Fillable Form I-129CW: Nonimmigrant Transitional Worker (American Immigration Lawyers Association)

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Form I-129CW: Nonimmigrant Transitional Worker (American Immigration Lawyers Association)

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Form I-129CW, Petition for a CNMI-Only
Nonimmigrant Transitional Worker
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-129CW 01/27/20 Page 1 of 15
USCIS
Form I-129CW
OMB No. 1615-0111
Expires 10/31/2021
For USCIS Use Only
Classification Approved
Consulate/POE/PFI Notified
Extension Granted
COS/Extension Granted
Partial Approval (explain)
Action BlockReceipt
Class:
# of Workers:
Job Code:
Validity Dates: From:
To:
At:
Priority Number:
Part 1. Information about the Employer Filing
This Petition
START HERE - Type or print in black ink.►
Name of Representative for Employer/Organization
Family Name
(Last Name)
1.a.
1.b. Given Name
(First Name)
1.c. Middle Name
Name of Employer/Organization and Address
2.d.
City or Town
2.f. State 2.g. ZIP Code
Name of Employer/Organization
2.e.
Street Number
and Name
2.a.
2.c.
Apt. Ste. Flr.
In Care Of Name (if any)2.b.
3. Federal Employer Identification Number
USCIS Online Account Number (if any)4.
Part 2. Information About This Petition
NOTE: See the Instructions for fee information.
Requested Nonimmigrant Classification1.
Basis for Classification (Select only one box):
New employment (including a duplicate for U.S.
Department of State notification).
Continuation of previously approved employment
without change with the same employer.
Change in previously approved employment.
New concurrent employment.
Change of employer.
Amended petition.
If you selected Item Number 2.b., 2.c., 2.d., 2.e., or 2.f.,
provide the petition receipt number.
3.
Prior Petition. If the beneficiary is in the CNMI as a
nonimmigrant and is applying to change and/or extend his
or her status, provide the prior petition or application
receipt number.
4.
►
►
2.a.
2.b.
2.c.
2.d.
2.e.
2.f.
(USPS ZIP Code Lookup)
Form I-129CW 01/27/20 Page 2 of 15
Requested Action (Select only one box):
Part 2. Information About This Petition
(continued)
Notify the office in Part 4. so the beneficiary can
obtain a visa or be admitted.
Change the beneficiary's status and extend their stay
since the beneficiary is in the CNMI in another status
(see the Instructions for limitations). This option is
available only where you select "New Employment"
in Item Number 2.a., above. Select the appropriate
box
indicating the type of status
change.
Initial Grant of CW-1 Status in CNMI
Change of Federal Nonimmigrant Status to
CW-1
Extend the stay of the beneficiary since they now
hold this status.
Amend the stay of the beneficiary since they now
hold this status.
Total number of workers in petition (See instructions
relating to when more than one worker can be included):
6.
Part 3. Information About the Beneficiaries For
Whom You Are Filing
Provide the requested information below. If you need
additional space to complete this section, use the space provided
in Part 10. Additional Information. If you need additional
space to name each beneficiary included in this petition use
Form I-129CW Classification Supplement.
Beneficiary's Full Name
Family Name
(Last Name)
1.a.
1.b. Given Name
(First Name)
1.c. Middle Name
Other Names Used (if any)
Provide all other names the beneficiary has ever used, including
aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 10.
Additional Information.
Family Name
(Last Name)
2.a.
2.b. Given Name
(First Name)
2.c. Middle Name
Date of Birth (mm/dd/yyyy)3.
U.S. Social Security Number (if any)4.
►
Alien Registration Number (A-Number) (if any)5.
►
A-
6. Country of Birth
Province of Birth7.
Country of Citizenship or Nationality8.
If in the CNMI, complete the following:
Date of Last Arrival (mm/dd/yyyy)9.
Form I-94 Arrival-Departure Record Number10.
Current Nonimmigrant Status11.a.
Date Status Expires (mm/dd/yyyy)11.b.
Passport Number12.a.
Date Passport Issued (mm/dd/yyyy)12.c.
