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I-566, Interagency Record of Request - (ILW.COM)

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OMB No. 1615-0027; Expires 01/31/07
NOTE: Please read these instructions carefully. If you need more space to complete an answer, use a separate sheet(s) of paper.
Write your name and Alien Registration Number (A #), if you have one, and your Personal Identification Number (PID), if you have
one, at the top of each sheet and indicate the number of the item to which the answer refers.
Use Form I-566 to provide necessary information to DOS,
DOD, NATO/HQ SACT and USCIS to establish your eligibility
to request certain immigration benefits. Such benefits may
be available to:
An eligible dependent of an A, G or NATO nonimmigrant
requesting employment authorization.
An A, G or NATO nonimmigrant requesting a change to
another nonimmigrant status; or if you are currently in
another nonimmigrant status and have been offered a
position that requires you and any dependents to be
reclassified as an A, G or NATO nonimmigrant; or
An A, G or NATO nonimmigrant requesting adjustment to
lawful permanent resident.
Form I-566 generally accompanies other forms. There is
no filing fee for the I-566.
When Should I Use Form I-566?
Use Form I-566 to facilitate the application process for various
benefits that may be available to you if you are in, or wish to
be in, A, G or NATO nonimmigrant status. This form provides
information needed to identify you and the person from whom
your status is, or will be, derived (the principal alien). Form
I-566 assists government agencies and organizations in the
exercise of their responsibility to adjudicate applications for
immigration benefits, including requests for employment
authorization and change or adjustment of status. The
government agencies and organizations involved in the
process are the:
Department of State (DOS);
Department of Defense (DOD);
North Atlantic Treaty Organization/Headquarters,
Supreme Allied Commander Transformation (NATO/HQ
SACT); and
U.S. Citizenship and Immigration Services (USCIS).
You must use this form if:
1. You are applying for employment authorization as an
eligible A-1, A-2, G-1, G-3, G-4 or NATO 1-6 dependent.
(Definitions and eligibility requirements may be found in 8
CFR 214.2(a), 214.2(g) and 214.2(s)); or
2.
You are applying for a change or adjustment of status to,
or from, A, G or NATO status.
Definitions.
A # - Alien Registration Number assigned to an alien's
administrative file.
8 CFR - Title 8, Code of Federal Regulations.
Certifying officer or official: A chief of a diplomatic mission,
international organization director or authorized deputy,
NATO member state official or NATO/HQ SACT Legal
Advisor who is authorized to certify information about an
applicant.
PID: Personal Identification Number. This is the number
provided to eligible A and G nonimmigrants by the DOS.
Principal alien: A nonimmigrant admitted to work exclusively
for a foreign government, international organization, or NATO
in A, G or NATO status from whom family members derive
their A, G or NATO status.
Statement from prospective employer: A statement on the
employer's letterhead identifying the dependent. It must
describe the position offered, duties to be performed, the
salary offered, hours to be worked and verify that the
dependent possesses the qualifications for the position. The
statement must include the phone number, name and original
signature of the person making the statement.
Statement from school: A statement on the letterhead of the
dependent's post-secondary school that identifies the
dependent, certifies that he or she is a full-time student,
identifies the courses being taken, the credit hours being
carried and provides the expected graduation date. The
statement must include the phone number, name and original
signature of the school official making the statement.
Statement from physician: A statement on the letterhead of
the dependent's physician identifying the dependent and the
certifying physician. It must identify the dependent's
condition, describe the symptoms, provide a prognosis and
certify that the dependent is physically/mentally unable to
establish, re-establish or maintain a home of his or her own.
The statement must include the phone number, name and
original signature of the physician making the statement.
DOS Forms.
DS-2003, Notification of Appointment of Foreign Diplomatic
Officer and Career Consular Officer.
DS-2004, Notification of Appointment of Foreign Government
Employee.
Form I-566 Instructions (Rev. 03/30/06) N
I-566, Interagency Record of Request -
Instructions
Department of Homeland Security
U.S. Citizenship and Immigration Services
A, G or NATO Dependent Employment Authorization
or Change/Adjustment to/from A, G or NATO Status
--
--
--
--
--
--
USCIS Forms.
