This form contains 194 fields organized into 40 sections, giving it a Form Complexity Index of 77/100 (complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Information Entry 3 (Page/Part/Item and Details)
Reference Page Number	Text	Enter the page number of the form page that this additional information refers to. Max length: 2 characters
Reference Part Number	Text	Enter the part number of the form section that this additional information relates to. Max length: 6 characters
Reference Item Number	Text	Enter the item number within the referenced part that this additional information is answering or explaining. Max length: 6 characters
Additional Information Details	Text	Provide the full additional information or explanation that corresponds to the page, part, and item number listed above.
Additional Information Entry 4 (Page/Part/Item and Details)
Reference Page Number	Text	Enter the page number of the form that this additional information refers to. Max length: 2 characters
Reference Part Number	Text	Enter the part number of the form that this additional information refers to. Max length: 6 characters
Reference Item Number	Text	Enter the item number of the form that this additional information refers to. Max length: 6 characters
Additional Information Details	Text	Provide the additional information or explanation that corresponds to the referenced page, part, and item number.
Additional Information Entry 5 (Page/Part/Item and Details)
Page Number (Reference)	Text	Enter the page number of the form page that this additional information refers to. Max length: 2 characters
Part Number (Reference)	Text	Enter the part number of the form section that this additional information refers to. Max length: 6 characters
Item Number (Reference)	Text	Enter the item number or letter on the form that this additional information refers to. Max length: 6 characters
Additional Information Details	Text	Provide the additional information or explanation for the referenced page, part, and item number.
Additional Information Entry 6 (Page/Part/Item and Details)
Page Number (Additional Information Entry 6)	Text	Enter the page number of the form that the additional information in this entry refers to. Max length: 2 characters
Part Number (Additional Information Entry 6)	Text	Enter the part number of the form that the additional information in this entry refers to. Max length: 6 characters
Item Number (Additional Information Entry 6)	Text	Enter the item number of the form that the additional information in this entry refers to. Max length: 6 characters
Additional Information Details (Entry 6)	Text	Provide the additional information or explanation for the specified page, part, and item number.
Additional Information Entry 7 (Page/Part/Item and Details)
Page Number (Reference)	Text	Enter the page number of the form that the additional information in this entry relates to. Max length: 2 characters
Part Number (Reference)	Text	Enter the part number of the form that the additional information in this entry relates to. Max length: 6 characters
Item Number (Reference)	Text	Enter the item number (such as 1.a or 2) of the form that the additional information in this entry relates to. Max length: 6 characters
Additional Information Details	Text	Provide the additional information or explanation that corresponds to the referenced page, part, and item number.
Applicant Name and A-Number
Family Name (Last Name)	Text	Enter the applicant’s family name (last name/surname).
Given Name (First Name)	Text	Enter the applicant’s given name (first name).
Middle Name	Text	Enter the applicant’s middle name, if any.
A-Number	Text	Enter the applicant’s USCIS A-Number (Alien Registration Number), if any. Max length: 9 characters
Attorney or Accredited Representative Information
Form G-28 attached	Checkbox	Check this box if a completed Form G-28 (Notice of Entry of Appearance as Attorney or Accredited Representative) is attached to this filing.
Attorney State Bar Number	Text	Enter the attorney’s state bar number, if applicable. Fill only if 'Form G-28 attached' is 'Yes'. 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
Volag Number	Number	Enter the attorney or accredited representative’s Volag (Voluntary Agency) number, if any. Fill only if 'Form G-28 attached' is 'Yes'. Max length: 10 characters Depends on: Form G-28 attached
Employer 1 Employment Details
Employer 1 Street Address	Text	Enter the street number and street name of your employer’s address. Max length: 34 characters
Apt.	Checkbox	Check this box if the Employer 1 address includes an apartment number.
Ste.	Checkbox	Check this box if the Employer 1 address includes a suite number.
Flr.	Checkbox	Check this box if the Employer 1 address includes a floor number.
Employer 1 Address Unit	Text	Enter the apartment, suite, or floor number for your employer’s address, if applicable. Fill only if 'Apt.', 'Ste.', 'Flr.' is 'Yes' (any). Max length: 6 characters Depends on: Apt., Ste., Flr.
