This form contains 762 fields organized into 251 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
10. Denied admission to the United States (Yes/No)
10. Denied admission to the United States — No	Checkbox	Check this box if you have NEVER been denied admission to the United States.
10. Denied admission to the United States — Yes	Checkbox	Check this box if you have EVER been denied admission to the United States.
11. Denied a visa to the United States (Yes/No)
11. Denied a visa to the United States — Yes	Checkbox	Check this box if you have EVER been denied a visa to the United States.
11. Denied a visa to the United States — No	Checkbox	Check this box if you have NEVER been denied a visa to the United States.
12. Worked in the United States without authorization (Yes/No)
12. Worked in the United States without authorization — Yes	Checkbox	Check this box if you have EVER worked in the United States without authorization.
12. Worked in the United States without authorization — No	Checkbox	Check this box if you have NEVER worked in the United States without authorization.
13. Violated terms or conditions of nonimmigrant status (Yes/No)
13. Ever violated terms or conditions of nonimmigrant status – No	Checkbox	Check this box if you have NEVER violated the terms or conditions of your nonimmigrant status.
13. Ever violated terms or conditions of nonimmigrant status – Yes	Checkbox	Check this box if you have EVER violated the terms or conditions of your nonimmigrant status at any time.
14. Presently or ever in removal/exclusion/rescission/deportation proceedings (Yes/No)
14. Presently or ever in removal/exclusion/rescission/deportation proceedings — Yes	Checkbox	Check this box if you are presently or have ever been in removal, exclusion, rescission, or deportation proceedings (including expedited removal proceedings).
14. Presently or ever in removal/exclusion/rescission/deportation proceedings — No	Checkbox	Check this box if you have never been and are not presently in removal, exclusion, rescission, or deportation proceedings (including expedited removal proceedings).
15. Issued a final order of exclusion, deportation, or removal (Yes/No)
15. Issued a final order of exclusion, deportation, or removal — No	Checkbox	Check this box if you have NEVER been issued a final order of exclusion, deportation, or removal.
15. Issued a final order of exclusion, deportation, or removal — Yes	Checkbox	Check this box if you have EVER been issued a final order of exclusion, deportation, or removal.
16. Prior final order reinstated (Yes/No)
16. Prior final order reinstated — Yes	Checkbox	Check this box if you have EVER had a prior final order of exclusion, deportation, or removal reinstated.
16. Prior final order reinstated — No	Checkbox	Check this box if you have NEVER had a prior final order of exclusion, deportation, or removal reinstated.
17. Granted voluntary departure (Yes/No)
17. Granted voluntary departure — Yes	Checkbox	Check this box if you have EVER been granted voluntary departure by an immigration officer or an immigration judge but failed to depart within the allotted time.
17. Granted voluntary departure — No	Checkbox	Check this box if you have NEVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time (i.e., the situation described does not apply to you).
18. Applied for relief or protection from removal, exclusion, or deportation (Yes/No)
18. Applied for relief or protection from removal — No	Checkbox	Check this box if you have never applied for any kind of relief or protection from removal, exclusion, or deportation.
18. Applied for relief or protection from removal — Yes	Checkbox	Check this box if you have ever applied for any kind of relief or protection from removal, exclusion, or deportation.
19. J nonimmigrant two-year foreign residence requirement (Yes/No)
19. J nonimmigrant two-year foreign residence requirement — Yes	Checkbox	Check this box if you have ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement.
19. J nonimmigrant two-year foreign residence requirement — No	Checkbox	Check this box if you have never been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement.
20. If Yes to Item 19, complied with the foreign residence requirement (Yes/No)
20. Complied with foreign residence requirement — No	Checkbox	Check this box if you answered "Yes" to Item 19 and you did not comply with the two‑year foreign residence requirement. Fill only if '19. J nonimmigrant two-year foreign residence requirement — Yes' is 'Yes'. Depends on: 19. J nonimmigrant two-year foreign residence requirement — Yes
20. Complied with foreign residence requirement — Yes	Checkbox	Check this box if you answered "Yes" to Item 19 and you did comply with the two‑year foreign residence requirement. Fill only if '19. J nonimmigrant two-year foreign residence requirement — Yes' is 'Yes'. Depends on: 19. J nonimmigrant two-year foreign residence requirement — Yes
21. If Yes to Item 19 and No to Item 20, been granted a waiver (Yes/No)
21. Been granted a waiver or received a favorable waiver recommendation — Yes	Checkbox	Check this box if, having answered "Yes" to Item 19 and "No" to Item 20, you were granted a waiver or the Department of State issued a favorable waiver recommendation letter for you. Fill only if '19. J nonimmigrant two-year foreign residence requirement — Yes', '20. Complied with foreign residence requirement — No' is 'Yes' and is 'No' (all). Depends on: 19. J nonimmigrant two-year foreign residence requirement — Yes, 20. Complied with foreign residence requirement — No
21. Been granted a waiver or received a favorable waiver recommendation — No	Checkbox	Check this box if, having answered "Yes" to Item 19 and "No" to Item 20, you were not granted a waiver and the Department of State did not issue a favorable waiver recommendation letter for you. Fill only if '19. J nonimmigrant two-year foreign residence requirement — Yes', '20. Complied with foreign residence requirement — No' is 'Yes' and is 'No' (all). Depends on: 19. J nonimmigrant two-year foreign residence requirement — Yes, 20. Complied with foreign residence requirement — No
22. Ever been arrested/cited/charged or in diversion program (Yes/No)
22. Ever been arrested/cited/charged or in diversion program — Yes	Checkbox	Check this box if you have EVER been arrested, cited, charged, detained, or participated in a diversion program (including pre-trial diversion, deferred prosecution, deferred adjudication, or any withheld adjudication) by any law enforcement or immigration official in any country.
22. Ever been arrested/cited/charged or in diversion program — No	Checkbox	Check this box if you have NEVER been arrested, cited, charged, detained, or participated in a diversion program by any law enforcement or immigration official in any country.
3.b Employment-based options
3.b Alien Investor (Form I-526 or Form I-526E)	Checkbox	Check this box if you are applying under the employment‑based investor category and filing or have filed Form I-526 or Form I-526E.
3.b Alien of Extraordinary Ability	Checkbox	Check this box if you are applying as an alien of extraordinary ability (EB‑1A) under Form I-140.
3.b Outstanding Professor or Researcher	Checkbox	Check this box if you are applying as an outstanding professor or researcher (EB‑1B) under Form I-140.
3.b Multinational Executive or Manager	Checkbox	Check this box if you are applying as a multinational executive or manager (EB‑1C) under Form I-140.
3.b Member of the Professions Holding an Advanced Degree or Alien of Exceptional Ability (not seeking NIW)	Checkbox	Check this box if you are applying as a member of the professions with an advanced degree or an alien of exceptional ability and you are NOT seeking a National Interest Waiver (EB‑2 without NIW).
3.b A Professional (requires a bachelor's degree or foreign equivalent)	Checkbox	Check this box if you are applying as a professional who at minimum requires a U.S. bachelor's degree or foreign degree equivalent (EB‑3 professional).
3.b A Skilled Worker (requires at least 2 years training or experience)	Checkbox	Check this box if you are applying as a skilled worker requiring at least two years of specialized training or experience (EB‑3 skilled worker).
3.b Any Other Worker (requires less than 2 years of training or experience)	Checkbox	Check this box if you are applying as an other worker who requires less than two years of training or experience (EB‑3 other worker).
3.b Alien Applying for a National Interest Waiver (advanced degree or exceptional ability)	Checkbox	Check this box if you are applying for a National Interest Waiver and you are a member of the professions with an advanced degree or an alien of exceptional ability (EB‑2 with NIW).
3.c Special Immigrant categories
3.c Certain Afghan or Iraqi National, Form I-360 or Form DS-157	Checkbox	Check this box if you are a qualifying Afghan or Iraqi national applying under the designated category using Form I-360 or Form DS-157.
3.c Special Immigrant Juvenile, Form I-360	Checkbox	Check this box if you are applying as a Special Immigrant Juvenile and your eligibility is based on Form I-360.
3.c Certain G-4 International Organization or Family Member or NATO-6 Employee or Family Member, Form I-360	Checkbox	Check this box if you are a G-4 international organization employee or family member, or a NATO-6 employee or family member, applying as a special immigrant with Form I-360.
3.c Certain International Broadcaster, Form I-360	Checkbox	Check this box if you are a qualifying international broadcaster applying as a special immigrant with Form I-360.
3.c Panama Canal Zone Employees, Form I-360	Checkbox	Check this box if you are a Panama Canal Zone employee applying as a special immigrant using Form I-360.
3.c Certain U.S. Armed Forces Members (Six and Six program), Form I-360	Checkbox	Check this box if you are a qualifying U.S. armed forces member applying under the Six and Six program with Form I-360.
3.c Certain Physicians, Form I-360	Checkbox	Check this box if you are a qualifying physician applying as a special immigrant with Form I-360.
3.c Certain Employee or Former Employee of the U.S. Government Abroad, DS-1884	Checkbox	Check this box if you are a current or former U.S. government employee abroad applying under the designated category with DS-1884.
3.c Other Religious Worker (Religious Worker), Form I-360	Checkbox	Check this box if you are applying as another type of religious worker (not a minister) under the Religious Worker category using Form I-360.
3.c Minister of Religion (Religious Worker), Form I-360	Checkbox	Check this box if you are applying as a minister of religion under the Religious Worker category using Form I-360.
3.d Asylee or Refugee
3.d Asylum Status (INA section 208), Form I-589 or Form I-730	Checkbox	Check this box if you have been granted asylum under INA section 208 (filed on Form I-589 or Form I-730) and are reporting that asylum status.
3.d Refugee Status (INA section 207), Form I-590 or Form I-730	Checkbox	Check this box if you were admitted as a refugee under INA section 207 (filed on Form I-590 or Form I-730) and are reporting that refugee status.
3.d Asylum grant date	Date	Enter the date you were granted asylum under INA section 208 (Form I-589 or I-730). Fill only if '3.d Asylum Status (INA section 208), Form I-589 or Form I-730' is 'Yes'. Depends on: 3.d Asylum Status (INA section 208), Form I-589 or Form I-730
3.d Refugee initial admission date	Date	Enter the date of your initial admission as a refugee under INA section 207 (Form I-590 or I-730). Fill only if '3.d Refugee Status (INA section 207), Form I-590 or Form I-730' is 'Yes'. Depends on: 3.d Refugee Status (INA section 207), Form I-590 or Form I-730
3.e Human Trafficking Victim or Crime Victim
3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A	Checkbox	Check this box if you are a human trafficking victim applying as a T nonimmigrant (or a derivative family member) using Form I-914 or Form I-914A.
3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929	Checkbox	Check this box if you are a victim of qualifying criminal activity applying as a U nonimmigrant (or a derivative/qualifying family member) using Form I-918, Form I-918A, or Form I-929.
3.f Special Programs Based on Certain Public Laws
3.f. The Cuban Adjustment Act	Checkbox	Check this box if you are applying for adjustment of status under the Cuban Adjustment Act.
3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act	Checkbox	Check this box if you are a spouse or child who is a victim of battery or extreme cruelty and are applying under the Cuban Adjustment Act.
3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act	Checkbox	Check this box if you are applying for adjustment of status based on dependent status under the Haitian Refugee Immigrant Fairness Act.
3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act	Checkbox	Check this box if you are a spouse or child who is a victim of battery or extreme cruelty and are applying for adjustment based on dependent status under the Haitian Refugee Immigrant Fairness Act.
3.f. Lautenberg Parolees	Checkbox	Check this box if you are a Lautenberg parolee seeking adjustment of status under the Lautenberg provisions.
3.f. Diplomats or High‑Ranking Officials Unable to Return Home (Section 13 of the Act of September 11, 1957)	Checkbox	Check this box if you are a diplomat or high‑ranking official unable to return to your home country under Section 13 of the Act of September 11, 1957, and are applying for adjustment of status.
3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429	Checkbox	Check this box if you are a national of Vietnam, Cambodia, or Laos applying for adjustment of status under section 586 of Public Law 106-429.
3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360	Checkbox	Check this box if you are applying for adjustment of status under the Amerasian Act (Oct. 22, 1982) and/or filing based on Form I-360 eligibility.
3.g Additional Options - other checkboxes
3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry")	Checkbox	Check this box if you are claiming registry based on continuous residence in the U.S. since before January 1, 1972.
3.g.2 Individual Born in the United States Under Diplomatic Status	Checkbox	Check this box if you were born in the United States while your parents had diplomatic status and you are asserting that status here.
3.g.3 S Nonimmigrants and Qualifying Family Members	Checkbox	Check this box if you are an S nonimmigrant or a qualifying family member seeking adjustment in this category (only if there is an approved Form I-854B filed by a law enforcement officer).
3.g Diversity Visa program
3.g Diversity Visa program	Checkbox	Check this box if you were selected for the Diversity Visa program (if checked, provide your Diversity Visa Rank Number in the space provided).
3.g Diversity Visa Rank Number	Number	Enter the Diversity Visa rank number you were assigned in the Diversity Visa program (the numeric lottery rank). Fill only if '3.g Diversity Visa program' is 'Yes'. Depends on: 3.g Diversity Visa program
3.g Other Eligibility (Other - text and checkbox)
3.g Other Eligibility — Explain	Text	Enter a short description specifying the applicant's other eligibility category or additional details that do not fit the listed options in section 3.g. Fill only if '3.g Other Eligibility — Other Eligibility' is 'Yes'. Depends on: 3.g Other Eligibility — Other Eligibility
3.g Other Eligibility — Other Eligibility	Checkbox	Check this box if your eligibility for adjustment is not listed in the other 3.a–3.f options and you will describe the other eligibility in the adjacent text box.
A-Number
A-Number (Alien Registration Number)	Text	Enter your Alien Registration Number exactly as it appears on your immigration documents (include the leading “A” and all digits, with no extra spaces). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your A-Number (Alien Registration Number) exactly as it appears on your immigration documents, including any letters or dashes. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your USCIS Alien Registration Number shown on your immigration documents; provide the numeric portion only (do not include the 'A-' prefix). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your A-Number shown on your immigration documents; because the form displays 'A-' before the box, type only the numeric portion of your A-Number without spaces or hyphens. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your Alien Registration Number exactly as shown on your immigration documents, including the leading letter 'A' and the following digits and any hyphens or spacing used on the document. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number	Text	Enter your Alien Registration Number (A-Number) exactly as it appears on your immigration documents, including the leading 'A' and any dashes or spaces. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number	Text	Enter your Alien Registration Number (A-Number) exactly as it appears on your immigration documents, including the leading 'A' and all digits. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number	Text	Enter the applicant's A-Number (Alien Registration Number) exactly as shown on immigration documents, including the leading 'A' and all digits (include hyphens if they appear). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your A-Number exactly as it appears on your immigration documents, including the leading 'A' followed by the digits (for example: A123456789). Max length: 9 characters
A-Number (Alien Registration Number)	Text	Enter your A-Number exactly as it appears on your immigration documents, including the leading 'A' and any leading zeros or other characters. Max length: 9 characters
A-Number (Alien Registration Number)	Text	Enter your A-Number (Alien Registration Number) as shown on your immigration documents; omit the printed 'A-' prefix and type only the numeric characters. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter the applicant's A-Number exactly as it appears on immigration documents (include the leading 'A' and all digits and hyphens, if present). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your Alien Registration Number (A-Number) exactly as it appears on your immigration documents, including the leading 'A' if present. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your Alien Registration Number exactly as shown on your immigration documents — enter only the digits and include any leading zeros (do not type the 'A-' prefix). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter your A-Number, the USCIS Alien Registration Number including the leading “A” followed by the numeric digits (for example, A012345678). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (Alien Registration Number)	Text	Enter the applicant's A-Number (Alien Registration Number) exactly as it appears on official documents, including the leading 'A' and all digits and dashes if present. Max length: 9 characters
A-Number (Alien Registration Number)	Text	Enter your Alien Registration Number exactly as it appears on your immigration documents (include the leading 'A' and all digits/characters). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (applicant)
A-Number (Applicant)	Text	Enter the applicant's Alien Registration Number (A-Number) exactly as shown on immigration documents, including any leading 'A' or leading zeros. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
A-Number (top right)
A-Number (Top Right)	Text	Enter the applicant's Alien Registration Number (A-Number) exactly as it appears on immigration documents, including any leading 'A' and digits or hyphens (for example: A123456789 or A-123-456-789). Max length: 9 characters
A-Number (Top Right)
A-Number (Top Right)	Text	Enter your Alien Registration Number exactly as it appears on your documents, including the leading 'A' and the following digits (include any hyphen or leading zeros). Max length: 9 characters
Alien crewman visa (Question 16)
16. Have you ever been issued an "alien crewman" visa? — Yes	Checkbox	Check this box if you have at any time been issued an "alien crewman" visa.
16. Have you ever been issued an "alien crewman" visa? — No	Checkbox	Check this box if you have never been issued an "alien crewman" visa.
