Form I-914, Supplement A 04/15/19
2. Seizing or detaining, and threatening to kill, injure, or continue to detain another individual in order to
compel a third person (including a governmental organization) to do or abstain from doing any act as an
explicit or implicit condition for the release of the individual seized or detained?
1. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)?
b. Any other group of two or more individuals, whether organized or not, which has engaged in or has a
subgroup which has engaged in:
4. Has the family member for whom you are filing EVER been a member of, solicited money or members for, provided support for,
attended military training (as defined in section 2339D(c)(1) of title 18, United States Code) by or on behalf of, or been
associated with an organization that is:
a. Designated as a terrorist organization under section 219 of the Immigration and Nationality Act? Yes No
3. Assassination? Yes No
4. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more
individual or to cause substantial damage to property?
c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law
involving the export of goods, technology, or sensitive information?
6. The use of any biological agent; chemical agent; or nuclear weapon or device; explosive; or other
weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more
individuals or to cause substantial damage to property?
Yes5. Soliciting money or members or otherwise providing material support to a terrorist organization? No
5. Does the family member for whom you are filing intend to engage in the United States in:
b. Any unlawful activity, or any activity the purpose of which is in opposition, to control or overthrow of the
Government of the United States?
6. Has the family member for whom you are filing EVER been or does he or she continue to be a member of the
Communist or other totalitarian party, except when membership was involuntary?
7. Has the family member for whom you are filing, during the period of March 23, 1933, to May 8, 1945, in
association with either the Nazi Government of Germany or any organization or government associated or
allied with the Nazi Government of Germany, ever ordered, incited, assisted, or otherwise participated in the
persecution of any person because of race, religion, nationality, membership in a particular social group, or
8. Has the family member for whom you are filing EVER been present or nearby when any person was:
a. Intentionally killed, tortured, beaten, or injured? No
Yesb. Displaced or moved from his or her residence by force, compulsion, or duress? No
Yesc. In any way compelled or forced to engage in any kind of sexual contact or relations? No
PART E. Processing Information (continued)
b. Have removal, exclusion, rescission, or deportation proceedings EVER been initiated against the family
member for whom your are filing?
9. a. Are removal, exclusion, rescission, or deportation proceedings pending against the family member for
whom your are filing?
c. Has the family member for whom your are filing EVER been removed, excluded, or deported from the
d. Has the family member for whom your are filing EVER been ordered to be removed, excluded, or
deported from the United States?
e. Has the family member for whom your are filing EVER been denied a visa or denied admission to the
United States? (If a visa was denied, explain why on a separate sheet of paper.)