Employer 1 City or Town	Text	Enter the city or town where your employer is located. Max length: 20 characters
Employer 1 Province	Text	Enter the province for your employer’s address, if applicable. Max length: 20 characters
Employer 1 Postal Code	Text	Enter the postal code for your employer’s address, if applicable. Max length: 9 characters
Employer 1 ZIP Code	Text	Enter the ZIP code for your employer’s address. Max length: 5 characters
Employer 1 State	Combobox	Enter the state where your employer is located. 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 1 Country	Text	Enter the country where your employer is located.
Employer 1 Name	Text	Enter the name of your employer or company for this job. Max length: 34 characters
Employer 1 Occupation	Text	Enter your job title or occupation for this employer.
Employer 1 Employment Start Date	Date	Enter the date you started working for this employer.
Employer 1 Employment End Date	Date	Enter the date you stopped working for this employer.
Employer 2 Employment Details
Employer 2 Street Address	Text	Enter Employer 2’s street number and street name. Max length: 34 characters
Apt.	Checkbox	Check this box if the Employer 2 street address is an apartment number.
Ste.	Checkbox	Check this box if the Employer 2 street address includes a suite number.
Flr.	Checkbox	Check this box if the Employer 2 street address includes a floor number.
Employer 2 Address Unit (Apt/Ste/Flr)	Text	Enter Employer 2’s apartment, suite, or floor number, if applicable. Fill only if 'Apt.', 'Ste.', 'Flr.' is 'Yes' (any). Max length: 6 characters Depends on: Apt., Ste., Flr.
Employer 2 City or Town	Text	Enter the city or town where Employer 2 is located. Max length: 20 characters
Employer 2 Province	Text	Enter the province where Employer 2 is located, if applicable. Max length: 20 characters
Employer 2 Postal Code	Text	Enter Employer 2’s postal code, if applicable. Max length: 9 characters
Employer 2 ZIP Code	Text	Enter Employer 2’s ZIP Code. Max length: 5 characters
Employer 2 State	Combobox	Enter the state where Employer 2 is located. 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 Employer 2 is located.
Employer 2 Name	Text	Enter the name of your second employer or company. Max length: 34 characters
Footer Field
Page Number	Text	Enter the page number shown for this form page.
Form Footer Barcode/Tracking Field
Form Footer Barcode/Tracking Code	Text	Enter the barcode or tracking code printed in the footer of the form, if applicable.
Form Footer Field
Form footer tracking field	Text	Enter the internal tracking value shown in the form footer (if any).
Form Footer Identifier
Footer Identifier	Text	Enter the identifier text that should appear in the form footer for tracking or internal reference purposes.
Interpreter Certification (Fluent Language)
Other Fluent Language	Text	Enter the other language (in addition to English) that the interpreter is fluent in and used to interpret the form. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Interpreter Contact Information
Interpreter Daytime Telephone Number	Text	Enter the interpreter’s daytime telephone number. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 10 characters Depends on: Interpreter read form to me (Part 5)
Interpreter Email Address	Text	Enter the interpreter’s email address, if any. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Interpreter Mobile Telephone Number	Text	Enter the interpreter’s mobile telephone number, if any. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 13 characters Depends on: Interpreter read form to me (Part 5)
Interpreter Mailing Address
City or Town	Text	Enter the interpreter's city or town for their mailing address. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 20 characters Depends on: Interpreter read form to me (Part 5)
Street Number and Name	Text	Enter the interpreter's street number and street name for their mailing address. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 34 characters Depends on: Interpreter read form to me (Part 5)
Apt.	Checkbox	Check this box if the interpreter’s mailing address includes an apartment number. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Ste.	Checkbox	Check this box if the interpreter’s mailing address includes a suite number. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Flr.	Checkbox	Check this box if the interpreter’s mailing address includes a floor number. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Apt/Suite/Floor	Text	Enter the interpreter's apartment, suite, or floor number for their mailing address, if applicable. Fill only if 'Apt.', 'Ste.', 'Flr.' any is 'Yes'. Max length: 6 characters Depends on: Apt., Ste., Flr.
