I-765 Copy Deck Table of Changes

I-765-055_83C_eFileCopyDeckv5.0.6_11052024.pdf

Application for Employment Authorization

I-765 Copy Deck Table of Changes

OMB: 1615-0040

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Download: pdf | pdf

myUSCIS Copydeck: Interactive Forms

Form Number and Name
OMB Number
Form Edition Date:
Form Expiration Date:
Baseline Copydeck:

Form I-765, Application for Employment Authorization
1615-0040
4/1/2024
2/28/2027
I-765 Production Copy Deck v5.0.3

Revision Key

Description

• All original (old) text is black.
• All revised (new) text is red.

Example

• All original text is black.
• Any text that is removed from original
column is shown with a strikethrough and in
red.

Original

1. Oranges
2. Bananas
3. Apple
4. Pineapple

Revised

1. Oranges
2. Bananas
3. Apple
4. Pineapple

Copy Deck Version

Form I-765, Application for Employment Authorization

Date
2/9/2023

4/28/2023

1/23/2024
2/7/2024

Version

Requested Description
Yellow alert for c8 categories in Getting
Started, Basis of Eligibility
I-765 Production Copy • Updated Review and Submit numbering
Deck v5.0.0
conventions
• Minor cleanups to formatting
• Added Concurrent filing content to File a
Form, Overview, Getting Started, Review
and Submit, and Alerts sheets.
• Corrected typos
• Updated the "please review your form"
instructional text on the Review your
application page to the new global copy.
• Added revisions from the I-94 EU
Expansion Copy Deck v4.1.2.
I-765 Production Copy • Updated print formatting to meet PRA
Deck v5.0.1
standards.
I-765 Production Copy • Updated the Overview sections to include
Deck v5.0.2
the (c)(9) eligibility category and its related
accordion.
• Updated Getting Started/Eligibility section
to include conditional alerts
• Updated About You section to include
(c)(9) category and conditional alerts
• Updated Evidence section to include (c)(9)
conditional evidence uploader

Requested by
Formulators
Intakers/Formik Factory

Koalas

Changes made
Added missing yellow alert for c8 categories to
Getting Started, Basis of Eligibility
• Updated Review and Submit numbering
conventions
• Minor cleanups to formatting
• Added Concurrent filing content to File a Form,
Overview, Getting Started, Review and Submit, and
Alerts sheets.
• Corrected typos
• Updated the "please review your form"
instructional text on the Review your application
page to the new global copy.
• Added revisions from the I-94 EU Expansion Copy
Deck v4.1.2.
• Updated print formatting to meet PRA standards.

Audit to prepare for PRA - • Overview: Added (c)(9) eligibility category to the
036 revisions
list of categories eligible for online filing, added the
associated information in an accordion
• Getting Started - Basis of Eligibility - added in
conditional alerts that appear underneath question
"What is your eligibility category?"
• Revised conditions within Getting Started - Reason
for Applying
• Added I-485 EU for (c)(9) eligibility category

Revision History

FILE A FORM: I-765

Column Header Descriptions
Header: If needed, a header is located directly under the dropdown menu and above the body text.
Body Text: Based on the purpose of the form found in the paper form instructions.
Link: A reference column to include any URLs that appear as hyperlinks in the body text.
CTA: Copy to include for a button.
Notes: Internal notes for the myUSCIS teams to provide insight and explanations.
Page breaks are indicated by a bold horizontal line.
Heading

Instructional Text

Condition

Field Type

Body Text

Link

CTA

Notes

Select the form you want to file online. For some forms you will have the option to either fill out your
https://www.uscis.gov/feewaiv
form online or upload a completed form. Once you start, we will automatically save your information for er
30 days, or from the last time you worked on the form.

Select the form you want to
file online.
What is your eligibility
If your eligibility category is not listed in
category?
the drop down menu, you can submit a
paper form by mail.

Dropdown
Dropdown

Only show body text if user selects the following categories:
(c)(3)(A) Student Pre-Completion OPT
(c)(3)(B) Student Post-Completion OPT
(c)(3)(C) STEM Extension
(c)(33) Consideration of Deferred Action for Childhood Arrivals

Fee waiver: Fee waivers can be requested online only when submitting certain benefit requests using the
PDF filing option. If your desired benefit request is not eligible for PDF filing, you must file a paper
version of both the Form I-912, Request for Fee Waiver and the form for the specific benefit you are
requesting. You can review the fee waiver guidance at www.uscis.gov/feewaiver.
I-765, Application for Employment Authorization
(a)(12) Temporary Protected Status Granted
(c)(3)(A) Student Pre-Completion OPT
(c)(3)(B) Student Post-Completion OPT
(c)(3)(C) STEM Extension
(c)(8) Pending Asylum and Withholding of Removal Applicants and Applicants for Asylum under the ABC
Settlement Agreement
(c)(9) Adjustment Applicant under Section 245
(c)(11) Parole
(c)(11) Afghan Parole
(c)(11) Ukraine Parole
(c)(19) Temporary Protected Status Pending
(c)(33) Consideration of Deferred Action for Childhood Arrivals
Use this form to request employment authorization and an Employment Authorization Document (EAD) https://www.uscis.gov/i-765
if your immigration status allows you to work in the United States.
Note: You may apply online if your eligibility category is:
• (a)(12) - Temporary Protected Status (You are submitting an initial Form I-821 or you have an approved
Form I-821);
• (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);
• (c)(8) - Applicants for Asylum under the ABC Settlement Agreement;
• (c)(8) – Application for Employment Authorization Based on Pending Form I-589, Application
for Asylum or for Withholding of Removal;
• (c)(11) - Parole;
• (c)(19) - Temporary Protected Status (You have a pending Form I-821); or
• (c)(33) - Consideration of Deferred Action for Childhood Arrivals (DACA) (You must have a pending or
approved Form I-821D in order to file Form I-765).
All other applicants must submit a paper Form I-765.
Concurrent filing available
You can file Form I-907, Request for Premium Processing Service, if you are filing under one of the
eligible categories.

