This form contains 194 fields organized into 30 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Information
First Entry – Page Number	Text	Enter the page number in the form where the original item you are providing additional information for is located. Max length: 2 characters
First Entry – Part Number	Text	Enter the part number of the form corresponding to the original item you are expanding upon. Max length: 6 characters
First Entry – Item Number	Text	Enter the item number on the referenced part and page for which you are providing additional details. Max length: 6 characters
First Entry – Additional Information	Text	Provide the supplemental information or explanation related to the referenced page, part, and item. Type or print your answer clearly in this space.
Second Entry Page Number	Text	Enter the page number of the form to which this additional information refers. Provide only numeric digits. Max length: 2 characters
Second Entry Part Number	Text	Enter the part number on the form where the original question or item appears. Provide only numeric digits. Max length: 6 characters
Second Entry Item Number	Text	Enter the item number under the specified part that this additional information addresses. Provide only numeric digits. Max length: 6 characters
Second Entry Additional Information	Text	Type your detailed explanation or response corresponding to the page, part, and item numbers entered above. Use additional space or sheets if needed and ensure each sheet is labeled with your name, A-Number (if any), and the entry identifiers.
Fourth Entry Additional Information	Text	Provide the detailed additional information or explanation corresponding to the referenced page, part, and item for the fourth entry.
Third Additional Information – Details	Text	Type or print the full additional information for the above page, part, and item numbers. Use this space to continue your answer.
Fifth Additional Information – Details	Text	Type or print your additional information here, corresponding to the page, part, and item numbers you provided above.
Address Details
Physical Address 1 Apt.	CheckBox	Check this box if your first physical address includes an apartment number.
Physical Address 1 Ste.	CheckBox	Check this box if your first physical address includes a suite number.
Physical Address 1 Flr.	CheckBox	Check this box if your first physical address includes a floor number.
Physical Address 1 – Apartment/Suite/Floor Number	Text	If applicable, select Apt, Ste, or Flr and enter the corresponding unit number. Leave blank if none. Max length: 6 characters
Address History
Physical Address 1 – Street Number and Name	Text	Enter the street number and full street name for your current physical address. Max length: 34 characters
Physical Address 1 – City or Town	Text	Enter the city or town for your current physical address. Max length: 20 characters
Physical Address 1 – State	ComboBox	For a U.S. address, enter the two-letter postal abbreviation for the state. Leave blank for foreign addresses. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Physical Address 1 – ZIP Code	Text	For a U.S. address, enter the five-digit ZIP Code (you may include ZIP +4). Leave blank for foreign addresses. Max length: 5 characters
Physical Address 1 – Province	Text	For a foreign address, enter the province, state, or region. Leave blank for U.S. addresses. Max length: 20 characters
Physical Address 1 – Country	Text	Enter the country name for your current physical address.
Physical Address 1 – Postal Code	Text	For a foreign address, enter the postal code. Leave blank for U.S. addresses. Max length: 9 characters
Physical Address 2 – Street Number and Name	Text	Enter the street number and street name of your second physical address. Max length: 34 characters
Physical Address 2 Apt.	CheckBox	Check this box if your second physical address includes an apartment number.
Physical Address 2 Ste.	CheckBox	Check this box if your second physical address includes a suite number.
Physical Address 2 Flr.	CheckBox	Check this box if your second physical address includes a floor designation.
Physical Address 2 – Apartment, Suite, or Floor	Text	If applicable, enter your apartment, suite, or floor number for your second address. Leave blank if none. Max length: 6 characters
Physical Address 2 – City or Town	Text	Enter the city or town for your second physical address. Max length: 20 characters
Physical Address 2 – State	ComboBox	Enter the two-letter U.S. state abbreviation for your second address. Leave blank if the address is outside the United States. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Physical Address 2 – ZIP Code	Text	Enter the five-digit ZIP Code for your second address. Leave blank if the address is outside the United States. Max length: 5 characters
Physical Address 2 – Province	Text	If your second address is outside the United States, enter the province, territory, or region. Leave blank if not applicable. Max length: 20 characters
Physical Address 2 – Country	Text	Enter the country name for your second physical address.
Physical Address 2 – Postal Code	Text	If your second address is outside the United States, enter the postal code. Leave blank if not applicable. Max length: 9 characters
Physical Address 2 – Date From (mm/dd/yyyy)	Date	Enter the date you began living at your second physical address in MM/DD/YYYY format.