Postal Code	Text	Enter the interpreter's postal code for their mailing address (if applicable). Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 9 characters Depends on: Interpreter read form to me (Part 5)
ZIP Code	Text	Enter the interpreter's ZIP code for their mailing address (if applicable). Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 5 characters Depends on: Interpreter read form to me (Part 5)
State	Combobox	Enter the interpreter's state for their mailing address. 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 interpreter's country for their mailing address. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Province	Text	Enter the interpreter's province for their mailing address (if applicable). Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 20 characters Depends on: Interpreter read form to me (Part 5)
Interpreter Name and Organization
Interpreter Business or Organization Name	Text	Enter the name of the interpreter’s business or organization, if any. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 34 characters Depends on: Interpreter read form to me (Part 5)
Interpreter Given Name (First Name)	Text	Enter the interpreter’s given name (first name). Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Interpreter Family Name (Last Name)	Text	Enter the interpreter’s family name (last name). Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Interpreter Signature and Date
Date of Signature	Date	Enter the date the interpreter signed the certification. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
Interpreter Signature	Text	Enter the interpreter’s signature to certify the accuracy of the interpretation and the completed form responses. Fill only if 'The interpreter named in Part 5. read to me every question and instruction on this form' is 'Yes'. Max length: 1 characters Depends on: Interpreter read form to me (Part 5)
Item 9 Date Range
Date To	Date	Enter the end date for the period covered in Item 9.
Date From	Date	Enter the start date for the period covered in Item 9.
Last Physical Address Outside the United States
Postal Code (Outside U.S.)	Text	Enter the postal code for your last physical address outside the United States. Max length: 9 characters
Country (Outside U.S.)	Text	Enter the country where your last physical address outside the United States is located.
Province (Outside U.S.)	Text	Enter the province, state, region, or equivalent for your last physical address outside the United States. Max length: 20 characters
City or Town (Outside U.S.)	Text	Enter the city or town of your last physical address outside the United States. Max length: 20 characters
Apartment/Suite/Floor (Outside U.S.)	Text	Enter the apartment, suite, or floor identifier for your last physical address outside the United States, if applicable. 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 (Outside U.S.)	Text	Enter the street number and street name of your last physical address outside the United States. Max length: 34 characters
Parent 1 Identification and Demographics
Parent 1 Given Name (First Name)	Text	Enter Parent 1's given name (first name).
Parent 1 Middle Name	Text	Enter Parent 1's middle name, if any.
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 lives.
Parent 1 Country of Residence	Text	Enter the country where Parent 1 currently lives.
Parent 1 Country of Birth	Text	Enter the country where Parent 1 was born.
Parent 1 Date of Birth	Date	Enter Parent 1's date of birth.
Parent 1 Family Name (Maiden Name)	Text	Enter Parent 1's family name (last name), including maiden name if applicable.
Male	Checkbox	Check this box if Parent 1's sex is male.
Female	Checkbox	Check this box if Parent 1's sex is female.
Parent 2 Identification and Demographics
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 Country of Residence	Text	Enter the country where Parent 2 currently lives.
Parent 2 City/Town/Village of Residence	Text	Enter the city, town, or village where Parent 2 currently lives.
Parent 2 City/Town/Village of Birth	Text	Enter the city, town, or village where Parent 2 was born. Max length: 20 characters
Parent 2 Middle Name	Text	Enter Parent 2's middle name.
Parent 2 Given Name (First Name)	Text	Enter Parent 2's given name (first name).
Parent 2 Family Name (Last Name)	Text	Enter Parent 2's family name (last name).
Male	Checkbox	Check this box if Parent 2's sex is male.
Female	Checkbox	Check this box if Parent 2's sex is female.
Part 2 Employment (continued) - Occupation and Dates
Occupation	Text	Enter your occupation or job title for this period of employment.
Employment Start Date	Date	Provide the date you began this job or occupation.
Employment End Date	Date	Provide the date you ended this job or occupation.
Part 3 Employment Outside the United States - Employer Address
Employer Street Number and Name	Text	Enter the street number and street name of your employer/company address outside the United States. Max length: 34 characters
Apt.	Checkbox	Check this box if the employer/company street address includes an apartment number.
Ste.	Checkbox	Check this box if the employer/company street address includes a suite number.
Flr.	Checkbox	Check this box if the employer/company street address includes a floor number.
Employer Address Unit (Apt/Ste/Flr)	Text	Enter the apartment, suite, or floor number for your employer/company address, if applicable. Max length: 6 characters
Employer City or Town	Text	Enter the city or town of your employer/company address outside the United States. Max length: 20 characters
Employer Province	Text	Enter the province of your employer/company address outside the United States, if applicable. Max length: 20 characters
Employer Postal Code	Text	Enter the postal code for your employer/company address outside the United States, if applicable. Max length: 9 characters
Employer ZIP Code	Text	Enter the ZIP code for your employer/company address, if applicable. Max length: 5 characters
Employer State	Combobox	Enter the state of your employer/company address outside the United States, if 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 Country	Text	Enter the country where your employer/company address is located.