I-94, Arrival/Departure Record, issued to nonimmigrants upon
arrival in the United States.
I-129, Petition for a Nonimmigrant Worker.
I-407, Abandonment by Alien of Status as Lawful Permanent
Resident.
I-485, Application to Register Permanent Residence or Adjust
Status.
I-508, Waiver of Rights, Privileges, Exemptions and
Immunities.
I-508F, form used by French nationals in conjunction with the
I-508.
I-551, Alien Registration Receipt Card.
I-539, Application to Extend/Change Nonimmigrant Status.
I-765, Application for Employment Authorization.
How Do I File Form I-566?
A separate Form I-566 must be filed for each individual
seeking an immigration benefit. Follow these steps to
complete your request:
Step 1 - Reason for Filing Form I-566
Step 2 - Fill Out the Form I-566
Step 3 - Submit the Form I-566
Notice
USCIS wants to make sure that you receive the requested
benefit. To do this, we may ask for more evidence, interview
you and/or conduct an investigation. If you give us false
documents, misrepresent facts or otherwise engage in
fraud, USCIS will take appropriate action. This means we
will not only deny your request, you may lose current and
future immigration benefits. You may also face penalties,
including criminal and/or civil prosecution leading to fines
and/or imprisonment.
Step 1. Reason for Filing Form I-566.
Your request for employment authorization as an A, G or
NATO dependent may be based on either:
1. A formal, written bilateral agreement between the United
States and the country which employs the principal alien;
2. A de facto arrangement between the United States and the
country which employs the principal alien (employment
authorization under a de facto arrangement requires that
the principal is a national of the country which employs
him/her); or
3. The G-4 dependent employment regulations found in 8
CFR 214.2(g).
If you have a question about which provision may apply to
you, contact the diplomatic mission, international
organization, NATO/HQ SACT or DOD command that
employs the principal alien.
If one of the provisions in 1, 2 or 3 applies to you, you must
also show that you are an eligible dependent of a principal
alien. Eligible dependents are the:
Spouse or unmarried child under age 21; or
Dependent unmarried son or daughter who is a full-time,
post-secondary student between age 21 and 23 years (or
between age 21 and 25 under certain bilateral agreements);
or the
Dependent unmarried son or daughter who is mentally or
physically unable to care for him or herself and cannot
establish his or her own household.
If you meet one of these conditions and believe you are
eligible to apply for employment authorization, complete Parts
1, 2, 3 (Check Box "1a" or "1b"), 4 and 5 on Form I-566.
Evidence requirements.
If you are filing as the spouse or unmarried child under age
21:
Bilateral agreement - submit documentation as
specified in the applicable agreement.
De facto arrangement or G-4 regulations - submit a
statement from your prospective employer.
If you are filing as the dependent unmarried son or
daughter who is a full-time, post-secondary student
between ages 21 and 23 years (or between ages 21 and 25
under certain bilateral agreements):
Bilateral agreement - submit documentation as
specified in the applicable agreement and a statement
from your school.
De facto arrangement or G-4 regulations - submit a
statement from your prospective employer and school.
If you are filing as the dependent unmarried son or
daughter who is mentally or physically unable to care for
yourself and cannot establish your own household:
Bilateral agreement - submit documentation as
specified in the applicable agreement and a statement
from your physician.
De facto arrangement or G-4 regulations - submit a
statement from your prospective employer and
physician.
If you are requesting an extension of your employment
authorization, submit the above noted required documents
and
any other documents required by the principal alien's
sponsoring agency.
Form I-566 Instructions (Rev. 03/30/06) N Page 2
Dependent Employment Authorization.
--
--
--
--
--
--
--
--
--
--
--
Change to/from Nonimmigrant A, G or NATO
Change of nonimmigrant status
to A, G or NATO
nonimmigrant.
Complete Form I-566, Parts 1, 3 (check Box "2a"), 4 and
5. Complete Part 2 if you are
not
applying to be the
principal alien. Attach the required supporting documents:
Your Form I-94 and Form I-539.
A DS-2003 or DS-2004 form, as appropriate, if you are
applying to be the principal alien.
Section 247(a), immigrant
to
A or G nonimmigrant.