Date Passport Expires (mm/dd/yyyy)12.d.
Beneficiary's Current CNMI Address
13.b.
City or Town13.c.
Street Number
and Name
13.a.
Apt. Ste. Flr.
13.d. State 13.e. ZIP Code
►
►
5.a.
5.b.
5.c.
5.d.
Country Where Passport Was Issued12.b.
Form I-129CW 01/27/20 Page 3 of 15
Part 4. Processing Information
If the beneficiary named in Part 3. is outside the CNMI, or a
requested extension of stay, or change of status cannot be
granted, provide the U.S. Consulate or inspection facility you
want notified if this petition is approved.
Type of Office (Select only one box): 1.a.
Consulate
Pre-flight Inspection
Port of Entry
Office Address (City)1.b.
U.S. State or Foreign Country1.c.
Beneficiary's Foreign Address
2.c.
2.d.
City or Town
ZIP Code2.e.State
2.a.
2.b.
Street Number
and Name
Apt. Ste. Flr.
Province2.f.
2.h.
2.g.
Country
Postal Code
Does each beneficiary in this petition have a valid passport?3.
Not Required to Have Passport
No. If no, type or print a brief explanation in Part
10. Additional Information.
Yes
Are you filing any other petitions with this one?4.
No
Are applications for replacement/initial Form I-94's being
filed with this petition?
5.
No
Are applications by dependents being filed with this
petition?
6.
►Yes. If yes, how many?
Yes. If yes, how many?
►
►
No
Yes. If yes, how many?
Is any beneficiary in this petition in removal proceedings?7.
No
Yes. If yes, explain in Part 10. Additional
Information.
Have you ever filed an immigrant petition for any
beneficiary in this petition?
8.
No
If you indicated you were filing a new petition in Part 2., has
any beneficiary in this petition:
9.
Ever been given the classification you are now
requesting?
Yes. If yes, explain in Part 10. Additional
Information.
No
Ever been denied the classification you are now
requesting?
No
Have you ever previously filed a petition for this
beneficiary?
11.
No
Yes. If yes, explain in Part 10. Additional
Information.
Yes. If yes, explain in Part 10. Additional
Information.
Yes. If yes, explain in Part 10. Additional
Information.
Part 5. Basic Information About the Proposed
Employment and Employer
Job Title1.
Nontechnical Job Description3.
10.
NOTE: Attach Form I-129CW Classification Supplement for
each beneficiary you are petitioning for.
SOC Code2. ►
-
Form I-129CW 01/27/20 Page 4 of 15
Part 6. Information about the Beneficiary's
Public Benefits
Address where the beneficiary will work if different from
address in Part 1.
4.c.
4.d.
City or Town
ZIP Code4.e.State
4.a.
4.b.
Street Number
and Name
Apt. Ste. Flr.
Is this a full-time position?5.
No - Hours per week:
Yes - Wages per week or per year:
$
Part 5. Basic Information About the Proposed
Employment and Employer (continued)
Other Compensation (Explain)6.
Dates of Intended Employment
7.a. Date From (mm/dd/yyyy)
7.b. Date To (mm/dd/yyyy)
Type of Petitioner (Select only one box):8.
Business
Organization
Other (Type or print a brief explanation in Part 10.
Additional Information.)
Type of Business9.
Year Established10.
11. Current Number of Employees
Gross Annual Income12.
Net Annual Income13.
This Part 6. only applies to beneficiaries who are seeking to
change nonimmigrant status or extend their nonimmigrant stay
while they are in the CNMI. If the beneficiary is not seeking a
change of status or extension of stay, you may skip this Part 6.
Yes, the beneficiary has received or is currently
certified to receive the following benefits (select all
that apply):
Has the beneficiary, since obtaining the nonimmigrant
status that you seek to change on behalf of the
beneficiary, received, or is the beneficiary currently
certified to receive, any of the following public benefits?
(Select all that apply)
1.