Physical Address 2 – Date To (mm/dd/yyyy)	Date	Enter the date you stopped living at your second physical address in MM/DD/YYYY format.
Part 1. Information About You (Spouse Beneficiary). Address History. Physical Address 1. 5. A. Enter Date From. Enter as 2-digit Month, 2-digit Day and 4-digit Year	Date	Enter the start date for your first physical address in the format MM/DD/YYYY. This is part of your address history.
Part 1. Information About You (Spouse Beneficiary). Address History. Physical Address 1. 5. B. Date To. Present. No Entry	Text	This field indicates that your first physical address is your current address. No entry is needed as it is marked 'PRESENT'.
Postal Code	Text	Enter the postal code of your last physical address outside the United States where you resided for more than one year. Max length: 9 characters
Country	Text	Enter the country name of your last physical address outside the United States where you resided for more than one year.
Province	Text	Enter the province (or state/region) of your last physical address outside the United States where you resided for more than one year. Max length: 20 characters
City or Town	Text	Enter the city or town of your last physical address outside the United States where you resided for more than one year. Max length: 20 characters
Apartment, Suite, or Floor	Text	If applicable, enter the apartment number, suite, or floor for your last physical address outside the United States where you resided for more than one year. Max length: 6 characters
Apt.	CheckBox	Check this box if your last physical address outside the United States includes an apartment number.
Ste.	CheckBox	Check this box if your last physical address outside the United States includes a suite number.
Flr.	CheckBox	Check this box if your last physical address outside the United States includes a floor number.
Street Number and Name	Text	Enter the street number and name of your last physical address outside the United States where you resided for more than one year. Max length: 34 characters
9.b. Date To	Date	Enter the date you (the spouse beneficiary) stopped residing at this address in MM/DD/YYYY format.
9.a. Date From	Date	Enter the date you (the spouse beneficiary) began residing at this address in MM/DD/YYYY format.
Attorney Information
Form G-28 Attached	CheckBox	Check this box if you have included Form G-28 (Notice of Entry of Appearance as Attorney or Accredited Representative) with your submission.
Attorney State Bar Number	Text	Enter the state bar license number of the attorney, if applicable. Leave blank if none applies.
Barcode Information
Footer Continuation Field	Text	Enter any additional footer text or continuation information that extends from the previous page’s footer into this space.
Certification
Preparer prepared form based on provided information	CheckBox	Check this box if, at your request, the preparer named in Part 6 prepared this form for you based only upon information you provided or authorized.
Preparer Name	Text	Enter the full name of the preparer as listed in Part 6 who prepared this form at your request.
I can read and understand English, and I have read and understand every question and instruction on this form and my answer to every question	CheckBox	Check this box if you can read and understand English and have read and understood every question, instruction, and answer on this form.
6.b Date of Signature (mm/dd/yyyy)	Date	Enter the date you signed the form in month/day/year format (mm/dd/yyyy).
Contact Information
Spouse Beneficiary Daytime Telephone Number	Text	Enter the spouse beneficiary’s primary daytime telephone number, including area code (for example, 555-123-4567). Max length: 13 characters
Spouse Beneficiary Email Address	Text	If available, enter the spouse beneficiary’s email address in a valid format (for example, [email protected]); otherwise leave this field blank. Max length: 38 characters
Spouse Beneficiary Mobile Telephone Number	Text	If available, enter the spouse beneficiary’s mobile telephone number, including area code (for example, 555-987-6543); otherwise leave this field blank. Max length: 13 characters
Employment Address
Employer 1 Apartment (Apt.)	CheckBox	Select this box if you need to provide an apartment number as part of Employer 1’s address.
Employer 1 Suite (Ste.)	CheckBox	Select this box if you need to provide a suite number as part of Employer 1’s address.
Employer 1 Floor (Flr.)	CheckBox	Select this box if you need to provide a floor number as part of Employer 1’s address.