Complete Form I-566, Parts 1, 3 (check Box "2b"), 4 and
5. Complete Part 2 if you are
not applying to be the
principal alien. Attach the required supporting documents:
A DS-2003 or DS-2004 form, as appropriate, if you are
applying to be the principal alien.
NOTE: If you are a permanent resident who wishes to be
employed by an A or G mission or organization while
retaining your permanent resident status, contact the USCIS
district office having jurisdiction over your residence for
instructions. (See section 247(b) of the Immigration and
Nationality Act for more information.)
Change to other nonimmigrant status from A, G or
NATO.
Complete Form I-566, Parts 1, 3 (check Box "2c"), 4 and
5. Complete Part 2 if you are
not
applying to be the
principal alien.
Adjustment
from
A, G or NATO nonimmigrant to
immigrant status.
Complete Form I-566, Parts 1, 3 (check Box "2d"), 4 and
5. Complete Part 2 if you are
not
applying to be the
principal alien. Attach these required supporting
documents:
Your Form I-94 and Form I-485 package;
Your Form I-508;
If you are a French National, a Form I-508F; and
All documentation required to establish eligibility for
the status you are requesting.
A-1, A-2, G-1 or G-2 nonimmigrant applying under
Section 13 of the Act of September 11, 1957.
Complete Form I-566, Parts 1, 3 (check Box "2e"), 4 and
5. Complete Part 2 if you are
not
applying to be the
principal alien. Attach these required supporting
documents:
Your Form I-94 and Form I-485 package;
Your Form I-508;
If you are a French National, a Form I-508F; and
All documentation required to establish eligibility for
the status you are requesting.
Use black ink. Type or print clearly using capital letters. If
an item does not apply to you, write "N/A." If the answer is
none, write "NONE."
If you need extra space to answer any item, attach a sheet of
paper and at the top of each sheet, write your name, A # (if any)
and PID (if available). Indicate the item number to which
the answer refers.
NOTE: If you are filling out this form by hand, only complete
Page 1 and 2. When you are done, make a photocopy of these
pages. If you are filling out this form electronically, input your
information on the first two pages, pages 3 and 4 will be
automatically populated. When you print the form, you will
get 2 completed copies. No matter how you fill out the form,
both copies must have an original signature.
This form is divided into Parts 1 through 8. The following
information should help you fill out the form.
Part 1. Information about you.
( The person seeking
employment authorization or change/adjustment of
status.)
.
Family Name (Last name) - Give your legal name. If you
have two last names, include both and use a hyphen (-)
between the names, if appropriate.
.
Home Address - Give your physical street address in the
United States. This must include a street number and
name or a rural route number. Do not put a post office box (P.O.
Box) number here.
.
Mailing Address - Give your mailing address, if different
from your home address.
.
phone number in the United States where you may be
reached during the day.
Daytime Phone Number (include area code) - Give a
.
Marital Status - Check the appropriate box. If you are
divorced or widowed, mark "Not Married."
.
A # - This is your file number. If you do not have an A
number or do not know it, leave this blank.
.
Social Security # - Give your U.S. Social Security
number. If you do not have one, leave this blank.
Form I-566 Instructions (Rev. 03/30/06) N Page 3
Step 2. Fill Out the Form I-566.
Status or Adjustment of Status.
--
--
--
.
.
.
.
I-94 # - Give the number on the Form I-94,
Arrival/Departure Document, you received upon your
most recent admission into the United States.
DOS Personal Identification # (PID) - This is the number
provided to eligible A and G nonimmigrants by the DOS.
Date of Last Entry into the U.S. - Give the date you
last
entered the United States.
Current Immigration Status - Give your current status. If
you changed status after admission to the United States,
give your new status.
Part 2 - Information about principal alien.
.
If you are a dependent family member filing for
employment authorization or change/adjustment of status
to or from an A, G or NATO nonimmigrant status,
complete this part.
Part 3 - Type of request.
.
Check and fill in any boxes that apply to your request.
Part 4 - Certification.
.
Sign and date the Form I-566 (both copies). If both copies
of the form are not signed, your request will be returned as
incomplete. A parent or guardian may sign, if appropriate.
Part 5 - Your personal information.
.