Alien Registration Number (A-Number)
Alien Registration Number (A-Number)	Text	Enter your USCIS Alien Registration Number exactly as it appears on your immigration documents, including the leading 'A' (or A-prefix) and all digits/characters. Max length: 9 characters
Annual Household Income (Item 58)
Annual household income: $0-27,000	Checkbox	Check this box if your household's total annual income is between $0 and $27,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Annual household income: $27,001-52,000	Checkbox	Check this box if your household's total annual income is between $27,001 and $52,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Annual household income: $52,001-85,000	Checkbox	Check this box if your household's total annual income is between $52,001 and $85,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Annual household income: $85,001-141,000	Checkbox	Check this box if your household's total annual income is between $85,001 and $141,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Annual household income: Over $141,000	Checkbox	Check this box if your household's total annual income is more than $141,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Applicant Name (Family, Given, Middle)
Family Name (Last Name)	Text	Enter your family/last name exactly as it appears on official documents. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Item 76 — Unlawful presence: Yes
Given Name (First Name)	Text	Enter your given or first name exactly as it appears on official documents. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Item 76 — Unlawful presence: Yes
Middle Name (if applicable)	Text	Enter your middle name or initial if you have one, or leave blank if none. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Item 76 — Unlawful presence: Yes
Applicant's Contact Information
Applicant's Daytime Telephone Number	Text	Enter the primary daytime telephone number where you can be reached, including country and area code if applicable. Max length: 10 characters
Applicant's Email Address (if any)	Text	Provide your email address if you have one so the agency can contact you electronically. Max length: 38 characters
Applicant's Mobile Telephone Number (if any)	Text	Enter your mobile or cell phone number if you have one, including country and area code if applicable. Max length: 10 characters
Applicant's Signature and Date
Applicant's Signature	Text	Type the applicant’s handwritten signature or full printed name exactly as they wish to sign the form to certify the information provided. Max length: 1 characters
Date of Applicant's Signature	Date	Enter the date on which the applicant signed this form.
Arrived to join vessel as seaman/crewman (Question 17)
Question 17 — No (Did not arrive to join vessel as seaman/crewman)	Checkbox	Check this box if your most recent arrival in the United States was not to join a vessel as a seaman or crewman and you were not serving in any capacity aboard a vessel or aircraft at that arrival.
Question 17 — Yes (Arrived to join vessel as seaman/crewman)	Checkbox	Check this box if your most recent arrival in the United States was to join a vessel as a seaman or crewman, or while serving in any capacity aboard a vessel or aircraft.
Attorney or Accredited Representative Info
Attorney State Bar Number	Text	Enter the attorney's state bar identification number as issued by the state bar (include any letters or punctuation exactly as shown). Fill only if 'Select this box if Form G-28 is attached.' is 'Yes'. Max length: 9 characters
Form G-28 attached	Checkbox	Check this box if Form G-28 (Notice of Entry of Appearance as Attorney or Accredited Representative) is attached to this application. Fill only if 'Form G-28' is attached
Volag Number (if any)	Text	Enter the VOLAG (voluntary agency) number assigned to the representative or organization, if applicable. Fill only if 'Select this box if Form G-28 is attached.' is 'Yes'. Max length: 10 characters
USCIS Online Account Number (if any)	Text	Enter the attorney's or accredited representative's USCIS Online Account Number if they have one. Fill only if 'Select this box if Form G-28 is attached.' is 'Yes'. Max length: 12 characters
Bottom center footer field
Bottom center footer - Page number	Text	Enter the page number or other footer text that appears in the bottom-center footer area of the form (for example, "1").
Bottom center text field (field 1)
Bottom Center — Page or Identifier	Text	Enter the page number or other bottom-center form identifier exactly as it should appear on this sheet (for example, a single-page number or short identifier).
Bottom page field
Bottom Page Identifier	Text	Enter the document's bottom-page identifier or reference code (the small identifier printed in the highlighted box at the bottom of the page).
Page number (bottom center)	Text	Enter the page number that appears in the form footer for this page (e.g., 1).
Bottom Page Field
Page Number (bottom)	Text	Enter the page number for this form page as it should appear at the bottom of the sheet (e.g., 24).
Bottom page long text field
Part 9 — Additional information (bottom of page)	Text	Enter any continuation or explanatory information related to the Part 9 questions, including dates, locations, names, descriptions of events, your role, and any other relevant details requested by the form. Fill only if 'Item 46 - Yes', 'Item 47 - Yes (sold/provided/transported weapons)', 'Item 48 - Yes', 'Item 49 — Yes', 'Item 50 — Served in military or police unit: Yes', 'Item 52 - Yes', 'Item 51 — Yes (served in an armed group)', 'Item 55 - Used persons under 15 in hostilities: Yes', 'Item 53.d - Intentionally and severely injuring or trying to injure any person — Yes', 'Item 54 — Recruited/used persons under 15: Yes', 'Item 53.a — Torture (Yes)', 'Item 53.b (Genocide) — Yes', 'Item 53.c (Yes) - Killing, or trying to kill, any person' is 'Yes' on any. Depends on: Item 46 - Yes, Item 47 - Yes (sold/provided/transported weapons), Item 48 - Yes, Item 49 — Yes, Item 50 — Served in military or police unit: Yes, Item 51 — Yes (served in an armed group), Item 52 - Yes, Item 53.a — Torture (Yes), Item 53.b (Genocide) — Yes, Item 53.c (Yes) - Killing, or trying to kill, any person, Item 53.d - Intentionally and severely injuring or trying to injure any person — Yes, Item 54 — Recruited/used persons under 15: Yes, Item 55 - Used persons under 15 in hostilities: Yes
Bottom page text field
Bottom Page Text 1	Text	Enter any additional information, continuation text, or comments that belong at the bottom of this page as required by the form (free-text).
Child 1 Information
Child 1 — Family Name (Last Name)	Text	Enter the child's current legal family (last) name exactly as it appears on official documents. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 — Given Name (First Name)	Text	Enter the child's current legal given (first) name exactly as it appears on official documents. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 — Middle Name (if applicable)	Text	Enter the child's middle name if they have one; otherwise leave this field blank. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 — A-Number (if any)	Text	Enter the child's A-Number (the alien registration number) if they have one, including the 'A' prefix if shown, or leave blank if none. Fill only if 'Total number of children' is greater than or equal to 1. Max length: 9 characters Depends on: Total number of children
Child 1 — Date of Birth	Date	Enter the child's date of birth. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 — Country of Birth	Text	Enter the name of the country where the child was born. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 - Applying on separate Form I-485: No	Checkbox	Check this box if Child 1 is NOT filing/applying now on a separate Form I-485. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 - Applying on separate Form I-485: Yes	Checkbox	Check this box if Child 1 is also filing/applying now on a separate Form I-485. Fill only if 'Total number of children' is greater than or equal to 1. Depends on: Total number of children
Child 1 — Relationship to You	Text	Describe the child's relationship to you (for example, 'biological child', 'stepchild', or 'legally adopted child'). Fill only if 'Total number of children' is greater than or equal to 1. Max length: 34 characters Depends on: Total number of children
Child 2 Information
Child 2 - Family Name (Last Name)	Text	Enter the child's current legal family (last) name exactly as it appears on official records. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Given Name (First Name)	Text	Enter the child's current legal given (first) name exactly as it appears on official records. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Middle Name (if applicable)	Text	Enter the child's middle name if they have one; otherwise leave this field blank. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - A-Number (if any)	Text	Enter the child's Alien Registration Number (A-Number) if they have one, or leave blank if none. Fill only if 'Total number of children' is greater than or equal to 2. Max length: 9 characters Depends on: Total number of children
Child 2 - Date of Birth	Date	Enter the child's date of birth. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Country of Birth	Text	Enter the name of the country where the child was born. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Is this child also applying now on a separate Form I-485? No	Checkbox	Check this box if Child 2 is not applying now on a separate Form I-485. Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Is this child also applying now on a separate Form I-485? Yes	Checkbox	Check this box if Child 2 is also submitting a separate Form I-485 (i.e., the child is applying for adjustment of status separately). Fill only if 'Total number of children' is greater than or equal to 2. Depends on: Total number of children
Child 2 - Relationship to You	Text	Describe the child's relationship to you (for example: biological child, stepchild, legally adopted child). Fill only if 'Total number of children' is greater than or equal to 2. Max length: 34 characters Depends on: Total number of children
Country of Birth (Part 5)
Part 5 - Country of Birth (Item 4)	Text	Enter the full name of the country where the person referenced in this part was born.
Current Employer/School Address
Street Number and Name	Text	Enter the street number and full street name of your current employer's or school's address. Max length: 34 characters
Apt.	Checkbox	Check this box if the employer/school address includes an apartment number (unit) and you will enter that number in the adjacent 'Number' field.
Ste.	Checkbox	Check this box if the employer/school address includes a suite number and you will enter that suite number in the adjacent 'Number' field.
Flr.	Checkbox	Check this box if the employer/school address includes a floor designation and you will enter that floor number in the adjacent 'Number' field.
Apt./Suite/Floor Number	Text	If applicable, enter the apartment, suite, or floor number for the employer's or school's address; leave blank if none. Max length: 6 characters
City or Town	Text	Enter the city or town where your current employer or school is located. Max length: 28 characters
State	Combobox	Enter the state or primary administrative division where the employer or school is located. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC
ZIP Code	Text	Enter the ZIP code for the employer's or school's U.S. postal address. Max length: 5 characters
Postal Code	Text	Enter the postal code for the employer's or school's address (used for non-U.S. addresses as applicable). Max length: 9 characters
Province/Region	Text	Enter the province, region, or administrative area for the employer's or school's address if applicable. Max length: 20 characters
Country	Text	Enter the country name of the employer's or school's address.
Current Employment Dates and Financial Support
From Date (employment/attendance)	Date	Enter the starting date for this period of employment, unemployment, retirement, or school attendance.
To Date (employment/attendance)	Date	Enter the ending date for this period of employment, unemployment, retirement, or school attendance (or indicate if it is ongoing).
Source of Financial Support	Text	Provide the name or description of the source(s) of financial support you relied on while unemployed or retired. Fill only if 'Your Occupation (if unemployed or retired, so state)' indicates 'unemployed' or 'retired'. Max length: 34 characters Depends on: Item 7 - Your Occupation
Current immigration status (Question 14)
14. Current immigration status	Text	Enter your current immigration status as of today (if it changed since your last arrival), for example a visa classification, 'lawful permanent resident', 'asylee', 'D/S', 'pending adjustment', or other status and any relevant subclass or notation. Max length: 20 characters
Current Legal Name
Family Name (Last Name)	Text	Enter your current legal family (last) name exactly as it appears on legal documents; do not provide a nickname.
Given Name (First Name)	Text	Enter your current legal given (first) name exactly as it appears on legal documents; do not provide a nickname.
Middle Name (if applicable)	Text	Enter your current legal middle name(s) as they appear on legal documents, or leave blank if you have no middle name.
Current Mailing Address
Apt. (Current Mailing Address)	Checkbox	Check this box if your current mailing address includes an apartment number and you will enter that apartment number in the adjacent field. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Depends on: Question 18 — Is this your current mailing address? Yes
Ste. (Current Mailing Address)	Checkbox	Check this box if your current mailing address includes a suite number and you will enter that suite number in the adjacent field. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Depends on: Question 18 — Is this your current mailing address? Yes
Flr. (Current Mailing Address)	Checkbox	Check this box if your current mailing address includes a floor number and you will enter that floor number in the adjacent field. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - Apartment/Suite/Floor Number	Text	Enter the apartment, suite, floor, or unit number associated with this mailing address, or leave blank if none. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Max length: 6 characters Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - City or Town	Text	Enter the city or town for your current mailing address. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Max length: 20 characters Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - State	Combobox	Enter the U.S. state or territory of your mailing address (use the two-letter abbreviation or full name). Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - ZIP Code	Text	Enter the ZIP Code for your mailing address (5-digit or ZIP+4 as applicable). Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Max length: 5 characters Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - Street Number and Name	Text	Enter the street number and full street name for your current mailing address (for example, 123 Main St). Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Max length: 34 characters Depends on: Question 18 — Is this your current mailing address? Yes
Current Mailing Address - In Care Of Name (if any)	Text	Enter the name of the person or organization to receive mail at this address, or leave blank if not applicable. Fill only if 'Question 18 — Is this your current mailing address? Yes' is 'No'. Max length: 34 characters Depends on: Question 18 — Is this your current mailing address? Yes
Current Marital Status (checkboxes)
Divorced	Checkbox	Check this box if you are currently divorced.
Single, Never Married	Checkbox	Check this box if you have never been married and your current marital status is single.
Widowed	Checkbox	Check this box if your spouse has died and you are currently widowed.
Married	Checkbox	Check this box if you are currently married.
Marriage Annulled	Checkbox	Check this box if your marriage was annulled and you are not currently married.
Legally Separated	Checkbox	Check this box if you are currently legally separated from your spouse.
Current Spouse A-Number
Current Spouse A-Number	Text	Enter your current spouse's Alien Registration Number (A-Number) as the sequence of digits that follow the printed 'A-' on the form, exactly as shown on their immigration documents. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 9 characters Depends on: Married, Legally Separated
Current Spouse Country of Birth
Current Spouse's Country of Birth	Text	Enter the name of the country where your current spouse was born. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Current Spouse Current Physical Address
Country	Text	Enter the country where your current spouse physically resides. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Street Number and Name	Text	Enter the street number and full street name of your current spouse's physical address (include building number and street name). Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 34 characters Depends on: Married, Legally Separated
City or Town	Text	Enter the city or town of your current spouse's current physical address. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 28 characters Depends on: Married, Legally Separated
Postal Code	Text	Enter the postal code (mailing code) for your current spouse's address. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 9 characters Depends on: Married, Legally Separated
Province / Region	Text	Enter the province, region, or other administrative area for your current spouse's physical address, if applicable. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 20 characters Depends on: Married, Legally Separated
Apt. (Apartment)	Checkbox	Check this box if the current spouse's street address includes an apartment number and you will enter that apartment number in the adjacent field. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Ste. (Suite)	Checkbox	Check this box if the current spouse's street address includes a suite number and you will enter that suite number in the adjacent field. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Flr. (Floor)	Checkbox	Check this box if the current spouse's street address includes a floor number and you will enter that floor number in the adjacent field. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Apt./Suite/Unit Number	Text	Enter the apartment, suite, unit, or house number for your current spouse's address, or leave blank if not applicable. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 6 characters Depends on: Married, Legally Separated
State	Combobox	Enter the state or territory for your current spouse's physical address, if applicable. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC Depends on: Married, Legally Separated
ZIP Code	Text	Enter the ZIP code for your current spouse's physical address. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Max length: 5 characters Depends on: Married, Legally Separated
Current Spouse Date of Birth
Current Spouse Date of Birth	Date	Enter the current spouse's date of birth. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Current Spouse Legal Name
Current Spouse Family Name (Last Name)	Text	Enter your current spouse's family or last name exactly as it appears on legal documents. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Current Spouse Given Name (First Name)	Text	Enter your current spouse's given or first name as shown on legal records. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Current Spouse Middle Name (if applicable)	Text	Enter your current spouse's middle name or initial if they have one; leave blank if none. Fill only if 'Married', 'Legally Separated' is 'Married' or is 'Legally Separated' (any). Depends on: Married, Legally Separated
Current U.S. Physical Address
Apt./Ste./Flr. Number — Box 2 (middle)	Checkbox	Enter the second (middle) character or digit of your apartment, suite, or floor number for your current U.S. physical address in this box.
Apt./Ste./Flr. Number — Box 3 (rightmost)	Checkbox	Enter the third (rightmost) character or digit of your apartment, suite, or floor number for your current U.S. physical address in this box (leave blank if not applicable).
Apt/Ste/Flr/Unit Number	Text	Enter the apartment, suite, floor, or unit number associated with this address, or leave blank if not applicable. Max length: 6 characters
Apt./Ste./Flr. Number — Box 1 (leftmost)	Checkbox	Enter the first (leftmost) character or digit of your apartment, suite, or floor number for your current U.S. physical address in this box.
City or Town	Text	Enter the city or town where your current U.S. physical address is located. Max length: 20 characters
State	Combobox	Enter the U.S. state for your current physical address (use the state name or two-letter abbreviation). MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC
ZIP Code	Text	Enter the ZIP Code for your current U.S. physical address, including ZIP+4 if available. Max length: 5 characters
Street Number and Name	Text	Provide the street number and full street name for your current U.S. physical address (for example, 123 Main St). Max length: 34 characters
In Care Of Name (c/o)	Text	Enter the name of the person or organization (c/o) who receives mail or is responsible for this address, or leave blank if none. Max length: 34 characters
Date You First Resided at This Address	Date	Enter the date you first began living at this current U.S. physical address.
Date of Birth and Other Dates
Date of Birth	Date	Enter your legal date of birth for the applicant.
Have you ever used any other date of birth? — Yes	Checkbox	Check this box if you have ever used any other date of birth (if checked, provide all other dates of birth in the space provided).
Have you ever used any other date of birth? — No	Checkbox	Check this box if you have never used any other date of birth.
Other Date of Birth — Alternate 1	Date	If you have ever used another date of birth, enter the first alternate date of birth you have used. Fill only if 'Have you ever used any other date of birth?' is 'Yes'.
Other Date of Birth — Alternate 2	Date	If you have used more than one other date of birth, enter the second alternate date of birth you have used. Fill only if 'Have you ever used any other date of birth?' is 'Yes'.
Date of Marriage to Prior Spouse
Date of Marriage to Prior Spouse	Date	Enter the date you were married to the prior spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Dates of Membership or Involvement (From, To)
Membership/Involvement Start Date (From)	Date	Enter the date when your membership or involvement with the organization began. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - Membership/Involvement Start Date
Membership/Involvement End Date (To)	Date	Enter the date when your membership or involvement with the organization ended or last occurred. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - Membership/Involvement End Date
EOIR Removal/Proceedings (Yes/No)
Are you filing with EOIR while in removal proceedings? — Yes	Checkbox	Check this box if you are filing for adjustment of status with the Executive Office for Immigration Review (EOIR) while you are in removal, exclusion, rescission, or deportation proceedings.
Are you filing with EOIR while in removal proceedings? — No	Checkbox	Check this box if you are NOT filing for adjustment of status with the Executive Office for Immigration Review (EOIR) while in removal, exclusion, rescission, or deportation proceedings.
Ethnicity (Part 8 - Item 1)
Part 8 - Item 1: Hispanic or Latino	Checkbox	Check this box if you identify as Hispanic or Latino (select only one box for Ethnicity).
Part 8 - Item 1: Not Hispanic or Latino	Checkbox	Check this box if you do not identify as Hispanic or Latino (select only one box for Ethnicity).
Expiration Date of Current Immigration Status (Question 15)
15. Expiration Date of Current Immigration Status	Text	Enter the expiration date of your current immigration status in mm/dd/yyyy format, or type "D/S" if you have Duration of Status.
