I-918 Frm Toc

TABLE OF CHANGES – FORM

Form I-918, Petition for U Nonimmigrant Status

OMB Number: 1615-0104

09/06/2024

Reason for Revision: REV

Project Phase: OMBReview

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 02/28/2026

Edition Date 04/01/2024

Current Page Number and Section	Current Text	Proposed Text
Page 1	[Page 1] For USCIS Use Only Remarks Receipt Action Block U.S. Embassy Consulate Validity Dates (mm/dd/yyyy) From: / / / To: / / / Wait Listed Stamp Number Date (mm/dd/yyyy) To be completed by an attorney or accredited representative (if any). Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any) START HERE – Type or print in black or blue ink	[Page 1] For USCIS Use Only Remarks Receipt Action Block U.S. Embassy Consulate Validity Dates (mm/dd/yyyy) From: / / / To: / / / Wait Listed Stamp Number Date (mm/dd/yyyy) To be completed by an attorney or accredited representative. Select this box if Form G-28 or G-28I is attached. Attorney State Bar Number Attorney or Accredited Representative USCIS Online Account Number START HERE – Type or print in black ink.
Pages 1-2, Part 1. Information About You (Person filing this petition as a victim)	[Page 1] Part 1. Information About You (Person filing this petition as a victim) 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name Other Names Used (Include maiden name, nicknames, and aliases, if applicable) 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name Home Address 3.a. Street Number and Name 3.b. Apt./Ste./Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Safe Mailing Address (if other than Home Address) 4.a. In Care Of Name 4.b. Street Number and Name 4.c. Apt./Ste./Flr. 4.d. City or Town 4.e. State 4.f. ZIP Code 4.g. Province 4.h. Postal Code 4.i. Country [new] Other Information 5. Alien Registration Number (A-Number) (if any) 7. USCIS Online Account Number (if any) 6. U.S. Social Security Number (if any) [Page 2] 9. Gender Male Female 10. Date of Birth (mm/dd/yyyy) 11. Country of Birth 12. Country of Citizenship or Nationality [Page 1] 8. Marital Status Single Married Divorced Widowed [new] 13. Form I-94 Arrival-Departure Record Number 14. Passport Number 15. Travel Document Number 16. Country of Issuance for Passport or Travel Document 17. Date of Issuance for Passport or Travel Document (mm/dd/yyyy) 18. Expiration Date for Passport or Travel Document (mm/dd/yyyy) Place and Date of Last Entry into the United States and Date Authorized Stay Expired 19.a. City or Town 19.b. State 20. Date of Last Entry into the United States (mm/dd/yyyy) 21. Date Authorized Stay Expired (mm/dd/yyyy) 22. Current Immigration Status	[Page 1] Part 1. Information About You (Person filing this petition as a victim) 1. Your Full Legal Name (Do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 2. Other Names Used Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 8. Additional Information. Family Name (Last Name) [x2] Given Name (First Name) [x2] Middle Name (if applicable) [x2] 3. Current Physical Address In Care Of Name (if any) Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province or Region (foreign address only) Postal Code (foreign address only) Country (foreign address only) [Page 2] 4. Current Mailing Address (Safe Mailing Address) If you do not want USCIS to send notices about this petition to your physical address, you may provide a safe mailing address. If you do not provide a mailing address below, USCIS may send correspondence to the physical address listed in Item Number 3. In Care Of Name (if any) Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province (foreign address only) Postal Code (foreign address only) Country (foreign address only) 5. Consular or Inspection Facility Information If you are outside of the United States, provide the U.S. Consulate or inspection facility to which you would like notification about this petition sent. Type of Office (Select only one box): U.S. Consulate/Pre-Flight Inspection/Port-of-Entry City or Town State Country Other Information 6. Alien Registration Number (A-Number) (if any) 7. USCIS Online Account Number (if any) 8. U.S. Social Security Number (if any) 9. Gender Male   Female   Another Gender Identity 10. Date of Birth (mm/dd/yyyy) 11. City or Town of Birth [Fillable field] State or Province of Birth [Fillable field] Country of Birth [Fillable field] 12. Country of Citizenship or Nationality [Fillable field] 13. Marital Status Single [Single, Never Married] Married Divorced Widowed 14. Do you have a currently valid passport or travel document? Yes/No Please provide a copy of the biographical page of your passport or travel document, even if it has expired. 15. Do you have a Form I-94 Arrival/Departure Record? Yes/No If you answered “Yes,” provide a copy of the document(s) with your petition. [deleted]