You, the person making the request, must complete this
part to assist the agencies involved in responding to your
request.
Parts 6, 7 and 8 are for official use only.
.
This page, with only Part 5 filled in, must be submitted
with your request. You, the requester, do not fill in any of
Parts 6, 7 and 8.
Step 3. Submitting the Form I-566.
Your Form I-566 must include the following items.
.
Your signed and completed Form I-566.
Two (2)
copies of both pages of the form must be submitted.
Both
copies must have an original signature in Part 4.
NOTE: If your request is urgent, you may so indicate by
attaching a written request. Every effort will be made to
expedite processing.
.
Filing fee.
There is no fee for filing Form I-566.
However, there may be a filing fee for the associated
petition or application. If the petition or application is
submitted with this request, read the instructions on the
associated form for fee information.
.
Evidence. Attach copies of the front and back of the
documents you need to support your request. See Step 1,
Reason for Filing Form I-566, for detailed document
requirements. Do not send original documents unless
instructed to do so.
NOTE: Documents not in English must have a full English
translation. The translator must provide a statement that
the translation is complete and correct and that he or she
is competent to translate the foreign language into English.
.
Submit your Form I-566. See the following to
determine how your I-566 is to be submitted.
NOTE: A completed and signed Form I-765 must be
attached to the Form I-566, and include all required
documentation. See Form I-765 instructions for additional
information.
Submit your request as follows:
A and G Dependents: Submit your complete Form I-566
package, including the Form I-765, to the DOS office in
Washington, D.C. through your diplomatic mission or
international organization. In New York City, the
United Nations (UN) and UN missions should submit
the package to the U.S. Mission to the UN (USUN).
The DOS or USUN will forward favorably endorsed
requests directly to USCIS. If your Form I-765
application is approved, USCIS will transmit your
employment authorization in accordance with current
procedures.
NATO Dependents: Submit your complete Form I-566
package, including the Form I-765, to NATO/HQ SACT
Legal Affairs, 7857 Blandy Road, Suite 100, Norfolk,
VA 23551-2490. Questions regarding the process
or document requirements may be directed to HQ
SACT by telephoning (757) 747-3640.
If a bilateral dependent employment agreement
contains a numerical limitation on the number of
dependents authorized to work, NATO/HQ SACT or
DOD will consult with DOS to determine whether this
numerical limitation has been reached. NATO/HQ
SACT or DOD will forward favorably endorsed
requests directly to USCIS.
If your Form I-765 application is approved, USCIS will
transmit your employment authorization in accordance
with current procedures.
Form I-566 Instructions (Rev. 03/30/06) N Page 4
If You Are Requesting a Change / Adjustment of
Status. - Submit your request as follows:
Submit the following requests to your diplomatic
mission, international organization or NATO/HQ
SACT.
If You Are Requesting Employment.
--
--
.
Change of nonimmigrant status
to
A, G or NATO
status.
The diplomatic mission, international organization
or NATO/HQ SACT will forward your Form
I-566 and Form I-539 application package to the
DOS/Visa Office or USUN. the DOS/Visa Office
or USUN will forward favorable endorsements to
USCIS.
.
.
Change to other nonimmigrant status from A, G or
NATO.
Upon receipt of a favorable endorsement from the
DOS/Visa Office or USUN, submit both copies of
the Form I-566, your Form I-94, Form I-539 or Form
I-129 (as appropriate), and all documentation
required to establish eligibility for the requested
status to the USCIS office having jurisdiction (see
instructions on Forms I-539 or I-129).
.
Adjustment from A, G or NATO nonimmigrant
to
immigrant.
.
A-1, A-2, G-1 or G-2 nonimmigrant applying under
Section 13 of the Act of September 11, 1957.
USCIS will forward this request to the DOS/Visa
Office or USUN, as appropriate. The DOS/Visa
Office or USUN will advise USCIS of its official
position, the date of onset and termination of
status, and whether there are any objections to the
requested adjustment under Section 13.
