This form contains 764 fields organized into 227 sections, giving it a Form Complexity Index of 87/100 (very complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
A-Number
A-Number	Text	Enter your Alien Registration Number (A-Number), if you have one. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number), if you have one. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
A-Number Digits	Text	Enter your USCIS Alien Registration Number (A-Number) digits that come after the “A-” prefix. Max length: 9 characters
A-Number	Text	Enter your Alien Registration Number (A-Number) as it appears on your immigration documents. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number) after the “A-” prefix. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an 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'. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
A-Number	Text	Enter your Alien Registration Number (A-Number), excluding the preprinted “A-” prefix. Max length: 9 characters
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number), beginning with “A-” and including all digits. Max length: 9 characters
A-Number Fields
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'. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number), starting after the “A-” prefix shown on the form. Max length: 9 characters
Additional Information Entry 2 (Reference + Explanation)
Page Number (Reference)	Text	Enter the page number of the form where the question/item you are explaining appears. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Yes
Part Number (Reference)	Text	Enter the part number of the form that contains the question/item you are explaining. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Item Number (Reference)	Text	Enter the specific item number (and any sub-item, if applicable) that this additional information refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Additional Information Explanation	Text	Provide the additional information, explanation, or continuation of your answer for the referenced page, part, and item. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Additional Information Entry 3 (Reference + Explanation)
Entry 3 Page Number	Text	Enter the page number of the form where the question you are explaining appears. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Yes
Entry 3 Part Number	Text	Enter the part number of the form that contains the question you are referencing. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Entry 3 Item Number	Text	Enter the item number of the specific question you are referencing. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Entry 3 Additional Information	Text	Provide the additional information or explanation that corresponds to the page, part, and item number listed above. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Additional Information Entry 4 (Reference + Explanation)
Reference Page Number	Text	Enter the page number of the form that your additional information refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Yes
Reference Part Number	Text	Enter the part number of the form section that your additional information refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Reference Item Number	Text	Enter the item number within the referenced part that your additional information relates to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Additional Information Explanation	Text	Provide the full additional information, explanation, or continuation text related to the referenced page, part, and item. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Additional Information Entry 5 (Reference + Explanation)
Reference Page Number (Entry 5)	Text	Enter the page number of the form that the additional information in Entry 5 refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 2 characters Depends on: Yes
Reference Part Number (Entry 5)	Text	Enter the part number of the form that the additional information in Entry 5 refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Reference Item Number (Entry 5)	Text	Enter the item number of the form question that the additional information in Entry 5 refers to. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Max length: 6 characters Depends on: Yes
Additional Information Explanation (Entry 5)	Text	Provide the additional information or explanation that corresponds to the referenced page, part, and item for Entry 5. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Additional Options (3.g) and Related Details
Other Eligibility (Specify)	Text	Describe the specific eligibility category or basis for selecting the “Other Eligibility” option. Fill only if 'Other eligibility' is 'Yes'. Depends on: Other eligibility
Diversity Visa program	Checkbox	Check this box if you are applying for adjustment of status based on selection in the Diversity Visa (DV) program.
Continuous Residence since before January 1, 1972 (Registry)	Checkbox	Check this box if you are applying based on continuous residence in the United States since before January 1, 1972 (registry).
Individual born in the United States under diplomatic status	Checkbox	Check this box if you were born in the United States while your parent(s) held diplomatic status and you are applying under this basis.
S nonimmigrants and qualifying family members	Checkbox	Check this box if you are an S nonimmigrant or a qualifying family member applying in this category (generally with an approved Form I-854B).
Other eligibility	Checkbox	Check this box if you are applying under another eligibility basis not listed above and you will provide the specific basis in the space provided.
Diversity Visa Rank Number	Number	Enter your Diversity Visa program rank number if you selected the Diversity Visa program option. Fill only if 'Diversity Visa program' is 'Yes'. Depends on: Diversity Visa program
Admission/Removal/Status Questions (Q10-Q18)
Q10: No — Not denied admission to the United States	Checkbox	Check this box if you have never been denied admission to the United States.
Q10: Yes — Denied admission to the United States	Checkbox	Check this box if you have ever been denied admission to the United States.
Q11: Yes — Denied a visa to the United States	Checkbox	Check this box if you have ever been denied a visa to the United States.
Q11: No — Not denied a visa to the United States	Checkbox	Check this box if you have never been denied a visa to the United States.
Q13: No — Did not violate nonimmigrant status terms/conditions	Checkbox	Check this box if you have never violated the terms or conditions of your nonimmigrant status.
Q13: Yes — Violated nonimmigrant status terms/conditions	Checkbox	Check this box if you have ever violated the terms or conditions of your nonimmigrant status.
Q14: Yes — Been in removal/exclusion/rescission/deportation proceedings	Checkbox	Check this box if you are presently in, or have ever been in, removal, exclusion, rescission, or deportation proceedings (including expedited removal).
Q14: No — Not been in removal/exclusion/rescission/deportation proceedings	Checkbox	Check this box if you are not presently in, and have never been in, removal, exclusion, rescission, or deportation proceedings (including expedited removal).
Q15: No — Not issued a final order of exclusion/deportation/removal	Checkbox	Check this box if you have never been issued a final order of exclusion, deportation, or removal.
Q15: Yes — Issued a final order of exclusion/deportation/removal	Checkbox	Check this box if you have ever been issued a final order of exclusion, deportation, or removal.
Q12: Yes — Worked in the United States without authorization	Checkbox	Check this box if you have ever worked in the United States without authorization.
Q12: No — Did not work in the United States without authorization	Checkbox	Check this box if you have never worked in the United States without authorization.
Q16: Yes — Prior final order reinstated	Checkbox	Check this box if you have ever had a prior final order of exclusion, deportation, or removal reinstated.
Q16: No — Prior final order not reinstated	Checkbox	Check this box if you have never had a prior final order of exclusion, deportation, or removal reinstated.
Q17: Yes — Granted voluntary departure but did not depart on time	Checkbox	Check this box if you were ever granted voluntary departure by an immigration officer or judge but failed to depart within the time allowed.
Q17: No — Not granted voluntary departure and fail to depart on time	Checkbox	Check this box if you have never been granted voluntary departure and then failed to depart within the time allowed.
Q18: No — Did not apply for relief/protection from removal/exclusion/deportation	Checkbox	Check this box if you have never applied for any kind of relief or protection from removal, exclusion, or deportation.
Q18: Yes — Applied for relief/protection from removal/exclusion/deportation	Checkbox	Check this box if you have ever applied for any kind of relief or protection from removal, exclusion, or deportation.
Alien Crewman Visa Issued (Yes/No)
Yes	Checkbox	Check this box if you have 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)
A-Number	Text	Enter your Alien Registration Number (A-Number), if you have been assigned one. Max length: 9 characters
A-Number (Part 1, Item 4)	Text	If you answered “Yes” to having an Alien Registration Number, enter your A-Number. Fill only if 'Yes — I have an Alien Registration Number (A-Number)' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Yes — I have an Alien Registration Number (A-Number)	Checkbox	Check this box if you have been issued an Alien Registration Number (A-Number).
No — I do not have an Alien Registration Number (A-Number)	Checkbox	Check this box if you have not been issued an Alien Registration Number (A-Number).
Annual Household Income (Select One Range)
$0–27,000	Checkbox	Check this box if your annual household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$27,001–52,000	Checkbox	Check this box if your annual household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$52,001–85,000	Checkbox	Check this box if your annual household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$85,001–141,000	Checkbox	Check this box if your annual household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Over $141,000	Checkbox	Check this box if your annual household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Applicant A-Number
Applicant A-Number	Text	Enter the applicant’s Alien Registration Number (A-Number), if one has been assigned. Max length: 9 characters
Applicant A-Number (Page Footer)
Applicant A-Number	Text	Enter the applicant’s USCIS Alien Registration Number (A-Number), if any. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Applicant Identification (Name and A-Number)
Applicant A-Number (page footer)	Text	Enter the applicant’s Alien Registration Number (A-Number) to identify the applicant on this page.
Applicant A-Number (top of page)	Text	Enter the applicant’s Alien Registration Number (A-Number) as assigned by USCIS. Max length: 9 characters
Applicant Identification (Page Footer)
Applicant Name	Text	Enter the applicant’s full legal name as it should appear in the page footer.
A-Number	Text	Enter the applicant's Alien Registration Number (A-Number). Max length: 9 characters
Applicant Identifier (Last Name and A-Number)
Applicant Last Name (Family Name)	Text	Enter the applicant’s current legal last name (family name).
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number), if you have one. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Applicant Identifiers (Page Footer)
Applicant Name (Page Footer)	Text	Enter the applicant’s full name as it should appear in the page footer identifier.
A-Number	Text	Enter the applicant’s Alien Registration Number (A-Number), if one has been assigned. Max length: 9 characters
Applicant Identifiers (USCIS Online Account Number and A-Number)
USCIS Online Account Number	Text	Enter your USCIS Online Account Number, if you have one.
A-Number	Text	Enter your Alien Registration Number (A-Number), if you have one. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Applicant Name
Family Name (Last Name)	Text	Enter the applicant’s family name (last name). Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Given Name (First Name)	Text	Enter the applicant’s given name (first name). Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Middle Name	Text	Enter the applicant’s middle name, if applicable. Fill only if 'Item Number 76. Since April 1, 1997, have you been unlawfully present in the United States?' is 'Yes'. Depends on: Yes
Applicant Name (Page Header)
Applicant Name	Text	Enter the applicant’s full name as it should appear in the page header.
Applicant Name	Text	Enter the applicant’s full legal name as it should appear in the page header.
Applicant Name and A-Number (Page Header)
Applicant Full Name	Text	Enter the applicant’s full legal name as it should appear in the page header.
Applicant A-Number	Text	Enter the applicant’s Alien Registration Number (A-Number), if any. Max length: 9 characters
Applicant's Certification and Signature
Applicant Signature	Text	Enter the applicant’s full legal signature certifying that the information provided in the application is true and correct. Max length: 1 characters
Date of Signature	Date	Enter the date on which the applicant signed the application.
Applicant's Contact Information
Daytime Telephone Number	Text	Enter the applicant’s daytime telephone number where they can be reached. Max length: 10 characters
Email Address	Text	Enter the applicant’s email address, if they have one. Max length: 38 characters
Mobile Telephone Number	Text	Enter the applicant’s mobile telephone number, if they have one. Max length: 10 characters
Applied for Permanent Residence in U.S. Previously (Yes/No)
No	Checkbox	Check this box if you have not previously applied for permanent residence while in the United States.
Yes	Checkbox	Check this box if you have previously applied for permanent residence while in the United States.
