Form I-485, Application to Register Permanent Residence or Adjust Status Instructions
This form contains 114 fields organized into 41 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Child Support Orders | ||
| Child Support Order Amount | Number |
Enter the amount of the additional child support order you are paying. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Child Support Recipient | Text |
Enter the name of the person or entity to whom the additional child support order is paid. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you are currently paying additional child support orders.
|
| No | Checkbox |
Check this box if you are not currently paying additional child support orders.
|
| Affiant Information | ||
| Affiant Residence Street Address | Text |
Please provide the street address of the affiant's residence.
|
| Affiant Name | Text |
Please provide the full legal name of the person making this financial disclosure affirmation.
|
| Affiant Residence City, State, Zip | Text |
Please provide the city, state, and zip code of the affiant's residence.
|
| Affirmation Date | ||
| Affirmation Month | Date |
Enter the month of the affirmation date.
|
| Affirmation Year | Date |
Enter the year of the affirmation date.
|
| choicebutton_2_40_92062102 | CheckBox | |
| Automobile Details | ||
| Automobile Year | Text |
Enter the manufacturing year of the automobile.
|
| Automobile Model | Text |
Enter the model of the automobile.
|
| Automobile Value | Number |
Enter the current monetary value of the automobile.
|
| Automobile Make | Text |
Enter the make (manufacturer) of the automobile.
|
| Case Information | ||
| Docket Number | Text |
Provide the docket number for this court case.
|
| File Number | Text |
Provide the file number associated with this legal document.
|
| Court Date, Time, and Part | Text |
Enter the court date, time, and specific part of the court where the proceeding will take place.
|
| Checking Account | ||
| Bank Name | Text |
Enter the name of the bank where the checking account is held.
|
| Balance | Number |
Enter the current balance of the checking account.
|
| Child Care Expense | ||
| Child Care Monthly Expense | Number |
Enter the total monthly cost for child care. Fill only if 'Child Care' section is filled
Depends on:
Child Care Provider, Average Weekly Child Care Hours, Child Care Cost Per Unit
|
| Child Care Information | ||
| Average Weekly Child Care Hours | Number |
Please enter the average number of hours per week you require child care. Fill only if 'Are you paying additional child support orders?' is 'Yes'.
Depends on:
Yes
|
| Child Care Provider | Text |
Please provide the name of your child care provider. Fill only if 'Are you paying additional child support orders?' is 'Yes'.
Depends on:
Yes
|
| Child Care Cost Per Unit | Number |
Please enter the cost of child care per unit. Fill only if 'Are you paying additional child support orders?' is 'Yes'.
Depends on:
Yes
|
| choicebutton_1_37_2d5a2124 | CheckBox | |
| Child's Health Insurance Payer | ||
| Other Payer Name | Text |
Please specify the name of the health insurance payer or program if it is not one of the provided options for the child's health insurance. Fill only if 'choicebutton_1_23_d7fe7138' is 'Yes'.
Depends on:
choicebutton_1_23_d7fe7138
|
| choicebutton_1_23_d7fe7138 | CheckBox | |
| choicebutton_1_24_94e5635b | CheckBox | |
| choicebutton_1_29_6cdc44cd | CheckBox | |
| choicebutton_1_30_2bed4a73 | CheckBox | |
| choicebutton_1_35_76f55ef0 | CheckBox | |
| Clothing Expense | ||
| Clothing Expense | Number |
Provide the total monthly amount spent on clothing.
|
| Contributions | ||
| Contributions Amount | Number |
Enter the monthly amount for contributions.
|
| Employment Information | ||
| Employer Name | Text |
Provide the full legal name of your current employer.
|
| Weekly Hours Worked | Text |
Enter the total number of hours you work per week.
|
| Employer Address | Text |
Provide the full street address of your current employer.
|
| Yes | Checkbox |
Check this box if you are self-employed.
|
| No | Checkbox |
Check this box if you are not self-employed.
|
| Family Health Insurance Cost | ||
| Family Plan Cost Period | Text |
Enter the period for which the cost of the family health insurance plan is provided, such as 'month' or 'year'. Fill only if 'Through My Job', 'Medicare', 'Privately Purchased', 'Medicaid' is 'Yes', for any.