Paperwork Reduction Act Notice. You are not required to
respond to this form unless it displays a currently valid OMB
control number. We try to create forms and instructions that
are accurate, can be easily understood and impose the least
possible burden on you to provide us with information. Often
this is difficult because some immigration laws are very
complex. The estimated average time to complete and file this
form is 15 minutes. If you have comments regarding the
accuracy of this estimate, or suggestions for making this form
simpler, you may write to: U.S. Citizenship and Immigration
Services, Regulatory Management Division, 111
Massachusetts, Avenue N.W., Washington, D.C. 20529; OMB
No. 1615-0027. Do not mail your request to this address.
Our goal at USCIS is to process all requests fairly. The
processing time will vary depending on the specific
circumstances of each case. We may reject an incomplete
request. We may deny your request if you do not give us the
required information or do not go to a scheduled interview.
Form I-566 Instructions (Rev. 03/30/06) N Page 5
Submit the following request directly to DOS/
Visa Office or USUN.
Submit the following request directly to the
USCIS office having jurisdiction (see instructions
on Form I-485.)
Privacy Act Notice. USCIS will use the information on Form
I-566 to determine eligibility for the requested immigration
benefit. We may provide information on your request to other
government agencies.
If you filled out the Form I-566 by hand, did you:
Completely fill out the form;
Make two copies; and
Sign both copies?
If you filled out the Form I-566 electronically, did you:
Completely fill out the form;
Make two copies; and
Sign both copies?
AND:
Are both copies of the "Official Use Form attached?"
Did you attach all other required documents?
For your records, you should keep copies of your Form
I-566 package.
Section 247(a), immigrant to A or G nonimmigrant.
Upon receipt of your Form I-566 with a
favorable DOS endorsement, submit both
copies of it, your Permanent Resident Card (Form
I-551) and Form I-407 to the USCIS office
having jurisdiction (see instructions on Form
I-407).
Do You Need USCIS Forms or Information? To request
USCIS forms, call our toll-free forms line at 1-800-870-3676.
You may also obtain USCIS forms and information about
immigration laws and regulations by calling 1-800-375-5283
or from USCIS internet website at www.uscis.gov.
Use InfoPass to Make an Appointment. As an alternative to
waiting in line for assistance at your local USCIS office, you
can now schedule an appointment through our internet-based
system, InfoPass. To access the system, visit our website at
www.uscis.gov. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen. Print the notice and take it with you to
your appointment. The notice gives the time and date of your
appointment, along with the address of the USCIS office.
Processing Information.
Check List.
NOTE: For such request, a DOS/USUN/NATO/HQ
SACT favorable endorsement is not required prior to
USCIS adjudication of the adjustment application.
OMB No. 1615-0027; Expires 01/31/07
I-566, Interagency Record of Request -
Part 1. Information about you.
( The person seeking employment authorization or change/adjustment of status.)
1.
Family Name Given Name Middle Name
2.
State
Home Address - Street Number and Name Apt.#
City Zip Code
3.
Mailing Address - Street Number and Name
Apt. #
C/O (in care of):
City
State
Zip Code Daytime Phone # (with area code)
4.
Date of Birth (mm/dd/yyyy)
5.
Country of Birth
6.
Country of Citizenship
7.
Gender
8.
Marital Status
9.
A # (if any)
Male
Female
Married
Not Married
10.
U.S. Social Security # (if any)
11.
I-94 # (Arrival/Departure Document)
12.
DOS Personal Identification # (PID)
13.
Date of Last Entry into the U.S. (mm/dd/yyyy)
14.
Current Immigration Status
15.
Relationship to Principal (if applicable)
Part 2.
Information about principal alien.
1.
Family Name Given Name Middle Name
City
State
Zip Code
2.
Home Address - Street Number and Name Apt.#
3. Date Tour of Duty Expected to End (mm/dd/yyyy)
4.
Country of Citizenship
6.
Job Title
5.
Marital Status
Married Not Married
7.
I-94 # (Arrival/Departure Document)
8.
DOS Personal Identification # (PID)
Part 3. Type of request.
(See instructions for complete information on the different types of requests.)
1.
I am requesting employment authorization as a:
a. spouse.
b.
son or daughter, age: , who: is a full-time, post-secondary student. is disabled.
2.
I am requesting change/adjustment of status. (Select one.)
a.
Change of nonimmigrant status
to
A, G or NATO nonimmigrant - specifically to:
b.