Applying Based on INA Section 245(i) (Question 4)
No	Checkbox	Check this box if you are not applying for adjustment of status based on INA section 245(i). Fill only if 'Alien Investor (Form I-526 or I-526E)', 'Alien of Extraordinary Ability', 'Outstanding Professor or Researcher', 'Multinational Executive or Manager', 'Advanced Degree/Exceptional Ability (Not seeking National Interest Waiver)', 'Professional (requires at least a bachelor's degree or equivalent)', 'Skilled Worker (at least 2 years training/experience)', 'Other Worker (less than 2 years training/experience)', 'National Interest Waiver (Advanced Degree/Exceptional Ability)', 'Certain Afghan or Iraqi National (Form I-360 or DS-157)', 'Special Immigrant Juvenile (Form I-360)', 'Certain G-4 International Organization/NATO-6 Employee or Family Member (Form I-360)', 'Certain International Broadcaster (Form I-360)', 'Panama Canal Zone Employee (Form I-360)', 'Certain U.S. Armed Forces Member (Six and Six program) (Form I-360)', 'Certain Physician (Form I-360)', 'Certain Employee or Former Employee of the U.S. Government Abroad (DS-1884)', 'Religious Worker – Other Religious Worker', 'Religious Worker – Minister of Religion', 'Asylum Status (INA section 208) (Form I-589 or Form I-730)', 'Refugee Status (INA section 207) (Form I-590 or Form I-730)', 'Human Trafficking Victim (T Nonimmigrant) / Derivative Family Member', 'Victim of Qualifying Criminal Activity (U Nonimmigrant) / Derivative or Qualifying Family Member', 'The Cuban Adjustment Act', 'Victim of battery or extreme cruelty under the Cuban Adjustment Act (spouse or child)', 'Dependent status under the Haitian Refugee Immigrant Fairness Act (HRIFA)', 'Victim of battery or extreme cruelty under HRIFA (spouse or child applying as dependent)', 'Lautenberg Parolees', 'Diplomats or high-ranking officials unable to return home (Sept. 11, 1957 Act, Section 13)', 'Nationals of Vietnam, Cambodia, and Laos (Public Law 106-429, Section 586)', 'Diversity Visa program', 'Continuous Residence since before January 1, 1972 (Registry)', 'Individual born in the United States under diplomatic status', 'S nonimmigrants and qualifying family members', 'Other eligibility', 'Amerasian Act (Oct. 22, 1982), Form I-360' is 'Yes' (any). Depends on: Alien Investor (Form I-526 or I-526E), Alien of Extraordinary Ability, Outstanding Professor or Researcher, Multinational Executive or Manager, Advanced Degree/Exceptional Ability (Not seeking National Interest Waiver), Professional (requires at least a bachelor's degree or equivalent), Skilled Worker (at least 2 years training/experience), Other Worker (less than 2 years training/experience), National Interest Waiver (Advanced Degree/Exceptional Ability), Certain Afghan or Iraqi National (Form I-360 or DS-157), Special Immigrant Juvenile (Form I-360), Certain G-4 International Organization/NATO-6 Employee or Family Member (Form I-360), Certain International Broadcaster (Form I-360), Panama Canal Zone Employee (Form I-360), Certain U.S. Armed Forces Member (Six and Six program) (Form I-360), Certain Physician (Form I-360), Certain Employee or Former Employee of the U.S. Government Abroad (DS-1884), Religious Worker – Other Religious Worker, Religious Worker – Minister of Religion, Asylum Status (INA section 208) (Form I-589 or Form I-730), Refugee Status (INA section 207) (Form I-590 or Form I-730), Human Trafficking Victim (T Nonimmigrant) / Derivative Family Member, Victim of Qualifying Criminal Activity (U Nonimmigrant) / Derivative or Qualifying Family Member, The Cuban Adjustment Act, Victim of battery or extreme cruelty under the Cuban Adjustment Act (spouse or child), Dependent status under the Haitian Refugee Immigrant Fairness Act (HRIFA), Victim of battery or extreme cruelty under HRIFA (spouse or child applying as dependent), Lautenberg Parolees, Diplomats or high-ranking officials unable to return home (Sept. 11, 1957 Act, Section 13), Nationals of Vietnam, Cambodia, and Laos (Public Law 106-429, Section 586), Diversity Visa program, Continuous Residence since before January 1, 1972 (Registry), Individual born in the United States under diplomatic status, S nonimmigrants and qualifying family members, Other eligibility, Amerasian Act (Oct. 22, 1982), Form I-360
Yes	Checkbox	Check this box if you are applying for adjustment of status based on INA section 245(i). Fill only if 'Alien Investor (Form I-526 or I-526E)', 'Alien of Extraordinary Ability', 'Outstanding Professor or Researcher', 'Multinational Executive or Manager', 'Advanced Degree/Exceptional Ability (Not seeking National Interest Waiver)', 'Professional (requires at least a bachelor's degree or equivalent)', 'Skilled Worker (at least 2 years training/experience)', 'Other Worker (less than 2 years training/experience)', 'National Interest Waiver (Advanced Degree/Exceptional Ability)', 'Certain Afghan or Iraqi National (Form I-360 or DS-157)', 'Special Immigrant Juvenile (Form I-360)', 'Certain G-4 International Organization/NATO-6 Employee or Family Member (Form I-360)', 'Certain International Broadcaster (Form I-360)', 'Panama Canal Zone Employee (Form I-360)', 'Certain U.S. Armed Forces Member (Six and Six program) (Form I-360)', 'Certain Physician (Form I-360)', 'Certain Employee or Former Employee of the U.S. Government Abroad (DS-1884)', 'Religious Worker – Other Religious Worker', 'Religious Worker – Minister of Religion', 'Asylum Status (INA section 208) (Form I-589 or Form I-730)', 'Refugee Status (INA section 207) (Form I-590 or Form I-730)', 'Human Trafficking Victim (T Nonimmigrant) / Derivative Family Member', 'Victim of Qualifying Criminal Activity (U Nonimmigrant) / Derivative or Qualifying Family Member', 'The Cuban Adjustment Act', 'Victim of battery or extreme cruelty under the Cuban Adjustment Act (spouse or child)', 'Dependent status under the Haitian Refugee Immigrant Fairness Act (HRIFA)', 'Victim of battery or extreme cruelty under HRIFA (spouse or child applying as dependent)', 'Lautenberg Parolees', 'Diplomats or high-ranking officials unable to return home (Sept. 11, 1957 Act, Section 13)', 'Nationals of Vietnam, Cambodia, and Laos (Public Law 106-429, Section 586)', 'Diversity Visa program', 'Continuous Residence since before January 1, 1972 (Registry)', 'Individual born in the United States under diplomatic status', 'S nonimmigrants and qualifying family members', 'Other eligibility', 'Amerasian Act (Oct. 22, 1982), Form I-360' is 'Yes' (any). Depends on: Alien Investor (Form I-526 or I-526E), Alien of Extraordinary Ability, Outstanding Professor or Researcher, Multinational Executive or Manager, Advanced Degree/Exceptional Ability (Not seeking National Interest Waiver), Professional (requires at least a bachelor's degree or equivalent), Skilled Worker (at least 2 years training/experience), Other Worker (less than 2 years training/experience), National Interest Waiver (Advanced Degree/Exceptional Ability), Certain Afghan or Iraqi National (Form I-360 or DS-157), Special Immigrant Juvenile (Form I-360), Certain G-4 International Organization/NATO-6 Employee or Family Member (Form I-360), Certain International Broadcaster (Form I-360), Panama Canal Zone Employee (Form I-360), Certain U.S. Armed Forces Member (Six and Six program) (Form I-360), Certain Physician (Form I-360), Certain Employee or Former Employee of the U.S. Government Abroad (DS-1884), Religious Worker – Other Religious Worker, Religious Worker – Minister of Religion, Asylum Status (INA section 208) (Form I-589 or Form I-730), Refugee Status (INA section 207) (Form I-590 or Form I-730), Human Trafficking Victim (T Nonimmigrant) / Derivative Family Member, Victim of Qualifying Criminal Activity (U Nonimmigrant) / Derivative or Qualifying Family Member, The Cuban Adjustment Act, Victim of battery or extreme cruelty under the Cuban Adjustment Act (spouse or child), Dependent status under the Haitian Refugee Immigrant Fairness Act (HRIFA), Victim of battery or extreme cruelty under HRIFA (spouse or child applying as dependent), Lautenberg Parolees, Diplomats or high-ranking officials unable to return home (Sept. 11, 1957 Act, Section 13), Nationals of Vietnam, Cambodia, and Laos (Public Law 106-429, Section 586), Diversity Visa program, Continuous Residence since before January 1, 1972 (Registry), Individual born in the United States under diplomatic status, S nonimmigrants and qualifying family members, Other eligibility, Amerasian Act (Oct. 22, 1982), Form I-360
Arrived to Join Vessel/Aircraft as Seaman or Crewman (Yes/No)
No	Checkbox	Check this box if you did not last arrive in the United States to join a vessel as a seaman or crewman and were not serving aboard a vessel or aircraft.
Yes	Checkbox	Check this box if you last arrived in the United States to join a vessel as a seaman or crewman, or while serving in any capacity aboard a vessel or aircraft.
Asylee or Refugee (3.d) Selection and Dates
Asylum Status (INA section 208) (Form I-589 or Form I-730)	Checkbox	Check this box if you are applying for adjustment of status based on being granted asylum under INA section 208 (through Form I-589 or as a derivative via Form I-730).
Refugee Status (INA section 207) (Form I-590 or Form I-730)	Checkbox	Check this box if you are applying for adjustment of status based on being admitted as a refugee under INA section 207 (through Form I-590 or as a derivative via Form I-730).
Asylum Granted Date	Date	Enter the date you were granted asylum, if you selected Asylum Status. Fill only if 'Asylum Status (INA section 208) (Form I-589 or Form I-730)' is 'Yes'. Depends on: Asylum Status (INA section 208) (Form I-589 or Form I-730)
Initial Refugee Admission Date	Date	Enter the date of your initial admission as a refugee, if you selected Refugee Status. Fill only if 'Refugee Status (INA section 207) (Form I-590 or Form I-730)' is 'Yes'. Depends on: Refugee Status (INA section 207) (Form I-590 or Form I-730)
Attorney/Accredited Representative Information
Attorney State Bar Number	Text	Enter the attorney’s state bar number, if applicable. Fill only if 'Form G-28 Attached' is 'Yes'. Max length: 9 characters Depends on: Form G-28 Attached
Form G-28 Attached	Checkbox	Check this box if an attorney or accredited representative is representing the applicant and a completed Form G-28 is attached to the application.
Volag Number	Text	Enter the accredited representative’s Volag number, if any. Fill only if 'Form G-28 Attached' is 'Yes'. Max length: 10 characters Depends on: Form G-28 Attached
USCIS Online Account Number	Text	Enter the attorney or accredited representative’s USCIS online account number, if any. Fill only if 'Form G-28 Attached' is 'Yes'. Max length: 12 characters Depends on: Form G-28 Attached
Certifications/Licenses/Skills List
Certifications, Licenses, and Skills	Text	List all certifications, professional licenses, skills obtained through work experience, and educational certificates you have. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Child Status Protection Act (CSPA) Eligibility (Question 5)
No	Checkbox	Check this box if you are not 21 years of age or older applying as a child under the Child Status Protection Act (CSPA).
Yes	Checkbox	Check this box if you are 21 years of age or older and are applying for adjustment of status based on classification as a child under the Child Status Protection Act (CSPA).
Country of Citizenship or Nationality
Country of Citizenship or Nationality	Text	Enter the country of which you are a citizen or national.
Criminal Acts and Violations
Applicant Name	Text	Enter the applicant’s full name to identify whose information this page belongs to.
Yes	Checkbox	Check this box if you have ever been arrested, cited, charged, placed in or permitted to participate in a diversion program, or detained by any law enforcement official in any country for any reason.
No	Checkbox	Check this box if you have never been arrested, cited, charged, placed in or permitted to participate in a diversion program, or detained by any law enforcement official in any country for any reason.
A-Number	Text	Enter your Alien Registration Number (A-Number), if you have one. Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Current Employer/School Address
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
Current Immigration Status
Current Immigration Status	Text	Enter your current U.S. immigration status (for example, the status or classification you currently hold). Max length: 20 characters
Current Legal Name
Family Name (Last Name)	Text	Enter your current legal family name (last name).
Given Name (First Name)	Text	Enter your current legal given name (first name).
Middle Name	Text	Enter your current legal middle name, if you have one.
Current Mailing Address
Apt.	Checkbox	Check this box if your current mailing address includes an apartment number. Fill only if 'Is this your current mailing address?' is 'No'. Depends on: No
Ste.	Checkbox	Check this box if your current mailing address includes a suite number. Fill only if 'Is this your current mailing address?' is 'No'. Depends on: No
Flr.	Checkbox	Check this box if your current mailing address includes a floor number. Fill only if 'Is this your current mailing address?' is 'No'. Depends on: No
Unit Number	Text	Enter your apartment, suite, or floor number for this mailing address, if any. Fill only if 'Is this your current mailing address?' is 'No'. Max length: 6 characters Depends on: No
City or Town	Text	Enter the city or town for your current mailing address. Fill only if 'Is this your current mailing address?' is 'No'. Max length: 20 characters Depends on: No
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
ZIP Code	Text	Enter the ZIP code for your current mailing address. Fill only if 'Is this your current mailing address?' is 'No'. Max length: 5 characters Depends on: No
Street Number and Name	Text	Enter the street number and street name for your current mailing address. Fill only if 'Is this your current mailing address?' is 'No'. Max length: 34 characters Depends on: No
In Care Of Name	Text	Enter the name of the person or organization that should receive mail at this address, if applicable. Fill only if 'Is this your current mailing address?' is 'No'. Max length: 34 characters Depends on: No
Current Marital Status
Divorced	Checkbox	Check this box if you are currently divorced.
Single, Never Married	Checkbox	Check this box if you are currently single and have never been married.
Widowed	Checkbox	Check this box if your spouse has died and you have not remarried.
Married	Checkbox	Check this box if you are currently married.
Marriage Annulled	Checkbox	Check this box if your marriage was legally annulled and you are not currently married.
Legally Separated	Checkbox	Check this box if you are currently legally separated from your spouse.
Current or Most Recent Employer/School - Address
Street Number and Name	Text	Enter the street number and street name for the current or most recent employer, company, or school. Max length: 34 characters
Apt.	Checkbox	Check this box if the employer/school address is for an apartment number.
Ste.	Checkbox	Check this box if the employer/school address is for a suite number.
Flr.	Checkbox	Check this box if the employer/school address is for a floor number.
Apartment/Suite/Floor Number	Text	Enter the apartment, suite, or floor number for the employer/school address, if applicable. Max length: 6 characters
City or Town	Text	Enter the city or town of the employer/school address. Max length: 28 characters
ZIP Code	Text	Enter the ZIP code for the employer/school address. Max length: 5 characters
Postal Code	Text	Enter the postal code for the employer/school address (if outside the United States or if applicable). Max length: 9 characters
Province	Text	Enter the province for the employer/school address, if applicable. Max length: 20 characters
Country	Text	Enter the country of the employer/school address.
Current or Most Recent Employer/School - Basic Info
Employer or School Indicator	Text	Enter whether this entry is for your current or most recent employer or for a school you attended (for example, “Employer” or “School”). Max length: 34 characters
Occupation	Text	Enter your job title or occupation for this employer or school period, or state if you were unemployed or retired. Max length: 34 characters
Employer/Company/School Name	Text	Enter the full name of your current or most recent employer, company, or school. Max length: 34 characters
Current or Most Recent Employer/School - Dates and Financial Support
Employment/School Start Date	Date	Enter the date you started this employment, unemployment/retirement period, or school attendance.
Employment/School End Date	Date	Enter the date you ended this employment, unemployment/retirement period, or school attendance.