Employer 1 Apartment/Suite/Floor	Text	If applicable, enter the apartment, suite, or floor number for your first employer’s address; otherwise leave blank. Max length: 6 characters
Employer 1 City or Town	Text	Enter the city or town where your first employer is located. Max length: 20 characters
Employer 1 Province	Text	If Employer 1’s address is outside the U.S., enter the province, territory, or region; otherwise leave blank. Max length: 20 characters
Employer 1 Postal Code	Text	If Employer 1’s address is outside the U.S., enter the postal code; otherwise leave blank. Max length: 9 characters
Employer 1 ZIP Code	Text	If Employer 1’s address is within the U.S., enter the five- or nine-digit ZIP Code; otherwise leave blank. Max length: 5 characters
Employer 1 State	ComboBox	If Employer 1’s address is within the U.S., enter the two-letter state abbreviation; otherwise leave blank. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Employer 2 Street Number and Name	Text	Enter the street number and street name for your second employer’s address. Max length: 34 characters
Employer 2 Apt.	CheckBox	Check this box if the second employer’s street address includes an apartment number.
Employer 2 Ste.	CheckBox	Check this box if the second employer’s street address includes a suite number.
Employer 2 Flr.	CheckBox	Check this box if the second employer’s street address includes a floor number.
Employer 2 Apartment, Suite, or Floor	Text	If applicable, enter the apartment, suite, or floor number for your second employer’s address; otherwise leave blank. Max length: 6 characters
Employer 2 City or Town	Text	Enter the city or town where your second employer is located. Max length: 20 characters
Employer 2 Province	Text	If your second employer’s address is outside the U.S., enter the province or region; otherwise leave blank. Max length: 20 characters
Employer 2 Postal Code	Text	If your second employer’s address is outside the U.S., enter the postal code; otherwise leave blank. Max length: 9 characters
Employment History
Employer 1 Street Number and Name	Text	Enter the street number and street name of your first employer’s address. Max length: 34 characters
Employer 1 Country	Text	Enter the country name for your first employer’s address.
Employer 1 Company Name	Text	Enter the full name of your first employer or company. If you are currently unemployed, type “Unemployed.” Max length: 34 characters
Employer 1 Occupation or Job Title	Text	Enter your occupation or job title with your first employer.
Employer 1 Employment Start Date	Date	Enter the date you began working for Employer 1 in MM/DD/YYYY format.
Employer 1 Employment End Date	Date	Enter the date you stopped working for Employer 1 in MM/DD/YYYY format; if you still work there, type “Present.”
Employer 2 ZIP Code	Text	Enter the ZIP code for your second employer’s U.S. address; leave blank if not applicable. Max length: 5 characters
Employer 2 State	ComboBox	Enter the state of your second employer’s address (U.S. addresses only); leave blank if not applicable. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Employer 2 Country	Text	Enter the country where your second employer is located.
Employer 2 Name of Employer/Company	Text	Enter the full name of your second employer or company. Max length: 34 characters
Occupation	Text	Enter the job title of your current U.S. employment (for example, "Software Engineer").
Start Date of Current Employment	Date	Enter the date your current U.S. employment began, in mm/dd/yyyy format.
End Date of Current Employment	Date	Enter the date your current U.S. employment ended, in mm/dd/yyyy format. If you are still employed, enter "Present".
First Employer City or Town	Text	Enter the city or town in which the first employer’s office or facility is located. Max length: 20 characters
First Employer Province	Text	Enter the province, region, or district for the first employer’s address outside the United States, if applicable. Max length: 20 characters
First Employer Postal Code	Text	If the country uses a postal code instead of a ZIP code, enter it here; otherwise, leave this field blank. Max length: 9 characters
First Employer ZIP Code	Text	If the country uses a ZIP code, enter it here; otherwise, leave this field blank. Max length: 5 characters
First Employer State	ComboBox	If applicable, enter the state, province, or region for the first employer’s address; if not used in that country, leave blank. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
First Employer Country	Text	Enter the name of the country where the first employer is located.
Employment Information
First Employer Street Number and Name	Text	Enter the street number and street name of the first employer’s address outside the United States (for example, 123 Main St). Max length: 34 characters
First Employer Apartment (Apt.)	CheckBox	Check this box if your first employer’s address outside the United States includes an apartment number.
First Employer Suite (Ste.)	CheckBox	Check this box if your first employer’s address outside the United States includes a suite number.
First Employer Floor (Flr.)	CheckBox	Check this box if your first employer’s address outside the United States includes a floor number.
First Employer Apartment/Suite/Floor	Text	If applicable, enter the apartment, suite, or floor number of the first employer’s address; otherwise, leave this field blank. Max length: 6 characters
Employment Outside the U.S.
First Employer Occupation	Text	Enter the job title or occupation you held with the first employer outside the United States.
