This form contains 101 fields organized into 29 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Account Information
USCIS Online Account Number Text
Enter your 10-digit USCIS online account number, if you have created an account at myUSCIS. Leave blank if you do not have one.
Max length: 12 characters
Address Information
Receipt number Text
Enter the USCIS receipt number (three-letter prefix followed by 10 digits) that was issued for the underlying application or petition, if one exists.
Max length: 34 characters
Ste. CheckBox
Check this box when the attorney’s or representative’s address includes a suite number.
Flr. CheckBox
Check this box when including the floor number in the attorney or representative’s street address.
Part 1. Information About Attorney or Accredited Representative. Address of Attorney or Accredited Representative. 3. B. Enter Apartment, Suite or Floor Number Text
Enter the apartment, suite, or floor number of the attorney or accredited representative's address. This field can contain up to 6 characters.
Max length: 6 characters
Apt. CheckBox
Select this box when the attorney or accredited representative’s street address includes an apartment unit.
Agency Selection
U.S. Immigration and Customs Enforcement (ICE) CheckBox
Check this box when the appearance of the attorney or representative is entered for an immigration matter before U.S. Immigration and Customs Enforcement.
U.S. Customs and Border Protection (CBP) CheckBox
Check this box when the representation is entered for immigration matters before U.S. Customs and Border Protection.
U.S. Citizenship and Immigration Services (USCIS) CheckBox
Check this box when the appearance of the attorney or representative is being entered for immigration matters before USCIS.
Attorney Address
City or Town Text
Enter the city, town, or village that corresponds to the street address you provided.
Max length: 20 characters
Part 1. Information About Attorney or Accredited Representative. Address of Attorney or Accredited Representative. 3. D. Select State from List of States ComboBox
Select the state from the list where the attorney or accredited representative's office is located.
IA FL CO FM GA ME MA MD MH DE AZ MT NJ WI SD CT KS WA NH AL KY MN VT DC PA MS AS IN MI TN RI AE VA PR ID PW LA GU NM UT NV VI AR SC WV CA MP AA HI MO ND OK AK IL NC OR NE OH TX NY AP WY
ZIP Code Text
For U.S. addresses, supply the 5-digit (or ZIP+4) postal ZIP Code that matches the street address.
Max length: 5 characters
Province Text
If the address is outside the United States, provide the province, state, or region. Leave blank for U.S. addresses.
Max length: 20 characters
Country Text
Write the full name of the country for the address you listed (e.g., “United States,” “Canada”).
Postal Code Text
Enter the postal code for non-U.S. addresses, or the ZIP Code if not already given above.
Max length: 9 characters
Attorney Contact Information
Fax Number Text
If you have a fax line, enter the complete fax number here, including country and area code where applicable.
Max length: 10 characters
Mobile Telephone Number Text
Enter your mobile/cell phone number, if you have one. Include country and area code as needed.
Max length: 10 characters
Email Address Text
Type the email address you regularly monitor. USCIS may use this to send notices or ask for additional information.
Max length: 38 characters
Attorney/Representative Information
Name of Recognized Organization Text
For accredited representatives, type the name of the DOJ-recognized nonprofit, religious, charitable, or social-service organization you represent.
Max length: 30 characters
Date of Accreditation (mm/dd/yyyy) Date
Enter the exact date on which the Department of Justice granted your accreditation, using the format MM/DD/YYYY.
Bar Number Text
Provide the bar membership number issued by the licensing authority. If that body does not assign numbers, write “N/A.”
Max length: 10 characters
Associated Attorney or Representative Name Text
If you are appearing for a limited purpose, provide the full name of the attorney or accredited representative of record with whom you are associated.
Max length: 30 characters
Client Contact Information
Mobile telephone number Text
Provide the client’s mobile/cell phone number, including country code if outside the United States.
Max length: 10 characters
Email address Text
Enter the client’s current email address. Use an address the client checks frequently, as USCIS may send notifications there.
Max length: 38 characters
Daytime telephone number Text
Enter the primary telephone number (including country and area code, if applicable) where the client can be reached during normal business hours.
Max length: 10 characters
Client Information
Client middle name Text
Enter the client’s middle name. If the client has no middle name, leave this field blank.
Client given (first) name Text
Provide the client’s legal given/first name exactly as it appears in official identity documents.
Client family (last) name Text
Provide the client’s legal family/last name exactly as it appears in official identity documents.