Start form

If you request premium processing, we will present Form I-907 for you to complete after you sign Form I765. This will allow you to pay for and submit both forms at the same time.

File a Form

FILING OPTIONS: I-765

Sub Heading

Instructional Text

Condition

Field Type

Question

Body Text

Button 1

Fill Out Form Fields Online

Select this option if you want to fill out the fields of the I-765 form online directly. This option currently
does not support fee waiver.

Button 2

Upload a Filled Out PDF Form Select this option if you want to upload and submit a filled out version of the I-765 form as a pdf
document. You may apply for a fee waiver with this option by uploading a fee waiver request to verify
qualifications.

Link

CTA

Only show this Filing Options page if user selects the following
categories:
(a)(12) Temporary Protected Status Granted
(c)(8) Pending Asylum and Withholding of Removal Applicants and
Applicants for Asylum under the ABC Settlement Agreement
(c)(9) Adjustment Applicant under Section 245
(c)(11) Parole
(c)(11) Afghan Parole
(c)(11) Ukraine Parole
(c)(19) Temporary Protected Status Pending
Form I-765, Application for
Employment Authorization
Select between the following
filing options.

Use this form to request employment authorization and an Employment
Authorization Document if your immigration status allows you to work in
the United States.

You can also mail a paper form by following the instructions on this page

https://www.uscis.gov/i-765
Go back

Filing Options

APPLICATION OVERVIEW: I-765

Column Header Descriptions
Heading: The primary heading on a page, typically the first part of a section of the page.
Sub-Heading: The secondary header, typically directly underneath the Heading.
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Body Text: Based on the questions from the paper form.
Li k A f
l
t i l d
URL th t
h
li k i th I t ti
Heading

Sub-Heading

Conditional Logic

I-765, Application for
Employment Authorization

Body Text

Alert

Required?

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 to U.S. Citizenship and Immigration Services (USCIS) for an EAD that shows such authorization.

Link

https://www.uscis.gov/

Foreign nationals may also apply for a Social Security number and card on Form I-765.
If you are a lawful permanent resident, a conditional permanent resident, or a nonimmigrant only authorized for employment with a specific employer under 8 CFR 274a.12(b), do not use Form I-765.
Learn more about employment authorization.
Before You Start Your
Application

Eligibility

You may apply online if your eligibility category is:
• (a)(12) - Temporary Protected Status (You are submitting an initial Form I-821 or you have an approved Form I-821);
• (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);
• (c)(8) - Applicants for Asylum under the ABC Settlement Agreement;
• (c)(8) – Application for Employment Authorization Based on Pending Form I-589, Application for Asylum or for Withholding of Removal;
• (c)(11) - Parole;
• (c)(19) - Temporary Protected Status (You have a pending Form I-821); or
• (c)(33) - Consideration of Deferred Action for Childhood Arrivals (DACA).

link to:
https://www.uscis.gov/
protected-status
www.ucsis.gov/i-765

All other applicants must submit a paper Form I-765.
Note: You can file Form I-907, Request for Premium Processing Service, if you are filing under one of the eligible categories. If you request premium processing, we will present Form I-907 for you to complete after you sign Form I-765. This will allow you
to pay for and submit both forms at the same time.
[accordion]

Please review the specific filing instructions if you are filing Form I-765 under one of the following eligibility categories:
F1 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.

[accordion]

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)

[accordion]

(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. For more information, review our instructions for TPS applicants.
Pending Asylum and Withholding of Removal Applicants and Applicants for Asylum under the ABC Settlement Agreement

www.uscis.gov/tps

https://www.uscis.gov/
ent/forms/i-765instr.pd

(c)(8) eligibility category: File Form I-765 if you have a pending Form I-589, Application for Asylum and Withholding of Removal. Please review the Special Filing Instructions for those with Pending Asylum Applications before submitting Form I-765.
Pending Asylum Applications
(c)(8) eligibility category: You are subject to a 150-day waiting period before you can apply for an EAD, and an additional 30-day period before we can issue you an EAD, for a total of 180 days. The number of days a completed asylum application is
considered pending does not include any delays requested or caused by you while your application is pending with the USCIS asylum office or with an EOIR IJ. (See 8 CFR 208.7.) This time period during which your asylum application is pending before we
may grant you an EAD is called the “180-day asylum EAD clock.” We may reject your Form I-765 if you file it before the 150-day waiting period has elapsed. Some examples of delays that may be caused by you while your application is pending with the
USCIS Asylum Office include, but are not limited to:
• Failure to appear at your interview or fingerprint appointment;
• Failure to receive and acknowledge your asylum decision in person (if required);
• A request to reschedule your interview for a later date;
• A request to transfer your case to a new asylum office or interview location, including when the transfer is based on a new address;
• A request to provide additional evidence after your interview; and
• Failure to provide a competent interpreter at your interview.
Additionally, if you fail to appear for your interview with a USCIS asylum office or for a hearing before an EOIR IJ, you may be ineligible for an EAD.
If you have received a Recommended Approval notice from the USCIS asylum office recommending a grant of asylum, you do not need to wait 150 days and may apply for an EAD immediately upon receipt of this notice. Provide a copy of your notice as
evidence of your recommended approval with your Form I-765.
Asylum application under the ABC Settlement Agreement
(c)(8) eligibility category: If you are a Salvadoran or Guatemalan national eligible for benefits under the ABC settlement agreement, American Baptist Churches v. Thornburgh, 760 F. Supp. 976 (N.D. Cal. 1991), you are entitled to an EAD under the ABC

Application Overview

APPLICATION OVERVIEW: I-765

Sub-Heading

Conditional Logic

Body Text

Alert

Required?