Eye Color (Part 8 - Item 5)
Part 8 - Item 5: Blue	Checkbox	Check this box if the applicant's eye color is Blue.
Part 8 - Item 5: Black	Checkbox	Check this box if the applicant's eye color is Black.
Part 8 - Item 5: Brown	Checkbox	Check this box if the applicant's eye color is Brown.
Part 8 - Item 5: Gray	Checkbox	Check this box if the applicant's eye color is Gray.
Part 8 - Item 5: Green	Checkbox	Check this box if the applicant's eye color is Green.
Part 8 - Item 5: Hazel	Checkbox	Check this box if the applicant's eye color is Hazel.
Part 8 - Item 5: Maroon	Checkbox	Check this box if the applicant's eye color is Maroon.
Part 8 - Item 5: Pink	Checkbox	Check this box if the applicant's eye color is Pink.
Part 8 - Item 5: Unknown/Other	Checkbox	Check this box if the applicant's eye color is unknown or not listed among the other options.
Family-based Immediate Relative Options
Spouse of a U.S. Citizen	Checkbox	Check this box if you are applying as the spouse of a U.S. citizen and are claiming an immediate-relative family-based category.
Unmarried child under 21 years of age of a U.S. Citizen	Checkbox	Check this box if you are an unmarried child under 21 years old and your parent is a U.S. citizen, and you are applying as their immediate relative.
Parent of a U.S. Citizen (if the citizen is at least 21 years of age)	Checkbox	Check this box if you are applying as the parent of a U.S. citizen who is at least 21 years old and are claiming the immediate-relative category.
Person admitted as a fiancé(e) or child of a fiancé(e) of a U.S. Citizen (K-1/K-2)	Checkbox	Check this box if you were admitted to the United States as a K-1 fiancé(e) or K-2 child of a fiancé(e) of a U.S. citizen and are applying under that immediate-relative classification.
Widow or Widower of a U.S. Citizen	Checkbox	Check this box if you are a widow or widower of a U.S. citizen and are filing based on that immediate-relative relationship.
Spouse, Child, or Parent of a Deceased U.S. Active-Duty Service Member (NDAA)	Checkbox	Check this box if you are the spouse, child, or parent of a deceased U.S. active-duty service member and are applying under the National Defense Authorization Act (NDAA) immediate-relative provision.
Filing As - Principal or Derivative
Principal Applicant	Checkbox	Check this box if you are filing Form I-485 as the primary applicant (the principal) rather than as a derivative.
Derivative Applicant	Checkbox	Check this box if you are filing Form I-485 as a derivative applicant and will provide the principal applicant’s information below.
Footer - Page Field
Page Number	Text	Enter the page number for this form page exactly as shown in the footer (e.g., "5" for page five).
Page Number	Text	Enter the form page number shown on this page (the numeric page identifier appearing in the footer).
Footer - Page/Edition Field
Page Number	Number	Enter the numeric page number for this page of the form (e.g., 1).
Footer / Internal field
Internal/Page Identifier	Text	Enter the internal page identifier or processing code used by the agency for this form page (for internal use only; do not enter applicant personal data).
Footer / Page field
Footer — Page number	Text	Enter the page sequence number for this form (the numeric page identifier for this sheet, e.g., "4" for page 4).
Footer / Page Field
Page number	Text	Enter the current page number of this form as shown in the footer (the page index for the document).
Footer Additional Field
Footer additional field	Text	Enter the short footer value to display on the form page (for example a page number or other short identifier). Fill only if '42.a Yes — Engage in espionage/sabotage', 'Item 42.b - Engage in export-prohibiting activity - Yes', '42.c — Yes: Opposing/overthrowing U.S. Government', 'Item 43.a — Yes: Received any weapons training, paramilitary training, or other military-type training', '42.d Engage in any other unlawful activity? — Yes', '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive', '43.d Yes - Threatened, attempted, conspired, prepared, or planned', 'Item 43.g — Yes: Recruited members or asked for money or things of value for a group or organization', '43.h Provided money, things of value, services or labor, or other assistance or support for activities in Items 43.b–43.e (Yes)', 'Item 43.e — Incited to cause death/serious harm (Yes)', 'Item 43.f — Yes: Participated in/been a member of a group or organization', 'Item 44 — Yes (Intent to engage in activities listed in 43.b–43.e)', 'Item 43.i — Yes (Provided support)', 'Item 45 - Yes' is 'Yes' (any). Depends on: 42.a Yes — Engage in espionage/sabotage, Item 42.b - Engage in export-prohibiting activity - Yes, 42.c — Yes: Opposing/overthrowing U.S. Government, 42.d Engage in any other unlawful activity? — Yes, Item 43.a — Yes: Received any weapons training, paramilitary training, or other military-type training, 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive, 43.d Yes - Threatened, attempted, conspired, prepared, or planned, Item 43.e — Incited to cause death/serious harm (Yes), Item 43.f — Yes: Participated in/been a member of a group or organization, Item 43.g — Yes: Recruited members or asked for money or things of value for a group or organization, 43.h Provided money, things of value, services or labor, or other assistance or support for activities in Items 43.b–43.e (Yes), Item 43.i — Yes (Provided support), Item 44 — Yes (Intent to engage in activities listed in 43.b–43.e), Item 45 - Yes
Form Bottom Field
Page Number (bottom of form)	Text	Enter the page number shown at the bottom of this form page as it appears on the form.
Form Footer / Page Field
Page Footer Field 1	Text	Enter the page identifier or page number that appears in the form footer for this page exactly as shown.
Form Footer Field
Page Number (Footer)	Text	Enter the page number that appears in the form footer for this page (for example: 1).
Footer Page/Sequence Number	Text	Enter the form's footer page or sequence number as shown at the bottom of the page (usually a small integer identifying this page).
Form I-485 Edition/Footer Field
Footer Field 1 (Form edition/page identifier)	Text	Enter the footer text displayed on this page — e.g., the form edition or page identifier as shown in the document footer.
Form I-94 Information
Form I-94 Family Name (Last Name)	Text	Enter your family/last name exactly as it appears on your most recent Form I-94 Arrival/Departure Record.
Form I-94 Given Name (First Name)	Text	Enter your given/first name exactly as it appears on your most recent Form I-94 Arrival/Departure Record.
Expiration Date of Authorized Stay (from Form I-94)	Date	Enter the expiration date of authorized stay shown on your most recent Form I-94.
Immigration Status on Form I-94	Text	Enter the immigration status shown on your most recent Form I-94 (for example, class of admission such as F1 or B2, or 'paroled' if applicable). Max length: 20 characters
Form I-94 Arrival/Departure Record Number	Text	Enter the I-94 arrival/departure record number exactly as shown on your most recent Form I-94, including any letters or leading zeros. Max length: 11 characters
Form Page Field
Page Number 1	Text	Enter the page number or identifier that appears in the form footer for this page (use the value shown on the printed form).
General
Part 8. Biographic Information. 4. Weight. Pounds. Enter first digit of Weight in Pounds	Text	Max length: 1 characters
Part 8. Biographic Information. 4. Weight. Pounds. Enter second digit of Weight in Pounds	Text	Max length: 1 characters
Part 8. Biographic Information. 4. Weight. Pounds. Enter third digit of Weight in Pounds	Text	Max length: 1 characters
TextField1	Text
TextField2	Text
TextField3	Text
TextField4	Text
TextField5	Text
TextField6	Text
TextField7	Text
TextField8	Text
Hair Color (Part 8 - Item 6)
Part 8 - Item 6: Bald (No hair)	Checkbox	Check this box if the person's hair is bald (no hair).
Part 8 - Item 6: Black	Checkbox	Check this box if the person's hair is black.
Part 8 - Item 6: Blond	Checkbox	Check this box if the person's hair is blond.
Part 8 - Item 6: Brown	Checkbox	Check this box if the person's hair is brown.
Part 8 - Item 6: Gray	Checkbox	Check this box if the person's hair is gray.
Part 8 - Item 6: Red	Checkbox	Check this box if the person's hair is red.
Part 8 - Item 6: Sandy	Checkbox	Check this box if the person's hair is sandy.
Part 8 - Item 6: White	Checkbox	Check this box if the person's hair is white.
Part 8 - Item 6: Unknown/Other	Checkbox	Check this box if the person's hair color is unknown or not listed above.
Height and Weight (Part 8 - Items 3 & 4)
Part 8 Item 3 - Height (Feet)	Combobox	Enter the number of feet component of your height (whole feet only) as shown on the form. 8 6 5 4 7 2 3
Part 8 Item 3 - Height (Inches)	Combobox	Enter the number of inches component of your height (0–11) as shown on the form. 8 0 6 5 4 7 2 9 10 11 3 1
Part 8 Item 4 - Weight (Pounds)	Number	Enter your weight in pounds as shown on the form. Max length: 3 characters
Highest Degree or Grade Completed (Item 61)
Item 61 — Highest grade completed (if less than high school)	Text	If you selected 'Less than a high school diploma,' enter the highest grade of school you completed (for example: 8, 10). Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.', 'Item 61 - Less than a high school diploma' are 'Yes' (all). Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66., Item 61 - Less than a high school diploma
Item 61 - Less than a high school diploma	Checkbox	Check this box if you did not complete high school; if you select this option, also enter the highest grade of school you completed in the provided space. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - 1 or more years of college credit, no degree	Checkbox	Check this box if you have completed one or more years of college credit but have not obtained a degree. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - High school diploma, GED, or alternative credential	Checkbox	Check this box if your highest completed credential is a high school diploma, GED, or other equivalent secondary credential. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - Associate's degree	Checkbox	Check this box if your highest completed degree is an associate's degree. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - Master's degree	Checkbox	Check this box if your highest completed degree is a master's (graduate) degree. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - Professional degree (JD, MD, DMD, etc.)	Checkbox	Check this box if your highest completed degree is a professional degree such as JD, MD, DMD, or similar. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - Doctorate degree	Checkbox	Check this box if your highest completed degree is a doctorate (PhD or equivalent). Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 61 - Bachelor's degree	Checkbox	Check this box if your highest completed degree is a bachelor's (undergraduate) degree. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Assets (Item 59)
Item 59 - $0-18,400	Checkbox	Check this box if the combined total value of your household assets is $0 to $18,400. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 59 - $18,401-136,000	Checkbox	Check this box if the combined total value of your household assets is $18,401 to $136,000. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 59 - $136,001-321,400	Checkbox	Check this box if the combined total value of your household assets is $136,001 to $321,400. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 59 - $321,401-707,100	Checkbox	Check this box if the combined total value of your household assets is $321,401 to $707,100. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 59 - Over $707,100	Checkbox	Check this box if the combined total value of your household assets is over $707,100. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Liabilities (Item 60)
Item 60 - $0	Checkbox	Check this box if the total value of your household liabilities (including both secured and unsecured liabilities) is $0. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 60 - $1-10,100	Checkbox	Check this box if the total value of your household liabilities (including both secured and unsecured liabilities) is between $1 and $10,100. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 60 - $10,101-57,700	Checkbox	Check this box if the total value of your household liabilities (including both secured and unsecured liabilities) is between $10,101 and $57,700. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 60 - $57,701-186,800	Checkbox	Check this box if the total value of your household liabilities (including both secured and unsecured liabilities) is between $57,701 and $186,800. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 60 - Over $186,800	Checkbox	Check this box if the total value of your household liabilities (including both secured and unsecured liabilities) is over $186,800. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Size (Item 57)
Item 57 — Household Size	Text	Enter the total number of people in your household for Item 57, including yourself, your spouse, children, other dependents, and any other persons who live with and are supported by you. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Max length: 3 characters Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
How Marriage Ended with Prior Spouse (Annulled / Divorced / Spouse Deceased / Other + Explain)
Spouse Deceased	Checkbox	Check this box if your prior marriage ended because your prior spouse died. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Annulled	Checkbox	Check this box if your prior marriage was legally annulled. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Other (Explain)	Checkbox	Check this box if the prior marriage ended for a reason other than annulment, divorce, or death, and provide an explanation in the space provided. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Divorced	Checkbox	Check this box if your prior marriage ended in divorce. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
How Marriage Ended with Prior Spouse — Other (Explain)	Text	If the prior marriage ended for a reason other than annulment, divorce, or death, briefly describe how it ended and include any relevant details (for example: legal basis, date, or location) so the reason is clear. Fill only if 'Other (Explain)' Fill only if Other (Explain) is 'Yes'. Depends on: Other (Explain)
I-140 filed by relative?
N/A (I am adjusting on the basis of a Form I-140 self-petition)	Checkbox	Check this box if you are adjusting status based on your own Form I-140 self-petition (meaning no relative filed an I-140 for you).
No	Checkbox	Check this box if a relative did not file the associated Form I-140 for you and no relative has a significant ownership interest (5% or more) in the business that filed an I-140 for you.
Yes	Checkbox	Check this box if a relative did file the associated Form I-140 for you or a relative has a significant ownership interest (5% or more) in the business that filed your Form I-140.
If yes, relationship to relative (select only one)
Father	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your father. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Mother	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your mother. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Child	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your child. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Adult Son	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your adult son. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Adult Daughter	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your adult daughter. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Brother	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your brother. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Sister	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you (or for the principal applicant, if you are a derivative applicant) is your sister. Fill only if 'Yes' is 'Yes'. Depends on: Yes
None of These	Checkbox	Check this box if you answered "Yes" and the relative who filed the associated Form I-140 for you is not any of the listed relationships. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Interpreter's Business/Organization Name
Interpreter's Business/Organization Name	Text	Enter the full name of the business or organization that employs or represents the interpreter (leave blank or enter 'None' if the interpreter is not affiliated with a business or organization). Max length: 34 characters
Interpreter's Certification, Signature, and Date
Interpreter's Language	Text	Enter the language (or languages) in which the interpreter is fluent and used to interpret the applicant's responses. Max length: 18 characters
Interpreter's Signature	Text	Provide the interpreter's handwritten signature certifying they interpreted the application and applicant's answers.
Interpreter's Date of Signature	Date	Enter the date the interpreter signed to certify the interpretation.
Interpreter's Contact Information
Interpreter's Daytime Telephone Number	Text	Enter the interpreter's primary daytime telephone number, including country and area code if applicable. Max length: 20 characters
Interpreter's Mobile Telephone Number (if any)	Text	Enter the interpreter's mobile telephone number if they have one, including country and area code if applicable. Max length: 20 characters
Interpreter's Email Address (if any)	Text	Enter the interpreter's email address if they have one.
Interpreter's Full Name
Interpreter's Given Name (First Name)	Text	Enter the interpreter's first name as it appears on official documents or as they use professionally.
Interpreter's Family Name (Last Name)	Text	Enter the interpreter's family name or last name as it appears on official documents or as they use professionally.
Is current spouse applying with you (Yes/No)
No (current spouse not applying with you)	Checkbox	Check this box if your current spouse is NOT applying with you. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
Yes (current spouse is applying with you)	Checkbox	Check this box if your current spouse IS applying with you. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
Is this your current mailing address (Question 18)
Question 18 — Is this your current mailing address? Yes	Checkbox	Check this box if the Current U.S. Physical Address you entered in Question 18 is also your current mailing address.
Question 18 — Is this your current mailing address? No	Checkbox	Check this box if the Current U.S. Physical Address you entered in Question 18 is NOT your current mailing address (and then provide your mailing address below).
Item 2 - Additional Information
Item 2 — Page Number	Text	Enter the page number of the application page that this additional information refers to. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Item 76 — Unlawful presence: Yes
Item 2 — Part Number	Text	Enter the part number of the form that your additional information refers to. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 2 — Item Number	Text	Enter the item number on the form to which this additional information corresponds. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 2 — Additional Information	Text	Provide the full additional information or explanation for your answers on the form, referring to the page, part, and item numbers above. Fill only if 'Item 2 — Page Number', 'Item 2 — Part Number', 'Item 2 — Item Number' are filled (all). Depends on: Item 2 — Page Number, Item 2 — Part Number, Item 2 — Item Number
Item 3 - Additional Information
Item 3 - Page Number	Text	Enter the page number of the form to which the additional information on this line refers. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Item 76 — Unlawful presence: Yes
Item 3 - Part Number	Text	Enter the part number of the form (for example, '14') that corresponds to the additional information provided. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 3 - Item Number	Text	Enter the specific item number within the indicated part that this additional information addresses. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 3 - Additional Information	Text	Provide the full additional information or explanation corresponding to the Page Number, Part Number, and Item Number entered above, including relevant names, dates, locations, and details. Fill only if 'Item 3 - Page Number', 'Item 3 - Part Number', 'Item 3 - Item Number' are filled (all). Depends on: Item 3 - Page Number, Item 3 - Part Number, Item 3 - Item Number
Item 38 - Trafficking (Yes/No)
Item 38 (Yes)	Checkbox	Check this box if you have EVER knowingly aided, abetted, assisted, conspired, or colluded with others in trafficking in persons for commercial sex acts or involuntary servitude, peonage, debt bondage, or slavery.
Item 38 (No)	Checkbox	Check this box if you have NEVER knowingly aided, abetted, assisted, conspired, or colluded with others in trafficking in persons for commercial sex acts or involuntary servitude, peonage, debt bondage, or slavery.
Item 39 - Spouse/Parent Benefit (Yes/No)
Item 39 - Spouse/Parent Benefit — No	Checkbox	Check this box if you are the spouse, son, or daughter of such an alien but you have not received or obtained any financial or other benefits from that activity of your spouse or parent within the last 5 years.
Item 39 - Spouse/Parent Benefit — Yes	Checkbox	Check this box if you are the spouse, son, or daughter of an alien who engaged in trafficking and you have received or obtained any financial or other benefits from that activity of your spouse or parent within the last 5 years.