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| choicebutton_1_39_c7807d9a | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| First Loan or Debt | ||
| Current Balance | Number |
Enter the current outstanding balance for the first loan or debt. Fill only if 'Mortgage' has a value
Depends on:
Property Mortgage
|
| For | Text |
Describe the purpose or nature of the first loan or debt. Fill only if 'Mortgage' has a value
Depends on:
Property Mortgage
|
| Owed To | Text |
Provide the name of the entity or individual to whom the first loan or debt is owed. Fill only if 'Mortgage' has a value
Depends on:
Property Mortgage
|
| Payment Amount | Number |
Enter the regular payment amount for the first loan or debt. Fill only if 'Mortgage' has a value
Depends on:
Property Mortgage
|
| Monthly | Checkbox |
Check this box if the payment for the first loan or debt is made on a monthly basis.
|
| Weekly | Checkbox |
Check this box if the payment for the first loan or debt is made on a weekly basis.
|
| First Other Asset | ||
| Other Asset Details | Text |
Please provide specific details about the first other asset being reported, such as its type (e.g., real estate, car, boat, stocks, bonds).
|
| Other Asset Value | Number |
Please provide the monetary value of the first other asset being reported.
|
| First Other Income | ||
| First Other Income Amount | Number |
Enter the amount of the first other income.
|
| First Other Income Source | Text |
Enter the source of the first other income.
|
| choicebutton_0_32_eb831248 | CheckBox | |
| Food Expense | ||
| Monthly Food Expense | Number |
Enter the total monthly amount spent on food.
|
| Health Insurance Coverage | ||
| Employment Health Insurance Information | Text |
Provide details regarding your health insurance coverage, particularly if it is available through your employment.
|
| Health Insurance Expense | ||
| Health Insurance Expense | Number |
Please provide the monthly expense for health insurance. Fill only if an insurance plan is selected
Depends on:
Through My Job, Medicare, Privately Purchased, Medicaid
|
| Household Information | ||
| Other Household Income Amount | Number |
Please provide the total income amount received from other members of the household.
|
| Other Household Income Frequency | Text |
Please specify the frequency (e.g., week, month, year) at which income from other household members is received.
|
| Number of Other Household Members | Text |
Please enter the number of other individuals in your household, excluding yourself.
|
| Income | ||
| Gross Income Period | Text |
Specify the period for which the gross income is reported (e.g., week, month, year).
|
| Gross Income | Number |
Enter your total gross income from all jobs before any deductions.
|
| Take-Home Income | Number |
Enter your total take-home income from all jobs after all deductions.
|
| Take-Home Income Period | Text |
Specify the period for which the take-home income is reported (e.g., week, month, year).
|
| Individual Health Insurance Cost | ||
| Individual Plan Cost | Number |
Please provide the cost of your health insurance for an individual plan. Fill only if 'Through My Job', 'Medicare', 'Privately Purchased', 'Medicaid' is 'Yes', for any.
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| choicebutton_1_38_b78c166f | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| Insurance Coverage Details | ||
| choicebutton_1_25_bfca82e4 | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| choicebutton_1_26_bcea238f | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| choicebutton_1_27_feb60679 | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| choicebutton_1_28_f04aadd9 | CheckBox |
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| Insurance Coverage Type | ||
| No Health Insurance Coverage | Checkbox |
Check this box if you do not have any health insurance coverage.
|
| Through My Job | Checkbox |
Check this box if your health insurance coverage is provided through your job.
|
| Medicare | Checkbox |
Check this box if your health insurance coverage is through Medicare.
|
| Privately Purchased | Checkbox |
Check this box if you privately purchased your health insurance coverage.
|
| Medicaid | Checkbox |
Check this box if your health insurance coverage is through Medicaid.
|
| Insurance Plan Information | ||
| Insurance Plan Name | Text |
Enter the name of your health insurance plan. Fill only if 'Through My Job', 'Medicare', 'Privately Purchased', 'Medicaid' is 'Yes', for any.
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| Policy Number | Text |
Provide your health insurance policy number. Fill only if 'Through My Job', 'Medicare', 'Privately Purchased', 'Medicaid' is 'Yes', for any.
Depends on:
Through My Job, Privately Purchased, Medicaid, Medicare
|
| Medical/Dental/Prescription Expense | ||
| Medical/Dental/Prescription Expense | Number |
Enter the monthly expense for medical, dental, and prescription costs.
|
| Other Expenses | ||
| Other Expense Description | Text |
Provide a detailed description of this other monthly expense. Fill only if 'Other Expense Amount' has a value.
Depends on:
Other Expense Amount
|
| Other Expense Amount | Number |
Enter the monthly amount for this other expense.
|
| Other Insurance Expenses | ||
| Home/Fire Insurance | Number |
Please enter the monthly expense for home or fire insurance. Fill only if 'House/Apt Owned' section is filled
Depends on:
Property Address, Property Market Value, Property Mortgage
|
| Auto Insurance | Number |
Please enter the monthly expense for auto insurance. Fill only if 'Automobile' section is filled
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value
|
| Other Insurance Amount | Number |
Please enter the monthly expense for the specified other insurance type.
|
| Life Insurance | Number |
Please enter the monthly expense for life insurance.
|
| Other Insurance Type | Text |
Please specify the type of other insurance expense. Fill only if 'Other Insurance Amount' has a value.