Section 247(a), immigrant
to
A or G nonimmigrant.
Change to other nonimmigrant status
from
A, G or NATO - specifically to:
c.
d.
e.
Adjustment
from
A, G or NATO nonimmigrant to immigrant.
A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
Submit two copies with original signatures - "For official use only" page must also be attached.
I certify under penalty of perjury that the foregoing is true and correct. I understand false information is a basis for denial or termination of the
benefit requested and for other penalties provided by law and regulation. If I am requesting employment authorization, I further certify that I do not
have a criminal record. I have not violated United States immigration and/or visa laws, I have not worked illegally in the United States, and I have
paid Social Security and all applicable taxes on all employment in the United States.
Signature
Date (mm/dd/yyyy)
Copy 1:USCIS
Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE
Form I-566 (Rev. 03/30/06) N
START HERE - Please type or print in black ink. ..
Department of Homeland Security
U.S. Citizenship and Immigration Services
A, G or NATO Dependent Employment Authorization
or Change/Adjustment to/from A, G or NATO Status
Part 4. Certification
Part 5.
Your personal information.
Your Name (family, given, middle) Date of Birth (mm/dd/yyyy) DOS Personal Identification # (PID)
Part 6.
Certification by Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State.
(Certifying official must have this information and page to complete process.)
I certify that the information provided on the first page of this Form I-566 is true and correct to the best of my knowledge and
according to our official records.
As an applicant for employment authorization, I further certify that his or her eligibility has been verified under the provisions of:
A bilateral agreement with: A de facto agreement with:
Check each of the following that apply:
Without a numerical limit.
With a numerical limit and this applicant is within the limit; and
Based on principal alien's G-4 status
As an applicant for status as a principal alien, I further
certify that he or she is being offered the position of:
and was notified to the DOS on (date):
Signature of Certifying Officer or Official
Printed Name
Official Seal
Name and Address of Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State
Phone Number (include area code) Date (mm/dd/yyyy)
Duty/Title
Part 7.
Recommends the request be granted. Recommends the request be denied.
The Department of State, NATO/HQ SACT and/or USUN:
1.
Date (mm/dd/yyyy) Phone Number (include area code)
2.
4. Signature 1
Signature 2
If the recommendation is for denial, provide a reason(s) for such recommendation:
Office:
Protocol
USUN
3.
NATO/HQ SACT Visa
DOS, NATO/HQ SACT and/or USUN use only.
From:
1.
USCIS Office
Office Phone Number (with area code)
Adjustment or Change of Status:
Protocol
2.
3.
A # / File #
To:
Granted Denied
If change of status granted, give new status:
Date of Decision (mm/dd/yyyy)
Adjudicator's Identification #
Request for Employment Authorization:
4.
Granted Denied
Valid to (mm/dd/yyyy):Date of Decision (mm/dd/yyyy):
DOS/NATO/HQ SACT/USUN/Visa
Office Notified:
5.
Yes
No
Date of Notification (mm/dd/yyyy):
Visa Office (Subject filed under Section 13.
USUN NATO/HQ SACT
Classification:
Please advise USCIS of your findings.)
Copy 1: USCIS
Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE
Form I-566 (Rev. 03/30/06) N Page 2
For official use only.
Part 8. USCIS use only.
OMB No. 1615-0027; Expires 01/31/07
I-566, Interagency Record of Request -
A, G or NATO Dependent Employment Authorization
or Change/Adjustment to/from A, G or NATO Status
Part 1. Information about you.
( The person seeking employment authorization or change/adjustment of status.)
1.
Family Name Given Name Middle Name
2.
State
Home Address - Street Number and Name Apt.#
City Zip Code
3.
Mailing Address - Street Number and Name
Apt. #
C/O (in care of):
City
State
Zip Code Daytime Phone # (with area code)
4.
Date of Birth (mm/dd/yyyy)
5.
Country of Birth
6.
Country of Citizenship
7.
Gender
8.
Marital Status
9.
A # (if any)
Male
Female
Married
Not Married
10.
U.S. Social Security # (if any)
11.
I-94 # (Arrival/Departure Document)
12.
DOS Personal Identification # (PID)
13.
