This form contains 101 fields organized into 31 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Accredited Representative Information
Recognized Organization Name Text
Provide the full name of the recognized organization. Fill only if 'Accredited Representative' is 'Yes'.
Max length: 30 characters
Depends on: Accredited Representative
Date of Accreditation Date
Enter the date of accreditation. Fill only if 'Accredited Representative' is 'Yes'.
Depends on: Accredited Representative
Accredited Representative Checkbox
Check this box if you are an accredited representative of a 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.
Address of Attorney or Accredited Representative
Street Number and Name Text
Enter the street number and name of the attorney or accredited representative's address.
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.
Apartment, Suite, or Floor Number Text
Enter the apartment, suite, or floor number of the attorney or accredited representative's address, if applicable.
Max length: 6 characters
Apt. Checkbox
Select this box when the attorney or accredited representative’s street address includes an apartment unit.
City or Town Text
Enter the city or town of the attorney or accredited representative's address.
Max length: 20 characters
State Combobox
Enter the state of the attorney or accredited representative's address.
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
Enter the ZIP Code of the attorney or accredited representative's address.
Max length: 5 characters
Province Text
Enter the province of the attorney or accredited representative's address, if applicable.
Max length: 20 characters
Country Text
Enter the country of the attorney or accredited representative's address.
Postal Code Text
Enter the postal code of the attorney or accredited representative's address, if applicable.
Max length: 9 characters
Associated Attorney/Representative Information
Associated Attorney/Representative Name Text
Enter the name of the attorney or accredited representative of record with whom you are associated. Fill only if 'I am associated with' is 'Yes'.
Max length: 30 characters
Depends on: I am associated with
I am associated with Checkbox
Check this box if you are associated with the attorney or accredited representative of record who previously filed Form G-28 in this case, and your appearance as an attorney or accredited representative is for a limited purpose or in his or her request.
Attorney Appearance Request Basis
Requestor Checkbox
Check this box if the attorney or accredited representative is appearing at the request of the requestor.
Applicant Checkbox
Check this box if the attorney or accredited representative is appearing at the request of the applicant.
Respondent (ICE, CBP) Checkbox
Check this box if the attorney or accredited representative is appearing at the request of the respondent in matters involving ICE or CBP.
Petitioner Checkbox
Check this box if the attorney or accredited representative is appearing at the request of the petitioner.
Beneficiary/Derivative Checkbox
Check this box if the attorney or accredited representative is appearing at the request of the beneficiary or derivative.
Attorney Eligibility Information
I am not subject to any order restricting practice Checkbox
Check this box if you are not subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting your practice of law.
I am subject to an order restricting practice Checkbox
Check this box if you are subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting your practice of law.
Bar Number Text
Enter the attorney's bar number, if applicable. Fill only if 'I am an attorney eligible to practice law' is 'Yes'.
Max length: 10 characters
Depends on: I am an attorney eligible to practice law
I am an attorney eligible to practice law Checkbox
Check this box if you are an attorney eligible to practice law and are a member in good standing of the bar of the highest courts of the specified jurisdictions.
Licensing Authority Text
Provide the name of the licensing authority where the attorney is eligible to practice law. Fill only if 'I am an attorney eligible to practice law' is 'Yes'.
Max length: 66 characters
Depends on: I am an attorney eligible to practice law
Law Firm or Organization Name Text
Enter the name of the law firm or organization, if applicable. Fill only if 'I am an attorney eligible to practice law' is 'Yes'.
Max length: 30 characters
Depends on: I am an attorney eligible to practice law
CBP Appearance Matter
CBP Specific Appearance Matter Text
Provide the specific form numbers or matter in which the appearance is entered for U.S. Customs and Border Protection (CBP). Fill only if 'U.S. Customs and Border Protection (CBP)' is 'Yes'.
Max length: 30 characters
Depends on: U.S. Customs and Border Protection (CBP)
Client's Alien Registration Number
Alien Registration Number Text
Enter your nine-digit Alien Registration Number (A-Number) assigned by USCIS, omitting the ‘A-’ prefix and intermitten prefixes, shown on the form.
Max length: 9 characters
Client's Contact Information
Mobile Telephone Number Text
Please provide the client's mobile telephone number, if applicable.
Max length: 10 characters
Email Address Text
Please provide the client's email address, if applicable.
Max length: 38 characters
Daytime Telephone Number Text
Please provide the client's daytime telephone number.
Max length: 10 characters
Client's Full Name
Middle Name Text
Provide the client's middle name.
Given Name Text
Provide the client's given name, also known as the first name.
Family Name Text
Provide the client's family name, also known as the last name.
Client's Mailing Address
Postal Code Text
Enter the postal code for the client's mailing address. Fill only if 'Country' is not the United States.