First Employer Name	Text	Enter the full legal name of the first employer or company where you worked outside the United States. Max length: 34 characters
First Employer Employment Start Date	Date	Enter the date you began employment with the first employer outside the United States in mm/dd/yyyy format.
First Employer Employment End Date	Date	Enter the date you ended employment with the first employer outside the United States in mm/dd/yyyy format.
Form Metadata
Page Number	Text	Enter the sequential page number of this form (for example, 1 for the first page, 2 for the second, etc.).
Page Number	Text	Enter the sequential page number of this form (for example, 1 on the first page, 2 on the second, etc.).
Page Number	Text	Enter the current page number and total number of pages in the format “X of Y” (for example, “4 of 6”).
Form Processing
Footer Page Number	Text	Enter the numeric page number for this form page in the footer (for example, enter “6” if this is page 6 of 6).
Form Reference
Third Additional Information – Page Number	Text	Enter the page number on the main form that this third block of additional information refers to. Max length: 2 characters
Third Additional Information – Part Number	Text	Enter the part number on the main form that this third block of additional information refers to. Max length: 6 characters
Third Additional Information – Item Number	Text	Enter the item number on the main form that this third block of additional information refers to. Max length: 6 characters
Fourth Entry Page Number	Text	Enter the page number on the original form that this fourth additional information entry refers to. Max length: 2 characters
Fourth Entry Part Number	Text	Enter the part number on the original form that this fourth additional information entry refers to. Max length: 6 characters
Fourth Entry Item Number	Text	Enter the item number on the original form that this fourth additional information entry refers to. Max length: 6 characters
Fifth Additional Information – Page Number	Text	Enter the page number of this form or any attached sheet to which this additional information refers. Max length: 2 characters
Fifth Additional Information – Part Number	Text	Enter the part number on the form that this additional information relates to. Max length: 6 characters
Fifth Additional Information – Item Number	Text	Enter the item number within that part that this additional information addresses. Max length: 6 characters
Identification
Beneficiary A-Number	Text	Enter the beneficiary’s Alien Registration Number without the “A-” prefix (the numeric portion only). If the beneficiary does not have an A-Number, leave this field blank. Max length: 9 characters
Internal Use
Internal Reference	Text	Enter the internal reference number shown at the bottom center of the page footer exactly as it appears on this form page.
Interpreter Information
Interpreter’s Business or Organization Name (if any)	Text	Enter the full legal name of the interpreter’s business or organization. If the interpreter is not affiliated with a business or organization, leave this field blank. Max length: 34 characters
Interpreter’s Given Name (First Name)	Text	Enter the interpreter’s given name (first name) exactly as it appears on official documents. Include all middle names if applicable.
Interpreter’s Family Name (Last Name)	Text	Enter the interpreter’s family name (surname) exactly as it appears on official documents. Use letters only; do not include prefixes or suffixes.
Interpreter’s Signature	Text	Sign your name in ink as the interpreter who read and translated the form. Max length: 1 characters
Daytime Telephone Number	Text	Enter the interpreter’s primary daytime telephone number, including area code, in numeric format (for example, 555-123-4567). Max length: 10 characters
Email Address (if any)	Text	Enter the interpreter’s email address in standard format (for example, [email protected]). Leave blank if the interpreter does not have an email address.
Mobile Telephone Number (if any)	Text	Enter the interpreter’s mobile (cell) telephone number, including area code, in numeric format (for example, 555-987-6543). Leave blank if the interpreter does not have a mobile number. Max length: 13 characters
Interpreter Mailing Address
City or Town	Text	Enter the city or town of the interpreter’s mailing address. Max length: 20 characters
Street Number and Name	Text	Enter the interpreter’s street number and street name of their mailing address (for example, 123 Main St). Max length: 34 characters
Apt.	CheckBox	Check this box if the interpreter’s mailing address includes an apartment number.
Ste.	CheckBox	Check this box if the interpreter’s mailing address includes a suite number.
Flr.	CheckBox	Check this box if the interpreter’s mailing address includes a floor number.
Interpreter's Certification
Interpreter Certification Language	Text	Enter the non-English language in which the interpreter is fluent alongside English. This must match the language provided in Part 4, Item Number 1.b.