Source of Financial Support (If Unemployed/Retired)	Text	Describe how you were financially supported during this period if you were unemployed or retired (for example, savings, family support, government benefits). Fill only if 'Occupation' indicates you are unemployed or retired. Max length: 34 characters Depends on: Occupation
Current Spouse Basic Details
Current Spouse A-Number	Text	Enter your current spouse’s Alien Registration Number (A-Number), if they have one. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Max length: 9 characters Depends on: Married, Legally Separated
Current Spouse Date of Birth	Date	Enter your current spouse’s date of birth. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Current Spouse Country of Birth	Text	Enter the country where your current spouse was born. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Current Spouse Current Physical Address
Country	Text	Enter the country where your current spouse’s current physical address is located. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Street Number and Name	Text	Enter your current spouse’s street address, including the house/building number and street name. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. 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 'What is your current marital status?' is 'Married' or 'Legally Separated'. Max length: 28 characters Depends on: Married, Legally Separated
Postal Code	Text	Enter the postal code for your current spouse’s current physical address, if applicable. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Max length: 9 characters Depends on: Married, Legally Separated
Province	Text	Enter the province for your current spouse’s current physical address, if applicable. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Max length: 20 characters Depends on: Married, Legally Separated
Apt.	Checkbox	Check this box if your current spouse’s physical address includes an apartment number. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Ste.	Checkbox	Check this box if your current spouse’s physical address includes a suite number. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Flr.	Checkbox	Check this box if your current spouse’s physical address includes a floor number. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Apartment/Suite/Floor Number	Text	Enter the apartment, suite, or floor number for your current spouse’s address, if applicable. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. 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
ZIP Code	Text	Enter the ZIP code for your current spouse’s current physical address. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Max length: 5 characters Depends on: Married, Legally Separated
Current Spouse Legal Name
Current Spouse Last Name	Text	Enter your current spouse’s legal family name (last name). Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Current Spouse First Name	Text	Enter your current spouse’s legal given name (first name). Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Current Spouse Middle Name	Text	Enter your current spouse’s legal middle name, if applicable. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Current U.S. Physical Address
Ste.	Checkbox	Check this box if the address includes a suite number.
Flr.	Checkbox	Check this box if the address includes a floor number.
Apartment/Suite/Floor Number	Text	Enter your apartment, suite, or floor number for this address, if any. Max length: 6 characters
Apt.	Checkbox	Check this box if the address includes an apartment number.
City or Town	Text	Enter the city or town for your current U.S. physical address. 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. Max length: 5 characters
Street Number and Name	Text	Enter the street number and street name for your current U.S. physical address. Max length: 34 characters
In Care Of Name	Text	Enter the name of the person or organization receiving mail at this address, if applicable. Max length: 34 characters
Date First Resided at This Address	Date	Enter the date you first lived at this current U.S. physical address.
Date Marriage with Prior Spouse Legally Ended
Prior Marriage Legally Ended Date	Date	Enter the date when your marriage to your prior spouse was legally terminated. 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 more than '1'. Depends on: Number of Times Married
Date of Birth and Any Other Dates of Birth
Date of Birth	Date	Enter your date of birth.
Yes	Checkbox	Check this box if you have ever used any other date of birth besides the one listed above.
No	Checkbox	Check this box if you have never used any other date of birth besides the one listed above.
Other Dates of Birth	Text	If you have ever used any other date of birth, list all other dates of birth you have used. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Date of Birth and Other Dates
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 Current Spouse
Date of Marriage to Current Spouse	Date	Enter the date you married your current spouse. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Employment-Based Immigrant Category (3.b) Selection
Alien Investor (Form I-526 or I-526E)	Checkbox	Check this box if you are applying for an employment-based immigrant category as an alien investor based on Form I-526 or Form I-526E.
Alien of Extraordinary Ability	Checkbox	Check this box if your employment-based immigrant petition (Form I-140) is in the Extraordinary Ability category.
Outstanding Professor or Researcher	Checkbox	Check this box if your employment-based immigrant petition (Form I-140) is in the Outstanding Professor or Researcher category.
Multinational Executive or Manager	Checkbox	Check this box if your employment-based immigrant petition (Form I-140) is in the Multinational Executive or Manager category.
Advanced Degree/Exceptional Ability (Not seeking National Interest Waiver)	Checkbox	Check this box if you are a member of the professions holding an advanced degree or an alien of exceptional ability and you are not seeking a National Interest Waiver.
Professional (requires at least a bachelor's degree or equivalent)	Checkbox	Check this box if you are applying as a professional whose position requires at least a U.S. bachelor's degree (or foreign equivalent).
Skilled Worker (at least 2 years training/experience)	Checkbox	Check this box if you are applying as a skilled worker requiring at least 2 years of specialized training or experience.
Other Worker (less than 2 years training/experience)	Checkbox	Check this box if you are applying as an other worker position requiring less than 2 years of training or experience.
National Interest Waiver (Advanced Degree/Exceptional Ability)	Checkbox	Check this box if you are applying for a National Interest Waiver as a member of the professions holding an advanced degree or as an alien of exceptional ability.
EOIR Proceedings Filing (Yes/No)
Yes	Checkbox	Check this box if you are filing for adjustment of status with EOIR while in removal, exclusion, rescission, or deportation proceedings.
No	Checkbox	Check this box if you are not filing for adjustment of status with EOIR while in removal, exclusion, rescission, or deportation proceedings.
Ethnicity (Select One)
Hispanic or Latino	Checkbox	Check this box if your ethnicity is Hispanic or Latino.
Not Hispanic or Latino	Checkbox	Check this box if your ethnicity is not Hispanic or Latino.
Ever Had LPR Status Later Rescinded (Yes/No)
No	Checkbox	Check this box if you have NEVER held lawful permanent resident (LPR) status that was later rescinded under INA section 246.
Yes	Checkbox	Check this box if you have EVER held lawful permanent resident (LPR) status that was later rescinded under INA section 246.
Expiration Date of Current Immigration Status
Expiration Date of Current Immigration Status	Text	Enter the expiration date of your current immigration status, or enter “D/S” if your status is for duration of status.
Eye Color (Select One)
Blue	Checkbox	Check this box if your eye color is blue.
Black	Checkbox	Check this box if your eye color is black.
Brown	Checkbox	Check this box if your eye color is brown.
Gray	Checkbox	Check this box if your eye color is gray.
Green	Checkbox	Check this box if your eye color is green.
Hazel	Checkbox	Check this box if your eye color is hazel.
Maroon	Checkbox	Check this box if your eye color is maroon.
Pink	Checkbox	Check this box if your eye color is pink.
Unknown/Other	Checkbox	Check this box if your eye color is unknown or not listed.
Family-Based Filing Category (select one option)
Spouse of a U.S. citizen	Checkbox	Check this box if you are filing Form I-485 as the spouse of a U.S. citizen (immediate relative category).
Unmarried child under 21 of a U.S. citizen	Checkbox	Check this box if you are filing Form I-485 as the unmarried child under age 21 of a U.S. citizen (immediate relative category).
Parent of a U.S. citizen (U.S. citizen is 21 or older)	Checkbox	Check this box if you are filing Form I-485 as the parent of a U.S. citizen and the U.S. citizen is at least 21 years old (immediate relative category).
Fiancé(e) (K-1) or child of fiancé(e) (K-2) of a U.S. citizen	Checkbox	Check this box if you were admitted to the United States as a K-1 fiancé(e) of a U.S. citizen or as a K-2 child of that fiancé(e) and are filing Form I-485 based on that admission.
Widow or widower of a U.S. citizen	Checkbox	Check this box if you are filing Form I-485 as the widow or widower of a U.S. citizen (immediate relative category).
Spouse, child, or parent of deceased U.S. active-duty service member (NDAA)	Checkbox	Check this box if you are filing Form I-485 as the spouse, child, or parent of a deceased U.S. active-duty service member under the National Defense Authorization Act (NDAA).
Unmarried son or daughter (21 or older) of a U.S. citizen	Checkbox	Check this box if you are filing Form I-485 as the unmarried son or daughter of a U.S. citizen and you are 21 years of age or older (family-based preference category).
Married son or daughter of a U.S. citizen	Checkbox	Check this box if you are filing Form I-485 as the married son or daughter of a U.S. citizen (family-based preference category).
Brother or sister of a U.S. citizen (U.S. citizen is 21 or older)	Checkbox	Check this box if you are filing Form I-485 as the brother or sister of a U.S. citizen and the U.S. citizen is at least 21 years old (family-based preference category).
Spouse of a lawful permanent resident	Checkbox	Check this box if you are filing Form I-485 as the spouse of a lawful permanent resident (family-based preference category).
Unmarried child under 21 of a lawful permanent resident	Checkbox	Check this box if you are filing Form I-485 as the unmarried child under age 21 of a lawful permanent resident (family-based preference category).
Unmarried son or daughter (21 or older) of a lawful permanent resident	Checkbox	Check this box if you are filing Form I-485 as the unmarried son or daughter of a lawful permanent resident and you are 21 years of age or older (family-based preference category).
VAWA self-petitioning spouse of a U.S. citizen or lawful permanent resident	Checkbox	Check this box if you are filing Form I-485 as a VAWA self-petitioning spouse of a U.S. citizen or lawful permanent resident (victim of battery or extreme cruelty).
VAWA self-petitioning child of a U.S. citizen or lawful permanent resident	Checkbox	Check this box if you are filing Form I-485 as a VAWA self-petitioning child of a U.S. citizen or lawful permanent resident (victim of battery or extreme cruelty).
VAWA self-petitioning parent of a U.S. citizen (U.S. citizen is 21 or older)	Checkbox	Check this box if you are filing Form I-485 as a VAWA self-petitioning parent of a U.S. citizen and the U.S. citizen is at least 21 years old (victim of battery or extreme cruelty).
First Child Information
Child 1 Family Name (Last Name)	Text	Enter the first child's current legal family name (last name). Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Child 1 Given Name (First Name)	Text	Enter the first child's current legal given name (first name). Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Child 1 Middle Name	Text	Enter the first child's middle name, if applicable. Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Child 1 A-Number	Text	Enter the first child's Alien Registration Number (A-Number), if any. Fill only if 'Total Number of Living Children' is '1 or more'. Max length: 9 characters Depends on: Total Number of Living Children
Child 1 Date of Birth	Date	Enter the first child's date of birth. Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Child 1 Country of Birth	Text	Enter the country where the first child was born. Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Child 1 Relationship to You	Text	Describe the first child's relationship to you (for example, biological child, stepchild, or legally adopted child). Fill only if 'Total Number of Living Children' is '1 or more'. Max length: 34 characters Depends on: Total Number of Living Children
First Child Separate Form I-485 (Yes/No)
No	Checkbox	Check this box if Child 1 is not applying now on a separate Form I-485. Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
Yes	Checkbox	Check this box if Child 1 is also applying now on a separate Form I-485. Fill only if 'Total Number of Living Children' is '1 or more'. Depends on: Total Number of Living Children
First Institutionalization Details Row
Institution Name, City, and State	Text	Enter the name of the institution and its city and state for this period of institutionalization. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Reason for Institutionalization	Text	Describe the reason you were institutionalized during this period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization Start Date	Date	Provide the date this period of institutionalization began. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization End Date	Date	Provide the date this period of institutionalization ended. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge (Yes)	Checkbox	Check this box if, during the first listed period of institutionalization, you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge (No)	Checkbox	Check this box if, during the first listed period of institutionalization, you were not in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
First Public Benefits Received Row
Benefit Received (Row 1)	Text	Enter the name of the specific public benefit you received for the first listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Dollar Amount (Row 1)	Number	Enter the total dollar amount of benefits you received for the first listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Start Date (Row 1)	Date	Enter the start date of the first listed period during which you received this benefit. Fill only if 'Yes' is 'Yes'. Depends on: Yes
End Date (Row 1)	Date	Enter the end date of the first listed period during which you received this benefit. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge — Yes (Row 1)	Checkbox	Check this box if, for the first listed benefit period 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 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge — No (Row 1)	Checkbox	Check this box if, for the first listed benefit period 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 'Yes' is 'Yes'. Depends on: Yes
Footer Unlabeled Field (Page 18)
A-Number (Footer)	Text	Enter your USCIS Alien Registration Number (A-Number) to identify this page as part of your application.
Footer Unlabeled Field (Page 19)
Footer Reference Text	Text	Enter the reference text required in the footer field on this page (leave blank unless you have been instructed to provide a specific value).
Form Footer Tracking Field (Page 6)
Footer Tracking Identifier	Text	Enter the internal tracking value shown in the form footer for this page (if any).
Form Footer Tracking Field (Page 7)
Page 7 Footer Tracking Code	Text	Enter the internal tracking code or identifier provided for this form page (leave blank if none was provided).
Form I-485 Filing As (Principal or Derivative)
Principal Applicant	Checkbox	Check this box if you are filing Form I-485 as the primary (principal) applicant based on your own eligibility.
Derivative Applicant	Checkbox	Check this box if you are filing Form I-485 as a derivative applicant based on a principal applicant, and you will provide the principal applicant’s information below.
Fourth Institutionalization Details Row
Institution Name, City, and State (Row 4)	Text	Enter the name of the institution and its city and state for the fourth period of institutionalization. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Reason for Institutionalization (Row 4)	Text	Describe the reason you were institutionalized for the fourth period listed. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization Date From (Row 4)	Date	Enter the start date of the fourth period of institutionalization at government expense. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization Date To (Row 4)	Date	Enter the end date of the fourth period of institutionalization at government expense. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a category exempt from public charge — Yes (4th institutionalization entry)	Checkbox	Check this box if, for the 4th listed period of institutionalization, you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a category exempt from public charge — No (4th institutionalization entry)	Checkbox	Check this box if, for the 4th listed period of institutionalization, you were not in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Fourth Public Benefits Received Row
Benefit dollar amount (Row 4)	Number	Enter the dollar amount of benefits received for the fourth public benefit entry. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit received (Row 4)	Text	Enter the specific name of the public benefit you received for the fourth entry in the list. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit start date (Row 4)	Date	Enter the date the fourth public benefit receipt period began. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit end date (Row 4)	Date	Enter the date the fourth public benefit receipt period ended. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - Yes (Row 4)	Checkbox	Check this box if, for the fourth listed public benefit received, you were in an immigration category exempt from the public charge ground of inadmissibility while you received the benefit. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - No (Row 4)	Checkbox	Check this box if, for the fourth listed public benefit received, you were not in an immigration category exempt from the public charge ground of inadmissibility while you received the benefit. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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 (Select One)
Bald (No hair)	Checkbox	Check this box if your hair color is bald/no hair.