Item 4 - Additional Information
Item 4 - Page Number	Text	Enter the page number of the application or attached sheet where the additional information for Item 4 appears. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Item 76 — Unlawful presence: Yes
Item 4 - Part Number	Text	Enter the part number of the form that corresponds to the additional information you are providing for Item 4. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 4 - Item Number	Text	Enter the specific item number within the form part that this additional information refers to. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 4 - Additional Information	Text	Provide the full additional information, explanation, or continuation of your answers for Item 4; type or print the details you wish to add. Fill only if 'Item 4 - Page Number', 'Item 4 - Part Number', 'Item 4 - Item Number' are filled (all). Depends on: Item 4 - Page Number, Item 4 - Part Number, Item 4 - Item Number
Item 40 - Knowledge of Benefit from Item 39 (Yes/No)
Item 40 - No	Checkbox	Check this box if your answer to Item 39 was 'Yes' but you did not know and reasonably should not have known that the benefit resulted from the trafficking-related activity of your spouse or parent.
Item 40 - Yes	Checkbox	Check this box if your answer to Item 39 was 'Yes' and you knew or reasonably should have known that the benefit resulted from the trafficking-related activity of your spouse or parent. Fill only if 'Item 39 - Spouse/Parent Benefit — Yes' is 'Yes'. Depends on: Item 39 - Spouse/Parent Benefit — Yes
Item 41 - Money Laundering (Yes/No)
Item 41 - Money Laundering: Yes	Checkbox	Check this box if you have EVER engaged in money laundering, have EVER knowingly aided, assisted, abetted, conspired, or colluded with others in money laundering, or if you seek to enter the United States to engage in such activity.
Item 41 - Money Laundering: No	Checkbox	Check this box if you have NEVER engaged in money laundering, have not aided or participated in money laundering with others, and do not seek to enter the United States to engage in such activity.
Item 42.a - Espionage/Sabotage Intent (Yes/No)
42.a Yes — Engage in espionage/sabotage	Checkbox	Check this box if you intend to engage in any activity that violates or evades any law relating to espionage (including spying) or sabotage in the United States.
42.a No — Do not engage in espionage/sabotage	Checkbox	Check this box if you do not intend to engage in any activity that violates or evades any law relating to espionage (including spying) or sabotage in the United States.
Item 42.b - Export Prohibition Violations (Yes/No)
Item 42.b - Engage in export-prohibiting activity - No	Checkbox	Check this box if you do not intend to engage in any activity in the United States that violates or evades laws prohibiting the export of U.S. goods, technology, or sensitive information.
Item 42.b - Engage in export-prohibiting activity - Yes	Checkbox	Check this box if you intend to 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.
Item 42.c - Opposing/Overthrowing US Government (Yes/No)
42.c — No: Opposing/overthrowing U.S. Government	Checkbox	Check this box if you do not intend to engage in any activity while in the United States whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means.
42.c — Yes: Opposing/overthrowing U.S. Government	Checkbox	Check this box if you intend to engage in any activity while in the United States whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means.
Item 42.d - Any Other Unlawful Activity (Yes/No)
42.d Engage in any other unlawful activity? — Yes	Checkbox	Check this box if you intend to engage in any other unlawful activity in the United States (i.e., you affirm that you plan to engage in unlawful activity).
42.d Engage in any other unlawful activity? — No	Checkbox	Check this box if you do not intend to engage in any other unlawful activity in the United States (i.e., you affirm that you do not plan to engage in unlawful activity).
Item 43.a - Weapons/Paramilitary Training (Yes/No)
Item 43.a — No: Received any weapons training, paramilitary training, or other military-type training	Checkbox	Check this box if you HAVE NOT received any weapons training, paramilitary training, or other military-type (military-style) training.
Item 43.a — Yes: Received any weapons training, paramilitary training, or other military-type training	Checkbox	Check this box if you HAVE received any weapons training, paramilitary training, or other military-type (military-style) training.
Item 43.b - Kidnapping/Assassination/Sabotage (Yes/No)
43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)	Checkbox	Check this box if you HAVE committed kidnapping, assassination, hijacking, or sabotage of a conveyance (including an aircraft, vessel, vehicle, or train).
43.b - Committed kidnapping, assassination, hijacking or sabotage (No)	Checkbox	Check this box if you HAVE NOT committed kidnapping, assassination, hijacking, or sabotage of a conveyance (including an aircraft, vessel, vehicle, or train).
Item 43.c - Use of Weapon/Explosive (Yes/No)
Item 43.c (Yes) - Used a weapon or explosive	Checkbox	Check this box if you have used a weapon, explosive, or any dangerous device with the intent to endanger the safety of another person or people or to cause damage to property.
Item 43.c (No) - Did not use a weapon or explosive	Checkbox	Check this box if you have NOT used a weapon, explosive, or any dangerous device with the intent to endanger the safety of another person or to cause damage to property.
Item 43.d - Threatened/Planned Activities from 43.b-43.c (Yes/No)
43.d Yes - Threatened, attempted, conspired, prepared, or planned	Checkbox	Check this box if you threatened, attempted, conspired, prepared, or planned to do any of the things described in Item Numbers 43.b–43.c. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive
43.d No - Threatened, attempted, conspired, prepared, or planned	Checkbox	Check this box if you did not threaten, attempt, conspire, prepare, or plan to do any of the things described in Item Numbers 43.b–43.c.
Item 43.e - Incitement to Cause Death/Serious Harm (Yes/No)
Item 43.e — Incited to cause death/serious harm (Yes)	Checkbox	Check this box if you incited, under circumstances indicating an intention to cause death or serious bodily harm/injury, any of the activities described in Item Numbers 43.b or 43.c. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive
Item 43.e — Incited to cause death/serious harm (No)	Checkbox	Check this box if you did not incite, under circumstances indicating an intention to cause death or serious bodily harm/injury, any of the activities described in Item Numbers 43.b or 43.c.
Item 43.f - Participation/Membership in Group (Yes/No)
Item 43.f — Yes: Participated in/been a member of a group or organization	Checkbox	Check this box if you DID participate in, or were a member of, a group or organization that carried out any of the activities described in Item Numbers 43.b–43.e. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive', '43.d Yes - Threatened, attempted, conspired, prepared, or planned', 'Item 43.e — Incited to cause death/serious harm (Yes)' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive, 43.d Yes - Threatened, attempted, conspired, prepared, or planned, Item 43.e — Incited to cause death/serious harm (Yes)
Item 43.f — No: Did not participate in/was not a member of a group or organization	Checkbox	Check this box if you DID NOT participate in, and were NOT a member of, any group or organization that carried out the activities described in Item Numbers 43.b–43.e.
Item 43.g - Recruited or Asked for Money for Group (Yes/No)
Item 43.g — Yes: Recruited members or asked for money or things of value for a group or organization	Checkbox	Check this box if you DID recruit members or ask for money or things of value for a group or organization that carried out any of the activities described in Item Numbers 43.b–43.e. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive', '43.d Yes - Threatened, attempted, conspired, prepared, or planned', 'Item 43.e — Incited to cause death/serious harm (Yes)' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive, 43.d Yes - Threatened, attempted, conspired, prepared, or planned, Item 43.e — Incited to cause death/serious harm (Yes)
Item 43.g — No: Recruited members or asked for money or things of value for a group or organization	Checkbox	Check this box if you DID NOT recruit members or ask for money or things of value for a group or organization that carried out any of the activities described in Item Numbers 43.b–43.e.
Item 43.h - Provided Money/Support for Activities 43.b-43.e (Yes/No)
43.i Provided money, things of value, services or labor, or other assistance or support for an individual/group who did activities in Items 43.b–43.e (Yes)	Checkbox	Check this box if you provided money, a thing of value, services or labor, or any other assistance or support for an individual, group, or organization that carried out any of the activities described in Item Numbers 43.b through 43.e.
43.h Provided money, things of value, services or labor, or other assistance or support for activities in Items 43.b–43.e (Yes)	Checkbox	Check this box if you provided money, a thing of value, services or labor, or any other assistance or support for the activities described in Item Numbers 43.b through 43.e. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive', '43.d Yes - Threatened, attempted, conspired, prepared, or planned', 'Item 43.e — Incited to cause death/serious harm (Yes)' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive, 43.d Yes - Threatened, attempted, conspired, prepared, or planned, Item 43.e — Incited to cause death/serious harm (Yes)
Item 43.i - Provided Support to Individuals/Groups in 43.b-43.e (Yes/No)
Item 43.i — No (Did not provide support)	Checkbox	Check this box if you DID NOT provide money, things of value, services, labor, or any other assistance or support for an individual, group, or organization that did any of the activities described in Item Numbers 43.b.–43.e.
Item 43.i — Yes (Provided support)	Checkbox	Check this box if you PROVIDED money, things of value, services, labor, or any other assistance or support for an individual, group, or organization that did any of the activities described in Item Numbers 43.b.–43.e. Fill only if '43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes)', 'Item 43.c (Yes) - Used a weapon or explosive', '43.d Yes - Threatened, attempted, conspired, prepared, or planned', 'Item 43.e — Incited to cause death/serious harm (Yes)' is 'Yes' (any). Depends on: 43.b - Committed kidnapping, assassination, hijacking or sabotage (Yes), Item 43.c (Yes) - Used a weapon or explosive, 43.d Yes - Threatened, attempted, conspired, prepared, or planned, Item 43.e — Incited to cause death/serious harm (Yes)
Item 44 - Intent to Engage in Activities Listed in 43.b-43.e (Yes/No)
Item 44 — Yes (Intent to engage in activities listed in 43.b–43.e)	Checkbox	Check this box if you DO intend to engage in any of the activities listed in any part of Item Numbers 43.b through 43.e.
Item 44 — No (Intent to engage in activities listed in 43.b–43.e)	Checkbox	Check this box if you DO NOT intend to engage in any of the activities listed in any part of Item Numbers 43.b through 43.e.
Item 45 - Intent to Engage in Activities Endangering US (Yes/No)
Item 45 - No	Checkbox	Check this box if you do not intend to engage in any activity that could endanger the welfare, safety, or security of the United States.
Item 45 - Yes	Checkbox	Check this box if you intend to engage in any activity that could endanger the welfare, safety, or security of the United States.
Item 46 - Spouse or child engaged in listed activities (Yes/No)
Item 46 - Yes	Checkbox	Check this box if you are the spouse or child of an individual who EVER engaged in any of the activities listed in Item Numbers 43.b. - 43.i.
Item 46 - No	Checkbox	Check this box if you are NOT the spouse or child of an individual who EVER engaged in any of the activities listed in Item Numbers 43.b. - 43.i.
Item 47 - Sold/provided/transported weapons (Yes/No)
Item 47 - No (sold/provided/transported weapons)	Checkbox	Check this box if you have NEVER sold, provided, transported, or assisted anyone in selling, providing, or transporting weapons that you knew or believed would be used against another person.
Item 47 - Yes (sold/provided/transported weapons)	Checkbox	Check this box if you EVER sold, provided, transported, or assisted any person in selling, providing, or transporting weapons that you knew or believed would be used against another person.
Item 48 - Worked/served in prisons or detention facilities (Yes/No)
Item 48 - No	Checkbox	Check this box if you have NEVER worked, volunteered, served, directed, or participated in any activity in any prison, jail, prison camp, detention facility, labor camp, or any other place where people were detained.
Item 48 - Yes	Checkbox	Check this box if you have EVER worked, volunteered, or otherwise served in any prison, jail, prison camp, detention facility, labor camp, or any other place where people were detained, or if you EVER directed or participated in any activity that involved detaining people.
Item 49 - Member/assisted any group using violence (Yes/No)
Item 49 — Yes	Checkbox	Check this box if you have EVER been a member of, assisted, 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.
Item 49 — No	Checkbox	Check this box if you have NEVER been a member of, assisted, or participated in any group, unit, or organization in which weapons were used against any person or threatened to be used.
Item 5 - Additional Information
Item 5 - Page Number	Text	Enter the page number of the form page to which the additional information on this line refers. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Item 76 — Unlawful presence: Yes
Item 5 - Part Number	Text	Enter the part number (the numbered section of the form) that the additional information refers to. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 5 - Item Number	Text	Enter the specific item number within the referenced part that this additional information addresses. Fill only if 'Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Item 76 — Unlawful presence: Yes
Item 5 - Additional Information	Text	Provide the full additional explanation or details related to the referenced page/part/item, including any relevant facts, dates, and clarifications needed to complete the application. Fill only if 'Item 5 - Page Number', 'Item 5 - Part Number', 'Item 5 - Item Number' are filled (all). Depends on: Item 5 - Page Number, Item 5 - Part Number, Item 5 - Item Number
Item 50 - Served in military or police unit (Yes/No)
Item 50 — Served in military or police unit: No	Checkbox	Check this box if you have NEVER served in, been a member of, assisted (helped), or participated in any military or police unit.
Item 50 — Served in military or police unit: Yes	Checkbox	Check this box if you have EVER served in, been a member of, assisted (helped), or participated in any military or police unit.
Item 51 - Served in an armed group (Yes/No)
Item 51 — Yes (served in an armed group)	Checkbox	Check this box if you have EVER served in, been a member of, assisted (helped), or participated in any armed group (a group that carries weapons) such as a paramilitary, self-defense, vigilante, rebel, or guerrilla group.
Item 51 — No (did not serve in an armed group)	Checkbox	Check this box if you have NEVER served in, been a member of, assisted, or participated in any armed group as described in Item 51.
Item 52 - Member of Communist/totalitarian party (Yes/No)
Item 52 - No	Checkbox	Check this box if you have NEVER been a member of, or in any way affiliated with, the Communist Party or any totalitarian party (in the United States or abroad).
Item 52 - Yes	Checkbox	Check this box if you have EVER been a member of, or in any way affiliated with, the Communist Party or any totalitarian party (in the United States or abroad).
Item 53.a - Torture (Yes/No)
Item 53.a — Torture (Yes)	Checkbox	Check this box if you have EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in torture.
Item 53.a — Torture (No)	Checkbox	Check this box if you have NEVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in torture.
Item 53.b - Genocide (Yes/No)
Item 53.b (Genocide) — Yes	Checkbox	Check this box if you have ever ordered, incited, called for, committed, assisted, helped with, or otherwise participated in genocide.
Item 53.b (Genocide) — No	Checkbox	Check this box if you have never ordered, incited, called for, committed, assisted, helped with, or otherwise participated in genocide.
Item 53.c - Killing or trying to kill (Yes/No)
Item 53.c (Yes) - Killing, or trying to kill, any person	Checkbox	Check this box if you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing or trying to kill any person.
Item 53.c (No) - Killing, or trying to kill, any person	Checkbox	Check this box if you have NEVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing or trying to kill any person.
Item 53.d - Intentionally/severely injuring (Yes/No)
Item 53.d - Intentionally and severely injuring or trying to injure any person — No	Checkbox	Check this box if you have NEVER intentionally and severely injured or tried to injure any person.
Item 53.d - Intentionally and severely injuring or trying to injure any person — Yes	Checkbox	Check this box if you have EVER intentionally and severely injured or tried to injure any person.
Item 54 - Recruited/used persons under 15 (Yes/No)
Item 54 — Recruited/used persons under 15: No	Checkbox	Check this box if you have NEVER recruited, enlisted, conscripted, or used any person under 15 years of age to take part in hostilities or to serve in or help an armed force or group, and have not attempted or worked with others to do so.
Item 54 — Recruited/used persons under 15: Yes	Checkbox	Check this box if you have EVER recruited, enlisted, conscripted, or used any person under 15 years of age to take part in hostilities or to serve in or help an armed force or group, or attempted or worked with others to do so.
Item 55 - Used persons under 15 in hostilities (Yes/No)
Item 55 - Used persons under 15 in hostilities: Yes	Checkbox	Check this box if you EVER used any person under 15 years of age to take part in hostilities or to serve in or help an armed force or group (for example, participating in combat, providing combat-related services such as sabotage or courier duties, providing support services such as transporting supplies), or attempted or worked with others to do so.
Item 55 - Used persons under 15 in hostilities: No	Checkbox	Check this box if you have NEVER used any person under 15 years of age to take part in hostilities, to serve in or help an armed force or group, or attempted or worked with others to do so.