Max length: 9 characters
Depends on: Country
Province Text
Enter the province for the client's mailing address, if applicable. Fill only if 'Country' is not the United States.
Max length: 20 characters
Depends on: Country
Country Text
Enter the country for the client's mailing address.
Street Number and Name Text
Enter the street number and name for the client's mailing address.
Max length: 34 characters
City or Town Text
Enter the city or town for the client's mailing address.
Max length: 20 characters
ZIP Code Text
Enter the ZIP code for the client's mailing address. Fill only if 'Country' is the United States.
Max length: 5 characters
Depends on: Country
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.
Apartment, Suite, or Floor Text
Enter the apartment, suite, or floor number for the client's mailing address, if applicable.
Max length: 6 characters
Apt. Checkbox
Check this box when the client’s mailing address includes an apartment designation.
State Combobox
Enter the state for the client's mailing address. Fill only if 'Country' is the United States.
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
Depends on: Country
Client's USCIS Online Account Number
USCIS Online Account Number Text
Provide the client's USCIS online account number if they have one.
Max length: 12 characters
Contact Information of Attorney or Accredited Representative
Daytime Telephone Number Text
Please provide the daytime telephone number for the attorney or accredited representative.
Max length: 10 characters
Fax Number Text
Please provide the fax number for the attorney or accredited representative, if applicable.
Max length: 10 characters
Mobile Telephone Number Text
Please provide the mobile telephone number for the attorney or accredited representative, if applicable.
Max length: 10 characters
Email Address Text
Please provide the email address for the attorney or accredited representative, if applicable.
Max length: 38 characters
Entity Information
Entity Name Text
Provide the full legal name of the entity, if applicable.
Max length: 34 characters
Signatory Title Text
Enter the official title of the authorized signatory for the entity, if applicable.
Fifth Additional Information Entry
Additional Information Item Number Text
Enter the item number of the form to which this additional information refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Additional Information Part Number Text
Enter the part number of the form to which this additional information refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Additional Information Page Number Text
Enter the page number of the form to which this additional information refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 2 characters
Depends on: I am subject to an order restricting practice
Additional Information Details Text
Provide the additional information or details for the specified page, part, and item number. Fill only if 'Additional Information Item Number', 'Additional Information Part Number', 'Additional Information Page Number' is filled.
Depends on: Additional Information Page Number, Additional Information Part Number, Additional Information Item Number
First Additional Information Entry
Additional Information Entry Text
Provide any additional information that does not fit in other sections of the form in this space. Fill only if 'Page Number', 'Part Number', 'Item Number' is filled.
Depends on: Page Number, Part Number, Item Number
Page Number Text
Enter the page number to which the additional information provided in this entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 2 characters
Depends on: I am subject to an order restricting practice
Part Number Text
Enter the part number to which the additional information provided in this entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Item Number Text
Enter the item number to which the additional information provided in this entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Fourth Additional Information Entry
Entry 5 Additional Information Text
Provide additional details relevant to entry 5, referring to the page, part, and item numbers specified. Fill only if 'Entry 5 Page Number', 'Entry 5 Part Number', 'Entry 5 Item Number' is filled.
Depends on: Entry 5 Page Number, Entry 5 Part Number, Entry 5 Item Number
Entry 5 Page Number Text
Enter the page number relevant to the additional information provided in entry 5. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 2 characters
Depends on: I am subject to an order restricting practice
Entry 5 Part Number Text
Enter the part number relevant to the additional information provided in entry 5. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Entry 5 Item Number Text
Enter the item number relevant to the additional information provided in entry 5. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
ICE Appearance Matter
Specific ICE Matter Text
Provide the specific matter or case details in which the appearance before U.S. Immigration and Customs Enforcement (ICE) is entered. Fill only if 'U.S. Immigration and Customs Enforcement (ICE)' is 'Yes'.
Max length: 30 characters
Depends on: U.S. Immigration and Customs Enforcement (ICE)
Immigration Matter Agency
U.S. Immigration and Customs Enforcement (ICE) Checkbox
Check this box if the immigration matter is before U.S. Immigration and Customs Enforcement (ICE).
U.S. Customs and Border Protection (CBP) Checkbox
Check this box if the immigration matter is before U.S. Customs and Border Protection (CBP).
U.S. Citizenship and Immigration Services (USCIS) Checkbox
Check this box if the immigration matter is before U.S. Citizenship and Immigration Services (USCIS).
Law Student/Graduate Information
Law Student or Law Graduate Checkbox
Check this box if you are 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 8 CFR 292.1(a)(2).
Name of Law Student or Law Graduate Text
Provide the full name of the law student or law graduate. Fill only if 'Law Student or Law Graduate' is 'Yes'.
