number

3.

Page Number

Part Number Item Number

4.

Page Number

Part Number Item Number

Form I-918 Sup B Edition 04/01/24

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