Any Federal, State, Local, or Tribal Cash
Assistance For Income Maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families
(TANF)
General Assistance (GA)
Supplemental Nutrition Assistance Program
(SNAP, formerly called “Food Stamps”)
Section 8 Housing Assistance under the Housing
Choice Voucher Program
Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937,
42 U.S.C. 1437 et seq.
Federally-funded Medicaid
No, the beneficiary has not received any of the above
listed public benefits.
No, the beneficiary is not certified to receive any of
the above listed public benefits.
Provide the requested information and submit documentation as
outlined in the Instructions. For additional beneficiaries, please
respond to the questions in Part 2., Information about the
Additional Beneficiary's Public Benefits, in the Form
I-129CW Classification Supplement.
2.
If the beneficiary has received or is currently certified to
receive any of the above public benefits, provide
information about the public benefits below. If you need
additional space to complete any Item Number in this
Part, use the space provided in Part 10. Additional
Information. Submit evidence as outlined in the
Instructions.
Form I-129CW 01/27/20 Page 5 of 15
Type of BenefitA.
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
B.
C.
D.
If you answered “Yes” to Item Number 1., do any of the
following apply to the beneficiary? Provide the evidence
listed in the Form I-129CW Instructions.
3.
The beneficiary is enlisted in the U.S. Armed Forces,
or is serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
The beneficiary is the spouse or the child of an
individual who is enlisted in the U.S. Armed Forces,
or who is serving in active duty or in the Ready
Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary (or the beneficiary's spouse
or parent) was enlisted in the U.S. Armed Forces, or
was serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States in a status exempt from the public charge
ground of inadmissibility and the beneficiary
received the public benefits during that time.
At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States after being granted a waiver of the public
charge ground of inadmissibility.
None of the above statements apply to the
beneficiary.
Part 6. Information about the Beneficiary's
Public Benefits (continued)
(mm/dd/yyyy)
(mm/dd/yyyy)
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
The beneficiary is a child currently residing abroad
who entered the United States with a nonimmigrant
visa to attend an N-600K, Application for Citizenship
and Issuance of Certificate Under INA Section 322
interview.
Form I-129CW 01/27/20 Page 6 of 15
Part 6. Information about the Beneficiary's
Public Benefits (continued)
Has the beneficiary received, applied for, or have been
certified to receive federally-funded Medicaid in
connection with any of the following (select all that
apply):
4.a.
NOTE: Submit evidence as outlined in the Instructions.
An Emergency Medical Condition
Other School-based Benefits or Services Available
Up to the Oldest Age Eligible for Secondary
Education Under State Law
While Pregnant or During the 60-day Period
Following the Last Day of Pregnancy
While Under 21 Years of Age
For a Service Under the Individuals with Disabilities
Education Act (IDEA)
4.b. Provide the Applicable Dates
Start Date (mm/dd/yyyy)
End Date (mm/dd/yyyy)
NOTE: Read the Penalties section of the Form I-129CW
Instructions before completing this part. You, the petitioner,
must file Form I-129CW while in the United States.
Part 7. Statement, Contact Information,
Declaration, Certification, and Signature of the
Petitioner or Authorized Signatory
Petitioner's or Authorized Signatory's Statement
I can read and understand English, and I have read
and understand every question and instruction on this
petition and my answer to every question.
1.a.
NOTE: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.
The interpreter named in Part 8. has read to me every
question and instruction on this petition and my
answer to every question in
1.b.
a language in which I am fluent. I understood all of
this information as interpreted.
,
2. At my request, the preparer named in Part 9.,
,
prepared this petition for me based only upon
information I provided or authorized.
Petitioner's or Authorized Signatory's Contact
Information
Authorized Signatory's Given Name (First Name)3.b.
Authorized Signatory's Family Name (Last Name)3.a.
Authorized Signatory's Title4.
Authorized Signatory's Daytime Telephone Number5.
Authorized Signatory's Email Address (if any)7.
Authorized Signatory's Mobile Telephone Number (if any)
6.
If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization.