Interpreter's Mailing Address
Apartment / Suite / Floor Number	Text	If applicable, check the Apt., Ste., or Flr. box and enter the corresponding apartment, suite, or floor number here. Max length: 6 characters
Postal Code	Text	Enter the postal code for the interpreter’s mailing address if it is outside the United States. Max length: 9 characters
ZIP Code	Text	Enter the U.S. ZIP Code (5- or 9-digit) for the interpreter’s mailing address. Max length: 5 characters
State	ComboBox	Enter the two-letter U.S. state abbreviation for the interpreter’s address (e.g., NY, CA). AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Country	Text	Enter the full name of the country for the interpreter’s mailing address.
Province	Text	Enter the province or region for the interpreter’s mailing address if it is outside the United States. Max length: 20 characters
Interpreter's Signature
Date of Signature	Date	Enter the date you sign this form in mm/dd/yyyy format.
Legal Representation
Attorney or Accredited Representative USCIS Online Account Number	Text	Enter the USCIS online account number for the attorney or accredited representative, if any. Leave blank if not applicable. Max length: 12 characters
Volag Number	Number	Enter the Voluntary Agency (VOLAG) number assigned to the attorney or accredited representative, if any. Leave blank if none exists. Max length: 10 characters
Parent Information
Parent 1 Given Name (First Name)	Text	Type or print Parent 1’s given name (first name).
Parent 1 Middle Name	Text	Type or print Parent 1’s middle name. If Parent 1 has no middle name, leave this field blank.
Parent 1 City/Town/Village of Birth	Text	Enter the city, town, or village where Parent 1 was born. Max length: 38 characters
Parent 1 City/Town/Village of Residence	Text	Enter the city, town, or village where Parent 1 currently resides.
Parent 1 Country of Residence	Text	Enter the country where Parent 1 currently resides.
Parent 1 Country of Birth	Text	Enter the country where Parent 1 was born.
Parent 1 Date of Birth (mm/dd/yyyy)	Date	Enter Parent 1’s date of birth in the format month/day/year (e.g., 01/31/1980).
Parent 1 Family Name (Maiden Name)	Text	Type or print Parent 1’s family name (maiden name) exactly as it appears on their legal documents.
Parent 2 Date of Birth (mm/dd/yyyy)	Date	Enter Parent 2’s date of birth in month/day/year format (for example, 01/31/1970).
Parent 2 Country of Birth	Text	Enter the country where Parent 2 was born.
Parent 2 Country of Residence	Text	Enter the country where Parent 2 currently resides.
Parent 2 City/Town/Village of Residence	Text	Enter the current city, town, or village where Parent 2 resides.
Parent 2 City/Town/Village of Birth	Text	Enter the name of the city, town, or village where Parent 2 was born. Max length: 20 characters
Parent 2 Middle Name	Text	Enter the middle name of Parent 2. If Parent 2 does not have a middle name, leave this field blank.
Parent 2 Given Name (First Name)	Text	Enter the first name (given name) of Parent 2.
Parent 2 Family Name (Last Name)	Text	Enter the last name (family name) of Parent 2 exactly as it appears on their official documents.
Parent 1 Sex – Male	CheckBox	Check this box if Parent 1’s sex is male.
Parent 1 Sex – Female	CheckBox	Check this box if Parent 1’s sex is female.
Parent 2 Sex – Male	CheckBox	Check this box if Parent 2’s sex is male.
Parent 2 Sex – Female	CheckBox	Check this box if Parent 2’s sex is female.
Personal Information
Spouse Beneficiary Alien Registration Number (A-Number)	Text	Enter the spouse beneficiary’s USCIS Alien Registration Number (A-Number) exactly as shown on any USCIS documents. Provide the full number without spaces or dashes. If the spouse has no A-Number, leave this field blank. Max length: 9 characters
Spouse Beneficiary Family Name (Last Name)	Text	Type the spouse beneficiary’s family name (last name) exactly as shown on their legal documents.
Spouse Beneficiary Given Name (First Name)	Text	Type the spouse beneficiary’s given name (first name) exactly as shown on their legal documents.
Spouse Beneficiary Middle Name	Text	Type the spouse beneficiary’s middle name. If they do not have a middle name, leave this field blank.
Spouse Beneficiary USCIS Online Account Number	Text	Enter the spouse beneficiary’s USCIS Online Account Number if they have created one. Provide the full account number as displayed in their USCIS online profile. Leave blank if none. Max length: 12 characters
Beneficiary Family Name (Last Name)	Text	Enter the beneficiary’s family name (surname) exactly as it appears on official documents.
