Official Federal Forms > US Citizenship And Immigration Services
Supplement A Application For Immediate Family Member Of T-1 Recipient I-914 - Official Federal Forms
| Supplement A Application For Immediate Family Member Of T-1 Recipient Form. This is a national form and can be used in US Citizenship And Immigration Services . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
OMB No. 1615-0099 Department of Homeland Security U.S. Citizenship and Immigration Services I-914, Supplement A, Application for Immediate Family Member of T-1 Recipient For USCIS Use Only Returned Date Date Resubmitted Date Date Reloc Sent Date Receipt START HERE - Type or print. Use black ink. See Instructions for information about eligibility and how to complete and file this application. The recipient of the T nonimmigrant classification is referred to as the principal applicant. His or her family member(s) is referred to as a derivative applicant. Form I-914, Supplement A, is to be completed by the principal applicant. PART A. Family Member Relationship to You (the principal) The family member that I am filing for is my: (Check one) Husband/Wife Child Parent Unmarried Sibling Under Age 18 PART B. General Information About You (the principal) Family Name (Last Name) Date of Birth (mm/dd/yyyy) Given Name (First Name) A # (if any) Middle Name (if any) Date Reloc Rec'd Date Date Validity Dates From: To: Status of your Form I-914, Application for T Nonimmigrant Status: (Check one) Filing this Form I-914, Supplement A, concurrently Pending Approved PART C. Information About Your Family Member (the derivative) Family Name (Last Name) Given Name (First Name) Middle Name (if any) Other Names Used (include maiden name/nickname) Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship Remarks Residence or Intended Residence in the U.S. - Street Number and Name City State Zip Code Apt. # Conditional Approval Stamp # Date Safe Mailing Address (if other than above) - Street Number and Name C/O (in care of): City Home Telephone # (with area code) A # (if any) State/Province Safe Daytime Phone # (with area code) Apt. # Action Block Zip/Postal Code I-94 # (Arrival-Departure Document) Gender Male Female Widowed Form I-914, Supplement A (Rev. 02/01/11) Y To Be Completed by Attorney or Representative, if any Fill in box if G-28 is attached to represent the applicant. ATTY State License # U.S. Social Security # (if any) Marital Status: Married Single/Never Married Divorced American LegalNet, Inc. www.FormsWorkFlow.com PART C. Information About Your Family Member (Continued) 1. Give the following information about your family member if he or she is currently in the United States. Place of Last Entry Passport # Date of Last Entry (mm/dd/yyyy) Place of Issuance Current Immigration Status Date of Issue (mm/dd/yyyy) 2. Give the following information about your family member if he or she has previously traveled to the United States. Place of Entry Date of Entry (mm/dd/yyyy) Date Authorized Stay Expired (mm/dd/yyyy) Immigration Status 3. If your family member was previously married, list names of prior spouses and dates of termination of marriage. Documents such as divorce decrees or death certificates must be attached. Name of Former Spouse(s) Date Marriage Ended (mm/dd/yyyy) Where and How Marriage Ended 4. If your family member is outside the United States, indicate the U.S. consulate or inspection facility you want notified if this application is approved. Type of Office (Check one): Office Address (City) Consulate Pre-Flight Inspection Port of Entry U.S. State or Foreign Country Foreign Address Where You Want Notification Sent 5. Has your family member ever been in immigration proceedings? If "Yes," what type of proceedings? (Check all that apply) Removal Date (mm/dd/yyyy) Exclusion Date (mm/dd/yyyy) Deportation Date (mm/dd/yyyy) Rescission Date (mm/dd/yyyy) Yes No Judicial Date (mm/dd/yyyy) Form I-914, Supplement A (Rev. 02/01/11) Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com PART C. Information About Your Family Member (Continued) Yes No 6. Is your family member requesting an Employment Authorization Document? (If "Yes," submit Form I-765, Application for Employment Authorization Document, separately.) NOTE: If your family member is living outside the United States, he or she is not eligible to receive employment authorization until he or she is lawfully admitted to the United States. Do not file Form I-765 for a family member living outside the United States. PART D. Processing Information Answer the following questions about your family member. For the purposes of this application, if applicable, you must answer "Yes" to the following questions even if the records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that your family member no longer has a record. (If your answer is "Yes" to any one of these questions, explain on a separate sheet of paper. Answering "Yes" does not necessarily mean that your family member will be denied T nonimmigrant status.) 1. Has the family member for whom you are filing EVER: a. Committed a crime or offense for which he or she has not been arrested? b. Been arrested, cited, or detained by any law enforcement officer (including DHS, former INS, and military officers) for any reason? c. Been charged with committing any crime or offense? d. Been convicted of a crime or offense (even if violation was subsequently expunged or pardoned)? e. Been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)? f. Received a suspended sentence, been placed on probation, or been paroled? g. Been in jail or prison? h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No If the answer is "Yes" to any of the above questions, complete the following table. If you need more space, use a separate sheet of paper. Why was the family member for whom Date of arrest, you are filing arrested, cited, detained, citation, or charged? detention, charge (mm/dd/yyyy) Where was the family member for whom you are filing arrested, cited, detained, or charged? (City, State, Country) Outcome or disposition (e.g., no charges filed, charges dismissed, jail, probation, etc.) Form I-914, Supplement A (Rev. 02/01/11) Y Page 3 American LegalNet, Inc. www.FormsWorkFlow.com PART D. Processing Information (Continued) Yes No 2. Has the family member for whom you are filing EVER received public assistance in the United States from any source, including the U.S. Government or any State, county, city or other municipality
|
|||||||