Item 56 exemptions (select only one)
Item 56 — Certain Afghan or Iraqi National (Form I-360 or Form DS-157)	Checkbox	Check this box if you are exempt because you qualify as a certain Afghan or Iraqi national documented by Form I-360 or Form DS-157. Fill only if 'Certain Afghan or Iraqi National, Form I-360 or Form DS-157' is 'Yes'. Depends on: 3.c Certain Afghan or Iraqi National, Form I-360 or Form DS-157
Item 56 — Refugee (Form I-590 or Form I-730)	Checkbox	Check this box if you are exempt because you are a refugee as documented by Form I-590 or Form I-730. Fill only if 'Refugee Status (INA section 207), Form I-590 or Form I-730' is 'Yes'. Depends on: 3.d Refugee Status (INA section 207), Form I-590 or Form I-730
Item 56 — Victim of Qualifying Criminal Activity (U nonimmigrant) under INA section 245(m) (Form I-918, I-918A, or I-929)	Checkbox	Check this box if you are exempt because you are a U nonimmigrant victim of qualifying criminal activity under INA 245(m) with the appropriate Form I-918, I-918A, or I-929. Fill only if 'Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918, Derivative Family Member, Form I-918A, or Qualifying Family Member, Form I-929' is 'Yes'. Depends on: 3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929
Item 56 — Asylee (Form I-589 or Form I-730)	Checkbox	Check this box if you are exempt because you have asylee status as shown on Form I-589 or Form I-730. Fill only if 'Asylum Status (Immigration and Nationality Act (INA) section 208), Form I-589 or Form I-730' is 'Yes'. Depends on: 3.d Asylum Status (INA section 208), Form I-589 or Form I-730
Item 56 — Other U nonimmigrant category (not INA 245(m)) valid U status at filing	Checkbox	Check this box if you are exempt because you are in a U nonimmigrant category other than INA 245(m) and you were in valid U nonimmigrant status at the time you filed your adjustment of status application. Fill only if 'Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918, Derivative Family Member, Form I-918A, or Qualifying Family Member, Form I-929' is 'Yes'. Depends on: 3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929
Item 56 — VAWA Self-Petitioner (Form I-360)	Checkbox	Check this box if you are exempt from the public charge ground because you are a VAWA self-petitioner with a Form I-360. Fill only if 'VAWA self-petitioner (victim of battery or extreme cruelty), Form I-360' is 'Yes'. Depends on: VAWA self-petitioning spouse of a U.S. citizen or lawful permanent resident, VAWA self-petitioning child of a U.S. citizen or lawful permanent resident, VAWA self-petitioning parent of a U.S. citizen (citizen is at least 21 years of age)
Item 56 — Special Immigrant Juvenile (Form I-360)	Checkbox	Check this box if you are exempt because you are a special immigrant juvenile with a Form I-360. Fill only if 'Special Immigrant Juvenile, Form I-360' is 'Yes'. Depends on: 3.c Special Immigrant Juvenile, Form I-360
Item 56 — Cuban Adjustment Act	Checkbox	Check this box if you are exempt because you qualify under the Cuban Adjustment Act. Fill only if 'The Cuban Adjustment Act' is 'Yes'. Depends on: 3.f. The Cuban Adjustment Act
Item 56 — Dependent Status under the Haitian Refugee Immigrant Fairness Act for Battered Spouses and Children	Checkbox	Check this box if you are exempt because you have dependent status under the Haitian Refugee Immigrant Fairness Act as a battered spouse or child. Fill only if 'A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act' is 'Yes'. Depends on: 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act
Item 56 — Human Trafficking Victim (T nonimmigrant) under INA section 245(l) (Form I-914 or Form I-914A)	Checkbox	Check this box if you are exempt because you are a T nonimmigrant victim of human trafficking under INA 245(l) with Form I-914 or I-914A. Fill only if 'Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A' is 'Yes'. Depends on: 3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A
Item 56 — Cuban Adjustment Act for Battered Spouses and Children	Checkbox	Check this box if you are exempt because you qualify under the Cuban Adjustment Act specifically for battered spouses and children. Fill only if 'A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act' is 'Yes'. Depends on: 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act
Item 56 — Dependent Status under the Haitian Refugee Immigrant Fairness Act	Checkbox	Check this box if you are exempt because you have dependent status under the Haitian Refugee Immigrant Fairness Act. Fill only if 'Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act' is 'Yes'. Depends on: 3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act
Item 56 — Other T nonimmigrant category (not INA 245(l)) pending or valid T status	Checkbox	Check this box if you are exempt because you are in a category other than INA 245(l) but you have a pending Form I-914 that establishes prima facie T eligibility or you are in valid T nonimmigrant status at filing. Fill only if 'Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A' is 'Yes'. Depends on: 3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A
Item 56 — Continuous Residence in the United States Since Before January 1, 1972 (Registry)	Checkbox	Check this box if you are exempt because you meet the registry continuous residence requirement of residing in the U.S. since before January 1, 1972. Fill only if 'Continuous Residence in the United States Since Before January 1, 1972 ("Registry")' is 'Yes'. Depends on: 3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry")
Item 56 — Nicaraguans and Other Central Americans under NACARA (section 203)	Checkbox	Check this box if you are exempt because you qualify as a Nicaraguan or other Central American under section 203 of the Nicaraguan Adjustment and Central American Relief Act (NACARA).
Item 56 — Amerasian Homecoming Act	Checkbox	Check this box if you are exempt because you qualify under the Amerasian Homecoming Act. Fill only if 'Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360' is 'Yes'. Depends on: 3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360
Item 56 — Polish or Hungarian Parolee	Checkbox	Check this box if you are exempt because you are a Polish or Hungarian parolee.
Item 56 — Cuban and Haitian Entrants Applying for Adjustment of Status under section 202 of IRCA of 1986	Checkbox	Check this box if you are exempt because you are a Cuban or Haitian entrant applying for adjustment of status under section 202 of the Immigration Reform and Control Act of 1986.
Item 56 — A Lautenberg Parolee	Checkbox	Check this box if you are exempt because you qualify as a Lautenberg parolee. Fill only if 'Lautenberg Parolees' is 'Yes'. Depends on: 3.f. Lautenberg Parolees
Item 56 — National of Vietnam, Cambodia, or Laos Applying under Foreign Operations/Export Financing Programs	Checkbox	Check this box if you are exempt because you are a national of Vietnam, Cambodia, or Laos applying under the specified Foreign Operations, Export Financing, and related programs. Fill only if 'Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429' is 'Yes'. Depends on: 3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429
Item 56 — American Indian Born in Canada (INA section 289) or Texas Band of Kickapoo Indians of Oklahoma	Checkbox	Check this box if you are exempt because you are an American Indian born in Canada under INA section 289 or a member of the Texas Band of Kickapoo Indians of Oklahoma.
Item 56 — Section 7611, NDAA FY2020 (Liberian Refugee Immigration Fairness)	Checkbox	Check this box if you are exempt because you qualify under Section 7611 of the National Defense Authorization Act for Fiscal Year 2020 (Liberian Refugee Immigration Fairness).
Item 65 - Benefit Row 1
Item 65 - Benefit Received (Row 1)	Text	Enter the name or brief description of the public benefit you received for Row 1. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Dollar Amount (Row 1)	Number	Enter the total dollar amount of benefits you received for this period listed in Row 1. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Start Date (Row 1)	Date	Enter the start date when you began receiving this benefit for Row 1. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - End Date (Row 1)	Date	Enter the end date when you stopped receiving this benefit or the last date of receipt for Row 1. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Benefit Row 1: In a Category Exempt from Public Charge - Yes	Checkbox	Check this box if, for the benefit listed on row 1, you received the benefit while you were in an immigration category that is exempt from the public‑charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Benefit Row 1: In a Category Exempt from Public Charge - No	Checkbox	Check this box if, for the benefit listed on row 1, you did NOT receive the benefit while in an immigration category exempt from the public‑charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Benefit Row 2
Benefit 2 - Benefit Received	Text	Enter the name or type of the benefit you received for Item 65, Row 2 (for example, the program name or benefit description). Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Benefit 2 - Dollar Amount	Number	Enter the total dollar amount of benefits you received for this period for Item 65, Row 2. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Benefit 2 - Start Date	Date	Enter the start date when you began receiving this benefit for Item 65, Row 2. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Benefit 2 - End Date	Date	Enter the end date when you stopped receiving this benefit for Item 65, Row 2. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 2 - In a Category Exempt from Public Charge: Yes	Checkbox	Check this box if, for the benefit listed on row 2 of Item 65, you received that benefit while you were in an immigration category that is exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 2 - In a Category Exempt from Public Charge: No	Checkbox	Check this box if, for the benefit listed on row 2 of Item 65, you did not receive that benefit while in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Benefit Row 3
Item 65 Row 3 — Benefit Received	Text	Enter the name or type of the benefit you received for the third listed period (for example, Supplemental Security Income, SNAP, TANF). Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 3 — Dollar Amount	Number	Enter the dollar amount of benefits you received during this third listed period. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 3 — Start Date	Date	Enter the date when you began receiving the benefit for this third listed period. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 3 — End Date	Date	Enter the date when you stopped receiving the benefit for this third listed period. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 — Benefit Row 3: Yes	Checkbox	Check this box if for the third benefit listed in Item 65 you received the benefit while you were in an immigration category exempt from the public‑charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 — Benefit Row 3: No	Checkbox	Check this box if for the third benefit listed in Item 65 you did not receive the benefit while you were in an immigration category exempt from the public‑charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Benefit Row 4
Item 65 - Row 4: Dollar Amount	Number	Enter the total dollar amount of benefits you received for the period shown on this row. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Row 4: Benefit Received	Text	Enter the name or type of the public benefit you received for this entry (for example, SNAP, Medicaid, TANF, etc.). Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Row 4: Start Date	Date	Enter the start date of the period when you began receiving the benefit listed on this row. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 - Row 4: End Date	Date	Enter the end date of the period when you stopped receiving the benefit listed on this row, or the date the benefit is scheduled to end. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 4 - Yes	Checkbox	Check this box if, for the benefit listed on row 4 of Item 65, you received that benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 65 Row 4 - No	Checkbox	Check this box if, for the benefit listed on row 4 of Item 65, you did NOT receive that benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state, Tribal, territorial, or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which also exist under other names)?' is 'Yes'. Depends on: Item 63 (Yes) Received SSI/General Assistance
Item 66 - Institution Row 1
Item 66 Row 1 - Institution Name/City/State	Text	Enter the name of the institution and the city and state where it is located for the first period of institutionalization. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 1 - Reason for Institutionalization	Text	Provide the reason you were institutionalized at this institution for the first listed period (for example, medical treatment, psychiatric care, incarceration, etc.). Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 1 - Date From	Date	Enter the start date of the period of institutionalization at this institution. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 1 - Date To	Date	Enter the end date of the period of institutionalization at this institution. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 1: Yes	Checkbox	Check this box if the institution listed in Row 1 was in a category exempt from the public charge ground of inadmissibility during your period of institutionalization. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 1: No	Checkbox	Check this box if the institution listed in Row 1 was NOT in a category exempt from the public charge ground of inadmissibility during your period of institutionalization. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 2
Item 66 Row 2 - Institution Name/City/State	Text	Enter the institution's full name and the city and state where it is located for Item 66, row 2. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 2 - Reason for Institutionalization	Text	Describe the reason you were institutionalized for Item 66, row 2 (for example: medical treatment, incarceration, rehabilitation, foster care). Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 2 - Date From	Date	Enter the date when this period of institutionalization began for Item 66, row 2. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 Row 2 - Date To	Date	Enter the date when this period of institutionalization ended for Item 66, row 2. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 2: Yes (In a Category Exempt from Public Charge)	Checkbox	Check this box if the institution listed in row 2 was in a category exempt from the public charge ground of inadmissibility during the period of institutionalization. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 2: No (Not in a Category Exempt from Public Charge)	Checkbox	Check this box if the institution listed in row 2 was not in a category exempt from the public charge ground of inadmissibility during the period of institutionalization. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 3
Item 66 — Row 3: Institution Name/City/State	Text	Enter the full name of the institution and the city and state where you were institutionalized for the third row of Item 66. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 — Row 3: Reason for Institutionalization	Text	Provide the reason you were institutionalized for the third row of Item 66 (brief description of the cause or circumstance). Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 — Row 3: Date From	Date	Enter the start date of the institutionalization period for the third row of Item 66. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 — Row 3: Date To	Date	Enter the end date of the institutionalization period for the third row of Item 66. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 3: Yes	Checkbox	Check this box if, for the third institution listed in Item 66, you were institutionalized while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 3: No	Checkbox	Check this box if, for the third institution listed in Item 66, you were NOT institutionalized while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 4
Item 66, Row 4 — Institution Name/City/State	Text	Enter the full name of the institution and the city and state where it is located. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66, Row 4 — Reason	Text	Provide the reason you were institutionalized for the period listed in this row. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66, Row 4 — Date From	Date	Enter the start date of the institutionalization period for this entry. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66, Row 4 — Date To	Date	Enter the end date of the institutionalization period for this entry. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 4: Yes	Checkbox	Check this box if, for the fourth institution listed in Item 66, you were institutionalized while in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 66 - Institution Row 4: No	Checkbox	Check this box if, for the fourth institution listed in Item 66, you were NOT institutionalized while in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Have you ever received long-term institutionalization at government expense?' is 'Yes'. Depends on: Item 64 — Long-term institutionalization (Yes)
Item 67 - Failed/refused to attend removal proceeding (Yes/No)
Item 67 - No (Did not fail/refuse to attend removal proceeding)	Checkbox	Check this box if you have NEVER failed or refused to attend or to remain in attendance at any removal proceeding filed against you on or after April 1, 1997.
Item 67 - Yes (Failed/refused to attend removal proceeding)	Checkbox	Check this box if you EVER failed or refused to attend or to remain in attendance at any removal proceeding filed against you on or after April 1, 1997.
Item 68 - Submitted altered/fraudulent documentation (Yes/No)
Item 68 - Yes	Checkbox	Check this box if you have EVER submitted altered, fraudulent, or counterfeit documentation to any U.S. Government official to obtain or attempt to obtain any immigration benefit (including a visa or entry into the United States).
Item 68 - No	Checkbox	Check this box if you have NEVER submitted altered, fraudulent, or counterfeit documentation to any U.S. Government official to obtain or attempt to obtain any immigration benefit (including a visa or entry into the United States).
Item 69 - Lied/ misrepresented info on application (Yes/No)
Item 69 - No	Checkbox	Check this box if you have NEVER lied about, concealed, or misrepresented any information on an application or petition to obtain a visa, other documentation required for entry to the United States, admission to the United States, or any other kind of immigration benefit.
Item 69 - Yes	Checkbox	Check this box if you have EVER lied about, concealed, or misrepresented any information on an application or petition to obtain a visa, other documentation required for entry to the United States, admission to the United States, or any other kind of immigration benefit.
Item 70 - Falsely claimed U.S. citizen (Yes/No)
Item 70 - Yes	Checkbox	Check this box if you have ever falsely claimed to be a U.S. citizen (in writing or any other way).
Item 70 - No	Checkbox	Check this box if you have never falsely claimed to be a U.S. citizen (in writing or any other way).
Item 71 - Been a stowaway (Yes/No)
Item 71 - Been a stowaway (No)	Checkbox	Check this box if you have NEVER been a stowaway on a vessel or aircraft arriving in the United States.
Item 71 - Been a stowaway (Yes)	Checkbox	Check this box if you have EVER been a stowaway on a vessel or aircraft arriving in the United States.
Item 72 - Encouraged/assisted alien smuggling (Yes/No)
Item 72 - Yes (knowingly encouraged/assisted alien smuggling)	Checkbox	Check this box if you EVER knowingly encouraged, induced, assisted, abetted, or aided any alien to enter or try to enter the United States illegally (alien smuggling).
Item 72 - No (knowingly encouraged/assisted alien smuggling)	Checkbox	Check this box if you have NEVER knowingly encouraged, induced, assisted, abetted, or aided any alien to enter or try to enter the United States illegally (alien smuggling).
Item 73 - Final order for civil penalty (INA 274C) (Yes/No)
Item 73 - Final order for civil penalty (INA 274C) — No	Checkbox	Check this box if you are not under a final order imposing a civil penalty for violating INA section 274C for use of fraudulent documents.
Item 73 - Final order for civil penalty (INA 274C) — Yes	Checkbox	Check this box if you are currently under a final order imposing a civil penalty for violating INA section 274C for use of fraudulent documents.
Item 74 - Excluded/deported/removed (Yes/No)
Item 74 - No	Checkbox	Check this box if you have NEVER been excluded, deported, or removed from the United States and have not departed the United States on your own after being ordered excluded, deported, or removed.
Item 74 - Yes	Checkbox	Check this box if you have EVER been excluded, deported, or removed from the United States or have ever departed the United States on your own after having been ordered excluded, deported, or removed from the United States.
Item 75 - Entered without inspection/admitted or paroled (Yes/No)
Item 75 - Yes	Checkbox	Check this box if you have EVER entered the United States without being inspected and admitted or paroled.
Item 75 - No	Checkbox	Check this box if you have NEVER entered the United States without being inspected and admitted or paroled.
Item 76 - Unlawful presence (Yes/No)
Item 76 — Unlawful presence: No	Checkbox	Check this box if, since April 1, 1997, you have NOT been unlawfully present in the United States.
Item 76 — Unlawful presence: Yes	Checkbox	Check this box if, since April 1, 1997, you HAVE been unlawfully present in the United States (and if yes, provide the dates of unlawful presence in Part 14).
Item 77 - Severe trafficking (Yes/No)
Item 77 - Yes	Checkbox	Check this box if you answered "Yes" to Item 76 and a severe form of trafficking in persons was at least one central reason for your unlawful presence in the United States. Fill only if 'Item 76 — Unlawful presence: Yes' is 'Yes'. Depends on: Item 76 — Unlawful presence: Yes
Item 77 - No	Checkbox	Check this box if you answered "Yes" to Item 76 and a severe form of trafficking in persons was not a central reason for your unlawful presence in the United States. Fill only if 'Item 76 — Unlawful presence: Yes' is 'Yes'. Depends on: Item 76 — Unlawful presence: Yes
Item 78.a - Unlawfully present >1 year (Yes/No)
78.a Having been unlawfully present more than one year (No)	Checkbox	Check this box if you have NOT been unlawfully present in the United States for more than one year in the aggregate on or after April 1, 1997.
78.a Having been unlawfully present more than one year (Yes)	Checkbox	Check this box if you have been unlawfully present in the United States for more than one year in the aggregate on or after April 1, 1997.
Item 78.b - Deported/excluded/removed (Yes/No)
Item 78.b - Yes (Deported, excluded, or removed)	Checkbox	Check this box if you have been deported, excluded, or removed from the United States.
Item 78.b - No (Not deported, excluded, or removed)	Checkbox	Check this box if you have not been deported, excluded, or removed from the United States.
Item 79 - Practice polygamy (Yes/No)
Item 79 — Do you plan to practice polygamy in the United States? (Yes)	Checkbox	Check this box if you plan to practice polygamy in the United States.
Item 79 — Do you plan to practice polygamy in the United States? (No)	Checkbox	Check this box if you do not plan to practice polygamy in the United States.
Item 80 - Accompanying inadmissible helpless alien (Yes/No)
Item 80 - No: Not accompanying an inadmissible helpless alien	Checkbox	Check this box if you are NOT accompanying an alien described above (i.e., you are not accompanying an inadmissible alien who has been certified as helpless and requires your protection or guardianship).
Item 80 - Yes: Accompanying an inadmissible helpless alien	Checkbox	Check this box if you ARE accompanying an alien who is inadmissible and has been certified by a medical officer as helpless from sickness, mental or physical disability, or infancy and who requires your protection or guardianship under INA section 232(c).