Part 3 Employment Outside the United States - Employer/Company Name
Employer/Company Name (Outside U.S.)	Text	Enter the full name of the employer or company you worked for outside the United States. Max length: 34 characters
Part 3 Employment Outside the United States - Occupation and Dates
Occupation Outside the United States	Text	Enter your occupation for the employment you held outside the United States.
Employment Start Date (Outside the United States)	Date	Enter the date you started this job outside the United States.
Employment End Date (Outside the United States)	Date	Enter the date you ended this job outside the United States.
Part 4 Spouse Beneficiary Statement - English vs Interpreter Selection and Interpreter Language
Interpreter read form to me (Part 5)	Checkbox	Check this box if the interpreter listed in Part 5 read every question and instruction to you in a language you are fluent in and you understood everything, and your answers to every question.
Interpreter Language	Text	Enter the language in which the interpreter read the form to you and translated your answers. Fill only if 'Interpreter read form to me (Part 5)' is 'Yes'. Depends on: Interpreter read form to me (Part 5)
I can read and understand English	Checkbox	Check this box if you read and understood every question and instruction on this form in English and your answers to every question.
Part 4 Spouse Beneficiary Statement - Preparer Selection and Preparer Name
Preparer prepared this form at my request	Checkbox	Check this box if you requested the preparer named in Part 6 to prepare this form based only on information you provided or authorized.
Preparer Name (Requested)	Text	Enter the full name of the person who prepared this form for you at your request (the preparer named in Part 6). Fill only if 'Preparer prepared this form at my request' is 'Yes'. Depends on: Preparer prepared this form at my request
Physical Address 1 (Address History)
Physical Address 1 Street Number and Name	Text	Enter the street number and street name for your first physical address in the address history. Max length: 34 characters
Apt.	Checkbox	Check this box if your Physical Address 1 includes an apartment number.
Ste.	Checkbox	Check this box if your Physical Address 1 includes a suite number.
Flr.	Checkbox	Check this box if your Physical Address 1 includes a floor number.
Physical Address 1 Apartment/Suite/Floor	Text	Enter the apartment, suite, or floor identifier for this address, if any. Max length: 6 characters
Physical Address 1 City or Town	Text	Enter the city or town for this address. Max length: 20 characters
Physical Address 1 State	Combobox	Enter the state for this address. 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	Enter the ZIP code for this address. Max length: 5 characters
Physical Address 1 Province	Text	Enter the province for this address, if applicable. Max length: 20 characters
Physical Address 1 Country	Text	Enter the country for this address.
Physical Address 1 Postal Code	Text	Enter the postal code for this address, if applicable. Max length: 9 characters
Physical Address 1 Date From	Date	Enter the date you started living at this address.
Physical Address 1 Date To	Date	Enter the date you stopped living at this address (or the current date if you still live there).
Physical Address 2 (Address History)
Street number and name	Text	Enter the street number and street name for Physical Address 2. Max length: 34 characters
Apt.	Checkbox	Check this box if your Physical Address 2 includes an apartment number.
Ste.	Checkbox	Check this box if your Physical Address 2 includes a suite number.
Flr.	Checkbox	Check this box if your Physical Address 2 includes a floor number.
Apartment/Suite/Floor	Text	Enter the apartment, suite, or floor number (as applicable) for Physical Address 2. Max length: 6 characters
City or town	Text	Enter the city or town for Physical Address 2. Max length: 20 characters
State	Combobox	Enter the state for Physical Address 2. 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
ZIP code	Text	Enter the ZIP code for Physical Address 2. Max length: 5 characters
Province	Text	Enter the province for Physical Address 2, if applicable. Max length: 20 characters
Country	Text	Enter the country for Physical Address 2.
Postal code	Text	Enter the postal code for Physical Address 2, if applicable. Max length: 9 characters
Date from	Date	Enter the date when you began living at Physical Address 2.
Date to	Date	Enter the date when you stopped living at Physical Address 2.
Preparer Mailing Address
Preparer City or Town	Text	Enter the city or town for the preparer’s mailing address. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 20 characters Depends on: Preparer prepared this form at my request
Preparer Street Address	Text	Enter the preparer’s street number and street name. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 34 characters Depends on: Preparer prepared this form at my request
Apt.	Checkbox	Check this box if the preparer’s mailing address is an apartment number. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Ste.	Checkbox	Check this box if the preparer’s mailing address is a suite number. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Flr.	Checkbox	Check this box if the preparer’s mailing address includes a floor number. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer Address Unit (Apt/Ste/Flr)	Text	Enter the preparer’s apartment, suite, or floor number, if applicable. Fill only if 'Apt.', 'Ste.', 'Flr.' any is 'Yes'. Max length: 6 characters Depends on: Apt., Ste., Flr.