Name of entity (if client is an organization) Text
If the client is an organization rather than an individual, type the full legal name of that entity.
Max length: 34 characters
USCIS Online Account Number Text
Enter the client’s USCIS Online Account Number, if they have created one at my.uscis.gov. Leave blank if none.
Max length: 12 characters
Alien Registration Number (A-Number) Text
Provide the client’s nine-digit Alien Registration Number beginning with “A”. Leave blank if the client has never been assigned an A-Number.
Max length: 9 characters
Title of authorized signatory Text
If an entity is listed above, specify the job title or position of the person authorized to sign on the entity’s behalf (e.g., President, HR Manager).
Client Mailing Address
Postal code (foreign address) Text
Enter the foreign postal code for non-U.S. addresses.
Max length: 9 characters
Province (foreign address) Text
If the mailing address is outside the United States, enter the province here.
Max length: 20 characters
Country Text
Specify the country of the mailing address. For addresses within the United States, write “United States”.
Street number and name Text
Type the street number and name of the client’s mailing address. Include apartment or unit only if space permits.
Max length: 34 characters
City or town Text
Enter the city or town of the client’s mailing address.
Max length: 20 characters
ZIP Code Text
Provide the five-digit (and optional four-digit) ZIP Code for U.S. addresses.
Max length: 5 characters
Ste. CheckBox
Check this box when the client’s mailing address includes a suite number.
Flr. CheckBox
Check this box when the client’s mailing address specifies a floor number.
Floor (Flr.) Text
If the mailing address includes a specific floor, enter the floor number here; otherwise leave blank.
Max length: 6 characters
Apt. CheckBox
Check this box when the client’s mailing address includes an apartment designation.
State ComboBox
Type the two-letter abbreviation of the U.S. state or territory for the mailing address. Leave blank for non-U.S. addresses.
IA FL CO FM GA ME MA MD MH DE AZ MT NJ WI SD CT KS WA NH AL KY MN VT DC PA MS AS IN MI TN RI AE VA PR ID PW LA GU NM UT NV VI AR SC WV CA MP AA HI MO ND OK AK IL NC OR NE OH TX NY AP WY
Contact Information
Daytime Telephone Number Text
Provide a phone number where you can be reached during normal business hours. Include the country and area code if outside the U.S.
Max length: 10 characters
Eligibility Information
I am an accredited representative of the following qualified nonprofit religious, charitable, social service, or similar organization established in the United States and recognized by the Department of Justice in accordance with 8 CFR part 1292 CheckBox
Check this box if you are accredited by the Department of Justice to represent clients as a representative of a qualified nonprofit religious, charitable, social service, or similar U.S. organization.
I am not subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law CheckBox
Check this box if you have no disciplinary or legal orders limiting your ability to practice law.
I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law CheckBox
Check this box if the attorney is currently under any official suspension, injunction, restraint, disbarment, or other restriction on practicing law.
I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest courts of the following states, possessions, territories, commonwealths, or the District of Columbia. CheckBox
Check this box if the attorney is licensed to practice law and is currently in good standing before the highest court of any U.S. state, territory, possession, commonwealth, or the District of Columbia.
I am associated with the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an attorney or accredited representative for a limited purpose is at his or her request CheckBox
Check this box when you are appearing only for a limited purpose at the request of the attorney or accredited representative who originally filed Form G-28 in this case.
I am a law student or law graduate working under the direct supervision of the attorney or accredited representative of record on this form in accordance with the requirements in 8 CFR 292.1(a)(2). CheckBox
Check this box if you are appearing as a law student or law graduate under the direct supervision of the attorney or accredited representative of record as allowed by DHS regulations.
Name of Law Student or Law Graduate Text
If you are a supervised law student or law graduate, list your full name as it appears in school or bar records.
Max length: 38 characters
Licensing Authority Text
Specify the state, territory, possession, or other jurisdiction whose bar has admitted you to practice law (e.g., “State Bar of California”).
Max length: 66 characters
Name of Law Firm or Organization Text
Enter the full legal name of the law firm, practice, or organization with which you are currently affiliated.
Max length: 30 characters
Footer: Bottom additional text
Footer — Bottom Additional Text Text
Enter the freeform footer text to appear in the bottom bar of the page (any short notes, identifiers, or labels).