Black	Checkbox	Check this box if your hair color is black.
Blond	Checkbox	Check this box if your hair color is blond.
Brown	Checkbox	Check this box if your hair color is brown.
Gray	Checkbox	Check this box if your hair color is gray.
Red	Checkbox	Check this box if your hair color is red.
Sandy	Checkbox	Check this box if your hair color is sandy.
White	Checkbox	Check this box if your hair color is white.
Unknown/Other	Checkbox	Check this box if your hair color is unknown or not listed in the other options.
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
Highest Education Completed (Select One) and Highest Grade (If Applicable)
Highest Grade Completed (If Less Than High School)	Text	Enter the highest grade of school you completed if you selected the option indicating you have less than a high school diploma. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.', 'Less than a high school diploma' are selected (all). Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66., Less than a high school diploma
Less than a high school diploma	Checkbox	Check this box if you have not completed high school or earned a GED/alternative credential, and then enter the highest grade level you completed. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
1 or more years of college credit, no degree	Checkbox	Check this box if you completed at least one year of college coursework/credits but did not earn a college degree. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
High school diploma, GED, or alternative credential	Checkbox	Check this box if the highest level of education you completed is a high school diploma, GED, or another equivalent/alternative credential. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Associate's degree	Checkbox	Check this box if the highest degree you have completed 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Master's degree	Checkbox	Check this box if the highest degree you have completed is a master’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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Professional degree (JD, MD, DMD, etc.)	Checkbox	Check this box if the highest degree you have completed is a professional degree such as JD, MD, DMD, or a similar professional doctorate. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Doctorate degree	Checkbox	Check this box if the highest degree you have completed is a doctorate degree (for example, a PhD). Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Bachelor's degree	Checkbox	Check this box if the highest degree you have completed is a bachelor’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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Assets Total Value (Select One Range)
$0–18,400	Checkbox	Check this box if the total value of all your household assets is between $0 and $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$18,401–136,000	Checkbox	Check this box if the total value of all your household assets is between $18,401 and $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$136,001–321,400	Checkbox	Check this box if the total value of all your household assets is between $136,001 and $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$321,401–707,100	Checkbox	Check this box if the total value of all your household assets is between $321,401 and $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Over $707,100	Checkbox	Check this box if the total value of all your household assets is more than $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Liabilities Total Value (Select One Range)
$0	Checkbox	Check this box if the total value of your household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$1-10,100	Checkbox	Check this box if the total value of your household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$10,101-57,700	Checkbox	Check this box if the total value of your household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
$57,701-186,800	Checkbox	Check this box if the total value of your household 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Over $186,800	Checkbox	Check this box if the total value of your household liabilities is more than $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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Household Size
Household Size	Text	Enter the total number of people in your household. Fill only if 'I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.' is selected. 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 (Select One / Explain Other)
Spouse Deceased	Checkbox	Check this box if your marriage to your prior spouse 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 more than '1'. Depends on: Number of Times Married
Annulled	Checkbox	Check this box if your marriage to your prior spouse legally ended by annulment. 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 more than '1'. Depends on: Number of Times Married
Other (Explain)	Checkbox	Check this box if your marriage to your prior spouse ended in another way not listed, 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 more than '1'. Depends on: Number of Times Married
Divorced	Checkbox	Check this box if your marriage to your prior spouse legally ended by 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 more than '1'. Depends on: Number of Times Married
Other Reason Marriage Ended (Explain)	Text	If you selected "Other" for how your marriage to your prior spouse ended, describe the reason or circumstances here. Fill only if 'Other (Explain)' is 'Yes'. Depends on: Other (Explain)
Human Trafficking Victim or Crime Victim (3.e) Selection
Human Trafficking Victim (T Nonimmigrant) / Derivative Family Member	Checkbox	Check this box if you are applying as a human trafficking victim with T nonimmigrant status (Form I-914) or as a derivative family member (Form I-914A).
Victim of Qualifying Criminal Activity (U Nonimmigrant) / Derivative or Qualifying Family Member	Checkbox	Check this box if you are applying as a victim of qualifying criminal activity with U nonimmigrant status (Form I-918), as a derivative family member (Form I-918A), or as a qualifying family member (Form I-929).
Immigrant Visa Application Abroad (Yes/No)
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.
Yes	Checkbox	Check this box if you have ever applied for an immigrant visa to obtain permanent resident status at a U.S. Embassy or U.S. Consulate abroad.
Interpreter Certification and Signature
Language Interpreted	Text	Enter the language (other than English) in which you interpreted the application and instructions for the applicant. Max length: 18 characters
Interpreter Signature	Text	Provide the interpreter’s signature certifying that the interpretation was complete and accurate.
Interpreter Signature Date	Date	Enter the date the interpreter signed this certification.
Interpreter's Contact Information
Interpreter Daytime Telephone Number	Text	Enter the interpreter's daytime telephone number. Max length: 20 characters
Interpreter Mobile Telephone Number	Text	Enter the interpreter's mobile telephone number, if any. Max length: 20 characters
Interpreter Email Address	Text	Enter the interpreter's email address, if any.
Interpreter's Full Name
Interpreter Given Name	Text	Enter the interpreter’s given (first) name.
Interpreter Family Name	Text	Enter the interpreter’s family (last) name.
Interpreter Business or Organization Name	Text	Enter the name of the interpreter’s business or organization, if applicable. Max length: 34 characters
Is This Your Current Mailing Address (Yes/No)
Yes	Checkbox	Check this box if the U.S. physical address listed above is also your current mailing address.
No	Checkbox	Check this box if the U.S. physical address listed above is not your current mailing address and you will provide a different current mailing address.
Is Your Current Spouse Applying With You (Yes/No)
No	Checkbox	Check this box if your current spouse is not applying with you on this application. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Yes	Checkbox	Check this box if your current spouse is applying with you on this application. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Item 42a Espionage/Sabotage Law Violation Intent (Yes/No)
Yes	Checkbox	Check this box if you intend to engage in any activity that violates or evades any U.S. law relating to espionage (including spying) or sabotage.
No	Checkbox	Check this box if you do not intend to engage in any activity that violates or evades any U.S. law relating to espionage (including spying) or sabotage.
Item 42b Export Prohibition Violation Intent (Yes/No)
42b - No	Checkbox	Check this box if you do not 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.
42b - 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 42c Oppose/Control/Overthrow U.S. Government Intent (Yes/No)
No	Checkbox	Check this box if you do not intend to engage in any activity whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means while in the United States.
Yes	Checkbox	Check this box if you intend to engage in any activity whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means while in the United States.
Item 42d Other Unlawful Activity Intent (Yes/No)
Yes	Checkbox	Check this box if you intend to engage in any other unlawful activity (Item 42.d).
No	Checkbox	Check this box if you do not intend to engage in any other unlawful activity (Item 42.d).
Item 43a Weapons/Paramilitary Training Received (Yes/No)
No	Checkbox	Check this box if you have never received any weapons training, paramilitary training, or other military-type training.
Yes	Checkbox	Check this box if you have ever received any weapons training, paramilitary training, or other military-type training.
Item 43b Kidnapping/Assassination/Hijacking/Sabotage Committed (Yes/No)
Yes	Checkbox	Check this box if you have ever committed kidnapping, assassination, hijacking, or sabotage of a conveyance (including an aircraft, vessel, vehicle, or train).
No	Checkbox	Check this box if you have never committed kidnapping, assassination, hijacking, or sabotage of a conveyance (including an aircraft, vessel, vehicle, or train).
Item 43c Used Weapon/Explosive to Endanger or Damage Property (Yes/No)
Yes	Checkbox	Check this box if you have ever used a weapon, explosive, or dangerous device with the intent to endanger another person or people or to cause damage to property.
No	Checkbox	Check this box if you have never used a weapon, explosive, or dangerous device with the intent to endanger another person or people or to cause damage to property.
Item 43d Threatened/Attempted/Planned 43b-43c Activities (Yes/No)
Yes	Checkbox	Check this box if you have ever threatened, attempted, conspired, prepared, or planned to do any of the acts listed in Items 43.b–43.c.
No	Checkbox	Check this box if you have never threatened, attempted, conspired, prepared, or planned to do any of the acts listed in Items 43.b–43.c.
Item 43e Incited Violence Causing Death/Serious Harm (Yes/No)
43e. Yes	Checkbox	Check this box if you have ever incited, under circumstances indicating an intent to cause death or serious bodily harm/injury, any of the activities described in Items 43.b through 43.c.
43e. No	Checkbox	Check this box if you have never incited, under circumstances indicating an intent to cause death or serious bodily harm/injury, any of the activities described in Items 43.b through 43.c.
Item 43f Member of Group That Did 43b-43e Activities (Yes/No)
Yes	Checkbox	Check this box if you participated in, or were a member of, a group or organization that did any of the activities described in Item Numbers 43.b–43.e.
No	Checkbox	Check this box if you did not participate in and were not a member of any group or organization that did any of the activities described in Item Numbers 43.b–43.e.
Item 43g Recruited Members or Solicited Money/Value for Group Doing 43b-43e (Yes/No)
Yes	Checkbox	Check this box if you have recruited members or asked for money or things of value for a group or organization that did any of the activities described in Item Numbers 43.b–43.e.
No	Checkbox	Check this box if you have not recruited members or asked for money or things of value for a group or organization that did any of the activities described in Item Numbers 43.b–43.e.
Item 43h Provided Support/Assistance for 43b-43e Activities (Yes/No)
No	Checkbox	Check this box if you have not provided money, things of value, services or labor, or any other assistance or support for any of the activities described in Items 43b–43e.
Yes	Checkbox	Check this box if you have provided money, things of value, services or labor, or any other assistance or support for any of the activities described in Items 43b–43e.
Item 43i Provided Support to Individual/Group Who Did 43b-43e Activities (Yes/No)
No	Checkbox	Check this box if you have not provided money, a thing of value, services or labor, or any other assistance or support to an individual, group, or organization who did any of the activities described in Item Numbers 43.b–43.e.
Yes	Checkbox	Check this box if you have provided money, a thing of value, services or labor, or any other assistance or support to an individual, group, or organization who did any of the activities described in Item Numbers 43.b–43.e.
Item 44 Intent to Engage in Any 43b-43e Activities (Yes/No)
Yes	Checkbox	Check this box if you intend to engage in any of the activities listed in Item Numbers 43.b through 43.e.
No	Checkbox	Check this box if you do not intend to engage in any of the activities listed in Item Numbers 43.b through 43.e.
Item 45 Intent to Endanger U.S. Welfare/Safety/Security (Yes/No)
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.
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/Child of Person Who Did 43b-43i Activities (Yes/No)
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 through 43.i.
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 through 43.i.
Item 47 Sold/Provided/Transported Weapons or Assisted in Such (Yes/No)
Item 47 - No	Checkbox	Check this box if you have NEVER sold, provided, or transported weapons, and have not assisted anyone in selling, providing, or transporting weapons, that you knew or believed would be used against another person.
Item 47 - Yes	Checkbox	Check this box if you have EVER sold, provided, or transported weapons, or assisted anyone in selling, providing, or transporting weapons, which you knew or believed would be used against another person.
Item 48 Worked/Volunteered/Served in Prison/Jail/Detention Facility (Yes/No)
No	Checkbox	Check this box if you have NEVER worked, volunteered, or otherwise served in any prison/jail/detention facility (or similar place where people were detained) and have NEVER directed or participated in detaining people.
Yes	Checkbox	Check this box if you have EVER worked, volunteered, or otherwise served in any prison/jail/detention facility (or similar place where people were detained), or if you have EVER directed or participated in detaining people.
Item 49 Member/Assisted in Group Using Weapons Against Others (Yes/No)
Yes	Checkbox	Check this box if you have EVER been a member of, assisted, or participated in a group, unit, or organization in which you or others used any type of weapon against any person or threatened to do so.
No	Checkbox	Check this box if you have NEVER been a member of, assisted, or participated in a group, unit, or organization in which you or others used any type of weapon against any person or threatened to do so.
Item 50 Served/Member/Assisted in Military or Police Unit (Yes/No)
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.
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/Member/Assisted in Armed Group (Yes/No)
Yes	Checkbox	Check this box if you have ever served in, been a member of, assisted (helped), or participated in any armed group (e.g., paramilitary, self-defense, vigilante, rebel, or guerrilla group).
No	Checkbox	Check this box if you have never served in, been a member of, assisted (helped), or participated in any armed group.
Item 52 Member/Affiliated with Communist or Totalitarian Party (Yes/No)
No	Checkbox	Check this box if you have NEVER been a member of, or affiliated with, the Communist Party or any totalitarian party (in the United States or abroad).
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 53a Torture (Yes/No)
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).
No	Checkbox	Check this box if you have NEVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in torture (Item 53.a).
Item 53b Genocide (Yes/No)
Yes	Checkbox	Check this box if you have EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in genocide.