I authorize the release of any information from my records, or
from the petitioning organization's records, to USCIS or other
entities and persons where necessary to determine eligibility for
the immigration benefit sought or where authorized by law. I
recognize the authority of USCIS to conduct audits of this
petition using publicly available open source information. I
also recognize that any supporting evidence submitted in
support of this petition may be verified by USCIS through any
means determined appropriate by USCIS, including but not
limited to, on-site compliance reviews.
Copies of any documents submitted are exact photocopies of
unaltered, original documents, and I understand that, as the
petitioner, I may be required to submit original documents to
USCIS at a later date.
Petitioner's or Authorized Signatory's Declaration
and Certification
1) I reviewed and understood all of the information
contained in, and submitted with, my petition; and
2) All of this information was complete, true, and correct
at the time of filing.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
Form I-129CW 01/27/20 Page 7 of 15
Part 7. Statement, Contact Information,
Declaration, Certification, and Signature of the
Petitioner or Authorized Signatory (continued)
I certify, under penalty of perjury, that I have reviewed this
petition, I understand all of the information contained in, and
submitted with, my petition, and all of this information is
complete, true, and correct.
Petitioner's or Authorized Signatory's Signature
Date of Signature (mm/dd/yyyy)8.b.
Petitioner's Signature8.a.
NOTE TO ALL PETITIONERS AND AUTHORIZED
SIGNATORIES: If you do not completely fill out this petition
or fail to submit required documents listed in the Instructions,
USCIS may delay a decision on or deny your petition.
Interpreter's Given Name (First Name)1.b.
Interpreter's Family Name (Last Name)1.a.
Interpreter's Full Name
Part 8. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code
Street Number
and Name
3.a.
3.b. Apt. Ste. Flr.
3.g.
3.h. Country
Province
Interpreter's Contact Information
Interpreter's Daytime Telephone Number4.
Interpreter's Email Address (if any)6.
Interpreter's Mobile Telephone Number (if any)5.
Interpreter's Certification
I am fluent in English and
which is the same language specified in Part 7., Item Number
1.b., and I have read to this petitioner or the authorized
signatory in the identified language every question and
instruction on this petition and his or her answer to every
question. The petitioner or authorized signatory informed me
that he or she understands every instruction, question, and
answer on the petition, including the Petitioner's or
Authorized Signatory's Declaration and Certification, and
has verified the accuracy of every answer.
I certify, under penalty of perjury, that:
,
Interpreter's Signature
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature7.a.
Part 9. Contact Information, Declaration, and
Signature of the Person Preparing This Petition,
if Other Than the Petitioner
Preparer's Given Name (First Name)1.b.
2. Preparer's Business or Organization Name (if any)
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
Form I-129CW 01/27/20 Page 8 of 15
Part 9. Contact Information, Declaration, and
Signature of the Person Preparing This Petition,
if Other Than the Petitioner (continued)
Preparer's Mailing Address
3.f.
Postal Code
3.g.
3.h. Country
Province
3.c. City or Town
3.d. State 3.e. ZIP Code
Street Number
and Name
3.a.
3.b. Apt. Ste. Flr.
Preparer's Contact Information
Preparer's Mobile Telephone Number (if any)5.
Preparer's Daytime Telephone Number4.
Preparer's Email Address (if any)6.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this petition at the request of the petitioner or
authorized signatory. The petitioner has reviewed this
completed petition, including the Petitioner's or Authorized
Signatory's Declaration and Certification, and informed me
that all of this information in the form and in the supporting
documents is complete, true, and correct.
Preparer's Signature
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Statement
I am not an attorney or accredited representative but
have prepared this petition on behalf of the petitioner
and with the petitioner's consent.
7.a.
I am an attorney or accredited representative and my
representation of the petitioner in this case
7.b.
NOTE: If you are an attorney or accredited
representative, you may need to submit a completed
Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this
petition.
extends does not extend beyond the
preparation of this petition.
Form I-129CW 01/27/20 Page 9 of 15
3.d.
6.a.
Page Number 6.b. Part Number 6.c. Item Number
6.d.