Beneficiary Given Name (First Name)	Text	Enter the beneficiary’s given name (first name) exactly as it appears on official documents.
Beneficiary Middle Name	Text	Enter the beneficiary’s middle name exactly as it appears on official documents. If there is no middle name, leave this field blank.
Preparer Information
Preparer’s Given Name (First Name)	Text	Enter the first name of the individual who prepared this form.
Preparer’s Business or Organization Name	Text	If the preparer operates through a business or organization, enter its full name here; otherwise leave this field blank. Max length: 34 characters
Preparer’s Family Name (Last Name)	Text	Enter the family name (last name) of the individual who prepared this form.
City or Town	Text	Enter the city or town for the preparer’s mailing address. Max length: 20 characters
Street Number and Name	Text	Enter the street number and street name of the preparer’s mailing address. Max length: 34 characters
Representation does not extend beyond the preparation of this form.	CheckBox	Check this box if your representation of the spouse beneficiary is limited solely to preparing this form.
Preparer’s Signature	Text	Sign your name in ink as the person who prepared this form. Max length: 1 characters
Date of Signature	Date	Enter the date you signed the form in MM/DD/YYYY format.
Preparer's Contact Information
Mobile Telephone Number (if any)	Text	Enter the preparer’s mobile telephone number, including area code (for example, 123-456-7890). Leave blank if not applicable. Max length: 13 characters
Daytime Telephone Number	Text	Enter the preparer’s daytime telephone number, including area code (for example, 123-456-7890). Use digits only. Max length: 13 characters
Email Address (if any)	Text	Enter the preparer’s email address in standard format (for example, [email protected]). Leave blank if not applicable.
Preparer's Mailing Address
Apartment (Apt.)	CheckBox	Check this box if the preparer's mailing address includes an apartment number.
Suite (Ste.)	CheckBox	Check this box if the preparer's mailing address includes a suite number.
Floor (Flr.)	CheckBox	Check this box if the preparer's mailing address includes a floor number.
Apartment, Suite, or Floor	Text	If applicable, enter the apartment, suite, or floor designation for the preparer’s mailing address; leave blank if none. Max length: 6 characters
Postal Code	Text	Enter the postal code (for non-U.S. addresses) of the preparer’s mailing address; leave blank if using a U.S. ZIP Code. Max length: 9 characters
ZIP Code	Text	Enter the U.S. ZIP Code for the preparer’s mailing address; leave blank if using a non-U.S. postal code. Max length: 5 characters
State	ComboBox	Enter the two-letter U.S. state abbreviation for the preparer’s mailing address; leave blank for non-U.S. addresses. AR WV AZ WI IA CO MA CA WY MI ND AA DE FM VI FL TX HI NM MH MO RI AL MN PA DC KS SD VT AP OH CT MP ID OK AK WA UT KY MD GU NV IN ME LA NC NE IL NJ MS VA MT AE GA AS NH NY TN OR PW PR SC
Country	Text	Enter the country name for the preparer’s mailing address.
Province	Text	Enter the province, district, or region for the preparer’s mailing address when the address is outside the United States; leave blank for U.S. addresses. Max length: 20 characters
Preparer's Statement
I am not an attorney or accredited representative but have prepared this form on behalf of the spouse beneficiary and with the spouse beneficiary's consent.	CheckBox	Check this box if you are not an attorney or accredited representative and you prepared this form on behalf of the spouse beneficiary with their consent.
I am an attorney or accredited representative and my representation of the spouse beneficiary in this case	CheckBox	Check this box if you are an attorney or accredited representative representing the spouse beneficiary in this case.
Representation extends beyond the preparation of this form.	CheckBox	Check this box if your representation of the spouse beneficiary extends beyond preparing this form.
Spouse Beneficiary's Certification
6.a Spouse Beneficiary’s Signature	Text	Sign your name in ink in this field as the spouse beneficiary.
Spouse Beneficiary's Statement
1.b. Interpreter read questions and answers	CheckBox	Check this box if the interpreter named in Part 5 read every question and instruction on this form and your answer to every question to you in a language in which you are fluent.
Language Read by Interpreter	Text	Enter the name of the language in which the interpreter named in Part 5 read every question and instruction on this form and your answers, using a language in which you are fluent and fully understood everything.

Form I-130A, Supplemental Info for Spouse Beneficiary Instructions