Form Footer Additional Field
Footer Page Number Text
Enter the page number or other footer identifier that appears in the form footer (as shown in the highlighted box).
Form Metadata
PDF417BarCode1 Text
This field contains a barcode that encodes the form type and version. No input is required from the user.
PDF417BarCode1 Text
This field contains a PDF417 barcode with encoded information about the form version and other metadata.
Immigration Matter Details
Part 3. Notice of Appearance as Attorney or Accredited Representative. This appearance relates to immigration matters before (select only one box). 4. Enter Receipt Number, if any Text
Enter the receipt number related to the immigration matter, if available. This number is typically provided by USCIS upon receipt of an application or petition.
Max length: 13 characters
Matter Details
ICE matter description Text
State the specific investigation, detention, or other ICE matter in which you are representing the client.
Max length: 30 characters
CBP matter description Text
Identify the particular CBP inspection, seizure, or other proceeding for which you are appearing on the client’s behalf.
Max length: 30 characters
USCIS form number or matter Text
List the specific form number(s) (e.g., I-130, I-765) or a brief description of the immigration matter for which you are entering your appearance before USCIS.
Max length: 30 characters
Notice of Appearance
Requestor CheckBox
Check this box when you are entering your appearance at the specific request of the requestor as the party needing representation.
Applicant CheckBox
Check this box when the attorney or accredited representative is entering their appearance at the request of the applicant.
Respondent (ICE, CBP) CheckBox
Check this box when you are entering your appearance at the request of a respondent in proceedings before U.S. Immigration and Customs Enforcement or Customs and Border Protection.
Petitioner CheckBox
Check this box when the attorney or accredited representative is entering their appearance at the request of the petitioner.
Options Regarding Receipt of USCIS Notices - Checkboxes
1.a. Request USCIS send original notices to attorney/business address Checkbox
Check this box when you want USCIS to send original notices on your application or petition to the business address of your attorney or accredited representative listed on the form.
1.b. Request USCIS send secure identity documents to attorney/business address Checkbox
Check this box when you want USCIS to send any secure identity document (for example, Permanent Resident Card, Employment Authorization Document, or Travel Document) you receive to the U.S. business address of your attorney or accredited representative (or designated military/diplomatic address if permitted).
1.c. Request USCIS send Form I-94 to my U.S. mailing address Checkbox
Check this box when you want USCIS to send your notice containing Form I-94 directly to your U.S. mailing address instead of to your attorney or accredited representative.
Personal Information
Middle Name Text
Provide your middle name. If you do not have one, leave the field blank or write “N/A.”
Given Name (First Name) Text
Enter your first (given) name as shown on your official identification or bar records.
Family Name (Last Name) Text
Type your legal last (family) name exactly as it appears on your bar license or government-issued identity documents.
Representation Request
Beneficiary/Derivative CheckBox
Check this box when the attorney or accredited representative is entering an appearance at the request of the beneficiary or derivative client.
Section 1: Name (Family, Given, Middle)
Section 1 — Family Name (Last Name) Text
Enter your family or last name exactly as you want it recorded on this form.
Section 1 — Given Name (First Name) Text
Enter your given or first name as it should appear on this form.
Section 1 — Middle Name Text
Enter your middle name or initial, if any; if you have no middle name, leave this field blank or write 'N/A' if instructed.
Section 2: Page/Part/Item and Details
Section 2.d — Additional Information / Details Text
Type or print the full additional information, explanation, or answer related to the page, part, and item indicated above. Fill only if 'Section 2.a — Page Number', 'Section 2.b — Part Number', 'Section 2.c — Item Number' are provided (depend on all).
Depends on: Section 2.a — Page Number, Section 2.b — Part Number, Section 2.c — Item Number
Section 2.a — Page Number Text
Enter the page number that this additional information refers to.
Max length: 2 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 2.b — Part Number Text
Enter the part number on the form that this additional information refers to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 2.c — Item Number Text
Enter the item number on the form that this additional information refers to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 3: Page/Part/Item and Details
3.d Additional Details Text
Enter the full additional information or explanation related to the referenced page/part/item — a multi-line text description of your answer. Fill only if '3.a Page Number', '3.b Part Number', '3.c Item Number' are provided (depend on all).
Depends on: 3.a Page Number, 3.b Part Number, 3.c Item Number
3.a Page Number Text
Enter the page number on the original form to which this additional information refers.
