Fillable Suspension Of Deportation Form I-881 (Visa Pro)

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Suspension Of Deportation Form I-881 (Visa Pro)

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Page 1 of 15Form I-881 Edition 11/08/19
Application for Suspension of Deportation or
Special Rule Cancellation of Removal
(Pursuant to Section 203 of Public Law 105-100, NACARA)
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-881
OMB No. 1615-0072
Expires 11/30/2021
For
USCIS
Use
Only
EOIR ActionsDecisionReturned
Granted suspension of deportation or
special rule cancellation of removal and
adjustment of status
Receipt
Resubmitted
Reloc Sent
Reloc Rec'd
Referred to Immigration Judge in
accordance with 8 CFR Section 240.70
(Adjudicating Officer's Signature)
(Office Location)(Date of Action)
To be completed by an
Attorney or Accredited
Representative (if any).
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Select this box if
Form G-28 is
attached.
Part 1. Information About You
START HERE - Type or print in black ink.►
1.b.
1.c.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Your Current Legal Name
Other Names You Have Used Since Birth
(if applicable)
Provide all other names you have ever been known by or used,
including aliases, maiden name, and nicknames. Make sure to
include all variations of your name as it appears on identity
documents, passports, birth certificates, bank loan documents,
etc. If you need extra space to complete this section, use the
space provided in Part 15. Additional Information.
2.b.
2.c.
2.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
3.b.
3.c.
3.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
U.S. Mailing Address
4.d. City or Town
4.e. State 4.f. ZIP Code
Street Number
and Name
4.b.
4.c. Flr.Apt. Ste.
4.a. In Care Of Name (if any)
Other Information About You
Date of Birth (mm/dd/yyyy)5.
6. Gender
Male Female
7. City or Town of Birth
Country of Birth
8.
Alien Registration Number (A-Number/USCIS Number)
(if any)
10.
A-
Country of Citizenship or Nationality
9.
USCIS Online Account Number (if any)11.
►
Page 2 of 15Form I-881 Edition 11/08/19
Part 2. Application Type
I am eligible to apply for suspension of deportation or special
rule cancellation of removal under the Nicaraguan Adjustment
and Central American Relief Act (NACARA) because I have
not been convicted of an aggravated felony and (Select all
applicable boxes in Item Numbers 1. - 4.):
1.
Registered ABC Class Members
I am a national of El Salvador who first entered the
United States on or before September 19, 1990 and
registered for benefits on time under the ABC
settlement agreement in American Baptist Churches
v. Thornburgh, 760 F. Supp. 796 (N.D. Cal. 1991),
either directly or by applying for Temporary
Protected Status (TPS) between January 1, 1991 and
October 31, 1991; and I have not been apprehended
at the time of entry after December 19, 1990.
I am a national of Guatemala who first entered the United
States on or before October 1, 1990, and registered for
benefits on time under the ABC settlement agreement in
American Baptist Churches v. Thornburgh, 760 F. Supp.
796 (N.D. Cal. 1991), and I have not been apprehended
at the time of entry after December 19, 1990.
2. I am a national of Guatemala or El Salvador who filed
an application for asylum on or before April 1, 1990.
3. I entered the United States on or before December
31, 1990; filed an application for asylum on or before
December 31, 1991; and, at the time of filing, was a
national of the Soviet Union (USSR), Russia, any
republic of the former Soviet Union, Latvia, Estonia,
Lithuania, Poland, Czechoslovakia, Romania,
Hungary, Bulgaria, Albania, East Germany, or any
state of the former Yugoslavia.
4.
Spouse, child, son, or daughter of someone who has
already applied or is currently filing for suspension of
deportation or special rule cancellation of removal
under NACARA:
I am the spouse or child (unmarried and under 21 years
of age) of someone who has already applied, or who is
currently filing with me, for suspension of deportation or
special rule cancellation of removal under NACARA.
I am the unmarried son or unmarried daughter of someone
who has already applied or who is currently filing with me,
for suspension of deportation or special rule cancellation of
removal under NACARA, and I entered the United States
on or before October 1, 1990, or my parent was granted
suspension of deportation or special rule cancellation of
removal when I was under 21 years of age.
NOTE: If you selected either checkbox in Item Number 4.,
attach evidence of the relationship and provide the following
information about the spouse or parent who has already applied
or is currently filing with you:
Spouse or Parent's Name
5.b.
5.c.
5.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)6.
A-
The person who has applied for suspension of deportation
or special rule cancellation of removal is your:
7.
