Form I-765WS, Worksheet

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Form I-765 Worksheet
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-765WS
OMB No. 1615-0040
Expires 08/31/2027

If you are applying for employment authorization under the (c)(11) Parole, (c)(14) Deferred Action, (c)(18) Aliens Ordered Removed
and Released from Custody on Orders of Supervision, or (c)(33) Consideration of Deferred Action for Childhood Arrivals, categories,
you must complete this worksheet so we can determine whether you have an economic need to work. In the spaces provided, indicate
your current annual income, your current annual expenses, and the total current value of your assets. Supporting evidence must be
submitted with your Form I-765 WS, Worksheet. Supporting evidence includes, but is not limited to, pay stubs, an Internal Revenue
Service (IRS) transcript for the most recent tax year, Form W-2 or Form 1099 for the most recent tax year, evidence of the value of
your assets such as the appraised value of your home, utility bills, credit card statements, bank statements, and evidence of your
claimed income including alimony, child support, and dividends. You do not need to include other household members' financial
information to establish your own economic necessity.

Part 1. Your Full Name

DRAFT
NOT FOR
PRODUCTION
05/28/2026

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

1.c. Middle Name

Part 2. Financial Information
1.

My current annual income is:

$

2.

My current annual expenses are:

$

3.

The total current value of my assets is:
$

Part 3. Explanation

If you are unable to provide supporting evidence, use the space
below to provide an explanation regarding your current
financial information, your economic need for employment
authorization, and why you cannot provide supporting evidence.
You may also use the space below to provide additional
information regarding your economic need for employment
authorization if submitting supporting evidence with your Form
I-765 WS, Worksheet.

Form I-765WS Edition 08/21/25

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