Max length: 2 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
3.b Part Number Text
Enter the part number from the original form that corresponds to the information you are providing.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
3.c Item Number Text
Enter the specific item number from the original form that this additional information addresses.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 4: Page/Part/Item and Details
Section 4.d Additional Details Text
Provide the full additional information, explanation, or continuation text related to the referenced page, part, and item numbers. Fill only if 'Section 4.a Page Number', 'Section 4.b Part Number', 'Section 4.c Item Number' are provided (depend on all).
Depends on: Section 4.a Page Number, Section 4.b Part Number, Section 4.c Item Number
Section 4.a Page Number Text
Enter the page number that this additional information refers to.
Max length: 2 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 4.b Part Number Text
Enter the part number that this additional information refers to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 4.c Item Number Text
Enter the item number that this additional information pertains to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 5: Page/Part/Item and Details
Section 5.d — Additional Details Text
Provide the full additional information, explanation, or answer related to the referenced page, part, and item. Fill only if 'Section 5.a — Page Number', 'Section 5.b — Part Number', 'Section 5.c — Item Number' are provided (depend on all).
Depends on: Section 5.a — Page Number, Section 5.b — Part Number, Section 5.c — Item Number
Section 5.a — Page Number Text
Enter the page number that the additional information on this sheet refers to.
Max length: 2 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 5.b — Part Number Text
Enter the part number of the form to which the additional information applies.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 5.c — Item Number Text
Enter the item number that corresponds to the detailed information you will provide below.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 6: Page/Part/Item and Details
Section 6 - Item Number Text
Enter the item number on the form that this additional information refers to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 6 - Part Number Text
Enter the part number on the form that this additional information refers to.
Max length: 6 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 6 - Page Number Text
Enter the page number on the form that this additional information refers to.
Max length: 2 characters
Depends on: I am subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law
Section 6 - Additional Information Details Text
Provide the full additional information, explanation, or narrative related to the referenced page, part, and item numbers; type or print clearly and include any applicable dates or identifiers. Fill only if 'Section 6 - Item Number', 'Section 6 - Part Number', 'Section 6 - Page Number' are provided (depend on all).
Depends on: Section 6 - Page Number, Section 6 - Part Number, Section 6 - Item Number
Signature of Attorney or Accredited Representative
Signature of Attorney or Accredited Representative Text
Enter the attorney’s or accredited representative’s signature as it should appear on the form (full name or electronic signature). Fill only if '1.a. Request USCIS send original notices to attorney/business address', '1.b. Request USCIS send secure identity documents to attorney/business address' is 'Yes' (any).
Max length: 1 characters
Depends on: 1.a. Request USCIS send original notices to attorney/business address, 1.b. Request USCIS send secure identity documents to attorney/business address
Date of Signature Date
Enter the date the attorney or accredited representative signed this form. Fill only if '1.a. Request USCIS send original notices to attorney/business address', '1.b. Request USCIS send secure identity documents to attorney/business address' is 'Yes' (any).
Depends on: 1.a. Request USCIS send original notices to attorney/business address, 1.b. Request USCIS send secure identity documents to attorney/business address
Signature of Client or Authorized Signatory for an Entity
2.b. Date of Signature Date
Enter the date when the client or authorized signatory signed this form.
2.a. Signature of Client or Authorized Signatory for an Entity Text
Enter the client’s or authorized signatory’s signature (typed or printed name) to authorize representation on behalf of the entity.
Signature of Law Student or Law Graduate
Signature of Law Student or Law Graduate Text
Enter the law student’s or law graduate’s full signature (handwritten or typed) who is signing as the representative on this form. Fill only if '1.a. Request USCIS send original notices to attorney/business address', '1.b. Request USCIS send secure identity documents to attorney/business address' is 'Yes' (any).
Max length: 1 characters
Depends on: 1.a. Request USCIS send original notices to attorney/business address, 1.b. Request USCIS send secure identity documents to attorney/business address
Date of Signature (Law Student or Law Graduate) Date
Enter the date when the law student or law graduate signed this form. Fill only if '1.a. Request USCIS send original notices to attorney/business address', '1.b. Request USCIS send secure identity documents to attorney/business address' is 'Yes' (any).
Depends on: 1.a. Request USCIS send original notices to attorney/business address, 1.b. Request USCIS send secure identity documents to attorney/business address