Pages 2-3, Part 2. Additional Information About You	[Page 3] Part 2. Additional Information About You [new] Answering “Yes” to the following questions below requires explanations and supporting documentation. Attach relevant documents in support of your claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA) section 101(a)(15)(U)(iii). You must also attach a personal narrative statement describing the criminal activity of which you are a victim. If you are only petitioning for U derivative status for qualifying family members subsequent to your (the principal petitioner) initial filing, you are not required to submit evidence supporting the original petition with the new Form I-918. If you need extra space to complete Part 2., use the space provided in Part 8. Additional Information. Select "Yes" or "No," as appropriate, for each of the following questions. 1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U)(iii). Yes No 2. I have suffered substantial physical or mental abuse as a result of having been a victim of this criminal activity. Yes No 3. I possess information concerning the criminal activity of which I was a victim. Yes No 4. I am submitting Form I-918, Supplement B, U Nonimmigrant Status Certification, from a certifying official. Yes No 5. The crime of which I am a victim occurred in the United States (including Indian country and military installations) or violated the laws of the United States. Yes No 6. I am under 16 years of age. Yes No 7.a. I was or am in immigration proceedings. Yes No If you answered "Yes," select the type of proceedings. If you were in proceedings in the past and are no longer in proceedings, provide the date of action. If you are currently in proceedings, type or print “Current” in the appropriate date field. Select all applicable boxes. Use the space provided in Part 8. Additional Information to provide an explanation. 7.b. Removal Proceedings Removal Date (mm/dd/yyyy) 7.c. Exclusion Proceedings Exclusion Date (mm/dd/yyyy) 7.d. Deportation Proceedings Deportation Date (mm/dd/yyyy) 7.e. Rescission Proceedings Rescission Date (mm/dd/yyyy) 7.f. Judicial Proceedings Judicial Date (mm/dd/yyyy) Provide the date of entry, place of entry, and status under which you entered the United States for each entry during the five years preceding the filing of this petition. 8.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 8.b. City or Town 8.c. State 8.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) 9.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 9.b. City or Town 9.c. State 9.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) 10.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 10.b. City or Town 10.c. State 10.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) If you are outside of the United States, provide the U.S. Consulate or inspection facility or a safe foreign mailing address you want notified if this petition is approved. 11.a. Type of Office (Select only one box): U.S. Consulate Pre-Flight Inspection Port-of-Entry 11.b. City or Town 11.c. State 11.d. Country Safe Foreign Address Where You Want Notification Sent (if other than U.S. Consulate, Pre-Flight Inspection, or Port-of-Entry) 12.a. Street Number and Name 12.b. Apt./Ste./Flr. 12.c. City or Town 12.d. Province 12.e. Postal Code 12.f. Country	[Page 3] Part 2. Additional Information and General Inadmissibility Grounds NOTE: If you answer “Yes” to any of the below inadmissibility questions, please refer to the Form I-918 Instructions, Waiver of Grounds of Inadmissibility section, as you may be required to file a Form I-192 waiver. Answer Item Numbers 1. - 31. about yourself. If you answer “Yes” to any questions (or if you answer “No,” but are unsure of your answer), provide an explanation of the events and circumstances in the space provided in Part 8. Additional Information. 1. Have you EVER been denied a visa or denied admission to the United States? Yes/No 2. Are you now or have you EVER been in exclusion, deportation, removal, or rescission proceedings? Yes/No Unknown If you answered "Yes," to Item Number 2., select the type of proceedings. If you were in proceedings in the past and are no longer in proceedings, provide the date of action. If you are currently in proceedings, select the box next to “Present.” If you answered “Unknown” to Item Number 2., use the space provided in Part 8. Additional Information to provide an explanation. You may also use the space provided in Part 8. Additional Information to provide information about more than one type of proceeding, if necessary. [] Removal [ ] Exclusion [ ] Deportation []Rescission [] Unknown Date (mm/dd/yyyy) [] Present 3. Have you EVER been issued a final order of exclusion, deportation, or removal? Yes/No 4. Have you EVER departed the United States on your own after having been ordered excluded, deported, or removed from the United States? Yes/No 5. Since April 1, 1997, have you been unlawfully present in the United States: A. For more than 180 days but less than a year, and then departed the United States? [ ] Yes [ ] No B. For one year or more and then departed the United States? [ ] Yes [ ] No NOTE: You were unlawfully present in the United States if you entered the United States without being inspected and admitted or paroled, or if you legally entered the United States but you stayed longer than permitted. 