Item 81 - Assisted in detaining U.S. citizen child (Yes/No)
Item 81 - Assisted in detaining U.S. citizen child — Yes	Checkbox	Check this box if you have EVER assisted in detaining, retaining, or withholding custody of a U.S. citizen child outside the United States from a person who has been granted custody of that child.
Item 81 - Assisted in detaining U.S. citizen child — No	Checkbox	Check this box if you have NEVER assisted in detaining, retaining, or withholding custody of a U.S. citizen child outside the United States from a person who has been granted custody of that child.
Item 82 - Voted in violation (Yes/No)
Item 82 - Voted in violation: No	Checkbox	Check this box if you have NEVER voted in violation of any Federal, state, or local constitutional provision, statute, ordinance, or regulation in the United States.
Item 82 - Voted in violation: Yes	Checkbox	Check this box if you have EVER voted in violation of any Federal, state, or local constitutional provision, statute, ordinance, or regulation in the United States.
Item 83 - Renounced U.S. citizenship to avoid tax (Yes/No)
Item 83 - Renounced U.S. citizenship to avoid tax — Yes	Checkbox	Check this box if you have EVER renounced U.S. citizenship for the purpose of avoiding U.S. taxation.
Item 83 - Renounced U.S. citizenship to avoid tax — No	Checkbox	Check this box if you have NEVER renounced U.S. citizenship to avoid being taxed by the United States.
Item 84.a - Applied for exemption/discharge from training (Yes/No)
84.a - No	Checkbox	Check this box if you did not apply for exemption or discharge from training or service in the U.S. armed forces or the U.S. National Security Training Corps on the ground that you are an alien.
84.a - Yes	Checkbox	Check this box if you applied for exemption or discharge from training or service in the U.S. armed forces or the U.S. National Security Training Corps on the ground that you are an alien.
Item 84.b - Relieved/discharged from training (Yes/No)
84.b Been relieved or discharged from such training or service — No	Checkbox	Check this box if you WERE NOT relieved or discharged from training or service on the ground that you are an alien.
84.b Been relieved or discharged from such training or service — Yes	Checkbox	Check this box if you WERE relieved or discharged from training or service on the ground that you are an alien.
Item 84.c - Convicted of desertion (Yes/No)
Item 84.c — Been convicted of desertion from the U.S. armed forces? (No)	Checkbox	Check this box if you HAVE NOT been convicted of desertion from the U.S. armed forces.
Item 84.c — Been convicted of desertion from the U.S. armed forces? (Yes)	Checkbox	Check this box if you HAVE been convicted of desertion from the U.S. armed forces.
Item 85 - Left/remained outside to avoid service (Yes/No)
Item 85 - No	Checkbox	Check this box if you have NOT left or remained outside the United States to avoid or evade training or service in the U.S. armed forces during a time of war or a period declared by the President to be a national emergency.
Item 85 - Yes	Checkbox	Check this box if you have EVER left or remained outside the United States to avoid or evade training or service in the U.S. armed forces during a time of war or a period declared by the President to be a national emergency.
Item 86 - Nationality/status before leaving (text)
Item 86 — Nationality/status before leaving	Text	Enter the nationality or immigration status you held immediately before you left the United States (for example: U.S. citizen, lawful permanent resident, nonimmigrant, parolee, or other status). Fill only if 'Item 85 - Yes' is 'Yes'. Depends on: Item 85 - Yes
Last arrival first time in US (Question 13)
Question 13 - Yes	Checkbox	Check this box if your most recent (last) arrival was the first time you were ever physically present in the United States.
Question 13 - No	Checkbox	Check this box if your most recent (last) arrival was not the first time you were physically present in the United States.
List of Certifications (Item 62)
Item 62 — List of Certifications	Text	Enter your certifications, professional licenses, skills obtained through work experience, and any educational certificates relevant to your application, listing each certification separated by commas or on separate lines as needed. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Long-term Institutionalization (Item 64)
Item 64 — Long-term institutionalization (Yes)	Checkbox	Check this box if you have received long-term institutionalization at government expense. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 64 — Long-term institutionalization (No)	Checkbox	Check this box if you have not received long-term institutionalization at government expense. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Most Recent Address Outside the United States
Street Number and Name	Text	Enter the street number and full street name of your most recent address outside the United States. Max length: 34 characters
Most Recent Address Outside the United States - Apt.	Checkbox	Check this box if your most recent physical address outside the United States included an apartment number and you will enter that apartment number in the adjacent field.
Most Recent Address Outside the United States - Ste.	Checkbox	Check this box if your most recent physical address outside the United States included a suite number and you will enter that suite number in the adjacent field.
Most Recent Address Outside the United States - Flr.	Checkbox	Check this box if your most recent physical address outside the United States included a floor designation and you will enter that floor number in the adjacent field.
Apt/Ste/Flr Number	Text	Enter the apartment, suite, floor, or unit number for this address, if applicable. Max length: 6 characters
City or Town	Text	Enter the city or town of your most recent address outside the United States. Max length: 28 characters
State	Combobox	Enter the state, region, or equivalent administrative area for this address, if applicable. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC
ZIP Code	Text	Enter the ZIP code for this address, if applicable. Max length: 5 characters
Province	Text	Enter the province, department, or similar subdivision for this address, if applicable. Max length: 20 characters
Postal Code	Text	Enter the postal code or postcode for this address. Max length: 9 characters
Country	Text	Enter the country name of your most recent address outside the United States.
Dates of Residence — From	Date	Enter the date you began living at this address.
Dates of Residence — To	Date	Enter the date you stopped living at this address.
Most Recent Employer Outside US - Address
Street Number and Name	Text	Enter the street number and name for your most recent employer or school located outside the United States. Max length: 34 characters
Apt. (Apartment)	Checkbox	Check this box when the Most Recent Employer Outside US address includes an apartment number.
Ste. (Suite)	Checkbox	Check this box when the Most Recent Employer Outside US address includes a suite number.
Flr. (Floor)	Checkbox	Check this box when the Most Recent Employer Outside US address specifies a floor number.
Apt/Suite/Floor/Unit Number	Text	Enter the apartment, suite, floor, or unit number for that address, if applicable; otherwise leave blank. Max length: 6 characters
City or Town	Text	Enter the city or town of your most recent employer or school located outside the United States. Max length: 28 characters
State	Combobox	Enter the state, province abbreviation, or regional subdivision used by the address, if applicable. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC
ZIP Code	Text	Enter the ZIP code for the address if one is used for that location; otherwise leave blank. Max length: 5 characters
Postal Code	Text	Enter the postal code for the address as used in that country (may be alphanumeric). Max length: 9 characters
Province or Region	Text	Enter the province, region, or other administrative division for the address, if applicable. Max length: 20 characters
Country	Text	Enter the name of the country where your most recent employer or school is located.
Most Recent Employer Outside US - Name and Occupation
Your Occupation (Most Recent Outside US)	Text	Enter the job title or occupation you held with that most recent overseas employer, or state 'unemployed' or 'retired' if applicable. Max length: 34 characters
Name of Employer, Company, or School (Most Recent Outside US)	Text	Enter the full legal name of your most recent employer, company, or school located outside the United States. Max length: 34 characters
Most Recent Employment Dates and Financial Support
Most Recent Employment: From	Date	Enter the starting date for this most recent period of employment, unemployment, retirement, or school attendance.
Most Recent Employment: To	Date	Enter the ending date for this most recent period of employment, unemployment, retirement, or school attendance.
Source of Financial Support (if unemployed/retired)	Text	If you were unemployed or retired during this period, provide the source of your financial support (for example, savings, family, pension, unemployment benefits, sponsor, etc.). Fill only if 'Your Occupation (Most Recent Outside US)' is 'unemployed' or 'retired'. Max length: 34 characters Depends on: Your Occupation (Most Recent Outside US)
Nature of Organization and Role/Positions
Nature of Organization (purpose and activities)	Text	Enter the organization's name and a concise description of its nature, purposes and activities (including whether those activities were illicit or legitimate). Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - Nature of Organization
Nature of Involvement (role/positions held)	Text	Describe your involvement with the organization, specifying roles, positions, duties or activities you performed and whether those activities were illicit or legitimate. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - Nature of Involvement / Role
Number of Times Married
Number of Times Married	Text	Enter the total number of times you have been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person). Max length: 5 characters
Organization 1 - Details (Name, City, State/Province, Country, Nature, Role, Dates)
Organization 1 - Name of Organization	Text	Enter the full official or commonly used name of the organization with which you were associated. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - City or Town	Text	Provide the city or town where the organization is located or where your involvement took place. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - State or Province	Text	Enter the state, province, or regional subdivision in which the organization is located. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - Country	Text	Enter the country where the organization is based or where you were involved. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - Nature of Organization	Text	Describe the organization's purpose and main activities, noting whether those activities were lawful or illicit. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - Nature of Involvement / Role	Text	Describe your role, positions, duties, or level of involvement with the organization and whether those activities were lawful or illicit. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - Membership/Involvement Start Date	Date	Enter the date you began membership or involvement with this organization. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 1 - Membership/Involvement End Date	Date	Enter the date your membership or involvement ended, or leave blank if the involvement is ongoing. Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization 2 - Name
Organization 2 — Name of Organization	Text	Enter the full name of the second organization with which you were associated (use the official or commonly used name). Fill only if 'Part 9, Question 1 — Yes' is 'Yes'. Depends on: Part 9, Question 1 — Yes
Organization Location (City, State/Province, Country)
City or Town	Text	Enter the name of the city or town where the organization is located. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - City or Town
State or Province	Text	Enter the state, province, region, or similar subnational division where the organization is located. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - State or Province
Country	Text	Enter the country in which the organization is located. Fill only if '1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world?' is 'Yes'. Depends on: Part 9, Question 1 — Yes, Organization 1 - Country
Other Names Used Since Birth — Row 1
Row 1 - Family Name (Last Name)	Text	Enter the family/last name you have used since birth for this row (for example your birth name, maiden name, other legal last names, or assumed surnames). Fill only if 'Other Names You Have Used Since Birth' is applicable.
Row 1 - Given Name (First Name)	Text	Enter the given/first name you have used since birth for this row (including any legal first names, nicknames used as a legal name, or other first-name variations). Fill only if 'Other Names You Have Used Since Birth' is applicable.
Row 1 - Middle Name (if applicable)	Text	Enter the middle name you have used since birth for this row, or leave blank if none or not applicable. Fill only if 'Other Names You Have Used Since Birth' is applicable.
Other Names Used Since Birth — Row 2
Row 2 — Other Family Name (Last Name)	Text	Enter the last name (family name) you have used since birth for this second other name, including birth name, previous legal names, or assumed names. Fill only if 'Other Names You Have Used Since Birth' is applicable.
Row 2 — Other Given Name (First Name)	Text	Enter the first name (given name) you have used since birth for this second other name, including nicknames, aliases, or other legal first names. Fill only if 'Other Names You Have Used Since Birth' is applicable.
Row 2 — Other Middle Name	Text	Enter the middle name (if any) you have used since birth for this second other name, or leave blank if none. Fill only if 'Other Names You Have Used Since Birth' is applicable.
Other Relative of a U.S. Citizen Options
Unmarried son or daughter of a U.S. citizen and I am 21 years of age or older	Checkbox	Check this box if you are the unmarried son or daughter of a U.S. citizen and you are at least 21 years old.
Married son or daughter of a U.S. citizen	Checkbox	Check this box if you are the married son or daughter of a U.S. citizen.
Brother or sister of a U.S. citizen (if the citizen is at least 21 years of age)	Checkbox	Check this box if you are the brother or sister of a U.S. citizen and that U.S. citizen is at least 21 years old.
Page 20 - Bottom Text Field
Page 20 — Bottom text field	Text	Enter the text to appear in the bottom-center box on page 20, such as a brief continuation note, page-specific comment, or other short information required for this page.
Page bottom continuation field
Page continuation / footer text	Text	Enter any continuation text, brief notes, or additional information that continues from the rest of this page (for example overflow answers or page-specific comments); leave blank if not needed.
Page bottom field
Page bottom footer	Text	Enter the text to appear in the highlighted footer area at the bottom of the page, such as a page annotation, internal tracking code, reviewer ID, or other short identifier.
Page Footer Field
Page Footer Text 1	Text	Enter the text that should appear in the form footer on this page, such as a short identifier, tracking note, or other page-specific information.
Parent 1 - Date of Birth
Parent 1 - Date of Birth	Date	Enter Parent 1's date of birth.
Parent 1 - Legal Name
Parent 1 — Family Name (Last Name)	Text	Enter Parent 1's family (last) name exactly as it appears on legal documents.
Parent 1 — Given Name (First Name)	Text	Enter Parent 1's given (first) name as it appears on legal documents.
Parent 1 — Middle Name (if applicable)	Text	Enter Parent 1's middle name or initial if they have one; leave blank if none.
Parent 1 - Name at Birth
Parent 1 — Given Name (First Name) at Birth	Text	Enter Parent 1's given (first) name as it was at birth; include the full first name as shown on their birth certificate. Fill only if 'Parent 1 — Given Name (First Name)' is different than above. Depends on: Parent 1 — Given Name (First Name)
Parent 1 — Family Name (Last Name) at Birth	Text	Enter Parent 1's family (last) name as it was at birth; provide the full last name exactly as it appears on their birth records if available. Fill only if 'Parent 1 — Family Name (Last Name)' is different than above. Depends on: Parent 1 — Family Name (Last Name)
Parent 1 — Middle Name at Birth (if applicable)	Text	Enter Parent 1's middle name as it was at birth, or leave blank if they did not have a middle name. Fill only if 'Parent 1 — Middle Name (if applicable)' is different than above. Depends on: Parent 1 — Middle Name (if applicable)
Parent 2 Date of Birth and Country
Parent 2 Date of Birth	Date	Enter Parent 2's date of birth.
Parent 2 Country of Birth	Text	Enter the name of the country where Parent 2 was born.
Parent 2 Legal Name
Parent 2 Family Name (Last Name)	Text	Enter Parent 2's family (last) name exactly as it should appear on the form.
Parent 2 Given Name (First Name)	Text	Enter Parent 2's given (first) name.
Parent 2 Middle Name (if applicable)	Text	Enter Parent 2's middle name if they have one, or leave blank if not applicable.
Parent 2 Name at Birth
Parent 2 Family Name at Birth (Last Name)	Text	Enter Parent 2's family (last) name as it was at birth; provide the full last name exactly as it appears on their birth record. Fill only if 'Parent 2 Family Name (Last Name)', 'Parent 2 Given Name (First Name)', 'Parent 2 Middle Name (if applicable)' is different than above (any). Depends on: Parent 2 Family Name (Last Name), Parent 2 Given Name (First Name), Parent 2 Middle Name (if applicable)
Parent 2 Given Name at Birth (First Name)	Text	Enter Parent 2's given (first) name as it was at birth; provide the full first name exactly as it appears on their birth record. Fill only if 'Parent 2 Family Name (Last Name)', 'Parent 2 Given Name (First Name)', 'Parent 2 Middle Name (if applicable)' is different than above (any). Depends on: Parent 2 Family Name (Last Name), Parent 2 Given Name (First Name), Parent 2 Middle Name (if applicable)
Parent 2 Middle Name at Birth (if applicable)	Text	Enter Parent 2's middle name as it was at birth, or leave blank if they did not have a middle name. Fill only if 'Parent 2 Family Name (Last Name)', 'Parent 2 Given Name (First Name)', 'Parent 2 Middle Name (if applicable)' is different than above (any). Depends on: Parent 2 Family Name (Last Name), Parent 2 Given Name (First Name), Parent 2 Middle Name (if applicable)
Part 13 - 'including the' field
Part 13 — Included item(s)	Text	Enter the description or identifier of the item(s) or document(s) you are including with this Form I-485 that you are referencing in the phrase “including the,” such as a brief name or label for the attachment(s).
Part 13 - Changes numbered (start/end)
Starting change number	Text	Enter the first (starting) numbered change referenced on this application that you are certifying, for example the lowest change number in the range. Fill only if 'Part 13 — Included item(s)' is filled. Depends on: Part 13 — Included item(s)
Ending change number	Text	Enter the last (ending) numbered change referenced on this application that you are certifying, for example the highest change number in the range. Fill only if 'Part 13 — Included item(s)' is filled. Depends on: Part 13 — Included item(s)
Part 13 - Interview Signatures and Date
Part 13 - USCIS Officer's Signature	Text	Enter the USCIS officer's signature used to certify the interview (the name/signature the officer provided in ink). Max length: 1 characters
Part 13 - USCIS Officer's Printed Name or Stamp	Text	Enter the printed name of the USCIS officer or the officer's official stamp as provided at the interview. Max length: 38 characters
Part 13 - Applicant's Signature	Text	Enter the applicant's signature exactly as signed at the interview (the name/signature the applicant provided in ink). Max length: 1 characters
Part 13 - Date of Signature (USCIS Officer)	Date	Enter the date the USCIS officer signed or stamped the form.
Part 13 - Pages numbered (start/end)
Part 13 - Numbered pages (start)	Text	Enter the first page number of the additional numbered pages you submitted with this Form I-485. Fill only if 'Part 13 — Included item(s)' is filled. Depends on: Part 13 — Included item(s)
Part 13 - Numbered pages (end)	Text	Enter the last page number of the additional numbered pages you submitted with this Form I-485. Fill only if 'Part 13 — Included item(s)' is filled. Depends on: Part 13 — Included item(s)
Part 3 Exemption Selections (1.a - 1.f)
1.a Earned or can receive credit for 40 qualifying quarters (SSA)	Checkbox	Check this box if you have earned or can receive credit for 40 qualifying quarters (credits) of work in the United States as defined by the Social Security Act (attach SSA earnings statements; do not count quarters during which you received a means‑tested public benefit).
1.b Under 18, unmarried child of a U.S. citizen (automatic citizenship under INA 320)	Checkbox	Check this box if you are under 18, unmarried, the child of a U.S. citizen, not likely to become a public charge, and will automatically become a U.S. citizen under INA section 320 upon admission as a lawful permanent resident.