Part 10. Additional Information
If you need extra space to provide any additional information
within this petition, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this petition or attach a separate sheet
of paper. Type or print your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
3.a. Page Number 3.b. Part Number 3.c. Item Number
4.d.
4.a.
Page Number 4.b. Part Number 4.c. Item Number
5.a.
Page Number 5.b. Part Number 5.c. Item Number
5.d.
7.a.
Page Number 7.b. Part Number 7.c. Item Number
7.d.
A-Number (if any) ►
A-
2.
Form I-129CW 01/27/20 Page 10 of 15
Part 11. Accommodations for Individuals With
Disabilities and/or Impairments
NOTE: Read the information in the Form I-129CW
Instructions before completing this part.
1. Name of Employer or Organization Filing Petition:
Name of Person for Whom You Are Filing:2.
Are you, the petitioning employer, requesting an
accommodation because of the beneficiary's disabilities
and/or impairments?
3.
Yes No
If you answered “Yes” to Item Number 3., select any
applicable in Item Numbers 4.a. - 4.c. and provide an answer.
The beneficiary is deaf or hard of hearing and
requests the following accommodation. (If they are
requesting a sign-language interpreter, indicate for
which language (for example, American Sign
Language).)
4.a.
The beneficiary is blind or has low vision and
requests the following accommodation:
4.b.
The beneficiary has another type of disability and/or
impairment. (Describe the nature of their disability
and/or impairment and the accommodation you are
requesting.)
4.c.
The position is not temporary or seasonal employment, and the
above named petitioning employer does not reasonably believe
the position to qualify for any other nonimmigrant worker
classification.
The position falls within the list of occupational categories
designated by the Secretary at 8 CFR 214.2(w)(1)(ix).
Select only one box:
1.a.
Professional, Technical, or Management Occupations
1.b. Clerical and Sales Occupations
1.c. Service Occupations
1.d. Agricultural, Fisheries, Forestry, and Related
Occupations
1.e.
Processing Occupations
1.f. Machine Trade Occupations
1.g. Benchwork Occupations
1.h. Structural Occupations
1.i. Miscellaneous Occupations
Part 12. Employer Attestation
Employer Attestation
There are no qualified U.S. workers available to fill the position
offered by the above named petitioning employer.
The above named petitioning employer is doing business as
defined in the regulations at 8 CFR 214.2(w)(1)(ii).
The above named petitioning employer is a legitimate business
as defined in the regulations at 8 CFR 214.2(w)(1)(vi).
The above named petitioning employer is an eligible employer
as described in 8 CFR 214.2(w)(4) and will continue to comply
with the requirements for an eligible employer until such time
as the employer no longer employs any CW-1 nonimmigrant
worker.
The beneficiary meets the qualifications for the position.
The beneficiary, if present in the CNMI, is lawfully present in
the CNMI.
I certify under penalty of perjury, under the laws of the United
States of America, that the contents of this attestation and the
evidence submitted with it are true and correct to the best of my
knowledge. If filing on behalf of an organization, I certify that I
am empowered to do so by the organization. If this petition is
to extend a prior petition, I certify that the proposed
employment is under the same terms and conditions as stated in
the prior approved petition. I authorize the release of any
information from my records, or from the petitioning
organization's record that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
2. Petitioner's Printed Name
3. Title
4. Employer/Organization Name
Form I-129CW 01/27/20 Page 11 of 15
5.c. City or Town
5.d. State 5.e. ZIP Code
Street Number
and Name
5.a.
5.b. Apt. Ste. Flr.
Part 12. Employer Attestation (continued)
Fax Number (if any)7.
Daytime Telephone Number6.
Email Address (if any)8.
Date of Signature (mm/dd/yyyy)
9.b.
Petitioner's Signature9.a.
Employer/Organization's Physical Address
Employer/Organization's Contact Information
Petitioner's Signature
Form I-129CW Classification Supplement
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-129CW 01/27/20 Page 12 of 15
USCIS
Form I-129CW
OMB No. 1615-0111
Expires 10/31/2021
Part 1. Information About the Additional
Beneficiary (if applicable)
Family Name
(Last Name)
1.a.