6. Since April 1, 1997, have you EVER reentered or attempted to reenter the United States without being inspected and admitted or paroled after: Having been unlawfully present in the United States for more than one year in the aggregate? [ ] Yes [ ] No Having been deported, excluded, or removed from the United States? [ ] Yes [ ] No If your answer is “Yes,” please provide an explanation including the date(s) of departure, re-entry or attempted reentry in Part 8. Additional Information. Criminal Acts and Violations For Item Numbers 7. - 31., you must answer "Yes" to any question that applies to you, even if your records were sealed or otherwise cleared, or even if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. You must also answer "Yes" to the following questions whether the action or offense occurred in the United States or anywhere else in the world. If you answer "Yes" to Item Numbers 7. - 31., use the space provided in Part 8. Additional Information to provide an explanation that includes why you were arrested, cited, detained, or charged; where you were arrested, cited, detained, or charged; when (date) the event occurred; and the outcome or disposition (for example, no charges filed, charges dismissed, jail, probation, community service). NOTE: Answering "Yes" does not mean that U.S. Citizenship and Immigration Services (USCIS) will automatically deny your Petition for U Nonimmigrant Status. 7. Have you EVER been arrested, cited, charged, or detained for any reason by any law enforcement official (including but not limited to any U.S. immigration official or any U.S. military official, U.S. Coast Guard or by a similar official of a country other than the United States)? Yes/No 8. Have you EVER committed a crime of any kind (even if you were not arrested, cited, charged with, tried for that crime, or convicted)? Yes/No [Page 4] 9. Have you EVER pled guilty to or been convicted of a crime or offense (even if the violation was subsequently expunged or sealed by a court, or if you were granted a pardon, amnesty, a rehabilitation decree, or other act of clemency)? If you answer “Yes,” provide documentation of the post-conviction action. Yes/No 10. Have you EVER been ordered, punished by a judge, or had conditions imposed on you that restrained your liberty (such as a prison sentence, suspended sentence, house arrest, parole, alternative sentencing, drug or alcohol treatment, rehabilitative programs or classes, probation, or community service)? Yes/No 11. Have you EVER been convicted of two or more offenses (other than purely political offenses) for which the combined sentences to confinement were five years or more? Yes/No 12. Have you EVER exercised immunity (diplomatic or otherwise) to avoid being prosecuted for a criminal offense in the United States? Yes/No 13. Have you EVER, while serving as a foreign government official, been responsible for or directly carried out violations of religious freedoms? Yes/No 14. Have you EVER illegally trafficked or benefited from the trafficking of any controlled substances, or knowingly aided, abetted, assisted, conspired, or colluded in the illegal trafficking of any controlled substances or chemicals? Yes/No 15. Have you EVER engaged in prostitution, or do you intend to engage in any form of commercialized vice such as prostitution, illegal gambling, bootlegging, or child pornography while in the United States? Yes/No 16. Have you EVER engaged in money laundering or have you EVER knowingly aided, assisted, conspired, or colluded with others in money laundering or do you seek to enter the United States to engage in such activity? Yes/No 17. Have you EVER trafficked, or knowingly aided, abetted, assisted, conspired, or colluded with others in trafficking persons for commercial sex acts or involuntary servitude, peonage, debt bondage, or slavery? Trafficking includes recruiting, harboring, transporting, providing, or obtaining a person for labor or services through force, fraud, or coercion. Yes/No Security and Related Do you intend to: 18.a. Engage in any activity that violates or evades any law relating to espionage (including spying) or sabotage in the United States? Yes/No 18.b. Engage in any activity in the United States that violates or evades any law prohibiting the export from the United States of goods, technology, or sensitive information? Yes/No 18.c. Engage in any activity whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means while in the United States? Yes/No Have you EVER: 19.a. Received any weapons training, paramilitary training, or other military-type training? Yes/No 19.b. Committed hijacking or sabotage of a conveyance (including an aircraft, vessel, or vehicle), kidnapping, or assassination? Yes/No 19.c. Threatened, attempted, conspired to use, or used a weapon or explosive or any dangerous device with the intent to endanger the safety of another person or people or cause substantial damage to property? Yes/No 20. Have you EVER assisted or participated in selling, providing, or transporting weapons to any person who, to your knowledge, planned to use them against another person? Yes/No 21. Have you EVER worked, volunteered, or otherwise served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons? Yes/No 