No	Checkbox	Check this box if you have NEVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in genocide.
Item 53c Killing or Trying to Kill (Yes/No)
Yes	Checkbox	Check this box if you have EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in killing or trying to kill any person.
No	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 53d Intentionally and Severely Injuring or Trying to Injure (Yes/No)
53.d No	Checkbox	Check this box if you have NEVER intentionally and severely injured or tried to injure any person.
53.d Yes	Checkbox	Check this box if you have EVER intentionally and severely injured or tried to injure any person.
Item 54 Recruited/Used Person Under 15 in Hostilities or Armed Group (Yes/No)
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 never attempted/worked with others to do so).
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/worked with others to do so).
Item 55 Used Person Under 15 in Hostilities/Combat Support (Yes/No)
Yes	Checkbox	Check this box if you have EVER used any person under 15 years of age to take part in hostilities/combat or combat-related support (for example, as a courier or to provide support services).
No	Checkbox	Check this box if you have NEVER used any person under 15 years of age to take part in hostilities/combat or combat-related support.
Item 67 Removal Proceeding Attendance (Yes/No)
No	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.
Yes	Checkbox	Check this box if you have 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 Fraudulent or Counterfeit Documentation (Yes/No)
Yes	Checkbox	Check this box if you have ever submitted altered, fraudulent, or counterfeit documentation to any U.S. Government official to obtain or try to obtain an immigration benefit (including a visa or entry into the United States).
No	Checkbox	Check this box if you have never submitted altered, fraudulent, or counterfeit documentation to any U.S. Government official to obtain or try to obtain an immigration benefit (including a visa or entry into the United States).
Item 69 Misrepresentation to Obtain Immigration Benefit (Yes/No)
No	Checkbox	Check this box if you have never lied about, concealed, or misrepresented information on an application or petition to obtain an immigration benefit.
Yes	Checkbox	Check this box if you have ever lied about, concealed, or misrepresented information on an application or petition to obtain an immigration benefit.
Item 70 False Claim of U.S. Citizenship (Yes/No)
Yes	Checkbox	Check this box if you have ever falsely claimed to be a U.S. citizen (in writing or in any other way).
No	Checkbox	Check this box if you have never falsely claimed to be a U.S. citizen (in writing or in any other way).
Item 71 Stowaway Arrival (Yes/No)
No	Checkbox	Check this box if you have never been a stowaway on a vessel or aircraft arriving in the United States.
Yes	Checkbox	Check this box if you have ever been a stowaway on a vessel or aircraft arriving in the United States.
Item 72 Alien Smuggling Assistance (Yes/No)
Yes	Checkbox	Check this box if you have ever knowingly encouraged, induced, assisted, abetted, or aided any alien to enter or try to enter the United States illegally (alien smuggling).
No	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 Civil Penalty for Fraudulent Documents (Yes/No)
No	Checkbox	Check this box if you are not under a final order of civil penalty for violating INA section 274C for use of fraudulent documents.
Yes	Checkbox	Check this box if you are under a final order of civil penalty for violating INA section 274C for use of fraudulent documents.
Item 76 Unlawfully Present Since April 1 1997
No	Checkbox	Check this box if you have not been unlawfully present in the United States at any time since April 1, 1997.
Yes	Checkbox	Check this box if you have been unlawfully present in the United States at any time since April 1, 1997.
Item 77 Severe Trafficking Reason for Unlawful Presence
Yes	Checkbox	Check this box if, after answering “Yes” to Item Number 76, a severe form of trafficking in persons was at least one central reason for your unlawful presence in the United States. Fill only if 'Yes' is 'Yes'. Depends on: Yes
No	Checkbox	Check this box if, after answering “Yes” to Item Number 76, a severe form of trafficking in persons was not a central reason for your unlawful presence in the United States. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Item 78a Reentry After More Than One Year Unlawful Presence
No	Checkbox	Check this box if you have not ever reentered or attempted to reenter the United States without being inspected and admitted or paroled after having been unlawfully present in the United States for more than one year in the aggregate on or after April 1, 1997.
Yes	Checkbox	Check this box if you have ever reentered or attempted to reenter the United States without being inspected and admitted or paroled after having been unlawfully present in the United States for more than one year in the aggregate on or after April 1, 1997.
Item 78b Reentry After Deportation Exclusion or Removal
Yes	Checkbox	Check this box if you have ever reentered or attempted to reenter the United States without being inspected and admitted or paroled after having been deported, excluded, or removed from the United States.
No	Checkbox	Check this box if you have not reentered or attempted to reenter the United States without being inspected and admitted or paroled after having been deported, excluded, or removed from the United States.
Item 79 Polygamy in the United States (Yes/No)
Yes	Checkbox	Check this box if 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 Alien Requiring Protection/Guardianship (Yes/No)
Item 80 - No	Checkbox	Check this box if you are not accompanying an inadmissible alien who has been certified as helpless and who requires your protection or guardianship (as described in INA section 232(c)).
Item 80 - Yes	Checkbox	Check this box if you are accompanying an inadmissible alien who has been certified as helpless and who requires your protection or guardianship (as described in INA section 232(c)).
Item 81 Assisted in Detaining/Withholding Custody of U.S. Citizen Child Outside U.S. (Yes/No)
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 the child.
No	Checkbox	Check this box if you have NOT 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 the child.
Item 82 Voted in Violation of Any Law (Yes/No)
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.
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 U.S. Taxes (Yes/No)
Yes	Checkbox	Check this box if you have ever renounced U.S. citizenship to avoid being taxed by the United States.
No	Checkbox	Check this box if you have never renounced U.S. citizenship to avoid being taxed by the United States.
Item 84a Applied for Exemption/Discharge from Military Training/Service Due to Alien Status (Yes/No)
No	Checkbox	Check this box if you have not applied for exemption or discharge from military training or service in the U.S. armed forces or the U.S. National Security Training Corps because you are an alien.
Yes	Checkbox	Check this box if you have applied for exemption or discharge from military training or service in the U.S. armed forces or the U.S. National Security Training Corps because you are an alien.
Item 84b Relieved/Discharged from Military Training/Service Due to Alien Status (Yes/No)
No	Checkbox	Check this box if you have not been relieved or discharged from U.S. military training or service because you are an alien.
Yes	Checkbox	Check this box if you have been relieved or discharged from U.S. military training or service because you are an alien.
Item 84c Convicted of Desertion from U.S. Armed Forces (Yes/No)
No	Checkbox	Check this box if you have not 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 or Remained Outside U.S. to Avoid/Evade Military Training/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.
Yes	Checkbox	Check this box if you have ever left or remained outside the United States to avoid or evade U.S. armed forces training or service in time of war or during a period declared a national emergency.
Item 86 Nationality/Immigration Status Before Leaving (If Yes to Item 85)
Nationality or Immigration Status Before Leaving	Text	Enter your nationality or immigration status immediately before you left the United States (if you answered Yes to Item 85). Fill only if 'Yes' is 'Yes'. Depends on: Yes
J-1 Exchange and Foreign Residence Requirement (Q19-Q21)
Q19: 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.
Q19: 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.
Q20: No	Checkbox	Check this box if you answered “Yes” to Q19 and you have not complied with the foreign residence requirement. Fill only if 'Q19: Yes' is 'Yes'. Depends on: Q19: Yes
Q20: Yes	Checkbox	Check this box if you answered “Yes” to Q19 and you have complied with the foreign residence requirement. Fill only if 'Q19: Yes' is 'Yes'. Depends on: Q19: Yes
Q21: Yes	Checkbox	Check this box if you answered “Yes” to Q19 and “No” to Q20 and you have been granted a waiver or the Department of State issued a favorable waiver recommendation letter for you. Fill only if 'Q19: Yes', 'Q20: No' is 'Yes' and is 'No' (all fields selection). Depends on: Q19: Yes, Q20: No
Q21: No	Checkbox	Check this box if you answered “Yes” to Q19 and “No” to Q20 and you have not been granted a waiver and the Department of State has not issued a favorable waiver recommendation letter for you. Fill only if 'Q19: Yes', 'Q20: No' is 'Yes' and is 'No' (all fields selection). Depends on: Q19: Yes, Q20: No
Last Arrival Admission/Parole Type (Select One)
Inspected and admitted at Port of Entry	Checkbox	Check this box if, on your last arrival, you were inspected at a U.S. Port of Entry and admitted in a nonimmigrant status (for example, visitor, student, exchange visitor, temporary worker).
Inspected and paroled at Port of Entry	Checkbox	Check this box if, on your last arrival, you were inspected at a U.S. Port of Entry and granted parole (for example, humanitarian parole or Cuban parole) rather than admitted.
Entered without admission or parole	Checkbox	Check this box if, on your last arrival, you entered the United States without being admitted or paroled.
Other Last Arrival Admission/Parole Type	Text	If none of the listed options apply, describe your last arrival admission or parole type. Fill only if 'Other (describe)' is 'Yes'. Max length: 20 characters Depends on: Other (describe)
Other (describe)	Checkbox	Check this box if none of the other options describe how you last arrived in the United States and you will provide an explanation in the space provided.
Admission Status at Last Arrival	Text	Enter the admission classification under which you were inspected and admitted at your last entry into the United States (for example, exchange visitor, visitor, temporary worker, or student). Fill only if 'Inspected and admitted at Port of Entry' is 'Yes'. Max length: 20 characters Depends on: Inspected and admitted at Port of Entry
Parole Type at Last Arrival	Text	Enter the type of parole under which you were inspected and paroled at your last entry into the United States (for example, humanitarian parole or Cuban parole). Fill only if 'Inspected and paroled at Port of Entry' is 'Yes'. Max length: 20 characters Depends on: Inspected and paroled at Port of Entry
Last Arrival First Time Physically Present in the U.S. (Yes/No)
Yes	Checkbox	Check this box if your most recent (last) arrival was the first time you were ever physically present in the United States.
No	Checkbox	Check this box if you had been physically present in the United States before your most recent (last) arrival.
Long-Term Institutionalization at Government Expense (Yes/No)
Yes	Checkbox	Check this box if you have ever 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
No	Checkbox	Check this box if you have never 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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Marriage to Prior Spouse Date
Date of Marriage to Prior Spouse	Date	Enter the date 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 more than '1'. Depends on: Number of Times Married
Most Recent Address Outside the United States
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
Most Recent Address Outside the United States (Address Details)
Street Number and Name	Text	Enter the street number and street name for your most recent address outside the United States. Max length: 34 characters
Apt.	Checkbox	Check this box if the address is for an apartment unit.
Ste.	Checkbox	Check this box if the address is for a suite.
Flr.	Checkbox	Check this box if the address includes a floor number.
Apartment/Suite/Floor Number	Text	Enter the apartment, suite, or floor number for this address, if any. Max length: 6 characters
City or Town	Text	Enter the city or town for your most recent address outside the United States. Max length: 28 characters
ZIP Code	Text	Enter the ZIP code for this address, if applicable. Max length: 5 characters
Province	Text	Enter the province for this address, if applicable. Max length: 20 characters
Postal Code	Text	Enter the postal code for this address, if applicable. Max length: 9 characters
Country	Text	Enter the country where this address is located.
Most Recent Address Outside the United States (Dates of Residence)
Residence Start Date	Date	Enter the date you began living at your most recent address outside the United States.
Residence End Date	Date	Enter the date you stopped living at your most recent address outside the United States.
Most Recent Employer Outside US - Address
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
Most Recent Employer/School Outside the U.S. - Address
Street Number and Name	Text	Enter the street number and street name for the most recent employer or school outside the United States. Max length: 34 characters
Apt.	Checkbox	Check this box if the address includes an apartment number.
Ste.	Checkbox	Check this box if the address includes a suite number.
Flr.	Checkbox	Check this box if the address includes a floor number.
Apartment/Suite/Floor Number	Text	Enter the apartment, suite, or floor number for the address, if applicable. Max length: 6 characters
City or Town	Text	Enter the city or town where the most recent employer or school outside the United States is located. Max length: 28 characters
ZIP Code	Text	Enter the ZIP code for the address, if applicable. Max length: 5 characters
Postal Code	Text	Enter the postal code for the address. Max length: 9 characters
Province	Text	Enter the province, region, or equivalent administrative area for the address. Max length: 20 characters
Country	Text	Enter the country where the most recent employer or school outside the United States is located.
Most Recent Employer/School Outside the U.S. - Basic Info
Occupation/Role (Outside U.S.)	Text	Enter your occupation or role for this most recent employer or school outside the United States (or state that you were unemployed or retired). Max length: 34 characters
Employer/School Name (Outside U.S.)	Text	Enter the name of your most recent employer, company, or school located outside the United States. Max length: 34 characters
Most Recent Employer/School Outside the U.S. - Dates and Financial Support
Employment/School Start Date (Outside U.S.)	Date	Enter the date you began working for this employer or attending this school outside the United States.
Employment/School End Date (Outside U.S.)	Date	Enter the date you stopped working for this employer or stopped attending this school outside the United States.
Source of Financial Support (If Unemployed/Retired)	Text	If you were unemployed or retired during this period, describe the source(s) of your financial support. Fill only if 'Occupation/Role (Outside U.S.)' indicates you are unemployed or retired. Max length: 34 characters Depends on: Occupation/Role (Outside U.S.)
Most Recent I-94 Information
I-94 Family Name (Last Name)	Text	Enter the family name (last name) exactly as it appears on your most recent Form I-94.
I-94 Given Name (First Name)	Text	Enter the given name (first name) exactly as it appears on your most recent Form I-94.