Link

settlement agreement. Follow the instructions contained in this section when filing your Form I-765.
If you are requesting an initial EAD under this category, you do not need to pay the filing fee. If you are requesting a renewal or replacement EAD, you must pay the filing fee. Mark your application as follows:
1. Type “ABC” in the top right corner of your EAD application. You must identify yourself as an ABC class member if you are applying for an EAD under the ABC settlement agreement.
2. Type “(c)(8)” in the Eligibility Category of the application.
3. Select the “Salvadoran or Guatemalan national eligible for benefits under the ABC settlement agreement” box of this application.
You are entitled to an EAD without regard to the merits of your asylum claim.
Your Form I-765 will be decided within 60 days if:
• You pay the filing fee;
• You have a complete pending asylum application on file; and
• You correctly mark your application as described above. You must pay the filing fee for an initial EAD request. If you cannot pay the filing fee for an EAD, you may apply for a fee waiver under 8 CFR.

[accordion]

Parole
(c)(11) eligibility category: File Form I-765 with a copy of your Form I-94, passport, or other travel document showing you were paroled into the United States for urgent humanitarian reasons or reasons of significant public benefit pursuant to INA
212(d)(5) (such as Cuban Family and Haitian Family Reunification Parole programs).

[accordion]
Fee

Note: For individuals paroled into the United States after a positive credible fear determination — On Feb. 7, 2022, in Asylumworks et al. v. Mayorkas et al., the U.S. District Court for the District of Columbia vacated several rules that affected applications
for employment authorization filed by individuals who received positive credible fear determinations and were subsequently paroled into the United States. Credible fear parolees may file an EAD application at any time after being paroled into the
United States, and may seek employment authorization under the (c)(11) category at the time of filing.
Consideration of Deferred Action for Childhood Arrivals
(c)(33) eligibility category: You must submit Form I-765 with Form I-821D or with proof that you previously filed Form I-821D.
We will automatically calculate the cost for you before you submit your application. For specific information about fees applicable to this form, see Form G-1055. There is an additional fee for Premium Processing Service.

https://www.uscis.gov/

Fee waiver: If you are requesting a fee waiver, you cannot file online. You must file a paper version of both the Form I-912, Request for Fee Waiver and Form I-765, Application for Employment Authorization. You can review the fee waiver guidance at
www.uscis.gov/feewaiver.

https://www.uscis.gov/
fees/additional-informa
waiver

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.

Documents you may need

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.
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.

Biometric services appointment

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.
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 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 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.
After you submit your form, you can track its status through your USCIS account. Sign into your account often to check your case status and read any important messages from USCIS.

After You Submit Your
Application

Track your case online
Respond to requests for information
Receive your decision

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.
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.

Completing Your Form
Online

Filing online

Submitting your form online is the same as mailing in a completed paper form. They both gather the same information.

Complete the Getting Started section first
Provide as many responses as you can
We will automatically save your responses

You should answer all questions in the Getting Started section first so we can best customize the rest of your online form experience.
You should provide as many responses as you can. Incomplete fields or sections and missing information can slow down processing of your case after you submit your form.
We will automatically save your information when you select next to go to a new page or navigate to another section of the form. We will save your information for 30 days from today, or from the last time you worked on the form.

How to continue filling out your form
DHS Privacy Notice

After you start your form, you can sign in to your account to continue where you left off.
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under the Immigration and Nationality Act, 8 U.S.C. section 1324a, and 8 CFR 274a.13.
PURPOSE: The primary purpose for providing the requested information on this application is to determine eligibility for certain aliens who are temporarily in the United States requesting an Employment Authorization Document. DHS uses the
information you provide to grant or deny the benefit you are seeking.

Application Overview

APPLICATION OVERVIEW: I-765

Sub-Heading

Paperwork Reduction Act

Conditional Logic

Body Text

Alert

Required?

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.
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-001 – Alien File, Index, and National File Tracking System; DHS/USCIS-007 – Benefit Information System;
DHS/USCIS-010 – Asylum Information and Pre-Screening; and DHS/USCIS-017 Refugee Case Processing and Security Screening Information System] and the published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked Application
Information Management System and Associated Systems; DHS/USCIS/PIA-027 Asylum Division; DHS/USCIS/PIA-056 USCIS Electronic Immigration System; and DHS/USCIS/PIA-068 Refugee Case Processing and Security Vetting], which you can find at
www.dhs.gov/privacy. DHS may also share this information as appropriate for law enforcement purposes or in the interest of national security.
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 and 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. 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 I-765 application to this address.
OMB No. 1615-0040
Expires: 09/30/2027

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.

Application Overview

Link

GETTING STARTED: I-765

Secondary Nav

Conditional Logic

Paper Form
Question
Question

Sub-Question

Field Type

Getting Started Basis of eligibility

Instructional Text

Help Text

Alert

Required?