22. Have you EVER served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla group, militia, insurgent organization, or any other armed group? Yes/No [Page 5] Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 23.a. Acts involving torture or genocide? Yes/No 23.b. Killing any person? Yes/No 23.c. Intentionally and severely injuring any person? Yes/No 23.d. Engaging in any kind of sexual contact or relations with any person who did not consent or was unable to consent, or was being forced or threatened? Yes/No 23.e. Limiting or denying any person's ability to exercise religious beliefs? Yes/No 24. Have you EVER recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed force or group? Yes/No 25. Have you EVER used any person under 15 years of age to take part in hostilities, or to help or provide services to people in combat? Yes/No Fraud and Misrepresentation 26. Are you NOW under a final order or civil penalty for violating section 274C of the INA (producing and/or using false documentation to unlawfully satisfy a requirement of the INA)? Yes/No 27. Have you EVER lied about, concealed, or misrepresented any information on an application or petition to obtain a visa, other documentation required for entry into the United States, admission to the United States, or any other immigration benefit? Yes/No 28. Have you EVER falsely claimed to be a U.S. citizen (in writing or any other way)? Yes/No Miscellaneous Conduct 29. Do you NOW have or have you EVER had a physical or mental disorder or behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? 30. Are you NOW or have you EVER been a drug abuser or drug addict? 31. Have you EVER been convicted of desertion from the U.S. armed forces? Yes/No [deleted]
Pages 3-6, Part 3. Processing Information	[Page 5] Part 3. Processing Information Answer the following questions about yourself. For the purposes of this petition, you must answer "Yes" to the following questions, if applicable, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. NOTE: If you answer “Yes” to ANY question in Part 3., provide an explanation in the space provided in Part 8. Additional Information. NOTE: Answering "Yes" does not necessarily mean that U.S. Citizenship and Immigration Services (USCIS) will deny your Petition for U Nonimmigrant Status. Have you EVER: 1.a. Committed a crime or offense for which you have not been arrested? Yes No 1.b. Been arrested, cited, or detained by any law enforcement officer (including Department of Homeland Security (DHS), former Immigration and Naturalization Service (INS), and military officers) for any reason? Yes No 1.c. Been charged with committing any crime or offense? Yes No 1.d. Been convicted of a crime or offense (even if the violation was subsequently expunged or pardoned)? Yes No 1.e. Been placed in an alternative sentencing or a rehabilitative program (for example, diversion, deferred prosecution, withheld adjudication, deferred adjudication)? Yes No [Page 4] 1.f. Received a suspended sentence, been placed on probation, or been paroled? Yes No 1.g. Been in jail or prison? Yes No 1.h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? Yes No 1.i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? Yes No Information About Arrests, Citations, Detentions, or Charges If you answered “Yes” to any of the above questions, respond to the questions below to provide additional details. If you need extra space, use the space provided in Part 8. Additional Information. 2.a Why were you arrested, cited, detained, or charged? 2.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 2.c. City or Town 2.d. State 2.e. Country 2.f. Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) 3.a Why were you arrested, cited, detained, or charged? 3.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 3.c. City or Town 3.d. State 3.e. Country 3.f. Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) Have you EVER: 4.a. Engaged in, or do you intend to engage in, prostitution or procurement of prostitution? Yes No 4.b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Yes No 4.c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? Yes No 4.d. Illicitly trafficked in any controlled substance or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance? Yes No Have you EVER committed, planned or prepared, participated in, threatened to, attempted to, conspired to commit, gathered information for, or solicited funds for any of the following: 5.a. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? Yes No 5.b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? Yes No 5.c. Assassination? Yes No 5.d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 5.e. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No Have you EVER been a member of, solicited money or members for, provided support for, attended military training (as defined in section 2339D(c)(1) of Title 18, United States Code) by or on behalf of, or been associated with any other group of two or more individuals, whether organized or not, which has been designated as, or has engaged in or has a subgroup which has been designated as, or has engaged in: 6.a. A terrorist organization under section 219 of the INA? Yes No 6.b. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? Yes No [Page 5] 6.c. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? Yes No 6.d. Assassination? Yes No 6.e. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 6.f. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 6.g. Soliciting money or members or otherwise providing material support to a terrorist organization? Yes No Do you intend to engage in the United States in: 7.a. Espionage? Yes No 7.b. Any unlawful activity, or any activity the purpose of which is in opposition to, or the control, or overthrow of the government of the United States? Yes No 7.c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law involving the export of goods, technology, or sensitive information? Yes No 8. Have you EVER been or do you continue to be a member of the Communist or other totalitarian party, except when membership was involuntary? Yes No 9. Have you EVER, during the period of March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ordered, incited, assisted or otherwise participated in the persecution of any person because of race, religion, nationality, membership in a particular social group, or political opinion? Yes No Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: 10.a. Acts involving torture or genocide? Yes No 10.b. Killing any person? Yes No 10.c. Intentionally and severely injuring any person? Yes No 10.d. Engaging in any kind of sexual conduct or relations with any person who was being forced or threatened? Yes No 10.e. Limiting or denying any person's ability to exercise religious beliefs? Yes No 10.f. The persecution of any person because of race, religion, national origin, membership in a particular social group, or political opinion? Yes No 10.g. Displacing or moving any person from their residence by force, threat of force, compulsion, or duress? Yes No NOTE: If you answered "Yes" to any question in Item Numbers 10.a. - 10.g., please describe the circumstances in Part 8. Additional Information. 11. Have you EVER advocated that another person commit any of the acts described in the preceding question, urged, or encouraged another person, to commit such acts? Yes No Have you EVER been present or nearby when any person was: 12.a. Intentionally killed, tortured, beaten, or injured? Yes No 12.b. Displaced or moved from his or her residence by force, compulsion, or duress? Yes No 12.c. In any way compelled or forced to engage in any kind of sexual contact or relations? Yes No Have you EVER: 13.a. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla group, militia, or other insurgent organization? Yes No [Page 6] 13.b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons? Yes No 13.c. Served in, been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons transported, possessed, or used any type of weapon? Yes No NOTE: If you answered "Yes" to any question in Item Numbers 13.a. - 13.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 14.a. Received any type of military, paramilitary, or weapons training? Yes No 14.b. Been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so? Yes No 14.c. Assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person? Yes No NOTE: If you answered "Yes" to any question in Item Numbers 14.a. - 14.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 15.a. Recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed force or group? Yes No 15.b. Used any person under 15 years of age to take part in hostilities, or to help or provide services to people in combat? Yes No 16. Are you NOW in removal, exclusion, rescission, or deportation proceedings? Yes No 17. Have you EVER had removal, exclusion, rescission, or deportation proceedings initiated against you? Yes No 18. Have you EVER been removed, excluded, or deported from the United States? Yes No 19. Have you EVER been ordered to be removed, excluded, or deported from the United States? Yes No 20. Have you EVER been denied a visa or denied admission to the United States? Yes No 21. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time? Yes No 22. Are you NOW under a final order or civil penalty for violating section 274C of the INA (producing and/or using false documentation to unlawfully satisfy a requirement of the INA)? Yes No 23. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure or procured a visa or other documentation, for entry into the United States or any immigration benefit? Yes No 24. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces or U.S. Coast Guard? Yes No 25. Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence requirement and not yet complied with that requirement or obtained a waiver of such? Yes No 26. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to United States citizenship, outside the United States from a United States citizen granted custody? Yes No 27. Do you plan to practice polygamy in the United States? Yes No 28. Have you EVER entered the United States as a stowaway? Yes No 29.a. Do you NOW have a communicable disease of public health significance? Yes No 29.b. Do you NOW have or have you EVER had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? Yes No 29.c. Are you NOW or have you EVER been a drug abuser or drug addict? Yes No	[deleted] [moved to Part 2., Item Number 8.] [moved to Part 2., Item Number 7.] [deleted] [moved to Part 2., Item Number 12.] [deleted]