Date of Last Entry into the U.S. (mm/dd/yyyy)
14.
Current Immigration Status
15.
Relationship to Principal (if applicable)
Part 2.
Information about principal alien.
1.
Family Name Given Name Middle Name
City
State
Zip Code
2.
Home Address - Street Number and Name Apt.#
3. Date Tour of Duty Expected to End (mm/dd/yyyy)
4.
Country of Citizenship
6.
Job Title
5.
Marital Status
Married Not Married
7.
I-94 # (Arrival/Departure Document)
8.
DOS Personal Identification # (PID)
Part 3. Type of request.
(See instructions for complete information on the different types of requests.)
1.
I am requesting employment authorization as a:
a.
spouse.
b.
son or daughter, age: , who: is a full-time, post-secondary student. is disabled.
2.
I am requesting change/adjustment of status. (Select one.)
a.
Change of nonimmigrant status
to
A, G or NATO nonimmigrant - specifically to:
b.
Section 247(a), immigrant
to
A or G nonimmigrant.
Change to other nonimmigrant status
from
A, G or NATO - specifically to:
c.
d.
e.
Adjustment
from
A, G or NATO nonimmigrant to immigrant.
A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
Submit two copies with original signatures - "For official use only" page must also be attached.
I certify under penalty of perjury that the foregoing is true and correct. I understand false information is a basis for denial or termination of the
benefit requested and for other penalties provided by law and regulation. If I am requesting employment authorization, I further certify that I do not
have a criminal record. I have not violated United States immigration and/or visa laws, I have not worked illegally in the United States, and I have
paid Social Security and all applicable taxes on all employment in the United States.
Signature
Date (mm/dd/yyyy)
Copy 1:USCIS
Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE
Form I-566 (Rev. 03/30/06) N
START HERE - Please type or print in black ink. ..
Department of Homeland Security
U.S. Citizenship and Immigration Services
Part 4. Certification -
Part 5. Your personal information.
Your Name (family, given, middle) Date of Birth (mm/dd/yyyy) DOS Personal Identification # (PID)
Part 6. Certification by Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State.
(Certifying official must have this information and page to complete process.)
I certify that the information provided on the first page of this Form I-566 is true and correct to the best of my knowledge and
according to our official records.
As an applicant for employment authorization, I further certify that his or her eligibility has been verified under the provisions of:
A bilateral agreement with:
A de facto agreement with:
Check each of the following that apply:
Without a numerical limit.
With a numerical limit and this applicant is within the limit; and
Based on principal alien's G-4 status
As an applicant for status as a principal alien, I further
certify that he or she is being offered the position of:
and was notified to the DOS on (date):
Signature of Certifying Officer or Official
Printed Name
Official Seal
Name and Address of Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State
Phone Number (include area code) Date (mm/dd/yyyy)
Duty/Title
Part 7.
Recommends the request be granted. Recommends the request be denied.
The Department of State, NATO/HQ SACT and/or USUN:
1.
Date (mm/dd/yyyy) Phone Number (include area code)
2.
4. Signature 1 Signature 2
If the recommendation is for denial, provide a reason(s) for such recommendation:
Office:
Protocol
USUN
3.
NATO/HQ SACT
Visa
From:
1.
USCIS Office
Office Phone Number (with area code)
Adjustment or Change of Status:
Protocol
2.
3.
A # / File #
To:
Granted Denied
If change of status granted, give new status:
Date of Decision (mm/dd/yyyy)
Adjudicator's Identification #
Request for Employment Authorization:
4.
Granted Denied
Valid to (mm/dd/yyyy):Date of Decision (mm/dd/yyyy):
DOS/NATO/HQ SACT/USUN/Visa
Office Notified:
5.
Yes
No
Date of Notification (mm/dd/yyyy):
Visa Office (Subject filed under Section 13.
USUN NATO/HQ SACT
Classification:
Please advise USCISof your findings.)
Copy 1: USCIS
Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE
Form I-566 (Rev. 03/30/06) N Page 2
For official use only.
Part 8. USCIS use only.
DOS, NATO?HQ SACT and/or USUN use only.
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I-566, Interagency Record of Request - (ILW.COM)

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Completed 9 January 2021

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