Links

Notes

You must complete all fields with an asterisk (*) to submit this form.
[alert - always displays]

[h] You can file your request online only for certain eligibility categories

2.27

What is your eligibility category?

[yellow alert]
(if 2.27 = a12)

(a)(12) Temporary Protected Status Granted
(c)(3)(A) Student Pre-Completion OPT
(c)(3)(B) Student Post-Completion OPT
(c)(3)(C) STEM Extension
(c)(8) Pending Asylum and Withholding of Removal
Applicants and Applicants for Asylum under the ABC
Settlement Agreement
(c)(11) Parole
(c)(11) Afghan Parole
(c)(11) Ukraine Parole
(c)(19) Temporary Protected Status Pending
(c)(33) Consideration of Deferred Action for Childhood
Arrivals

[b] 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 be denied.

Dropdown

https://www.u Always displays
scis.gov/sites/d
efault/files/doc
ument/forms/i765instr.pdf
Yes

[yellow alert]
[h] You must file Form I-821

[b] Based on the eligibility category you selected and your A-number, you may be a TPS
applicant or recipient and must file Form I-821 before you file Form I-765. If you are not a
TPS recipient, amend your eligibility category before proceeding.

(if 2.27 = c19)

If you are a TPS applicant or recipient, upload evidence that we accepted or approved your
Form I-821, otherwise, we will reject your application and you will not receive a refund.
[yellow alert]
(if 2.27 = c3a)

[yellow alert]
[h] Important information regarding your Form I-20
[b] Do NOT submit this form until you receive a Form I-20 recommendation from your
DSO. We will deny your application if you do not include your Form I-20 recommendation
when you submit Form I-765. If you need to provide Form I-765 to your DSO, print or
download this draft before you submit.
[yellow alert]

[yellow alert]
(if 2.27 = c8)

https://www.u
scis.gov/sites/d
efault/files/doc
ument/forms/i765instr.pdf

[h] Special filing instructions for pending asylum applications
[b] You are subject to a 150-day waiting period after the filing of your asylum application,
before you can apply for an EAD, and an additional 30-day period before we can issue you
an EAD, for a total of 180 days. Learn more about special filing instructions for asylum
applications.

[blue alert]
(if 2.27 = c11)

[blue alert]
[h] You can now file an EAD application after being paroled into the United States
[b] Pursuant to the Feb. 7, 2022 ruling in Asylumworks et al. v. Mayorkas et al., credible
fear parolees may file an EAD application at any time after being paroled into the United
States, and may seek employment authorization under the (c)(11) category at the time of
filing.
[yellow alert]

[yellow alert]
(if 2.27 = c33)

[h] You must file Form I-821D or currently have DACA
[b] Based on the EAD eligibility category you selected and your A-number, you cannot
submit a Form I-765, Application for Employment Authorization until you have filed an
initial or renewal Form I-821D, Consideration for Deferred Action for Childhood Arrivals
(DACA), or your request for DACA (initial or renewal) has been approved.
If you have not yet filed Form I-821D, return to the "File a Form" page and select "Form I821D, Consideration of Deferred Action for Childhood Arrivals." from the drop-down menu
to file your request for DACA first. After you complete and pay for your Form I-821D, you
will then be able to file Form I-765 online. If you already have a Form I-821D pending or
were recently approved for DACA, please upload your receipt notice for your pending
Form I-821D or the decision notice USCIS issued approving your request for DACA.
If you continue to file the Form I-765 and fail to provide evidence of a pending or approved
Form I-821D, we will reject your application and you will not receive a refund of the filing
fee.

(if 2.27 = c3c)
(if 2.27 = c3c)
(if 2.27 = c3c)

2.28.a
2.28.b
2.28.c

[If 2.27 = (c)(8)]

3.6

(if 2.27 = c3a, c3b, or c3c)

What is your degree?
What is your employer's name as listed in E-Verify?
What is your employer's E-Verify company identification
number or a valid E-Verify client company identification
number?
Are you a Salvadoran or Guatemalan national eligible for
benefits under the ABC settlement agreement?
Would you like to request Premium Processing Service?

Text
Text
Text

Yes/No

Radio

Yes/No

Radio

Provide a 4 to 7-digit employer
identification number.

Premium Processing Service guarantees that USCIS will take one of
several possible actions (issue an approval notice, a denial notice, a
notice of intent to deny, or a request for evidence or open an
investigation for fraud or misrepresentation) on your Form I-765 within
30 days.
If you request premium processing, you will be asked to complete the
Form I-907 after you sign your Form I-765. You will then be able to pay
for and submit both forms at the same time.

[blue alert]
[If 2.27 = c3a, c3b, or c3c]
AND
[if yes to premium
processing]
Reason for applying

(if 2.27 =
a12/c3a/c3b/c3c/c8/c11)

1.1.a

What is your reason for applying?

Initial permission to accept employment

Radio

You must complete all fields with an asterisk (*) to submit this form.

[blue alert]
Form I-765 and Form I-907 will be submitted together. After you sign the Form I-765, the
form will be locked. You will not be able to make any changes to the form once it is locked.
You will immediately be directed to the Form I-907 and will be able to pay for and submit
both forms after you provide your signatures.