Page 7, Part 4. Information About Your Spouse and/or Children	[Page 7] Part 4. Information About Your Spouse and/or Children If you need extra space to complete Part 4., use the space provided in Part 8. Additional Information. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Relationship 5. Current Location 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 6.c. Middle Name 7. Date of Birth (mm/dd/yyyy) 8. Country of Birth 9. Relationship 10. Current Location 11.a. Family Name (Last Name) 11.b. Given Name (First Name) 11.c. Middle Name 12. Date of Birth (mm/dd/yyyy) 13. Country of Birth 14. Relationship 15. Current Location 16.a. Family Name (Last Name) 16.b. Given Name (First Name) 16.c. Middle Name 17. Date of Birth (mm/dd/yyyy) 18. Country of Birth 19. Relationship 20. Current Location 21.a. Family Name (Last Name) 21.b. Given Name (First Name) 21.c. Middle Name 22. Date of Birth (mm/dd/yyyy) 23. Country of Birth 24. Relationship 25. Current Location Filing On Behalf of Family Members 26. I am petitioning for one or more qualifying family members. Yes No NOTE: If you answered “Yes” to 26., you must complete and include Supplement A for each family member for whom you are petitioning.	[deleted]
	[new]	[Page 5] Part 3. Biographic Information 1.  Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2.  Race (Select all applicable boxes) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White 3.  Height  Feet__ Inches __ 4.  Weight    Pounds _ ­_ _ 5.  Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other 6.  Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other
	[new]	[Page 6] Part 4. Victim Personal Statement Please provide your personal statement in the space below, including specific details describing the qualifying criminal activity, the harm you have suffered as a result, and your helpfulness to the certifying agency. If you need extra space to complete this section, use the space provided in Part 9. Additional Information for Personal Statement. If your personal statement is attached, please type or print “See attached” in the space below.
Page 8, Part 5. Petitioner’s Statement, Contact Information, Declaration, and Statement	[Page 8] Part 5. Petitioner's Statement, Contact Information, Declaration, and Signature NOTE: Read the Penalties section of the Form I-918 Instructions before completing this part. Petitioner's Statement NOTE: Select the box for either 1.a. or 1.b. If applicable, select the box for 2. 1.a. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. 1.b. The interpreter named in Part 6. read to me every question and instruction on this petition and my answer to every question in [fillable field], a language in which I am fluent, and I understood everything. 2. At my request, the preparer named in Part 7., [fillable field], prepared this petition for me based only upon information I provided or authorized. Petitioner's Contact Information 3. Petitioner's Daytime Telephone Number 4. Petitioner's Mobile Telephone Number (if any) 5. Petitioner's Email Address (if any) Petitioner'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 of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. I further authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. 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 provided or authorized all of the information contained in, and submitted with, my petition; 2) I reviewed and understood all of the information in, and submitted with, my petition; and 3) 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 petition 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 petition, and that all of this information is complete, true, and correct. Petitioner's Signature 6.a. Petitioner's Signature 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition. NOTE: A parent or legal guardian may sign for a person who is less than 14 years of age. A legal guardian may sign for a mentally incompetent person.	[Page 6] Part 5. Petitioner's Contact Information, Certification, and Signature [deleted] Petitioner’s Contact Information Provide your daytime telephone number, mobile telephone number (if any), and email address (if any). 1. Petitioner’s Daytime Telephone Number 2. Petitioner’s Mobile Telephone Number (if any) 3. Petitioner’s Email Address (if any) Petitioner’s Certification and Signature [deleted] I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with my petition, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 6., understood, all of the responses and information contained in, and submitted with, my petition, and that all of the responses and the information are complete, true, and correct. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for an immigration request and to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. [deleted] 4. Petitioner’s Signature Date of Signature (mm/dd/yyyy) [deleted]