I-94 Authorized Stay Expiration Date	Date	Provide the expiration date of authorized stay shown on your most recent Form I-94, or enter "D/S" if listed as Duration of Status.
I-94 Immigration Status (Class of Admission/Parole)	Text	Enter the immigration status shown on your most recent Form I-94 (such as your class of admission, or parole status if paroled). Max length: 20 characters
I-94 Record Number	Text	Enter the Form I-94 Arrival/Departure Record Number from your most recent I-94. Max length: 11 characters
Number of Times Married
Number of Times Married	Text	Enter the total number of times you have been married, including your current marriage and any marriages abroad, annulled marriages, or remarriages to the same person. Max length: 5 characters
Organization 1 Details
Organization 1 Name	Text	Enter the full name of the organization you were involved with. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 City or Town	Text	Enter the city or town where the organization was located. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 State or Province	Text	Enter the state or province where the organization was located. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 Country	Text	Enter the country where the organization was located. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 Nature of Organization	Text	Describe the organization, including its purposes and activities, whether illicit or legitimate. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 Nature of Involvement	Text	Describe your involvement in the organization, including any roles or positions you held, whether illicit or legitimate. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 Involvement Start Date	Date	Enter the date your membership or involvement with the organization began. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 1 Involvement End Date	Date	Enter the date your membership or involvement with the organization ended. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization 2 Details
Organization 2 Name	Text	Enter the full name of the second organization you have been a member of, involved in, or otherwise associated with. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
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'. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Organization Membership Question (Q1)
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 in the United States or anywhere else in the world.
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 anywhere else in the world.
Other A-Numbers Used or Assigned
Yes	Checkbox	Check this box if you have ever used or been assigned any other Alien Registration Number (A-Number) besides your current one.
No	Checkbox	Check this box if you have never used or been assigned any other Alien Registration Number (A-Number).
Other A-Numbers Used or Assigned	Text	Enter any other Alien Registration Number(s) (A-Numbers) you have ever used or been assigned, if applicable. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Other Names Used Since Birth - First Entry
Other Name Used Since Birth - Family Name (Last Name)	Text	Enter the family name (last name) for an additional name you have used since birth.
Other Name Used Since Birth - Given Name (First Name)	Text	Enter the given name (first name) for an additional name you have used since birth.
Other Name Used Since Birth - Middle Name	Text	Enter the middle name for an additional name you have used since birth, if applicable.
Other Names Used Since Birth - Second Entry
Other Name (Second Entry) - Family Name (Last Name)	Text	Enter the family name (last name) for the second additional name you have used since birth.
Other Name (Second Entry) - Given Name (First Name)	Text	Enter the given name (first name) for the second additional name you have used since birth.
Other Name (Second Entry) - Middle Name	Text	Enter the middle name for the second additional name you have used since birth, if applicable.
Page 16 Footer Identifiers (Name and A-Number)
Applicant Full Name	Text	Enter the applicant’s full legal name as it should appear in the page footer identifier.
A-Number	Text	Enter the applicant’s USCIS Alien Registration Number (A-Number). Max length: 9 characters
Page 17 Footer Identifiers (Name and A-Number)
Applicant Full Name	Text	Enter the applicant’s full legal name as it should appear on this page footer.
A-Number	Text	Enter the applicant’s USCIS Alien Registration Number (A-Number). Max length: 9 characters
Page Footer - Applicant Name and A-Number
Applicant Name	Text	Enter the applicant’s full legal name as it should appear on the page footer.
A-Number	Text	Enter the applicant’s Alien Registration Number (A-Number) shown for this application. Max length: 9 characters
Page Footer Control Field
Page Footer Control Field	Text	Enter the control value required for the form’s page footer (typically provided by the form issuer for internal tracking).
Page Footer Tracking Field
Footer Tracking Code	Text	Enter the page footer tracking code value shown for this page of the form.
Page Identification (Name and A-Number)
Applicant Name	Text	Enter your full legal name as the applicant to identify this page as belonging to you.
A-Number	Text	Enter your USCIS Alien Registration Number (A-Number). Fill only if 'Do you have an Alien Registration Number (A-Number)?' is 'Yes'. Max length: 9 characters Depends on: Yes — I have an Alien Registration Number (A-Number)
Parent 1 Birth Details (Date and Country of Birth)
Parent 1 Date of Birth	Date	Enter Parent 1's date of birth.
Employer/School Address	Text	Enter the address of the employer, company, or school listed in this section.
Parent 1 Legal Name
Parent 1 Legal Last Name	Text	Enter Parent 1's legal family name (last name).
Parent 1 Legal First Name	Text	Enter Parent 1's legal given name (first name).
Parent 1 Legal Middle Name	Text	Enter Parent 1's legal middle name, if applicable.
Parent 1 Name at Birth
Parent 1 Birth Given Name (First Name)	Text	Enter Parent 1's given name (first name) as it appeared at birth, if different from the legal name listed above. Fill only if 'Parent 1 Legal First Name' is different than above. Depends on: Parent 1 Legal First Name
Parent 1 Birth Family Name (Last Name)	Text	Enter Parent 1's family name (last name) as it appeared at birth, if different from the legal name listed above. Fill only if 'Parent 1 Legal Last Name' is different than above. Depends on: Parent 1 Legal Last Name
Parent 1 Birth Middle Name	Text	Enter Parent 1's middle name as it appeared at birth, if any and if different from the legal name listed above. Fill only if 'Parent 1 Legal Middle Name' is different than above. Depends on: Parent 1 Legal Middle Name
Parent 2 Birth Details
Parent 2 Date of Birth	Date	Enter Parent 2's date of birth.
Parent 2 Country of Birth	Text	Enter the country where Parent 2 was born.
Parent 2 Legal Name
Parent 2 Last Name	Text	Enter Parent 2's family name (last name) as it appears on their legal documents.
Parent 2 First Name	Text	Enter Parent 2's given name (first name) as it appears on their legal documents.
Parent 2 Middle Name	Text	Enter Parent 2's middle name as it appears on their legal documents, if any.
Parent 2 Name at Birth
Parent 2 Birth Last Name	Text	Enter Parent 2’s family name (last name) as it appeared at birth, if different from the legal name listed above. Fill only if 'Parent 2 Last Name', 'Parent 2 First Name', 'Parent 2 Middle Name' is different (any). Depends on: Parent 2 Last Name, Parent 2 First Name, Parent 2 Middle Name
Parent 2 Birth First Name	Text	Enter Parent 2’s given name (first name) as it appeared at birth, if different from the legal name listed above. Fill only if 'Parent 2 Last Name', 'Parent 2 First Name', 'Parent 2 Middle Name' is different (any). Depends on: Parent 2 Last Name, Parent 2 First Name, Parent 2 Middle Name
Parent 2 Birth Middle Name	Text	Enter Parent 2’s middle name as it appeared at birth (if applicable), if different from the legal name listed above. Fill only if 'Parent 2 Last Name', 'Parent 2 First Name', 'Parent 2 Middle Name' is different (any). Depends on: Parent 2 Last Name, Parent 2 First Name, Parent 2 Middle Name
Part 13 Certification Details (Item/Page Ranges)
Change Note	Text	Enter a short note describing the changes or corrections made to the application at the interview.
Changed Item Number (From)	Text	Enter the first item number in the range of items that were changed on this application.
Changed Page Number (From)	Text	Enter the first page number in the range of additional pages you submitted with this application that contain changes or corrections.
Changed Page Number (To)	Text	Enter the last page number in the range of additional pages you submitted with this application that contain changes or corrections.
Changed Item Number (To)	Text	Enter the last item number in the range of items that were changed on this application.
Part 13 Interview Signatures and Officer Information
USCIS Officer Signature	Text	Enter the USCIS officer’s signature as signed at the interview. Max length: 1 characters
USCIS Officer Printed Name or Stamp	Text	Enter the USCIS officer’s printed name or stamp information taken at the interview. Max length: 38 characters
Applicant Signature	Text	Enter the applicant’s signature as signed at the interview. Max length: 1 characters
Date of Signature	Date	Enter the date the interview signatures were provided.
Part 3 Exemption Request Reason (Select One)
40 qualifying quarters of U.S. work (SSA credits)	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.
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. Fill only if 'Unmarried child under 21 years of age of a U.S. citizen.' is 'Yes'. Depends on: Unmarried child under 21 of a U.S. citizen
Widow/widower of a U.S. citizen (Form I-360 category)	Checkbox	Check this box if you are applying as the widow or widower of a U.S. citizen in the Form I-360 immigrant category. Fill only if 'Widow or widower of a U.S. citizen.' is 'Yes'. Depends on: Widow or widower of a U.S. citizen
VAWA self-petitioner	Checkbox	Check this box if you are applying as a VAWA self-petitioner. Fill only if 'VAWA self-petitioning spouse/child/parent of a U.S. citizen or lawful permanent resident.' 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 (U.S. citizen is 21 or older)
No exemption applies; not required to submit Affidavit of Support under INA 213A	Checkbox	Check this box if none of the listed exemptions apply and you are not required by statute to submit an Affidavit of Support under INA section 213A (and therefore do not need to request an exemption).
No exemption applies; required to submit Affidavit of Support under INA 213A	Checkbox	Check this box if none of the listed exemptions apply and you are not requesting an exemption because you are required to submit an Affidavit of Support under INA section 213A.
Place Marriage with Prior Spouse Legally Ended
City or Town (Prior Marriage Ended)	Text	Enter the city or town where your marriage to your prior spouse was legally ended. 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 more than '1'. Depends on: Number of Times Married
State or Province (Prior Marriage Ended)	Text	Enter the state or province where your marriage to your prior spouse was legally ended. 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 more than '1'. Depends on: Number of Times Married
Country (Prior Marriage Ended)	Text	Enter the country where your marriage to your prior spouse was legally ended. 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 more than '1'. Depends on: Number of Times Married
Place of Birth
City or Town of Birth	Text	Enter the city or town where you were born.
Country of Birth	Text	Enter the country where you were born.
Place of Marriage to Current Spouse
City or Town of Marriage	Text	Enter the city or town where you were married to your current spouse. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
State or Province of Marriage	Text	Enter the state or province where you were married to your current spouse. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Country of Marriage	Text	Enter the country where you were married to your current spouse. Fill only if 'What is your current marital status?' is 'Married' or 'Legally Separated'. Depends on: Married, Legally Separated
Place of Marriage to Prior Spouse
City or Town	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 more than '1'. Depends on: Number of Times Married
State or Province	Text	Enter the state or province 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 more than '1'. Depends on: Number of Times Married
Country	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 more than '1'. Depends on: Number of Times Married
Preparer's Certification and Signature
Preparer Signature	Text	Enter the signature of the person who prepared this application on behalf of the applicant.
Date of Signature	Date	Enter the date on which the preparer signed this application.
Preparer's Contact Information
Daytime Telephone Number	Text	Enter the preparer's daytime telephone number where they can be reached. Max length: 10 characters
Email Address	Text	Enter the preparer's email address, if they have one. Max length: 38 characters
Mobile Telephone Number	Text	Enter the preparer's mobile telephone number, if any. Max length: 10 characters
Preparer's Full Name
Preparer Business or Organization Name	Text	Enter the name of the preparer’s business or organization, if applicable. Max length: 34 characters
Preparer Last Name	Text	Enter the preparer's family name (last name).
Preparer First Name	Text	Enter the preparer's given name (first name).
Principal Applicant Identification
Principal Applicant Last Name	Text	Enter the principal applicant’s family name (last name). Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant First Name	Text	Enter the principal applicant’s given name (first name). Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant Middle Name	Text	Enter the principal applicant’s middle name, if applicable. Fill only if 'Derivative Applicant' is 'Yes'. Depends on: Derivative Applicant
Principal Applicant 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 A-Number	Text	Enter the principal applicant’s Alien Registration Number (A-Number), if any. Fill only if 'Derivative Applicant' is 'Yes'. Max length: 9 characters Depends on: Derivative Applicant
Prior Address
In Care Of Name	Text	Enter the name of the person or organization (if any) who received mail for you at this prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 34 characters Depends on: No
Street Number and Name	Text	Enter the street number and street name of your prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 34 characters Depends on: No
Apt.	Checkbox	Check this box if the prior address includes an apartment number. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Ste.	Checkbox	Check this box if the prior address includes a suite number. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Flr.	Checkbox	Check this box if the prior address includes a floor number. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Apartment/Suite/Floor Number	Text	Enter the apartment, suite, or floor number for your prior address, if applicable. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 6 characters Depends on: No
City or Town	Text	Enter the city or town of your prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 28 characters Depends on: No
ZIP Code	Text	Enter the ZIP code for your prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 5 characters Depends on: No
Province	Text	Enter the province for your prior address if it is outside the United States or if a province applies. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 20 characters Depends on: No
Postal Code	Text	Enter the postal code for your prior address if applicable. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Max length: 9 characters Depends on: No
Country	Text	Enter the country of your prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Prior Address (Last 5 years) - Domestic
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
Prior Address Dates of Residence
Prior Address Residence Start Date	Date	Enter the date you began living at this prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Prior Address Residence End Date	Date	Enter the date you stopped living at this prior address. Fill only if 'Have you resided at your current address for at least 5 years?' is 'No'. Depends on: No
Prior Spouse Birth Details
Prior Spouse Date of Birth	Date	Enter your 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 more than '1'. Depends on: Number of Times Married
Prior Spouse Country of Citizenship or Nationality	Text	Enter your prior spouse’s country of citizenship or nationality. 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 more than '1'. Depends on: Number of Times Married
Prior Spouse Country of Birth	Text	Enter the country where your prior spouse was born. 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 more than '1'. Depends on: Number of Times Married
Prior Spouse Legal Name
Prior Spouse Family Name (Last Name)	Text	Enter your prior spouse’s legal family name (last name), including any family name before marriage if applicable. 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 more than '1'. Depends on: Number of Times Married
Prior Spouse Given Name (First Name)	Text	Enter your prior spouse’s legal given name (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 more than '1'. Depends on: Number of Times Married
Prior Spouse Middle Name	Text	Enter your prior spouse’s legal middle name, if applicable. 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 more than '1'. Depends on: Number of Times Married
Public Charge Exemption Category (Select One)
Certain Afghan or Iraqi National (Form I-360 or Form DS-157)	Checkbox	Check this box if you are exempt from the public charge ground because you qualify as a certain Afghan or Iraqi national under this category.