Yes

Getting Started

GETTING STARTED: I-765

Secondary Nav

Conditional Logic

Paper Form
Question
Question

(if 2.27 =
1.1.b
a12/c3a/c3b/c3c/c8/c11/c1
9/c33)
(if 2.27 =
1.1.c
a12/c3a/c3b/c3c/c8/c11/c1
9)
2.12
Preparer and interpreter
information

Preparer information

Sub-Question

Field Type

Instructional Text

Help Text

Alert

Required?

Links

Notes

Replacement of lost, stolen, or damaged employment
Radio
authorization document or correction of my employment
authorization document NOT DUE to US Citizenship and
Immigration Services error
Renewal of permission to accept employment
Radio

Have you previously filed Form I-765?

Yes/No

Radio
You must complete all fields with an asterisk (*) to submit this form.

Is someone assisting you with completing this application?

Yes/No

Radio

(IF YES)

Is a preparer assisting you with completing this application? Yes/No

Radio

(IF YES)

Is an interpreter assisting you with completing this
application?

Radio

(IF YES TO PREPARER
QUESTION)

You must complete all fields with an asterisk (*) to submit this form.
5.1.b
5.1.a
5.2

What is your preparer's full name?
What is your preparer's business or organization name?

5.3.a.-5.3.h. What is your preparer's mailing address?

(If non-USA use Province
and text field)
(If non-USA use Postal code
and remove help text)

5.4
5.5

What is your preparer's contact information?

5.6
Interpreter information (IF YES TO INTERPRETER)

(If non-USA use Province
and text field)
(If non-USA use Postal code
and remove help text)

Yes/No

A preparer is anyone who completes or helps you complete all or part
of your application using information and answers that you provide.
An interpreter is anyone who translates or helps you translate all or part
of your application using information and answers that you provide.

4.1.b
4.1.a
4.2

What is your interpreter's full name?

4.3

What is your interpreter's mailing address?

4.4
4.5

What is your interpreter's business or organization name?

What is your interpreter's contact information?

4.6
What language is your interpreter using to interpret this
application for you?

Given name (first name)
Family name (last name)
My preparer is not part of a business or organization.
Country
Address line 1
Address line 2
City or town
State/Province

Text
Text
Text
Checkbox
Dropdown/Text
Text
Text
Text
Dropdown/Text

ZIP code/Postal code

Text

Provide a 5 or 9-digit ZIP code.

Daytime phone number
Mobile telephone number
My preparer does not have a mobile telephone number
Email address
My preparer does not have an email address.

Text
Text
Checkbox
Text
Checkbox

Provide a 10-digit phone number.
Provide a 10-digit phone number.

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

Street number and name
Apartment, suite, unit, or floor

Example: [email protected]
You must complete all fields with an asterisk (*) to submit this form.

My interpreter is not part of a business or organization.
Country
Address line 1
Address line 2
City or town
State/Province

Text
Text
Text
Checkbox
Dropdown/Text
Text
Text
Text
Dropdown/Text

ZIP code/Postal code

Text

Provide a 5 or 9-digit ZIP code.

Daytime telephone number
Mobile telephone number
My interpreter does not have a mobile telephone
number
Email address
My interpreter does not have an email address.

Text
Text
Checkbox

Provide a 10-digit phone number.
Provide a 10-digit phone number.

Text
Checkbox
Text

Example: [email protected]

Street number and name
Apartment, suite, unit, or floor

Getting Started

ABOUT YOU: I-765

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
C diti
l L i I di t
h th th
ti
b
ti
l
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Conditional Logic

2.1.c
2.1a

Your contact
information

2.2b
2.2c
2.2a

3.3
3.4
3.5
2.5.a

2.5.b
2.5.c
2.5.d
2.5.e
2.5.f
2.6
(if 2.6 = no)

2.7.a
2.7.b
2.7.c
2.7.d
2.7.e

Describe yourself

When and where
you were born

Is your current mailing address the
same as your physical address?
Where in the United States do you
live?

What is your city, town, or village of
birth?
What is your state or province of
birth?
What is your country of birth?
What is your date of birth?

Sub-Question

Field Type

Given name (first name)

Middle name
Family name (last name)
Yes/No
Given name (first name)
Middle name
Family name (last name)

Address line 1
Address line 2
City or town
State
ZIP code
Yes/No

Text
Text
Text
Dropdown/Text
Text
Radio

Address line 1

Text

Street number and name

Address line 2
City or town
State
ZIP code

Text
Text
Dropdown/Text
Text

Apartment, suite, unit, or floor

Text
Text

Radio

Text

2.8

MM/DD/YYYY

Date of arrival (on or about)
Place of arrival
Status at last arrival

What is the passport number of your
most recently issued passport?
What is your travel document number
(if any)?
What is the expiration date of your
MM/DD/YYYY
passport or travel document?
What country issued your passport or Country
travel document?
What is your current immigration status
or category?
What is your Student and Exchange
NVisitor Information System (SEVIS)
Number (if any)?

What is your A-Number?

Notes

Yes
CTA = +Add another name

Provide a 10-digit phone number.
Provide a 10-digit phone number.
Example: [email protected]
We will use your current mailing address to contact
you throughout the application process. We may not
be able to contact you if you do not provide a
complete and valid address. Please provide a U.S.
address only.
Street number and name
Apartment, suite, unit, or floor

Yes
Yes
Yes
Yes

Provide a 5 or 9-digit ZIP code.

Provide a 5 or 9-digit ZIP code.
You must complete all fields with an
asterisk (*) to submit this form.

You must complete all fields with an
asterisk (*) to submit this form.

Dropdown/Text
Date

Text

Other information

Required?