Preparer Postal Code	Text	Enter the postal code for the preparer’s mailing address, if applicable. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 9 characters Depends on: Preparer prepared this form at my request
Preparer ZIP Code	Text	Enter the ZIP code for the preparer’s mailing address. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 5 characters Depends on: Preparer prepared this form at my request
Preparer State	Combobox	Enter the state for the preparer’s mailing address. 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
Preparer Country	Text	Enter the country for the preparer’s mailing address. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer Province	Text	Enter the province for the preparer’s mailing address, if applicable. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 20 characters Depends on: Preparer prepared this form at my request
Preparer Name and Organization
Preparer Given Name (First Name)	Text	Enter the preparer’s given name (first name). Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer Business or Organization Name	Text	Enter the name of the preparer’s business or organization, if any. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Max length: 34 characters Depends on: Preparer prepared this form at my request
Preparer Family Name (Last Name)	Text	Enter the preparer’s family name (last name). Fill only if 'At my request, the preparer named in Part 6. prepared this form for me' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer's Contact Information
Preparer Mobile Telephone Number	Text	Enter the preparer’s mobile telephone number, if any. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Max length: 13 characters Depends on: Preparer prepared this form at my request
Preparer Daytime Telephone Number	Text	Enter the preparer’s daytime telephone number where they can be reached. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Max length: 13 characters Depends on: Preparer prepared this form at my request
Preparer Email Address	Text	Enter the preparer’s email address, if any. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer's Signature
Preparer's Signature Additional Information	Text	Provide any additional information related to the preparer’s signature if required for this form section. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer's Signature	Text	Enter the preparer’s signature as it appears when signing the form. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Max length: 1 characters Depends on: Preparer prepared this form at my request
Date of Signature	Date	Enter the date the preparer signed the form. Fill only if 'At my request, the preparer name in Part 6., prepared this form for me based only upon information I provided or authorized.' is 'Yes'. Depends on: Preparer prepared this form at my request
Preparer's Statement
Not an attorney or accredited representative	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. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me based only upon information I provided or authorized' is 'Yes'. Depends on: Preparer prepared this form at my request
Attorney or accredited representative	Checkbox	Check this box if you are an attorney or accredited representative preparing this form and representing the spouse beneficiary in this case. Fill only if 'At my request, the preparer named in Part 6. prepared this form for me based only upon information I provided or authorized' is 'Yes'. Depends on: Preparer prepared this form at my request
Representation extends beyond preparation of this form	Checkbox	Check this box if your representation of the spouse beneficiary in this case extends beyond preparing this form. Fill only if 'Attorney or accredited representative' is 'Yes'. Depends on: Attorney or accredited representative
Representation does not extend beyond preparation of this form	Checkbox	Check this box if your representation of the spouse beneficiary in this case is limited to preparing this form only. Fill only if 'Attorney or accredited representative' is 'Yes'. Depends on: Attorney or accredited representative
Spouse Beneficiary Contact Information
Spouse beneficiary daytime phone number	Text	Enter the spouse beneficiary's daytime telephone number. Max length: 13 characters
Spouse beneficiary email address	Text	Enter the spouse beneficiary's email address, if any. Max length: 38 characters
Spouse beneficiary mobile phone number	Text	Enter the spouse beneficiary's mobile telephone number, if any. Max length: 13 characters
Spouse Beneficiary Full Name
Family Name (Last Name)	Text	Enter the spouse beneficiary's family name (last name/surname).
Given Name (First Name)	Text	Enter the spouse beneficiary's given name (first name).
Middle Name	Text	Enter the spouse beneficiary's middle name, if any.
Spouse Beneficiary Identifiers
Alien Registration Number (A-Number)	Text	Enter your Alien Registration Number (A-Number), if you have one. Max length: 9 characters
USCIS Online Account Number	Text	Enter your USCIS Online Account Number, if you have one. Max length: 12 characters
Spouse Beneficiary Signature and Date
Date of Signature	Date	Enter the date on which the spouse beneficiary signed this form.
Spouse Beneficiary Signature	Text	Enter the spouse beneficiary’s full legal signature.
Unlabeled Page Identifier Field
Page Identifier	Text	Enter the page identifier text shown or required for this form page (used to label or track the page).

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