1.c Applying under widow or widower of a U.S. citizen (Form I-360)	Checkbox	Check this box if you are applying as the widow or widower of a U.S. citizen under the immigrant category established by Form I-360.
1.d Applying as a VAWA self-petitioner	Checkbox	Check this box if you are applying as a self-petitioner under the Violence Against Women Act (VAWA).
1.e None of these exemptions apply and not required by statute to submit an Affidavit of Support	Checkbox	Check this box if none of the listed exemptions apply to you and you are not required by statute to submit an Affidavit of Support under Section 213A of the INA, nor required to request an exemption.
1.f None of these exemptions apply and I am required to submit an Affidavit of Support	Checkbox	Check this box if none of the listed exemptions apply to you and you are required to submit an Affidavit of Support under Section 213A of the INA, so you are not requesting an exemption.
Part 4 Item 1 - Applied for immigrant visa (Yes/No)
Part 4 Item 1 — No	Checkbox	Check this box if you have never applied for an immigrant visa to obtain permanent resident status at a U.S. Embassy or U.S. Consulate abroad.
Part 4 Item 1 — Yes	Checkbox	Check this box if you have applied for an immigrant visa to obtain permanent resident status at a U.S. Embassy or U.S. Consulate abroad.
Part 4 Item 2 - U.S. Embassy/Consulate Location (City, Country)
Part 4 Item 2 - City or Town (U.S. Embassy/Consulate)	Text	Enter the name of the city or town where the U.S. Embassy or Consulate is/was located for your immigrant visa application. Fill only if 'Part 4 Item 1 — Yes' is 'Yes'. Depends on: Part 4 Item 1 — Yes
Part 4 Item 2 - Country (U.S. Embassy/Consulate)	Text	Enter the country where the U.S. Embassy or Consulate is/was located for your immigrant visa application. Fill only if 'Part 4 Item 1 — Yes' is 'Yes'. Depends on: Part 4 Item 1 — Yes
Part 4 Item 3 - Decision
Part 4, Item 3 — Decision	Text	Enter the decision outcome for the prior visa/immigration application (for example, approved, refused, denied, withdrawn, or other outcome). Fill only if 'Part 4 Item 1 — Yes' is 'Yes'. Depends on: Part 4 Item 1 — Yes
Part 4 Item 4 - Date of Decision
Part 4 Item 4 — Date of Decision	Date	Enter the date the U.S. embassy or consulate rendered the decision on your immigrant visa application. Fill only if 'Part 4 Item 1 — Yes' is 'Yes'. Depends on: Part 4 Item 1 — Yes
Part 4 Item 5 - Previously applied for permanent residence (Yes/No)
Part 4 Item 5 - No	Checkbox	Check this box if you have not previously applied for permanent residence while in the United States.
Part 4 Item 5 - Yes	Checkbox	Check this box if you have previously applied for permanent residence while in the United States.
Part 4 Item 6 - Ever held LPR status rescinded (Yes/No)
Part 4 Item 6 - No	Checkbox	Check this box if you have NEVER held lawful permanent resident (LPR) status that was later rescinded under INA section 246.
Part 4 Item 6 - Yes	Checkbox	Check this box if you have EVER held lawful permanent resident (LPR) status that was later rescinded under INA section 246.
Part 4 Item 7 - Employment/Education (Employer/School, Name, Occupation)
Item 7 - Employer or School (current or most recent)	Text	Enter the name of the employer, company, or school where you are currently or most recently employed or attended; provide the entity name as it appears on records. Max length: 34 characters
Item 7 - Your Occupation	Text	Enter your job title or occupation for the listed employer or school; if you are unemployed or retired, write 'Unemployed' or 'Retired' and include any relevant details. Max length: 34 characters
Item 7 - Name of Employer, Company, or School	Text	Provide the full official name of the employer, company, or educational institution associated with the employment or attendance entry. Max length: 34 characters
Part 9 Exempt Category Selections
Spouse, Child, or Parent of a U.S. Active-Duty Service Member under the NDAA (Form I-130 or Form I-360)	Checkbox	Check this box if you are the spouse, child, or parent of a U.S. active-duty service member and are claiming eligibility under the National Defense Authorization Act (NDAA) based on Form I-130 or Form I-360.
I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.	Checkbox	Check this box if none of the exempt categories above apply to you and you will proceed to complete Item Numbers 57 through 66.
Syrian National Adjusting Status under Public Law 106-378	Checkbox	Check this box if you are a Syrian national who is adjusting status under Public Law 106-378.
Part 9 Question 1 - Ever Been a Member (Yes/No)
Part 9, Question 1 — No	Checkbox	Check this box if you have NEVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group anywhere in the world.
Part 9, Question 1 — Yes	Checkbox	Check this box if you HAVE ever been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world.
Place of Marriage to Current Spouse (City, State, Country, Date)
City or Town of Marriage	Text	Enter the city or town where you were married to your current spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
State or Province of Marriage	Text	Enter the state or province where you were married to your current spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
Country of Marriage	Text	Enter the country where you were married to your current spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
Date of Marriage to Current Spouse	Date	Enter the date on which you were married to your current spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 0. Depends on: Number of Times Married
Place of Marriage to Prior Spouse (City, State, Country)
City or Town of Marriage to Prior Spouse	Text	Enter the city or town where you were married to your prior spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
State or Province of Marriage to Prior Spouse	Text	Enter the state, province, or region where the marriage to your prior spouse took place. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Country of Marriage to Prior Spouse	Text	Enter the country where you were married to your prior spouse. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Place Where Marriage with Prior Spouse Legally Ended (City, State, Country, Date)
Place Marriage Legally Ended — City or Town	Text	Enter the city or town where your marriage with the prior spouse was legally ended. Fill only if 'Spouse Deceased', 'Annulled', 'Other (Explain)', 'Divorced' Fill only if How Marriage Ended with Prior Spouse (select one) is 'Yes' (any). Depends on: Annulled, Divorced, Spouse Deceased, Other (Explain)
Place Marriage Legally Ended — State or Province	Text	Enter the state, province, or equivalent administrative region where your marriage with the prior spouse was legally ended. Fill only if 'Spouse Deceased', 'Annulled', 'Other (Explain)', 'Divorced' Fill only if How Marriage Ended with Prior Spouse (select one) is 'Yes' (any). Depends on: Annulled, Divorced, Spouse Deceased, Other (Explain)
Place Marriage Legally Ended — Country	Text	Enter the country where your marriage with the prior spouse was legally ended. Fill only if 'Spouse Deceased', 'Annulled', 'Other (Explain)', 'Divorced' Fill only if How Marriage Ended with Prior Spouse (select one) is 'Yes' (any). Depends on: Annulled, Divorced, Spouse Deceased, Other (Explain)
Date Marriage Legally Ended	Date	Enter the date on which your marriage with the prior spouse was legally ended. Fill only if 'Spouse Deceased', 'Annulled', 'Other (Explain)', 'Divorced' Fill only if How Marriage Ended with Prior Spouse (select one) is 'Yes' (any). Depends on: Annulled, Divorced, Spouse Deceased, Other (Explain)
Preparer's Certification and Signature
Preparer's Signature	Text	Enter the preparer's signature (the name or handwritten signature of the person who prepared the application).
Date of Signature	Date	Enter the date on which the preparer signed the application.
Preparer's Contact Information
Preparer's Daytime Telephone Number	Text	Enter the preparer's primary daytime phone number, including area code and any necessary country or extension information. Max length: 10 characters
Preparer's Email Address (if any)	Text	Enter the preparer's email address if they have one, using a valid email format (for example: [email protected]). Max length: 38 characters
Preparer's Mobile Telephone Number (if any)	Text	Enter the preparer's mobile phone number, including area code and any country code or extension if applicable. Max length: 10 characters
Preparer's Full Name and Business
Preparer's Business or Organization Name	Text	Enter the full name of the preparer's business or organization as it should appear on the form. Max length: 34 characters
Preparer's Family Name (Last Name)	Text	Enter the preparer's family name (last name or surname).
Preparer's Given Name (First Name)	Text	Enter the preparer's given name (first name).
Principal Applicant A-Number and Date of Birth
Principal Applicant's Date of Birth	Date	Enter the principal applicant's date of birth. Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant's A-Number	Text	Enter the principal applicant's Alien Registration Number (A-Number), including the leading 'A' and all digits as shown on their immigration document. Fill only if 'Derivative Applicant' is 'Yes'. Max length: 9 characters Depends on: Derivative Applicant
Principal Applicant Name (Family, Given, Middle)
Principal Applicant Family Name	Text	Enter the principal applicant’s family (last) name exactly as it appears on legal documents or passport. Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant Given Name	Text	Enter the principal applicant’s given (first) name exactly as it appears on legal documents or passport. Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant Middle Name	Text	Enter the principal applicant’s middle name if any, or leave blank if the applicant has no middle name. Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Prior Address (Last 5 years) - Domestic
In Care Of Name	Text	Enter the name of the person or organization to whom mail should be directed at this prior address, if any. Fill only if 'No' is 'No'. Max length: 34 characters Depends on: No
Street Number and Name	Text	Enter the street number and street name of the prior residence. Fill only if 'No' is 'No'. Max length: 34 characters Depends on: No
Apt.	Checkbox	Check this box if the prior address includes an apartment (Apt.) number and you are providing that apartment number in the adjacent field. Fill only if 'No' is 'No'. Depends on: No
Ste.	Checkbox	Check this box if the prior address includes a suite (Ste.) number and you are providing that suite number in the adjacent field. Fill only if 'No' is 'No'. Depends on: No
Flr.	Checkbox	Check this box if the prior address includes a floor (Flr.) designation and you are providing that floor number in the adjacent field. Fill only if 'No' is 'No'. Depends on: No
Apt/Suite/Floor Number	Text	Enter the apartment, suite, or floor number associated with this prior address, if applicable. Fill only if 'No' is 'No'. Max length: 6 characters Depends on: No
City or Town	Text	Enter the city or town where the prior address is located. Fill only if 'No' is 'No'. Max length: 28 characters Depends on: No
State	Combobox	Enter the U.S. state or territory for the prior address (use the standard two-letter abbreviation if known). Fill only if 'No' is 'No'. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC Depends on: No
ZIP Code	Text	Enter the ZIP code for the prior address. Fill only if 'No' is 'No'. Max length: 5 characters Depends on: No
Province	Text	Enter the province for the prior address, if applicable. Fill only if 'No' is 'No'. Max length: 20 characters Depends on: No
Postal Code	Text	Enter the postal code for the prior address, if different from the ZIP code. Fill only if 'No' is 'No'. Max length: 9 characters Depends on: No
Country	Text	Enter the country where the prior address is located. Fill only if 'No' is 'No'. Depends on: No
Dates of Residence - From	Date	Enter the date you began residing at this prior address. Fill only if 'No' is 'No'. Depends on: No
Dates of Residence - To	Date	Enter the date you stopped residing at this prior address. Fill only if 'No' is 'No'. Depends on: No
Prior Spouse Countries (Citizenship, Birth)
Prior Spouse Country of Citizenship/Nationality	Text	Enter the country of citizenship or nationality of your prior spouse (provide the country name). Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Prior Spouse Country of Birth	Text	Enter the country where your prior spouse was born (provide the country name). Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Prior Spouse Date of Birth
Prior Spouse's Date of Birth	Date	Enter the prior spouse's date of birth. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Prior Spouse Legal Name (Family, Given, Middle)
Prior Spouse Family Name (Last Name)	Text	Enter the prior spouse's family or last name as it appeared before marriage. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Prior Spouse Given Name (First Name)	Text	Enter the prior spouse's given or first name. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Prior Spouse Middle Name	Text	Enter the prior spouse's middle name, if any; if none, leave this field blank. Fill only if 'How many times have you been married (including your current marriage, marriages abroad, annulled marriages, and marriages to the same person)?' is greater than 1. Depends on: Number of Times Married
Question 10 - Recent Immigration History (passport, visa, arrival)
Question 10 - Passport or Travel Document Number Used at Last Arrival	Text	Enter the passport or travel document number that you used when you last entered the United States. Fill only if 'You last entered the United States using a passport or travel document'.
Question 10 - Expiration Date of Passport or Travel Document	Date	Enter the expiration date of the passport or travel document you used at your last arrival. Fill only if 'You last entered the United States using a passport or travel document'.
Question 10 - Country That Issued the Passport or Travel Document	Text	Provide the name of the country that issued the passport or travel document used at your last arrival. Fill only if 'You last entered the United States using a passport or travel document'.
Question 10 - Nonimmigrant Visa Number Used During Most Recent Arrival	Text	If applicable, enter the nonimmigrant visa number that was used during your most recent arrival to the United States. Fill only if 'You last entered the United States using a passport or travel document'.
Question 10 - Place of Last Arrival: City or Town	Text	Enter the city or town where you last arrived in the United States. Fill only if 'You last entered the United States using a passport or travel document'. Max length: 20 characters
Question 10 - Place of Last Arrival: State	Combobox	Enter the U.S. state where you last arrived (use the state's full name or postal abbreviation). Fill only if 'You last entered the United States using a passport or travel document'. MT PR OK NY AS MI NJ VA MP TX RI NH WY AL LA ME AE SD KY IL CA MA NE AZ VI WI NM NV ND AR PW AK PA IN MD CO FM NC HI CT OH SC IA GA MO MN ID OR TN VT AP AA MS MH GU WV FL WA DE KS UT DC
Question 10 - Date of Last Arrival into the United States	Date	Enter the date you last arrived in the United States. Fill only if 'You last entered the United States using a passport or travel document'.
Question 10 - Date Nonimmigrant Visa Was Issued	Date	If a nonimmigrant visa was used, enter the date that visa was issued. Fill only if 'You last entered the United States using a passport or travel document'.
Question 11a - Inspected and admitted (entry classification)
11a - Inspected and admitted	Checkbox	Check this box if, when you last arrived in the United States, you were inspected at a Port of Entry and admitted (for example, as an exchange visitor, visitor, temporary worker, student).
11a. Inspected and admitted — Class of admission	Text	Enter the class or category you were admitted under when inspected at a U.S. port of entry (for example, exchange visitor, visitor, temporary worker, student). Fill only if 'I was inspected at a Port of Entry and admitted as (for example, exchange visitor, visitor, temporary worker, student):' is 'Yes'. Max length: 20 characters
Question 11b - Inspected and paroled (entry classification)
11b. I was inspected at a Port of Entry and paroled as (for example, humanitarian parole, Cuban parole)	Checkbox	Check this box if, when you last arrived in the United States, you were inspected at a Port of Entry and granted parole (for example, humanitarian parole or Cuban parole) rather than admitted.
11b. Paroled as (entry classification)	Text	Enter the parole entry classification you were admitted under when inspected and paroled at a U.S. port of entry (for example, "humanitarian parole," "Cuban parole," or other specific parole classification). Fill only if 'I was inspected at a Port of Entry and paroled as (for example, humanitarian parole, Cuban parole):' is 'Yes'. Max length: 20 characters
Question 11c - Entered without admission or parole
11c I came into the United States without admission or parole	Checkbox	Check this box if, when you last arrived in the United States, you entered without being admitted or paroled by an immigration officer.
Question 11d - Other arrival (specify)
Question 11d — Other arrival (specify)	Text	Enter a brief, specific description of how you last entered the United States if it does not match the other listed options (for example, explain the circumstances of the arrival or immigration status at entry). Fill only if 'Other' is 'Yes'. Max length: 20 characters
11d Other (specify)	Checkbox	Check this box if your last arrival to the United States does not match the other listed options (admitted, paroled, or without admission/parole) and you will specify the alternative arrival method in the adjacent text box.
Question 23 - Ever committed a crime
23. Have you EVER committed a crime? - No	Checkbox	Check this box if you have NEVER committed a crime of any kind (you did not commit any crime described in the question).
23. Have you EVER committed a crime? - Yes	Checkbox	Check this box if you HAVE ever committed a crime of any kind (even if you were not arrested, cited, charged with, tried for that crime, or convicted).
Question 24 - Ever pled guilty/been convicted
Question 24 - Yes	Checkbox	Check this box if you have ever pled guilty to or been convicted of any crime or offense (including convictions that were later expunged, sealed, pardoned, or subject to clemency).
Question 24 - No	Checkbox	Check this box if you have never pled guilty to and have never been convicted of any crime or offense.
Question 25 - Ordered punished/conditions imposed
Question 25 - No (Ordered punished/conditions imposed)	Checkbox	Check this box if you have never been ordered punished by a judge and have never had conditions imposed on you that restrained your liberty as described in the question.
Question 25 - Yes (Ordered punished/conditions imposed)	Checkbox	Check this box if you have ever been ordered punished by a judge or had conditions imposed on you that restrained your liberty (for example, prison sentence, suspended sentence, house arrest, parole, alternative sentencing, drug or alcohol treatment, rehabilitative programs or classes, probation, or community service).
Question 26 - Violated controlled substance law
Question 26 - No	Checkbox	Check this box if you have NEVER violated (and have not attempted or conspired to violate) any controlled substance law or regulation of a state, the United States, or a foreign country.
Question 26 - Yes	Checkbox	Check this box if you have EVER violated (or attempted or conspired to violate) any controlled substance law or regulation of a state, the United States, or a foreign country.
Question 27 - Trafficked in/benefited from controlled substances
27. Trafficked in or benefited from controlled substances — No	Checkbox	Check this box if you have NEVER trafficked in, benefited from, or knowingly aided, abetted, assisted, conspired or colluded in the illegal trafficking of any controlled substances.
27. Trafficked in or benefited from controlled substances — Yes	Checkbox	Check this box if you have EVER trafficked in, benefited from, or knowingly aided, abetted, assisted, conspired or colluded in the illegal trafficking of any controlled substances (for example chemicals, illegal drugs, or narcotics).