Text

What is your Form I-94 ArrivalDeparture Record Number (if any)?
When did you last arrive in the United
States?

2.26

Tooltip

Radio

2.21.a

2.25

You must complete all fields with an
asterisk (*) to submit this form.

Text
Text
Checkbox

Male
Female
Single
Married
Divorced
Widowed

Alert

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.

Daytime telephone number
Mobile telephone number (if any)
This is the same as my daytime
telephone number.
Email address
In care of name (if any)

Dropdown

2.21.d

Help Text

Other names used may include nicknames, aliases,
and maiden names.
Provide the other names you have used.

What is your country of citizenship or
nationality?

2.21.e

Instructional Text
You must complete all fields with an
asterisk (*) to submit this form.

2.18

2.21c

(if 2.27 = c19)

What is your current U.S. mailing
address?

What is your marital status?

2.22
2.23
2.24
2.21.b

How may we contact you?

2.12

2.19c
2.20

(if c11 hide this
checkbox)
[yellow alert]
(if 2.27 = a12)

Have you used any other names
since birth?

What is your gender?

2.19b

(if c11 this
question is
required)

What is your current legal name?

2.10

2.19a

Your immigration
information

it i

Paper Form
Question
Question

2.1.b

(if yes)

t i

Date
Dropdown/Text
Dropdown/Text
Text

Yes
You must complete all fields with an
asterisk (*) to submit this form.
List all countries where you are currently
a citizen or national.

Required field

User will be able to input multiple countries (at least
two based on paper form). It will be a table or list.
CTA = '+ Add country'

Provide an 11 character I-94 Number.
List your arrival date, place of arrival,
and status at arrival.

Text
Date
Dropdown/Text
Dropdown/Text
Text

A-

Text

I do not have or know my ANumber.

Checkbox

Use the "Additional Information" section Provide a 10, 11, or 12-digit SEVIS number.
to include all previously used SEVIS
numbers.
You must complete all fields with an
asterisk (*) to submit this form.
Provide a 7, 8, or 9-digit number. If the A-Number is
fewer than 9 digits, the system will automatically add
zero(s) after the "A" and before the first digit so there is a
total of 9 digits, for example: A-001234567.

Conditionally
required for c11

[yellow alert]
[h] You must file Form I-821
[b] Based on the eligibility category you selected and
your A-number, you may be a TPS applicant or
recipient and must file Form I-821 before you file
Form I-765. If you are not a TPS recipient, amend
your eligibility category before proceeding.
If you are a TPS applicant or recipient, upload
evidence that we accepted or approved your Form I821, otherwise, we will reject your application and
you will not receive a refund.

About You

ABOUT YOU: I-765

Secondary Nav

Tertiary Nav

Conditional Logic

[If 2.27 = (c)(8)]

I do not have or know my USCIS
Online Account Number.F55
Yes/No

Instructional Text

Text

Providing your unique USCIS Online
Provide a 12-digit Online Account Number.
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.

What is your Social Security number (if
known)?
Do you want the SSA to issue you a Yes/No
Social Security card?

Text

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

What is your father's birth name?

Given name (first name)
Family name (last name)
Given name (first name)
Family name (last name)
Yes/No

2.15

2.16b
2.16a
2.17b
2.17a
2.3

What is your mother's birth name?
Have you EVER been arrested for
and/or convicted of any crime?

Alert

Tooltip

Required?

Notes

Certain paper forms:
I-90, I-130, I-485, I-821, I-821D, N-336, N-400, N-565,
N-600, N-600K

Checkbox

2.13b

[yellow alert]
(if 2.15 = no)

(If yes to 2.15)

What is your USCIS Online Account
Number?

Help Text

Field Type

Has the Social Security
Administration (SSA) ever officially
issued a Social Security card to you?

[yellow alert]
(if 2.14 = yes)

(If yes to 2.15)

Sub-Question

2.13a

2.14

(If yes to 2.14)

it i

Paper Form
Question
Question
2.9

(If yes to 2.13a)

t i

Radio

Provide a 9-digit Social Security number.

Radio

Text
Text
Text
Text
Radio

[Yellow alert]
[h] You must agree to the Consent for Disclosure
[b] If you answer “Yes”, you must also answer
“Yes” to the Consent for Disclosure.

[yellow alert]
[h] You must agree to the Consent for Disclosure
[b] To receive a Social Security card, you must
select "Yes" to the Consent for Disclosure.

USCIS will make the determination as to
whether your convictions meet the
definition of aggravated felony. Learn
more about arrests and convictions for
Application for Employment
Authorization.

https://www.uscis.gov/sites/default/files/document
/forms/i-765instr.pdf

About You

EVIDENCE: I-765

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: Indicates whether the question or subquestion only applies if you meet certain criteria.
Evidence
Title: Name of the
individual
evidence All evidence evidence
titles should
Primary Nav
Secondary
Nav
Conditional
Logic be "Title Case " Paper Form
Evidence

2 x 2 photo of you

(if all)

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

Evidence Title

Field Type

2 x 2 Photo Of You

Upload

Instructional Text

You must complete all fields with an asterisk (*) to submit this form.
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 the Department of State's photo composition tools.
Please note that we cannot approve your application without your photo.

Form I-94 or passport

(if all)

Form I-765 instructions, "Required
Documentation" - page 25

Form I-94, Arrival And Departure
Record Or Passport

Upload

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 I94. 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.

Document type

File Requirements

Alerts

Required?

