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Supplement To Form I-924 I-924A - Official Federal Forms
| Supplement To Form I-924 Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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OMB No. 1615-0061; Expires 01/31/2015 Department of Homeland Security U.S. Citizenship and Immigration Services Form I-924A, Supplement to Form I-924 Part 1. Information About Principal of the Regional Center Name: Last First Middle In Care Of: Street Address/P.O. Box: City: Date of Birth (mm/dd/yyyy): Web site address: USCIS-assigned number for the Designated Regional Center (attach the Regional Center's most recently issued approval notice) Fax Number (include area code): State: Zip Code: Telephone Number (include area code): Part 2. Application Type (check one) a. Supplement for the Fiscal Year Ending September 30, (YYYY) (YYYY) and Ending on September 30, (YYYY) b. Supplement for a Series of Fiscal Years Beginning on October 1, Part 3. Information About the Regional Center (Use a continuation sheet, if needed, to provide information for additional management companies/agencies, regional center principals, agents, individuals, or entities who are or will be involved in the management, oversight, and administration of the regional center.) A. Name of Regional Center: Street Address/P.O. Box: City: Web site Address: B. Name of Managing Company/Agency: Street Address/P.O. Box: City: Web site Address: C. Name of Other Agent: Street Address/P.O. Box: City: Web site Address: State: Fax Number (include area code): Zip Code: Telephone (include area code): Form I-924A 01/03/13 Y Page 1 American LegalNet, Inc. www.FormsWorkFlow.com State: Fax Number (include area code): Zip Code: Telephone (include area code): State: Fax Number (include area code): Zip Code: Telephone (include area code): Part 3. Information About the Regional Center (Continued) Answer the following questions for the time period identified in Part 2 of this form. Note: If extra space is needed to complete any item, attach a continuation sheet, indicate the item number, and provide the response. 1. Identify the aggregate EB-5 capital investment and job creation has been the focus of EB-5 capital investments sponsored through the regional center. (Note: Separately identify jobs maintained through investments in "troubled businesses.") Aggregate EB-5 Capital Investment Aggregate Direct and Indirect Job Creation Aggregate Jobs Maintained 2. Identify each industry that has been the focus of EB-5 capital investments sponsored through the Regional Center, and the resulting aggregate EB-5 capital investment and job creation. (Note: Separately identify jobs maintained through investments in "troubled businesses".) a. Industry Category Title: NAICS Code for the Industry Category Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: b. Industry Category Title: NAICS Code for the Industry Category Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: c. Industry Category Title: NAICS Code for the Industry Category Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: 3. Provide the following information for each job creating commercial enterprise located within the geographic scope of your regional center that has received EB-5 investor capital: a. Name of Commercial Enterprise: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: Does this EB-5 commercial enterprise serve as a vehicle for investment into other business entities that have or will create or maintain jobs for EB-5 purposes? No Yes Form I-924A 01/03/13 Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About the Regional Center (Continued) If yes, then identify the name and address of each job creating business, as well as the amount of EB-5 capital investment and job creation/maintenance associated with each job creating business. (1) Business Name: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: EB-5 Capital Investment: Direct and Indirect Job Creation: Jobs Maintained: (2) Business Name Industry Category Title: Address (Street Number and Name): City: State: Zip Code: EB-5 Capital Investment: Direct and Indirect Job Creation: Jobs Maintained: b. Name of Commercial Enterprise: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: Does this EB-5 commercial enterprise serve as a vehicle for investment into other business entities that have or will create or maintain jobs for EB-5 purposes? No Yes If yes, then identify the name and address of each job creating business, as well as the amount of EB-5 capital investment and job creation/maintenance associated with each job creating business. (1) Business Name: Industry Category Title: Address (Street Number and Name): City: State: Zip Code EB-5 Capital Investment Direct and Indirect Job Creation Jobs Maintained Form I-924A 01/03/13 Y Page 3 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About the Regional Center (Continued) (2) Business Name: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: EB-5 Capital Investment: Direct and Indirect Job Creation: Jobs Maintained: c. Name of Commercial Enterprise: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: Aggregate EB-5 Capital Investment: Aggregate Direct and Indirect Job Creation: Aggregate Jobs Maintained: Does this EB-5 commercial enterprise serve as a vehicle for investment into other business entities that have or will create or maintain jobs for EB-5 purposes? No Yes If yes, then identify the name and address of each job creating business, as well as the amount of EB-5 capital investment and job creation/maintenance associated with each job creating business. (1) Business Name: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: EB-5 Capital Investment: Direct and Indirect Job Creation: Jobs Maintained: (2) Business Name: Industry Category Title: Address (Street Number and Name): City: State: Zip Code: EB-5 Capital Investment: Direct and Indirect Job Creation: Jobs Maintained: Form I-924A 01/03/13 Y Page 4 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About the Regional Center (Continued) d. Name of Commercial Enterprise: Industry Category Title: Address (Street
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