Depends on:
Other Insurance Amount
|
| Owned Property Details | ||
| Property Mortgage | Number |
Please enter the outstanding mortgage amount on the owned property.
|
| Property Market Value | Number |
Please enter the current market value of the owned property.
|
| Property Address | Text |
Please provide the full street address of the owned property.
|
| Proof of Public Assistance | ||
| Proof of Public Assistance Details | Text |
Please provide details regarding the proof of public assistance you are providing.
|
| Rent or Mortgage Expense | ||
| Monthly Rent or Mortgage Expense | Number |
Please provide the monthly amount paid for rent or mortgage.
|
| Savings Account | ||
| Savings Account Bank Name | Text |
Please provide the name of the bank where the savings account is held.
|
| Savings Account Balance | Number |
Please provide the current balance of the savings account.
|
| School Tuition and Expenses | ||
| School Tuition and Expenses | Number |
Enter the total monthly amount spent on school tuition and related expenses.
|
| Second Loan or Debt | ||
| Balance | Number |
Enter the current outstanding balance of this loan or debt. Fill only if a second loan or debt exists (e.g. from 'Automobile' or 'Other assets')
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value, Other Asset Details, Other Asset Value, Second Other Asset Details, Second Other Asset Value
|
| Loan Purpose | Text |
Specify the purpose or nature of this loan or debt. Fill only if a second loan or debt exists (e.g. from 'Automobile' or 'Other assets')
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value, Other Asset Details, Other Asset Value, Second Other Asset Details, Second Other Asset Value
|
| Payment Amount | Number |
Enter the regular payment amount for this loan or debt. Fill only if a second loan or debt exists (e.g. from 'Automobile' or 'Other assets')
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value, Other Asset Details, Other Asset Value, Second Other Asset Details, Second Other Asset Value
|
| Owed To | Text |
Provide the name of the individual or entity to whom this loan or debt is owed. Fill only if a second loan or debt exists (e.g. from 'Automobile' or 'Other assets')
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value, Other Asset Details, Other Asset Value, Second Other Asset Details, Second Other Asset Value
|
| weekly | Checkbox |
Check this box if the payment for the second loan or debt is made on a weekly basis.
|
| monthly | Checkbox |
Check this box if the payment for the second loan or debt is made on a monthly basis.
|
| Second Other Asset | ||
| Second Other Asset Value | Number |
Please enter the current monetary value of the second other asset.
|
| Second Other Asset Details | Text |
Please provide specific details about the second other asset listed, such as its type or description.
|
| Second Other Income | ||
| Second Other Income Amount | Number |
Please provide the amount of your second other income.
|
| Second Other Income Source | Text |
Please provide the source of your second other income.
|
| choicebutton_0_30_b0dd38a0 | CheckBox | |
| Signature | ||
| Print/Type Name | Text |
Please provide the printed or typed full name of the signatory.
|
| Signature | Text |
Please provide your signature in this field.
|
| Third Other Income | ||
| Third Other Income Amount | Number |
Please provide the total monetary amount for this third other income source.
|
| Third Other Income Source | Text |
Please specify the source of this third other income.
|
| choicebutton_0_31_70bf70a2 | CheckBox | |
| Total Monthly Expenses | ||
| Total Monthly Expenses | Number |
Please enter the total amount of your monthly expenses.
|
| Transportation Expenses | ||
| Gasoline Expenses | Number |
Please provide the monthly expenses for gasoline. Fill only if 'Automobile' section is filled
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value
|
| Public Transportation Expenses | Number |
Please provide the monthly expenses for public transportation.
|
| Auto Payment Expenses | Number |
Please provide the monthly auto payment amount. Fill only if 'Automobile' section is filled
Depends on:
Automobile Make, Automobile Model, Automobile Year, Automobile Value
|
| Utilities Expenses | ||
| Electric | Number |
Provide the monthly cost for electricity.
|
| Phone/TV/Internet | Number |
Provide the monthly cost for phone, TV, and internet services.
|
| Other Utilities Amount | Number |
Provide the monthly cost for any other specified utility expenses.
|
| Gas | Number |
Provide the monthly cost for gas.
|
| Other Utilities Description | Text |
Describe any other utility expenses not listed. Fill only if 'Other Utilities Amount' has a value.
Depends on:
Other Utilities Amount
|