Refugee (Form I-590 or Form I-730)	Checkbox	Check this box if you are exempt from the public charge ground because you are a refugee (or related refugee category) under this category.
Victim of Qualifying Criminal Activity (U Nonimmigrant) under INA 245(m)	Checkbox	Check this box if you are exempt from the public charge ground because you are adjusting status as a U nonimmigrant under INA 245(m).
Asylee (Form I-589 or Form I-730)	Checkbox	Check this box if you are exempt from the public charge ground because you are an asylee (or related asylee category) under this category.
Valid U Nonimmigrant Status (other than INA 245(m))	Checkbox	Check this box if you are exempt from the public charge ground because you are in valid U nonimmigrant status when you file (and remain in valid U status through adjudication) but are not adjusting under INA 245(m).
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 (Form I-360).
Special Immigrant Juvenile (Form I-360)	Checkbox	Check this box if you are exempt from the public charge ground because you are a Special Immigrant Juvenile (Form I-360).
Cuban Adjustment Act	Checkbox	Check this box if you are exempt from the public charge ground because you are applying under the Cuban Adjustment Act.
Dependent Status under HRIFA for Battered Spouses and Children	Checkbox	Check this box if you are exempt from the public charge ground because you have dependent status under HRIFA as a battered spouse or child.
Human Trafficking Victim (T Nonimmigrant) under INA 245(l) (Form I-914 or Form I-914A)	Checkbox	Check this box if you are exempt from the public charge ground because you are adjusting status as a T nonimmigrant under INA 245(l).
Cuban Adjustment Act for Battered Spouses and Children	Checkbox	Check this box if you are exempt from the public charge ground because you qualify under the Cuban Adjustment Act battered spouses and children provisions.
Dependent Status under the Haitian Refugee Immigrant Fairness Act	Checkbox	Check this box if you are exempt from the public charge ground because you have dependent status under HRIFA.
Pending/Valid T Nonimmigrant Status (other than INA 245(l))	Checkbox	Check this box if you are exempt from the public charge ground because you have a pending, prima facie eligible T application (Form I-914) or are in valid T status when filing (and remain eligible through adjudication), but are not adjusting under INA 245(l).
Continuous Residence Since Before January 1, 1972 (Registry)	Checkbox	Check this box if you are exempt from the public charge ground because you qualify for Registry based on continuous U.S. residence since before January 1, 1972.
Nicaraguans and Other Central Americans (NACARA section 203)	Checkbox	Check this box if you are exempt from the public charge ground because you are applying under NACARA section 203.
Amerasian Homecoming Act	Checkbox	Check this box if you are exempt from the public charge ground because you qualify under the Amerasian Homecoming Act.
Polish or Hungarian Parolee	Checkbox	Check this box if you are exempt from the public charge ground because you are a Polish or Hungarian parolee.
Cuban and Haitian Entrants (Adjustment under section 202 of the Immigration Reform and Control Act of 1986)	Checkbox	Check this box if you are exempt from the public charge ground because you are a Cuban or Haitian entrant applying for adjustment of status under IRCA section 202.
A Lautenberg Parolee	Checkbox	Check this box if you are exempt from the public charge ground because you are a Lautenberg parolee.
National of Vietnam, Cambodia, or Laos (applying under related programs)	Checkbox	Check this box if you are exempt from the public charge ground because you are a national of Vietnam, Cambodia, or Laos applying under the specified program category.
American Indian Born in Canada / Texas Band of Kickapoo Indians (INA 289 or Public Law 97-429)	Checkbox	Check this box if you are exempt from the public charge ground because you qualify under the American Indian born in Canada or Texas Band of Kickapoo Indians provisions.
NDAA FY2020 Section 7611 (Liberian Refugee Immigration Fairness)	Checkbox	Check this box if you are exempt from the public charge ground because you qualify under Section 7611 of the National Defense Authorization Act for Fiscal Year 2020 (LRIF).
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.
Q23 Crime of Any Kind (Yes/No)
No	Checkbox	Check this box if you have NEVER committed a crime of any kind.
Yes	Checkbox	Check this box if you have EVER committed a crime of any kind (even if you were not arrested, cited, charged, tried, or convicted).
Q24 Pled Guilty or Convicted (Yes/No)
Yes	Checkbox	Check this box if you have ever pled guilty to or been convicted of a crime or offense, even if it was later expunged or sealed or you received a pardon, amnesty, rehabilitation decree, or other clemency.
No	Checkbox	Check this box if you have never pled guilty to and have never been convicted of any crime or offense.
Q25 Ordered Punished or Conditions Imposed (Yes/No)
No	Checkbox	Check this box if you have never been ordered punished by a judge and have never had conditions imposed that restrained your liberty.
Yes	Checkbox	Check this box if you have ever been ordered punished by a judge or had conditions imposed that restrained your liberty (for example, prison or suspended sentence, house arrest, parole, probation, required treatment or classes, or community service).
Q26 Violated Controlled Substance Law (Yes/No)
No	Checkbox	Check this box if you have never violated (and never attempted or conspired to violate) any controlled substance law or regulation of a state, the United States, or a foreign country.
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.
Q27 Illicit Controlled Substance Trafficking Involvement (Yes/No)
No	Checkbox	Check this box if you have never trafficked in or benefited from, and have not knowingly aided, abetted, assisted, conspired, or colluded in the illegal trafficking of any controlled substances.
Yes	Checkbox	Check this box if you have ever trafficked in or benefited from, or knowingly aided, abetted, assisted, conspired, or colluded in the illegal trafficking of any controlled substances.
Q28-Q29 Family Benefit From Spouse/Parent Controlled Substance Trafficking + Knowledge (Yes/No)
Q28: No	Checkbox	Check this box if you are not the spouse, son, or daughter of such an alien, or you did not obtain any financial or other benefit from that activity within the last 5 years.
Q28: Yes	Checkbox	Check this box if you are the spouse, son, or daughter of an alien who illicitly trafficked or aided in controlled-substance trafficking and you obtained, within the last 5 years, any financial or other benefit from that activity.
Q29: No	Checkbox	Check this box if your answer to Q28 is "Yes" but you did not know and should not reasonably have known that the benefit you obtained resulted from your spouse’s or parent’s controlled-substance trafficking activity. Fill only if 'Q28: Yes' is 'Yes'. Depends on: Q28: Yes
Q29: Yes	Checkbox	Check this box if your answer to Q28 is "Yes" and you knew or reasonably should have known that the benefit you obtained resulted from your spouse’s or parent’s controlled-substance trafficking activity. Fill only if 'Q28: Yes' is 'Yes'. Depends on: Q28: Yes
Q30 Prostitution (Yes/No)
No	Checkbox	Check this box if you have never engaged in prostitution and you are not coming to the United States to engage in prostitution.
Yes	Checkbox	Check this box if you have ever engaged in prostitution or you are coming to the United States to engage in prostitution.
Q31 Procured/Imported Prostitutes (Yes/No)
Yes	Checkbox	Check this box if you have ever directly or indirectly procured or attempted to procure, or imported prostitutes or persons for the purpose of prostitution.
No	Checkbox	Check this box if you have never directly or indirectly procured or attempted to procure, and have not imported prostitutes or persons for the purpose of prostitution.
Q32 Received Proceeds/Money From Prostitution (Yes/No)
Yes	Checkbox	Check this box if you have ever received any proceeds or money from prostitution.
No	Checkbox	Check this box if you have never received any proceeds or money from prostitution.
Q33 Intend to Engage in Illegal Gambling or Commercialized Vice (Yes/No)
Yes	Checkbox	Check this box if you intend to engage in illegal gambling or any other form of commercialized vice while in the United States.
No	Checkbox	Check this box if you do not intend to engage in illegal gambling or any other form of commercialized vice while in the United States.
Q34 Exercised Immunity to Avoid Prosecution (Yes/No)
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.
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.
Q35a-Q35b Foreign Government Official + Religious Freedom Violations (Yes/No)
Q35a - Yes (Served as a foreign government official)	Checkbox	Check this box if you have ever served as a foreign government official.
Q35a - No (Served as a foreign government official)	Checkbox	Check this box if you have never served as a foreign government official.
Q35b - No (Responsible for violations of religious freedoms)	Checkbox	Check this box if you answered “Yes” to Q35a and you have not been responsible for, enforced, or directly carried out violations of religious freedoms. Fill only if 'Q35a - Yes (Served as a foreign government official)' is 'Yes'. Depends on: Q35a - Yes (Served as a foreign government official)
Q35b - Yes (Responsible for violations of religious freedoms)	Checkbox	Check this box if you answered “Yes” to Q35a and you have ever been responsible for, enforced, or directly carried out violations of religious freedoms. Fill only if 'Q35a - Yes (Served as a foreign government official)' is 'Yes'. Depends on: Q35a - Yes (Served as a foreign government official)
Q36 Sex Trafficking (Yes/No)
No	Checkbox	Check this box if you have never induced by force, fraud, or coercion (or otherwise been involved in) the trafficking of another person for commercial sex acts (sex trafficking).
Yes	Checkbox	Check this box if you have ever induced by force, fraud, or coercion (or otherwise been involved in) the trafficking of another person for commercial sex acts (sex trafficking).
Q37 Trafficked Person Into Involuntary Servitude/Slavery (Yes/No)
No	Checkbox	Check this box if you have never trafficked a person into involuntary servitude, peonage, debt bondage, or slavery.
Yes	Checkbox	Check this box if you have ever trafficked a person into involuntary servitude, peonage, debt bondage, or slavery.
Q38 Aided/Abetted Trafficking in Persons (Yes/No)
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.
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.
Q39-Q40 Family Benefit From Spouse/Parent Trafficking in Persons + Knowledge (Yes/No)
No (Item 39)	Checkbox	Check this box if you are NOT the spouse, son, or daughter of an alien who engaged in trafficking in persons and you have NOT received or obtained (within the last 5 years) any financial or other benefit from that activity.
Yes (Item 39)	Checkbox	Check this box if you are the spouse, son, or daughter of an alien who engaged in trafficking in persons and you have received or obtained (within the last 5 years) any financial or other benefit from that activity.
No (Item 40)	Checkbox	Check this box if (after answering "Yes" to Item 39) you did NOT know and should NOT reasonably have known that the benefit you received resulted from your spouse’s or parent’s trafficking activity. Fill only if 'Yes (Item 39)' is 'Yes'. Depends on: Yes (Item 39)
Yes (Item 40)	Checkbox	Check this box if (after answering "Yes" to Item 39) you knew or reasonably should have known that the benefit you received resulted from your spouse’s or parent’s trafficking activity. Fill only if 'Yes (Item 39)' is 'Yes'. Depends on: Yes (Item 39)
Q41 Money Laundering (Yes/No)
Yes	Checkbox	Check this box if you have ever engaged in money laundering, knowingly helped others with money laundering, or seek to enter the United States to engage in money laundering.
No	Checkbox	Check this box if you have never engaged in money laundering, never knowingly helped others with money laundering, and do not seek to enter the United States to engage in money laundering.
Question 10 - Recent Immigration History (passport, visa, arrival)
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 5 - Other A-Numbers (Yes/No and entries)
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 74 - Excluded/Deported/Removed From the United States (Yes/No)
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 after being ordered excluded, deported, or removed.
Yes	Checkbox	Check this box if you have ever been excluded, deported, or removed from the United States, or if you departed the United States on your own after being ordered excluded, deported, or removed.
Question 75 - Entered the United States Without Inspection/Admission/Parole (Yes/No)
Yes	Checkbox	Check this box if you have ever entered the United States without being inspected and admitted or paroled.
No	Checkbox	Check this box if you have never entered the United States without being inspected and admitted or paroled.
Race (Select All That Apply)
Asian	Checkbox	Check this box if you identify your race as Asian.
White	Checkbox	Check this box if you identify your race as White.
Black or African American	Checkbox	Check this box if you identify your race as Black or African American.
American Indian or Alaska Native	Checkbox	Check this box if you identify your race as American Indian or Alaska Native.
Native Hawaiian or Other Pacific Islander	Checkbox	Check this box if you identify your race as Native Hawaiian or Other Pacific Islander.
Received SSI/TANF/Other Cash Benefit (Yes/No)
Yes	Checkbox	Check this box if you have ever received SSI, TANF, or any other state/Tribal/territorial/local cash benefit for income maintenance (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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
No	Checkbox	Check this box if you have never received SSI, TANF, or any other state/Tribal/territorial/local cash benefit for income maintenance (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 selected. Depends on: I do not fall under any of the exempt categories listed above and will complete Item Numbers 57. - 66.