Pages 8-9, Part 6. Interpreter’s Contact Information, Certification, and Signature	[Page 8] Part 6. Interpreter's Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter's Full Name 1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) [Page 9] Interpreter's Mailing Address 3.a. Street Number and Name 3.b. Apt./Ste./Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter's Mobile Telephone Number (if any) 6. Interpreter's Email Address (if any) Interpreter's Certification I certify, under penalty of perjury, that: I am fluent in English and [fillable field], which is the same language specified in Part 5., 1.b., and I have read to this petitioner in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner's Declaration and Certification, and has verified the accuracy of every answer. Interpreter's Signature 7.a. Interpreter's Signature (sign in ink) 7.b. Date of Signature (mm/dd/yyyy)	[Page 7] Part 6. Interpreter's Contact Information, Certification, and Signature [deleted] Interpreter's Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) [deleted] Interpreter's Contact Information 3. Interpreter's Daytime Telephone Number 4. Interpreter's Mobile Telephone Number 5. Interpreter's Email Address Interpreter's Certification and Signature I certify, under penalty of perjury, that I am fluent in English and [Fillable language field], and I have interpreted every question on the petition and Instructions and interpreted the petitioner’s answers to the questions in the language listed above, and the petitioner informed me that they understood every instruction, question, and answer on the petition. [deleted] 6. Interpreter's Signature Date of Signature (mm/dd/yyyy)
Pages 9-10, Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner	[Page 9] Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner Provide the following information about the preparer. Preparer's Full Name 1.a. Preparer's Family Name (Last Name) 1.b. Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) Preparer's Mailing Address 3.a. Street Number and Name 3.b. Apt./Ste./Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Telephone Number (if any) 6. Preparer's Email Address (if any) [Page 10] Preparer's Statement 7.a. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent. 7.b. I am an attorney or accredited representative and my representation of the petitioner in this case extends/does not extend beyond the preparation of this petition. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this petition. Preparer's Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner. The petitioner then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner's Declaration and Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. Preparer's Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)	[Page 7] Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner [deleted] Preparer's Full Name 1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) [deleted] Preparer's Contact Information 3. Preparer's Daytime Telephone Number 4. Preparer's Mobile Telephone Number (if any) 5. Preparer's Email Address (if any) [deleted] [Page 8] Preparer's Certification and Signature I certify, under penalty of perjury, that I prepared this petition for the petitioner at their request and with express consent and that all of the responses and information contained in and submitted with the petition are complete, true, and correct and reflects only information provided by the petitioner. The petitioner reviewed the responses and information and informed me that they understand the responses and information in or submitted with the petition. [deleted] 6. Preparer's Signature Date of Signature (mm/dd/yyyy)
Page 11, Part 8. Additional Information	[Page 11] Part 8. Additional Information If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and A-Number (if any) 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. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. A-Number (if any) 3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. 4.a. Page Number 4.b. Part Number 4.c. Item Number 4.d. 5.a. Page Number 5.b. Part Number 5.c. Item Number 5.d. 6.a. Page Number 6.b. Part Number 6.c. Item Number 6.d. 7.a. Page Number 7.b. Part Number 7.c. Item Number 7.d.	[Page 9] Part 8. Additional Information If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or print your name and A-Number (if any) 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. 1. Family Name (Last Name) Given Name (First Name) Middle Name 2. A-Number (if any) 3. Page Number Part Number Item Number [fillable field] 4. Page Number Part Number Item Number [fillable field] 5. Page Number Part Number Item Number [fillable field] 6. Page Number Part Number Item Number [fillable field] [deleted]
	[new]	[Page 10] Part 9. Additional Information for Victim Personal Statement If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet. 1. Family Name (Last Name) [Auto-populated field] Given Name (First Name) [Auto-populated field] Middle Name [Auto-populated field] 2. A-Number (if any) 3. Victim Personal Statement [Fillable Fields]

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