1.b. Given Name
(First Name)
1.c. Middle Name
2. Date of Birth (mm/dd/yyyy)
U.S. Social Security Number (if any)3.
►
Alien Registration Number (A-Number) (if any)4.
►
A-
Beneficiary's Current CNMI Address
5.c. City or Town
5.d. State 5.e. ZIP Code
5.b. Apt. Ste. Flr.
Street Number
and Name
5.a.
6.f.
Postal Code
6.g.
6.h. Country
Province
6.c. City or Town
6.d. State 6.e. ZIP Code
Street Number
and Name
6.a.
6.b. Apt. Ste. Flr.
Beneficiary's Foreign Address
IF IN THE CNMI
7. Country of Birth
9. Date of Last Arrival (mm/dd/yyyy)
Form I-94 Arrival-Departure Record Number10.
►
Current Nonimmigrant Status11.a.
11.b. Date Status Expires (mm/dd/yyyy)
Country Where Passport Issued12.b.
12.c.
12.d. Date Passport Expires (mm/dd/yyyy)
Country of Citizenship or Nationality8.
Attach to Form I-129CW when more than one beneficiary is
included in the petition. (Provide each beneficiary separately.
Do not include the person you named on Form I-129CW.)
Passport Number12.a.
Date Passport Issued (mm/dd/yyyy)
Part 2.
Information about the Additional
Beneficiary's Public Benefits
Yes, t
he beneficiary has received or is currently
certified to receive the following benefits:
Has the beneficiary, since obtaining the nonimmigrant
status that you seek to extend or that you seek to change
on behalf of the beneficiary, received, or is the
beneficiary currently certified to receive, any of the
following public benefits (select all that apply)?
1.
Any Federal, State, Local or Tribal Cash
Assistance For Income Maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families
(TANF)
General Assistance (GA)
Supplemental Nutrition Assistance Program
(SNAP, formerly called “Food Stamps”)
Section 8 Housing Assistance under the Housing
Choice Voucher Program
Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation)
Federally-Funded Medicaid
Public Housing under the Housing Act of 1937,
42 U.S.C. 1437 et seq.
Form I-129CW 01/27/20 Page 13 of 15
Part 2.
Information about the Additional
Beneficiary's Public Benefits
(continued)
If the beneficiary has received or is currently certified to
receive any of the above public benefits, provide
information about the public benefits, below. If you need
additional space to complete any Item Number in this
Part, use the space provided in Part 10. Additional
Information. Submit evidence as outlined in the
Instructions.
2.
Type of BenefitA.
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
B.
C.
No, the beneficiary has not received any of the above
listed public benefits.
No, the beneficiary is not certified to receive any of
the above listed public benefits.
(mm/dd/yyyy)
(mm/dd/yyyy)
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
D.
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit
Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)
(mm/dd/yyyy)
If you answered “Yes” to Item Number 1., do any of the
following apply to the beneficiary? Provide the evidence
listed in the Form I-129CW Instructions.
3.
The beneficiary is enlisted in the U.S. Armed Forces,
or is serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
The beneficiary is the spouse or the child of an
individual who is enlisted in the U.S. Armed Forces,
or who is serving in active duty or in the Ready
Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary (or the beneficiary's spouse
or parent) was enlisted in the U.S. Armed Forces, or
was serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States in a status exempt from the public charge
ground of inadmissibility.
At the time the beneficiary received the public
benefits, the beneficiary was previously present in the
United States after being granted a waiver of the
public charge ground of inadmissibility.
Form I-129CW 01/27/20 Page 14 of 15
Part 2.
Information about the Additional
Beneficiary's Public Benefits
(continued)
NOTE: Submit evidence as outlined in the Instructions.
The beneficiary is a child currently residing abroad
who entered the United States with a nonimmigrant
visa to attend an N-600K, Application for Citizenship
and Issuance of Certificate Under INA Section 322,
interview.
None of the above statements apply to the
beneficiary.
