Fillable I-485supa I-485 Supp. A (ILW.COM)

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I-485supa I-485 Supp. A (ILW.COM)

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Department of Homeland Security
U.S. Citizenship Immigration and Service
OMB No. 1615-0023; Expires 09/30/08
Part B. Eligibility. (Check the correct response.)
Part A. Information about you.
I am the beneficiary of a visa petition filed on or before January 14, 1998.
I am the beneficiary of a visa petition filed on or after January 15, 1998, and on or before April 30, 2001.
I am the beneficiary of an application for a labor certification filed on or before January 14, 1998.
Supplement A to Form I-485,
Adjustment of Status Under Section 245(i)
For USCIS Use Only
1. I am filing Supplement A to Form I-485 because:
b.
c.
I entered the United States as an alien crewman;
I have accepted employment without authorization;
a.
b.
c.
d.
And I fall into one or more of these categories: (Check all that apply to you.)
I am in unlawful immigration status because I entered the United States without inspection or I remained in the United
States past the expiration of the period of my lawful admission;
I have failed (except through no fault of my own or for technical reasons) to maintain, continuously, lawful status;
I was admitted to the United States in transit without a visa;
I was admitted as a nonimmigrant visitor without a visa;
e.
f.
g.
h.
I was admitted to the United States as a nonimmigrant in the S classification; or
I am seeking employment-based adjustment of status and am not in lawful nonimmigrant status.
2.
Part C. Additional eligibility information.
1. Are you applying to adjust status based on any of the below reasons?
You were granted asylum in the United States;
a.
b.
You have continuously resided in the United States since January 1, 1972;
c.
You entered as a K-1 fiancé(e) of a U.S. citizen;
d.
You have an approved Form I-360, Petition for Amerasian, Widow(er), Battered or Abused Spouse or Child, or Special
Immigrant, and are applying for adjustment as a special immigrant juvenile court dependent or a special immigrant who has
served in the U.S. armed forces, or a battered or abused spouse or child;
e.
You are a native or citizen of Cuba, or the spouse or child of such alien, who was not lawfully inspected or admitted to the
United States;
f.
You are a special immigrant retired international organization employee or family member;
g.
You are a special immigrant physician;
Form I-485 Supplement A (Rev. 05/27/08)Y
If you checked box b or d in Question 1, you must submit evidence demonstrating that you were physically present in the
United States on December 21, 2000.
d.
a.
I am the beneficiary of an application for a labor certification filed on or after January 15, 1998, and on or before April 30, 2001.
Last Name
First Name
Middle Name
City
State
Zip Code
Address: In Care Of
Street Number and Name
Alien Registration Number (A #) if any
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship/Nationality
Apt. #
E-Mail Address, if any
Telephone Number
Action Block
(
)
2. Do any of the following conditions describe you?
You are already a lawful permanent resident of the United States.
a.
b.
You have continuously maintained lawful immigration status in the United States since November 5, 1986.
No. None of these conditions describe me. (Go to Part D. Signature.)
Yes. If you answered "Yes," do not file this form.
Part D. Signature. Read the information on penalties in the instructions before completing this section.
Part E. Signature of person preparing form, if other than above. Read the information on penalties in the instructions
before completing this section.
Form I-485 Supplement A (Rev. 05/27/08Y)Y Page 2
c.
You are applying to adjust status as the spouse or unmarried minor child of a U.S. citizen or the parent of a U.S. citizen
child at least 21 years of age, and you were inspected and lawfully admitted to the United States.
h.
You are a public interest parolee, who was denied refugee status, and are from the former Soviet Union, Vietnam, Laos or
Cambodia (a "Lautenberg Parolee" under Public Law 101-167); or
i.
You are eligible under the Immigration Nursing Relief Act.
No. I am not applying for adjustment of status for any of these reasons. (Go to next question.)
Yes. I am applying for adjustment of status for any one of these reasons. (If you answered "Yes," do not file this form.)
Part C. Additional eligibility information. (Continued.)
Signature
Print Name
Date
Firm Name and Address
Daytime Phone Number (Area Code and Number)
Print Name
Date
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit being sought.
Signature
E-Mail Address, if any
I certify, under penalty of perjury under the laws of the United States of America, that I prepared this form at the request of the above
person and that to the best of my knowledge the contents of this application are all true and correct.
(
)
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Completed 9 January 2021

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