Question 28 - Spouse/son/daughter involved in trafficking/benefit
28. Spouse/son/daughter involved — No	Checkbox	Check this box if you did not obtain any financial or other benefit within the last 5 years from the illicit trafficking activity of your spouse or parent, or if you are not the spouse, son, or daughter described in the question.
28. Spouse/son/daughter involved — Yes	Checkbox	Check this box if you are the spouse, son, or daughter of an alien who illicitly trafficked or aided (or otherwise abetted, assisted, conspired, or colluded) in the illicit trafficking of a controlled substance and you obtained any financial or other benefit from that activity of your spouse or parent within the last 5 years.
Question 29 - Knew/should have known about financial benefit (Item 28)
Question 29 (Item 28) — No	Checkbox	Check this box if your answer to Item 28 was 'Yes' but you did not know and should not have reasonably known that the financial or other benefit you obtained resulted from the illicit trafficking activity of your spouse or parent. Fill only if '28. Spouse/son/daughter involved — Yes' is 'Yes'. Depends on: 28. Spouse/son/daughter involved — Yes
Question 29 (Item 28) — Yes	Checkbox	Check this box if your answer to Item 28 was 'Yes' and you knew or should have reasonably known that the financial or other benefit you obtained resulted from the illicit trafficking activity of your spouse or parent. Fill only if '28. Spouse/son/daughter involved — Yes' is 'Yes'. Depends on: 28. Spouse/son/daughter involved — Yes
Question 30 - Engaged in prostitution/coming to engage in prostitution
Question 30: Engaged in prostitution — No	Checkbox	Check this box if you have never engaged in prostitution and are not coming to the United States to engage in prostitution.
Question 30: Engaged in prostitution — Yes	Checkbox	Check this box if you have ever engaged in prostitution or are coming to the United States to engage in prostitution.
Question 31 - Procured/imported prostitutes for prostitution
Question 31 (Yes) - Procured/imported prostitutes for prostitution	Checkbox	Check this box if you have EVER directly or indirectly procured, attempted to procure, or imported prostitutes or persons for the purpose of prostitution.
Question 31 (No) - Procured/imported prostitutes for prostitution	Checkbox	Check this box if you have NEVER directly or indirectly procured, attempted to procure, or imported prostitutes or persons for the purpose of prostitution.
Question 32 - Received proceeds or money from prostitution
Question 32 - Yes	Checkbox	Check this box if you HAVE EVER received any proceeds or money from prostitution.
Question 32 - No	Checkbox	Check this box if you have NEVER received any proceeds or money from prostitution.
Question 33 - Intend to engage in illegal gambling/commercialized vice
Question 33 – Yes	Checkbox	Check this box if you intend to engage in illegal gambling or any other form of commercialized vice in the United States (for example prostitution, bootlegging, or the sale of child pornography).
Question 33 – No	Checkbox	Check this box if you do not intend to engage in illegal gambling or any other form of commercialized vice in the United States.
Question 34 - Exercised immunity to avoid prosecution
34. Exercised immunity — No	Checkbox	Check this box if you have NEVER exercised immunity (diplomatic or otherwise) to avoid being prosecuted for a criminal offense in the United States.
34. Exercised immunity — Yes	Checkbox	Check this box if you have EVER exercised immunity (diplomatic or otherwise) to avoid being prosecuted for a criminal offense in the United States.
Question 35.a - Served as a foreign government official
35.a Yes — Served as a foreign government official	Checkbox	Check this box if you have EVER served as a foreign government official.
35.a No — Did not serve as a foreign government official	Checkbox	Check this box if you have NEVER served as a foreign government official.
Question 35.b - Responsible for violations of religious freedoms (if 35.a = Yes)
35.b No	Checkbox	Check this box if, in response to Item 35.a, you have NEVER been responsible for, enforced, or directly carried out violations of religious freedoms. Fill only if '35.a Yes — Served as a foreign government official' is 'Yes'. Depends on: 35.a Yes — Served as a foreign government official
35.b Yes	Checkbox	Check this box if, in response to Item 35.a, you have EVER been responsible for, enforced, or directly carried out violations of religious freedoms. Fill only if '35.a Yes — Served as a foreign government official' is 'Yes'. Depends on: 35.a Yes — Served as a foreign government official
Question 36 - Induced/trafficked another person for commercial sex acts
Question 36 - Induced/trafficked another person for commercial sex acts: No	Checkbox	Check this box if you have NEVER induced by force, fraud, or coercion (and were not otherwise involved in) the trafficking of another person for commercial sex acts.
Question 36 - Induced/trafficked another person for commercial sex acts: Yes	Checkbox	Check this box if you have EVER induced by force, fraud, or coercion (or were otherwise involved in) the trafficking of another person for commercial sex acts.
Question 37 - Trafficked a person into involuntary servitude/slavery
Question 37 — No	Checkbox	Check this box if you have NEVER engaged in trafficking a person into involuntary servitude, peonage, debt bondage, or slavery as described in the question.
Question 37 — Yes	Checkbox	Check this box if you have EVER trafficked a person into involuntary servitude, peonage, debt bondage, or slavery (including recruiting, harboring, transporting, providing, or obtaining a person for labor or services through force, fraud, or coercion).
Question 4 - A-Number (Yes/No and A-Number field)
Question 4 - A-Number (if any)	Text	Enter your Alien Registration Number (A-Number) exactly as issued; include the leading 'A' prefix if it appears on your documents. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters
Q4: Yes — Alien Registration Number (A-Number)	Checkbox	Check this box if you have an Alien Registration Number (A-Number); if checked, also provide your A-Number in the A-Number field.
Q4: No — Alien Registration Number (A-Number)	Checkbox	Check this box if you do not have an Alien Registration Number (A-Number).
Question 4 - INA section 245(i) (Yes/No)
Question 4 (INA section 245(i)) — No	Checkbox	Check this box if you ARE NOT applying for adjustment of status based on INA section 245(i) for the family-based, employment-based, special immigrant, or Diversity Visa category you selected in Item Numbers 3.a. - 3.g. Fill only if '3.d Asylum Status (INA section 208), Form I-589 or Form I-730', '3.d Refugee Status (INA section 207), Form I-590 or Form I-730', '3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A', '3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929', '3.f. The Cuban Adjustment Act', '3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act', '3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act', '3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act', '3.f. Lautenberg Parolees', '3.f. Diplomats or High‑Ranking Officials Unable to Return Home (Section 13 of the Act of September 11, 1957)', '3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429', '3.g Diversity Visa program', '3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry")', '3.g.2 Individual Born in the United States Under Diplomatic Status', '3.g.3 S Nonimmigrants and Qualifying Family Members', '3.g Other Eligibility — Other Eligibility', '3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360' are 'Yes' (any). Depends on: 3.d Asylum Status (INA section 208), Form I-589 or Form I-730, 3.d Refugee Status (INA section 207), Form I-590 or Form I-730, 3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A, 3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929, 3.f. The Cuban Adjustment Act, 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act, 3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act, 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act, 3.f. Lautenberg Parolees, 3.f. Diplomats or High‑Ranking Officials Unable to Return Home (Section 13 of the Act of September 11, 1957), 3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429, 3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360, 3.g Diversity Visa program, 3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry"), 3.g.2 Individual Born in the United States Under Diplomatic Status, 3.g.3 S Nonimmigrants and Qualifying Family Members, 3.g Other Eligibility — Other Eligibility
Question 4 (INA section 245(i)) — Yes	Checkbox	Check this box if you ARE applying for adjustment of status based on INA section 245(i) for the family-based, employment-based, special immigrant, or Diversity Visa category you selected in Item Numbers 3.a. - 3.g. Fill only if '3.d Asylum Status (INA section 208), Form I-589 or Form I-730', '3.d Refugee Status (INA section 207), Form I-590 or Form I-730', '3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A', '3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929', '3.f. The Cuban Adjustment Act', '3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act', '3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act', '3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act', '3.f. Lautenberg Parolees', '3.f. Diplomats or High‑Ranking Officials Unable to Return Home (Section 13 of the Act of September 11, 1957)', '3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429', '3.g Diversity Visa program', '3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry")', '3.g.2 Individual Born in the United States Under Diplomatic Status', '3.g.3 S Nonimmigrants and Qualifying Family Members', '3.g Other Eligibility — Other Eligibility', '3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360' are 'Yes' (any). Depends on: 3.d Asylum Status (INA section 208), Form I-589 or Form I-730, 3.d Refugee Status (INA section 207), Form I-590 or Form I-730, 3.e Human Trafficking Victim (T Nonimmigrant), Form I-914 or Derivative Family Member, Form I-914A, 3.e Victim of Qualifying Criminal Activity (U Nonimmigrant), Form I-918 or Derivative/Qualifying Family Member, Form I-918A or Form I-929, 3.f. The Cuban Adjustment Act, 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Under the Cuban Adjustment Act, 3.f. Applicant Adjusting Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act, 3.f. A Victim of Battery or Extreme Cruelty as a Spouse or Child Applying Based on Dependent Status Under the Haitian Refugee Immigrant Fairness Act, 3.f. Lautenberg Parolees, 3.f. Diplomats or High‑Ranking Officials Unable to Return Home (Section 13 of the Act of September 11, 1957), 3.f. Nationals of Vietnam, Cambodia, and Laos Applying for Adjustment of Status Under section 586 of Public Law 106-429, 3.f. Applicant Adjusting Under the Amerasian Act (October 22, 1982), Form I-360, 3.g Diversity Visa program, 3.g.1 Continuous Residence in the United States Since Before January 1, 1972 ("Registry"), 3.g.2 Individual Born in the United States Under Diplomatic Status, 3.g.3 S Nonimmigrants and Qualifying Family Members, 3.g Other Eligibility — Other Eligibility
Question 5 - CSPA eligibility (Yes/No)
Question 5 (CSPA) — No	Checkbox	Check this box if you are not 21 years of age or older and applying for adjustment under the Child Status Protection Act (CSPA) classification (i.e., the CSPA provision does not apply to your adjustment).
Question 5 (CSPA) — Yes	Checkbox	Check this box if you are 21 years of age or older and are applying for adjustment based on classification as a child under the Child Status Protection Act (CSPA).
Question 5 - Other A-Numbers (Yes/No and entries)
Question 5 — Yes (Have you ever used, or been assigned, any other A-Number?)	Checkbox	Check this box if you have ever used or been assigned any other A-Number; if checked, provide the other A-Numbers in the space provided.
Question 5 — No (Have you ever used, or been assigned, any other A-Number?)	Checkbox	Check this box if you have never used and have not been assigned any other A-Number.
Question 5 - Other A-Number 1	Text	Enter the first other Alien Registration Number (A-Number) you have used or been assigned, including the 'A-' prefix and digits. Fill only if 'Have you ever used, or been assigned, any other A-Number?' is 'Yes'.
Question 5 - Other A-Number 2	Text	Enter the second other Alien Registration Number (A-Number) you have used or been assigned, including the 'A-' prefix and digits. Fill only if 'Have you ever used, or been assigned, any other A-Number?' is 'Yes'.
Question 6 - Sex
Question 6 — Sex: Female	Checkbox	Check this box if you are female.
Question 6 — Sex: Male	Checkbox	Check this box if you are male.
Question 7 - Place of Birth (City, Country)
7. City or Town of Birth	Text	Enter the name of the city or town where you were born (do not include region or state unless it is part of the city's name).
7. Country of Birth	Text	Enter the name of the country where you were born as it is commonly known (write the full country name, not an abbreviation).
Question 8 - Country of Citizenship or Nationality
8. Country of Citizenship or Nationality	Text	Enter the name of the country (full country name) where you hold citizenship or nationality.
Question 9 - USCIS Online Account Number
Question 9 — USCIS Online Account Number	Text	Enter your USCIS Online Account Number (if any) exactly as shown on USCIS notices or correspondence; leave blank if you do not have one. Max length: 12 characters
Race (Part 8 - Item 2)
Race (Part 8, Item 2) — Asian	Checkbox	Check this box if you identify your race as Asian.
Race (Part 8, Item 2) — White	Checkbox	Check this box if you identify your race as White.
Race (Part 8, Item 2) — Black or African American	Checkbox	Check this box if you identify your race as Black or African American.
Race (Part 8, Item 2) — American Indian or Alaska Native	Checkbox	Check this box if you identify your race as American Indian or Alaska Native.
Race (Part 8, Item 2) — Native Hawaiian or Other Pacific Islander	Checkbox	Check this box if you identify your race as Native Hawaiian or Other Pacific Islander.
Receipt Number and Priority Date
Receipt Number of Underlying Petition	Text	Enter the USCIS receipt number (alphanumeric) of the underlying petition, if any, exactly as it appears on the receipt notice.
Priority Date from Underlying Petition	Date	Provide the priority date assigned to the underlying petition, if any.
Received SSI/General Assistance (Item 63)
Item 63 (Yes) Received SSI/General Assistance	Checkbox	Check this box if you have ever received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state/tribal/territorial/local cash benefit programs for income maintenance (often called “General Assistance”). Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Item 63 (No) Not Received SSI/General Assistance	Checkbox	Check this box if you have never received Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or state/tribal/territorial/local cash benefit programs for income maintenance (often called “General Assistance”). Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is 'Yes'. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Relative of a Lawful Permanent Resident Options
Spouse of a lawful permanent resident	Checkbox	Check this box if you are the spouse of a lawful permanent resident and are applying under the family-based preference category for relatives of a lawful permanent resident.
Unmarried child under 21 years of age of a lawful permanent resident	Checkbox	Check this box if you are an unmarried child under 21 years of age of a lawful permanent resident and are applying under that family-based preference category.
Unmarried son or daughter (21 years of age or older) of a lawful permanent resident	Checkbox	Check this box if you are an unmarried son or daughter of a lawful permanent resident and you are 21 years of age or older and are applying under that family-based preference category.
Relative's immigration status
U.S. Citizen	Checkbox	Check this box if the relative named above is a U.S. citizen (select only one of the status options). Fill only if 'Yes' is 'Yes'. Depends on: Yes
U.S. National	Checkbox	Check this box if the relative named above is a U.S. national (but not a U.S. citizen) (select only one of the status options). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Lawful Permanent Resident	Checkbox	Check this box if the relative named above is a lawful permanent resident (has a green card) (select only one of the status options). Fill only if 'Yes' is 'Yes'. Depends on: Yes
None of These	Checkbox	Check this box if the relative named above does not have any of the listed immigration statuses (select only one of the status options). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Resided at current address 5 years (Yes/No)
Yes	Checkbox	Check this box if you have resided at your current address for at least 5 years.
No	Checkbox	Check this box if you have NOT resided at your current address for at least 5 years.
Social Security Card and Consent
Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? — No	Checkbox	Check this box if the SSA has never issued you a Social Security card.
Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? — Yes	Checkbox	Check this box if the SSA has previously issued you a Social Security card.
U.S. Social Security Number (SSN)	Text	If the Social Security Administration has ever officially issued you a Social Security card, enter your U.S. Social Security Number (SSN) as issued by the SSA. Fill only if 'Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? — Yes' is 'Yes'. Max length: 9 characters Depends on: Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? — Yes
Do you want the SSA to issue you a Social Security card? — Yes	Checkbox	Check this box if you want the SSA to assign you a Social Security number and issue a Social Security card.
Do you want the SSA to issue you a Social Security card? — No	Checkbox	Check this box if you do not want the SSA to issue you a Social Security card.
Consent for Disclosure — Yes	Checkbox	Check this box to authorize disclosure of information from this application to the SSA as required to assign an SSN and issue a Social Security card. Fill only if 'Do you want the SSA to issue you a Social Security card? — Yes' is 'Yes'. Depends on: Do you want the SSA to issue you a Social Security card? — Yes
Consent for Disclosure — No	Checkbox	Check this box to withhold authorization for disclosure of information from this application to the SSA for assignment of an SSN or issuance of a Social Security card.
Spouse Armed Forces Membership (checkboxes)
Spouse Armed Forces Membership — No	Checkbox	Check this box if your spouse is not a current member of the U.S. armed forces or U.S. Coast Guard. Fill only if 'Married' is 'Married'. Depends on: Married
Spouse Armed Forces Membership — Yes	Checkbox	Check this box if your spouse is a current member of the U.S. armed forces or U.S. Coast Guard. Fill only if 'Married' is 'Married'. Depends on: Married
Spouse Armed Forces Membership — N/A	Checkbox	Check this box if the question does not apply (for example, you are not married or have no spouse to report). Fill only if 'Married' is 'Married'. Depends on: Married
Top A-Number
A-Number (Alien Registration Number)	Text	Enter the person's A-Number exactly as it appears on immigration documents (include the leading 'A' and the following digits, using any hyphens if normally shown). Max length: 9 characters
A-Number (Top)	Text	Enter your A-Number (Alien Registration Number) as it appears on immigration documents, e.g., 'A123456789' (include the leading 'A' and the digits, without spaces or dashes). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Q4: Yes — Alien Registration Number (A-Number)
Top A-Number (Form header)
A-Number (Alien Registration Number)	Text	Enter the person’s Alien Registration Number (A-Number) from immigration documents; include the numeric portion as shown (do not repeat the leading 'A' prefix). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters
Total number of children
Total number of children	Text	Enter the total number of ALL living children you have anywhere in the world (including biological, adopted, stepchildren, adult children, and those born outside of marriage). Max length: 5 characters
VAWA Self-Petitioner Options
VAWA self-petitioning spouse of a U.S. citizen or lawful permanent resident	Checkbox	Check this box if you are filing as a VAWA self-petitioning spouse who is the spouse of a U.S. citizen or a lawful permanent resident.
VAWA self-petitioning child of a U.S. citizen or lawful permanent resident	Checkbox	Check this box if you are filing as a VAWA self-petitioning child who is the child of a U.S. citizen or a lawful permanent resident.
VAWA self-petitioning parent of a U.S. citizen (citizen is at least 21 years of age)	Checkbox	Check this box if you are filing as a VAWA self-petitioning parent of a U.S. citizen and the U.S. citizen is at least 21 years old.

Form I-485, Application to Register Permanent Residence or Adjust Status Instructions