Links

• Clear and readable
• Accepted file formats: JPG, JPEG, or PNG
• 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 one document at a time
• Accepted file name characters: English letters, numbers, spaces,
periods, hyphens, underscores, and parentheses
• Maximum size: 12MB per file

https://travel.state.gov/conte
nt/travel/en/us-visas/visainformationresources/photos.html

• 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: 12MB per file

https://www.cbp.gov/travel/i
nternational-visitors/i-94

www.uscis.gov/i-102

https://www.uscis.gov/sites/d
efault/files/document/forms/i765instr.pdf

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. For specific information about fees applicable to this form, see Form G-1055.
If you do not have and cannot get a required document, you must demonstrate this and provide secondary evidence. If secondary evidence does not exist or is
unavailable, you must demonstrate both the unavailability of the required document and the relevant secondary evidence and submit two or more sworn affidavits by
people not named on this application who have direct knowledge of the event and circumstances.
Learn more about Primary and Secondary evidences.
Employment Authorization
Document Or Government ID

Upload

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

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.

Form I-765 instructions, "Who May File Previously Authorized CPT Or OPT Upload
Form I-765"- pages 7-8

Upload evidence of any previously authorized CPT or OPT and the academic level at which it was authorized.

Form I-765 instructions, "Who May File I-20, Certificate Of Eligibility For
Nonimmigrant Student Status
Form I-765"- pages 7-8

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.

Employment Authorization Document

(if all)

Form I-765 instructions, "Required
Documentation" - page 25

Proof of enrollment

(if c3a)

Form I-765 instructions, "Who May File Proof Of Enrollment
Form I-765"- page 7

Previously authorized CPT or OPT

(if c3a or c3b)

Form I-20

(if c3a, c3b, c3c)

Upload

(if c3a, c3b, c3c show alert)

[yellow alert]
[Header:] Important information regarding your
Form I-20
[Body:] Do NOT submit this form until you receive a
Form I-20 recommendation from your DSO. We will
deny your application if you do not include your
Form I-20 recommendation when you submit Form
I-765. If you need to provide Form I-765 to your
DSO, print or download this draft before you
submit.

College degree

(if c3c)

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

Upload

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.

Institution accreditation

(if c3c)

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

Upload

Upload evidence that the institution that granted your STEM degree is currently accredited by the U.S. Department of Education and certified by the Student Exchange
and Visitor Program (SEVP), if this STEM OPT extension is based on a previously earned STEM degree.

Proof of identity and nationality

(if a12/c19)

Form I-765 instructions, "Who May File Proof Of Identity And Nationality
Form I-765" page 6

Upload

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.

EOIR or BIA order

(if a12/c19)

Form I-765 instructions, "Who May File Proof of Temporary Protected Status Upload
Form I-765" page 6
Granted By EOIR Immigration Judge
Or Board Of Immigration Appeals

If you are submitting a first-time re-registration with USCIS following an Immigration Judge or Board of Immigration Appeals decision granting your TPS
application, upload a copy of the TPS decision order.

Form I-821

(if a12/c19)

Form I-765 instructions, "Who May File I-821, Application For Temporary
Protect Status
Form I-765" page 6

If you previously filed Form I-821, upload evidence that we accepted or approved your initial Form I-821.

Upload

https://studyinthestates.dhs.g
ov/stem-opt-hub/eligible-cipcodes-for-the-stem-optextension

Evidence

EVIDENCE: I-765

Evidence Title

Form I-821D

(if c33)

I-821D, Consideration Of Deferred
Action For Childhood Arrivals
(DACA)

Form I-765WS

(if c33)

I-765WS, Worksheet

Form I-589

(if c8)

Proof of appeal

(if c8) and (if renewal)

BIA remand order

Criminal history

Field Type

Upload

Instructional Text

Document type

File Requirements

If you previously filed Form I-821D, upload evidence that you have a pending or approved Form I-821D.

Download, complete, and upload Form I-765WS so that we can determine whether you have an economic need for work.

USCIS uses the evidence you submit with your application to determine your eligibility for employment authorization. You are not required to submit this evidence, but it
will help us process your request more efficiently.
If an EOIR IJ has denied your asylum and withholding of removal relief, but you met the requisite 180-day waiting period prior to the EOIR IJ’s decision in your case,
evidence that you:
• Timely appealed the EOIR IJ’s decision on your Form I-589 to the BIA and the appeal remains pending; and
• If applicable, evidence that you timely appealed the BIA decision on your Form I-589 to a U.S. Court of Appeals and that decision remains pending.

• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• 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: 12MB per file

Form I-765 instructions, "Additional
Evidence requirement for category
Form I-765 instructions, "Additional
Evidence requirement for category
(c)(8) applicants" page 4

I-589, Application For Asylum And
Withholding Of Removal
Proof Of Appeal

Upload

(if c8)

Form I-765 instructions, "Additional
Evidence requirement for category
(c)(8) applicants" page 4

Board Of Immigration Appeals
Remand Order

Upload

If your Form I-589 has been remanded to an EOIR IJ for further adjudication of your underlying asylum claim, upload:
• A copy of the BIA decision and order remanding your case to the EOIR IJ; and
• Evidence that your asylum claim remains under review by the EOIR IJ.