Has the beneficiary received, applied for, or has been
certified to receive federally-funded Medicaid in
connection with any of the following (select all that
apply):
4.a.
An Emergency Medical Condition
Other School-based Benefits or Services Available
Up to the Oldest Age Eligible for Secondary
Education Under State Law
While Pregnant or During the 60-day Period
Following the Last Day of Pregnancy
While Under 21 Years of Age
For a Service Under the Individuals with Disabilities
Education Act (IDEA)
4.b. Provide the Applicable Dates
Start Date (mm/dd/yyyy)
End Date (mm/dd/yyyy)
NOTE: Read the information in the Form I-129CW
Instructions before completing this part.
Part 3. Accommodations for Individuals With
Disabilities and/or Impairments
1. Name of Employer or Organization Filing Petition
Name of Person For Whom You Are Filing2.
Are you, the petitioning employer, requesting an
accommodation because of the beneficiary's disabilities
and/or impairments?
3.
Yes No
The beneficiary is deaf or hard of hearing and requests
the following accommodation. (If they are requesting
a sign-language interpreter, indicate for which
language (for example, American Sign Language).)
4.a.
If you answered “Yes” to Item Number 3., select any applicable
box in Item Numbers 4.a. - 4.c. and provide an answer.
The beneficiary is blind or has low vision and
requests the following accommodation:
4.b.
The beneficiary has another type of disability and/or
impairment. (Describe the nature of their disability
and/or impairment and the accommodation you are
requesting.)
4.c.
There are no qualified U.S. workers available to fill the position
offered by the above named petitioning employer.
The above named petitioning employer is doing business as
defined in the regulations at 8 CFR 214.2(w)(1)(ii).
The above named petitioning employer is a legitimate business
as defined in the regulations at 8 CFR 214.2(w)(1)(vi).
The above named petitioning employer is an eligible employer
as described in 8 CFR 214.2(w)(4) and will continue to comply
with the requirements for an eligible employer until such time
as the employer no longer employs any CW-1 nonimmigrant
worker.
Employer Attestation
Part 4. Employer Attestation
The beneficiary meets the qualifications for the position.
The beneficiary, if present in the CNMI, is lawfully present in
the CNMI.
The position is not temporary or seasonal employment, and the
above named petitioning employer does not reasonably believe
the position to qualify for any other nonimmigrant worker
classification.
The position falls within the list of occupational categories
designated by the Secretary at 8 CFR 214.2(w)(1)(ix).
Select only one box:
1.a.
Professional, Technical, or Management Occupations
1.b.
Clerical and Sales Occupations
1.c. Service Occupations
1.d. Agricultural, Fisheries, Forestry, and Related
Occupations
1.e.
Processing Occupations
1.f. Machine Trade Occupations
Form I-129CW 01/27/20 Page 15 of 15
Part 4. Employer Attestation (continued)
I certify under penalty of perjury, under the laws of the United
States of America, that the contents of this attestation and the
evidence submitted with it are true and correct to the best of my
knowledge. If filing on behalf of an organization, I certify that I
am empowered to do so by the organization. If this petition is to
extend a prior petition, I certify that the proposed employment is
under the same terms and conditions as stated in the prior
approved petition. I authorize the release of any information
from my records, or from the petitioning organization's record
that U.S. Citizenship and Immigration Services needs to
determine eligibility for the benefit sought.
2. Petitioner's Printed Name
3. Title
4. Employer/Organization Name
5.c. City or Town
5.d. State 5.e. ZIP Code
Street Number
and Name
5.a.
5.b. Apt. Ste. Flr.
Employer/Organization's Physical Address
1.g. Benchwork Occupations
1.h. Structural Occupations
1.i. Miscellaneous Occupations
Fax Number (if any)7.
Daytime Telephone Number6.
Email Address (if any)8.
Date of Signature (mm/dd/yyyy)
9.b.
Petitioner's Signature9.a.
Employer/Organization's Contact Information
Petitioner's Signature
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Form I-129CW: Nonimmigrant Transitional Worker (American Immigration Lawyers Association)

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Completed 29 July 2020

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