Recent Immigration History - Passport/Travel Document and Visa Details
Passport or Travel Document Number (Last Arrival)	Text	Enter the passport or travel document number you used to enter the United States on your most recent arrival.
Passport/Travel Document Expiration Date	Date	Provide the expiration date of the passport or travel document you used for your most recent entry to the United States.
Passport/Travel Document Issuing Country	Text	Enter the country that issued the passport or travel document you used for your most recent entry to the United States.
Nonimmigrant Visa Number (Most Recent Arrival)	Text	Enter the nonimmigrant visa number used for your most recent arrival to the United States, if you had one.
Nonimmigrant Visa Issue Date	Date	Provide the date the nonimmigrant visa was issued, if applicable.
Recent Immigration History - Place and Date of Last Arrival
City or Town of Last Arrival	Text	Enter the city or town where you last arrived in the United States. Max length: 20 characters
Date of Last Arrival	Date	Enter the date you last arrived in the United States.
Relative Citizenship/Status
U.S. Citizen	Checkbox	Check this box if the relative referenced above is a U.S. citizen. Fill only if 'Yes' is 'Yes'. Depends on: Yes
U.S. National	Checkbox	Check this box if the relative referenced above is a U.S. national (but not a U.S. citizen). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Lawful Permanent Resident	Checkbox	Check this box if the relative referenced above is a lawful permanent resident (green card holder). Fill only if 'Yes' is 'Yes'. Depends on: Yes
None of These	Checkbox	Check this box if the relative referenced above is not a U.S. citizen, not a U.S. national, and not a lawful permanent resident. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Relative Filed Associated Form I-140 Question
N/A (I am adjusting on the basis of a Form I-140 self-petition)	Checkbox	Check this box if the question about a relative filing the associated Form I-140 (or having a significant ownership interest) does not apply because you are adjusting based on your own Form I-140 self-petition.
No	Checkbox	Check this box if no relative filed the associated Form I-140 for you (or the principal applicant) and no relative has a 5% or greater ownership interest in the business that filed the Form I-140.
Yes	Checkbox	Check this box if a relative filed the associated Form I-140 for you (or the principal applicant) or a relative has a 5% or greater ownership interest in the business that filed the Form I-140.
Relative Type (If I-140 Answer Was Yes)
Father	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your father. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Mother	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your mother. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Child	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your child. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Adult Son	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your adult son. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Adult Daughter	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your adult daughter. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Brother	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your brother. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Sister	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is your sister. Fill only if 'Yes' is 'Yes'. Depends on: Yes
None of These	Checkbox	Check this box if the relative who filed the associated Form I-140 for you is not any of the listed relationship types. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Resided at Current Address at Least 5 Years (Yes/No)
Yes	Checkbox	Check this box if you have lived at your current address for at least 5 years.
No	Checkbox	Check this box if you have not lived at your current address for at least 5 years.
Second Child Information
Second Child Last Name	Text	Enter the second child's family name (last name) as it appears on their current legal name. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Child First Name	Text	Enter the second child's given name (first name) as it appears on their current legal name. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Child Middle Name	Text	Enter the second child's middle name as it appears on their current legal name, if any. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Child A-Number	Text	Enter the second child's Alien Registration Number (A-Number), if they have one. Fill only if 'Total Number of Living Children' is '2 or more'. Max length: 9 characters Depends on: Total Number of Living Children
Second Child Date of Birth	Date	Enter the second child's date of birth. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Child Country of Birth	Text	Enter the country where the second child was born. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Child Relationship to You	Text	Describe the second child's relationship to you (for example, biological child, stepchild, or legally adopted child). Fill only if 'Total Number of Living Children' is '2 or more'. Max length: 34 characters Depends on: Total Number of Living Children
Second Child Separate Form I-485 (Yes/No)
No	Checkbox	Check this box if Child 2 is not applying now on a separate Form I-485. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Yes	Checkbox	Check this box if Child 2 is also applying now on a separate Form I-485. Fill only if 'Total Number of Living Children' is '2 or more'. Depends on: Total Number of Living Children
Second Institutionalization Details Row
Second Institution Name/City/State	Text	Enter the name of the second institution and its city and state where you were institutionalized. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Institutionalization Reason	Text	Describe the reason you were institutionalized for the second period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Institutionalization Date From	Date	Enter the start date of the second period of institutionalization. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Institutionalization Date To	Date	Enter the end date of the second period of institutionalization. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - Yes (Row 2)	Checkbox	Check this box if, for the second listed period of institutionalization in Item 66, you were in an immigration category exempt from the public charge ground of inadmissibility during that period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - No (Row 2)	Checkbox	Check this box if, for the second listed period of institutionalization in Item 66, you were not in an immigration category exempt from the public charge ground of inadmissibility during that period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Second Public Benefits Received Row
Benefit Received (Row 2)	Text	Enter the name of the public benefit you received for this second listed period of receipt. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit Dollar Amount (Row 2)	Number	Enter the dollar amount of benefits received for this second listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit Start Date (Row 2)	Date	Enter the date when you first began receiving this benefit for the second listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Benefit End Date (Row 2)	Date	Enter the date when you stopped receiving this benefit for the second listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Exempt from public charge category (Yes) — Row 2	Checkbox	Check this box if, for the second listed benefit receipt period, you received the benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Exempt from public charge category (No) — Row 2	Checkbox	Check this box if, for the second listed benefit receipt period, you did not receive the benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Sex
Female	Checkbox	Check this box if your sex is female.
Male	Checkbox	Check this box if your sex is male.
Social Security Card Information
SSA has issued you a Social Security card — No	Checkbox	Check this box if the SSA has never officially issued you a Social Security card.
SSA has issued you a Social Security card — Yes	Checkbox	Check this box if the Social Security Administration (SSA) has ever officially issued you a Social Security card.
U.S. Social Security Number (SSN)	Text	Enter your U.S. Social Security Number as issued by the Social Security Administration. Fill only if 'SSA has issued you a Social Security card — Yes' is 'Yes'. Max length: 9 characters Depends on: SSA has issued you a Social Security card — Yes
Want SSA to issue you a Social Security card — Yes	Checkbox	Check this box if you want the SSA to issue you a Social Security card.
Want 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 to SSA — Yes	Checkbox	Check this box if you authorize disclosure of information from this application to the SSA for assigning an SSN and issuing a Social Security card. Fill only if 'Want SSA to issue you a Social Security card — Yes' is 'Yes'. Depends on: Want SSA to issue you a Social Security card — Yes
Consent for Disclosure to SSA — No	Checkbox	Check this box if you do not authorize disclosure of information from this application to the SSA.
Special Immigrant (3.c) Category Selection
Certain Afghan or Iraqi National (Form I-360 or DS-157)	Checkbox	Check this box if you qualify as a certain Afghan or Iraqi national under the special immigrant program (Form I-360 or DS-157, as applicable).
Special Immigrant Juvenile (Form I-360)	Checkbox	Check this box if you are applying as a Special Immigrant Juvenile based on an approved or pending Form I-360.
Certain G-4 International Organization/NATO-6 Employee or Family Member (Form I-360)	Checkbox	Check this box if you are a qualifying G-4 international organization employee or family member, or a NATO-6 employee or family member, applying based on Form I-360.
Certain International Broadcaster (Form I-360)	Checkbox	Check this box if you are applying as a certain international broadcaster based on an approved or pending Form I-360.
Panama Canal Zone Employee (Form I-360)	Checkbox	Check this box if you are applying as a qualifying Panama Canal Zone employee based on an approved or pending Form I-360.
Certain U.S. Armed Forces Member (Six and Six program) (Form I-360)	Checkbox	Check this box if you qualify as a certain U.S. Armed Forces member under the Six and Six program and are applying based on Form I-360.
Certain Physician (Form I-360)	Checkbox	Check this box if you qualify as a certain physician special immigrant and are applying based on Form I-360.
Certain Employee or Former Employee of the U.S. Government Abroad (DS-1884)	Checkbox	Check this box if you are a qualifying current or former U.S. Government employee abroad applying under this category using DS-1884.
Religious Worker – Other Religious Worker	Checkbox	Check this box if you are applying as a special immigrant religious worker and your specific category is Other Religious Worker (not a minister).
Religious Worker – Minister of Religion	Checkbox	Check this box if you are applying as a special immigrant religious worker and your specific category is Minister of Religion.
Special Programs Based on Certain Public Laws (3.f) Selection
The Cuban Adjustment Act	Checkbox	Check this box if you are applying for adjustment of status under the Cuban Adjustment Act.
Victim of battery or extreme cruelty under the Cuban Adjustment Act (spouse or child)	Checkbox	Check this box if you are a spouse or child who is applying under the Cuban Adjustment Act as a victim of battery or extreme cruelty.
Dependent status under the Haitian Refugee Immigrant Fairness Act (HRIFA)	Checkbox	Check this box if you are applying to adjust status based on dependent status under the Haitian Refugee Immigrant Fairness Act.
Victim of battery or extreme cruelty under HRIFA (spouse or child applying as dependent)	Checkbox	Check this box if you are a spouse or child applying under HRIFA based on dependent status and you are a victim of battery or extreme cruelty.
Lautenberg Parolees	Checkbox	Check this box if you are applying for adjustment of status as a Lautenberg parolee.
Diplomats or high-ranking officials unable to return home (Sept. 11, 1957 Act, Section 13)	Checkbox	Check this box if you are applying under Section 13 as a diplomat or high-ranking official who is unable to return home.
Nationals of Vietnam, Cambodia, and Laos (Public Law 106-429, Section 586)	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.
Amerasian Act (Oct. 22, 1982), Form I-360	Checkbox	Check this box if you are applying for adjustment of status under the Amerasian Act based on Form I-360.
Spouse Current Member of U.S. Armed Forces or Coast Guard
No	Checkbox	Check this box if you are married and your spouse is not currently a member of the U.S. armed forces or the U.S. Coast Guard. Fill only if 'Married' equals 'Married'. Depends on: Married
Yes	Checkbox	Check this box if you are married and your spouse is currently a member of the U.S. armed forces or the U.S. Coast Guard. Fill only if 'Married' equals 'Married'. Depends on: Married
N/A	Checkbox	Check this box if you are not married, so the question about your spouse being a current member of the U.S. armed forces or U.S. Coast Guard does not apply. Fill only if 'Married' equals 'Married'. Depends on: Married
Third Institutionalization Details Row
Institution name, city, and state (3rd entry)	Text	Enter the name of the institution and its city and state for the third period of institutionalization. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Reason for institutionalization (3rd entry)	Text	Describe the reason you were institutionalized during the third period listed. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization start date (3rd entry)	Date	Enter the date the third period of institutionalization began. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Institutionalization end date (3rd entry)	Date	Enter the date the third period of institutionalization ended. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Yes	Checkbox	Check this box if, for the third listed period of institutionalization, you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
No	Checkbox	Check this box if, for the third listed period of institutionalization, you were not in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Third Public Benefits Received Row
Benefit Received (Row 3)	Text	Enter the name of the specific public benefit you received for the third listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Dollar Amount (Row 3)	Number	Enter the total dollar amount of benefits you received for the third listed period. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Start Date (Row 3)	Date	Enter the date the third listed period of receiving this benefit began. Fill only if 'Yes' is 'Yes'. Depends on: Yes
End Date (Row 3)	Date	Enter the date the third listed period of receiving this benefit ended. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - Yes (Row 3)	Checkbox	Check this box for the third listed benefit period if you received the benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
In a Category Exempt from Public Charge - No (Row 3)	Checkbox	Check this box for the third listed benefit period if you did not receive the benefit while you were in an immigration category exempt from the public charge ground of inadmissibility. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Total Number of Living Children
Total Number of Living Children	Text	Enter the total number of all your living children worldwide, including biological, legally adopted, and current stepchildren of any age. Max length: 5 characters
U.S. Embassy/Consulate Location and Decision Details
Date of Decision	Date	Enter the date the decision was made on your immigrant visa application. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Embassy/Consulate City or Town	Text	Enter the city or town where the U.S. Embassy or U.S. Consulate was located when you applied for an immigrant visa. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Embassy/Consulate Country	Text	Enter the country where the U.S. Embassy or U.S. Consulate was located when you applied for an immigrant visa. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Visa Application Decision	Text	Enter the decision outcome for your immigrant visa application (for example, approved, refused, denied, or withdrawn). Fill only if 'Yes' is 'Yes'. Depends on: Yes
Underlying Petition Details
Underlying Petition Receipt Number	Text	Enter the receipt number of the underlying petition, if any.
Underlying Petition Priority Date	Date	Enter the priority date from the underlying petition, if any.
Unlabeled Field (Page Footer/Tracking)
Page Footer Tracking Value	Number	Enter the tracking or reference text shown in the page footer for this form page.
Unlabeled Footer Field
Applicant Name (Footer)	Text	Enter the applicant’s full name as it should appear in the form footer to identify this page.
Footer Internal Use Field	Text	Leave this field blank because it is reserved for internal processing by the form issuer.
USCIS Online Account Number
USCIS Online Account Number	Text	Enter your USCIS Online Account Number, if you have been assigned one. Max length: 12 characters
USCIS Online Account Number	Text	Enter your USCIS Online Account Number associated with your USCIS online account, if you have one.
USCIS Use Only Field
USCIS Use Only Notes/Entry	Text	Provide any USCIS internal-use information or notes to be entered in this field.
Weight (Pounds)
Weight (pounds)	Number	Enter your current weight in pounds. Max length: 3 characters

Form I-485, Application to Register Permanent Residence or Adjust Status (01/20/25) Instructions