Max length: 38 characters
Depends on: Law Student or Law Graduate
Name
Form Page Number Number
Enter the page number of this form. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Depends on: I am subject to an order restricting practice
Family Name (Last Name) Text
Provide your family name or last name. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Depends on: I am subject to an order restricting practice
Given Name (First Name) Text
Provide your given name or first name. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Depends on: I am subject to an order restricting practice
Middle Name Text
Provide your middle name. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Depends on: I am subject to an order restricting practice
Name of Attorney/Accredited Representative or Preparer
Middle Name Text
Enter the middle name of the attorney / accredited representative or Preparer
Given Name Text
Enter the given name (first name) of the attorney / accredited representative or Preparer
Family Name Text
Enter the family name (last name) of the attorney / accredited representative or Preparer
Options Regarding Receipt of USCIS Notices and Documents
Attorney or Accredited Representative Signature Text
Provide the signature of the attorney or accredited representative.
Send original notices to attorney Checkbox
Check this box if you want USCIS to send original notices on an application or petition to the business address of your attorney or accredited representative as listed in this form.
Send secure identity document to attorney Checkbox
Check this box if you want USCIS to send any secure identity document (Permanent Resident Card, Employment Authorization Document, or Travel Document) to the U.S. business address of your attorney or accredited representative or to a designated military or diplomatic address in a foreign country (if permitted).
Send Form I-94 notice to client Checkbox
Check this box if you want USCIS to send your notice containing Form I-94 directly to your U.S. mailing address.
Page 2
USCIS Appearance Matter Text
Provide the form numbers or specific matter in which appearance is entered for U.S. Citizenship and Immigration Services (USCIS).
Receipt Number
Receipt Number Text
Provide the receipt number, if applicable.
Max length: 13 characters
Second Additional Information Entry
Second Additional Information Entry Text Text
Provide the detailed additional information in this text field, corresponding to the page, part, and item numbers specified for this entry. Fill only if 'Second Additional Information Entry Page Number', 'Second Additional Information Entry Part Number', 'Second Additional Information Entry Item Number' is filled.
Depends on: Second Additional Information Entry Page Number, Second Additional Information Entry Part Number, Second Additional Information Entry Item Number
Second Additional Information Entry Page Number Text
Enter the page number that this additional information entry refers to. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 2 characters
Depends on: I am subject to an order restricting practice
Second Additional Information Entry Part Number Text
Enter the part number that this additional information entry refers to. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Second Additional Information Entry Item Number Text
Enter the item number that this additional information entry refers to. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Signature of Attorney or Accredited Representative
Attorney/Accredited Representative Signature Text
Please enter the signature of the attorney or accredited representative.
Max length: 1 characters
Signature Date Date
Please provide the date the attorney or accredited representative signed the form. Fill only if 'Attorney/Accredited Representative Signature' is filled.
Depends on: Attorney/Accredited Representative Signature
Signature of Client or Authorized Signatory for an Entity
Date of Signature Date
Please provide the date the signature was made. Fill only if 'Client or Authorized Signatory Name' is filled.
Depends on: Client or Authorized Signatory Name
Client or Authorized Signatory Name Text
Please provide the full name of the client or the authorized signatory for the entity.
Signature of Law Student or Law Graduate
Signature Text
Provide the signature of the law student or law graduate. Fill only if 'Name of Law Student or Law Graduate' is filled.
Max length: 1 characters
Depends on: Name of Law Student or Law Graduate
Date of Signature Date
Enter the date the law student or law graduate signed. Fill only if 'Signature' is filled.
Depends on: Signature
Third Additional Information Entry
Third Additional Information Details Text
Provide any additional information or details that do not fit elsewhere in the form for this third additional information entry. Fill only if 'Third Entry Page Number', 'Third Entry Part Number', 'Third Entry Item Number' is filled.
Depends on: Third Entry Page Number, Third Entry Part Number, Third Entry Item Number
Third Entry Page Number Number
Enter the page number of the form item to which the third additional information entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 2 characters
Depends on: I am subject to an order restricting practice
Third Entry Part Number Number
Enter the part number of the form item to which the third additional information entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
Third Entry Item Number Number
Enter the item number of the form item to which the third additional information entry refers. Fill only if 'Subject to order restricting practice of law' is 'Yes'.
Max length: 6 characters
Depends on: I am subject to an order restricting practice
USCIS Appearance Matter
USCIS Form Numbers or Matter Text
Provide the form numbers or specific matter related to the U.S. Citizenship and Immigration Services (USCIS) appearance. Fill only if 'U.S. Citizenship and Immigration Services (USCIS)' is 'Yes'.
Max length: 30 characters
Depends on: U.S. Citizenship and Immigration Services (USCIS)
USCIS Online Account Number
PDF417BarCode1 Text
This field contains a barcode that encodes the form type and version. No input is required from the user.
USCIS Online Account Number Text
Provide your USCIS Online Account Number, if you have one.
Max length: 12 characters