(if c8) and (if yes to convicted of
crime)

Form I-765 instructions, "Additional
Evidence requirement for category
(c)(8) applicants" page 4-5

Criminal History

Upload

For initial and renewal applications, you are required to submit evidence of any arrests and/or convictions. If you have been convicted of an aggravated felony, you
cannot be granted employment authorization under this eligibility category. USCIS will make the determination as to whether your convictions meet the definition of
aggravated felony. You must, however, provide information and any supporting documentation on all crimes which you were convicted of so USCIS can make an
appropriate decision. Provide a certified copy of all arrest reports, court dispositions, sentencing documents, and any other relevant documents.

Upload

NOTE: USCIS may, in its discretion, deny your application if you have been arrested and/or convicted of any crime.

Alerts

Required?

Links

https://www.uscis.gov/sites/d
efault/files/document/forms/i765ws.pdf

Evidence

ADDITIONAL INFORMATION: I-765

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Paper Form Question: The number in the paper form associated with the question.
Question: Based on content from the paper form. Often re-written from a statement into a question.
Sub-Question: Based on content from the paper form--the next level of information from the previous question Often re-written from a statement into a question
Primary Nav

Secondary Nav

Additional
Information

Additional information

Question

Sub-Question

Field Type

Instructional Text

Alert

Required?

Notes

Large
Table
Pattern
Ghost
Sub Nav

You must complete all fields with an asterisk (*) to submit this form.
You may provide additional information for your application. Add additional
information

Large table

If you need to provide any additional information for any of your answers to the questions in this form,
enter it into the space below. You should include the questions that you are referencing.
If you do not need to provide any additional information, you may leave this section blank.

Additional Information

REVIEW AND SUBMIT: I-765

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: A column used to indicate whether the question or subquestion only applies if you meet certain criteria.
Paper Form Question: The number in the paper form associated with the question.
Question: Based on content from the paper form. Often re-written from a statement into a question.
Primary Nav

Secondary Nav

Review and Submit

Review your application

Conditional Logic

Paper form question

Question

Sub-Question

Field Type

Check your application before you submit

Instructional Text

Help Text

Alert

Required?

CTA

Notes

Please review your ${formType} and check it for accuracy and completeness before you
submit it.
We encourage you to provide as many responses as you can throughout the ${formType}.
Missing or incomplete information may slow down the review process after you submit
your ${formType}.
You can return to this page to review your ${formType} as many times as you want before
you submit it.

[Yellow alert]
(if c3a, c3b, c3c)

Your form filing fee is: [$XXX}

Your fee

[Yellow alert]
[h] Important information regarding your Form I-20
[b] Do NOT submit this form until you receive a Form I-20
recommendation from your DSO. We will deny your
application if you do not include your Form I-20
recommendation when you submit Form I-765. If you
need to provide Form I-765 to your DSO, print or
download this draft before you submit.

Exact fee will be pulled from ELIS

Refund Policy: USCIS does not refund fees, regardless of any action we take on
your application, petition or request, or how long USCIS takes to reach a decision.
By continuing this transaction, you acknowledge that you must submit fees in the
exact amount and that you are paying the fees for a government service.

Alerts and warnings

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.
A yellow warning means you may be missing information or may need to follow-up with us
about your responses. You can still submit your application, but some warnings may slow
down the review process after you submit your application.

Your application summary

A green alert means you have completed all required fields and responses.
Here is a summary of all the information you provided in your application.

Review the I-765 form information

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.

Preparer statement

(IF PREPARER)

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 Radio
the applicant's consent.

We also prepared a draft case snapshot with your responses, which you can
download below.
You must complete all fields with an asterisk (*) to submit this form.
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.

5.7b
5.7b
5.8a

Preparer's certification and signature

I am an attorney or accredited representative and my representation of the applicant in this case does not extend
Radio
beyond the preparation of this application.
I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the
Radio
preparation of this application.
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The
applicant then reviewed this completed application and informed me that he or she understands all of the information
contained in, and submitted with, his or her application, including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct. I completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.

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.
2.
3.
4.

Download the Preparer Signature page
Print the Preparer Signature page
Read and sign the Preparer Signature page
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.
Preparer Signature

(IF PREPARER)

Interpreter certification

(IF INTERPRETER)

4.7a

Preparer's signature upload
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.

Upload

You must complete all fields with an asterisk (*) to submit this form.
Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

Upload
Checkbox

Scan and upload your interpreter's completed signature page below.
You must read and agree to the statement below.

Checkbox

You must read and agree to the statement below.

Checkbox

You must read and agree to the statement below.

As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these
steps:
1.
2.
3.
4.

Download the Interpreter Signature page
Print the Interpreter Signature page
Read and sign the Interpreter Signature page
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.
Interpreter signature
Your statement

Your signature

(IF INTERPRETER)
(IF NO INTERPRETER)

3.1a

Interpreter's signature upload
Applicant's statement

(IF PREPARER)

3.2

Applicant's statement regarding the preparer

(IF INTERPRETER)

3.1b

Applicant's statement regarding the interpreter

(If "Your statement" is
complete)

Form I-765, "Applicant's
Declaration and
Certification" - pages 4-5

Applicant's Declaration and Certification

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.
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.
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.

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.

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.

3.7a

Pay and submit

(If "Your Statement" and
"Your signature" pages
are complete)

Your signature

I have read and agree to the applicant's statement

Pay for and submit your application

Checkbox

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.
The final step to submit your Form I-765, Application for Employment Authorization
is to pay the required fee.
Your application fee is: [$XXX]

Yes

Required field
Review & Submit
Exact fee will be pulled from ELIS

File Type	application/pdf
Author	Microsoft Office User
File Modified	2024-11-21
File Created	2024-11-21