Spouse
Parent
I am or was the spouse or child of an individual
described in Item Numbers 1. - 3., and I or my child
has been battered or subjected to extreme cruelty by
that individual described in Item Numbers 1. - 3.
8.
Part 3. Information About Your Presence In the
United States
Address History
Provide your physical addresses for the last 10 years. Include
addresses for anywhere you resided 60 days or more. Provide
your current address first.
If you need extra space to complete
this section, use the space provided in Part 15. Additional
Information.
Physical Address 1 (current address)
1.c. City or Town
1.d. State 1.e. ZIP Code
Street Number
and Name
1.a.
1.b. Flr.
Apt. Ste.
Date of Residence
From (mm/dd/yyyy)2.a.
To (mm/dd/yyyy)2.b.
Part 1. Information About You (continued)
U.S. Social Security Number (if any)
►
12.
Page 3 of 15Form I-881 Edition 11/08/19
Part 3. Information About Your Presence In the
United States (continued)
Physical Address 2
3.c. City or Town
3.d. State 3.e. ZIP Code
Street Number
and Name
3.a.
3.b. Flr.
Apt. Ste.
Date of Residence
From (mm/dd/yyyy)4.a.
To (mm/dd/yyyy)4.b.
Information About Your First Entry Into the
United States
Name Used When You First Entered the United States
5.b.
5.c.
5.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
6. Place of First Entry Into the United States
Status When You First Entered the United States7.
Date of First Entry Into the United States (mm/dd/yyyy)8.
Period Admitted Into the United States
From (mm/dd/yyyy)9.a.
To (mm/dd/yyyy)9.b.
Did you change your nonimmigrant status after entry? 10.a.
Yes No
If you answered “Yes,” which nonimmigrant status did
you obtain?
10.b.
Information About Your Departures From and To
the United States
Provide information about any departure from and return to the
United States you have made since your first entry into the U.S.
List all departures, including short trips that lasted longer than
24 hours and visits to Canada and Mexico.
If you need extra
space to complete this section, use the space provided in Part
15. Additional Information.
NOTE: If you have not departed the United States since your
first date of entry, type or print “None” below.
Departure 1 (current or most recent)
Departure Date (mm/dd/yyyy)14.
Purpose of Travel15.
Destination16.
Return 1
Port of Entry17.
Return Date (mm/dd/yyyy)18.
Status at Entry19.
Inspected and Admitted 20. Yes No
Immigration Status in Which You Were Admitted21.
If you were admitted in a nonimmigrant status, were you
granted a change of status after you were admitted?
22.
Yes No
Which nonimmigrant status did you obtain?23.
Port of Departure13.
Date You First Changed Status (mm/dd/yyyy)11.
Date Your Last Extension of Stay Expired (mm/dd/yyyy)12.
Page 4 of 15Form I-881 Edition 11/08/19
Part 3. Information About Your Presence In the
United States (continued)
Departure 2
Departure Date (mm/dd/yyyy)25.
Purpose of Travel26.
Destination27.
Return 2
Port of Entry28.
Return Date (mm/dd/yyyy)29.
Status at Entry30.
Inspected and Admitted 31. Yes No
Immigration Status in Which You Were Admitted32.
If you were admitted in a nonimmigrant status, were you
granted a change of status after you were admitted?
33.
Yes No
Which nonimmigrant status did you obtain?34.
Port of Departure24
If you answer “Yes” or are unsure about any of your answers to
any of the questions in Item Numbers 35.a. - 35.e., use the
space provided in Part 15. Additional Information to provide
an explanation.
Failed to appear for deportation or removal?35.e.
Yes No
Part 4. Information About Your Employment
and Financial Status
Employment History
Provide your employment history for the last 10 years. List
your employment from most recent to the oldest, starting with
information on your current employment first. Include all
employment, even if it is not full-time. If you did the same type
of work for three or more employers during any six-month
period and you do not know the names and addresses of those
employers, you may type or print “multiple employers.” You
should specify any periods of unemployment, unpaid work
(such as a homemaker or intern), or school attendance.
If you
need extra space to complete this section, use the space
provided in Part 15. Additional Information.
2.c. City or Town
2.d. State 2.e. ZIP Code
2.f.
Postal Code
Street Number
and Name
2.a.
2.b. Flr.Apt. Ste.
2.g.
2.h. Country
Province
Employer 1 (current or most recent)
Address of Employer/Company
Name of Employer or Company1.
Have you EVER:
Been ordered deported or removed?35.a.
Yes No
Departed the United States under an order of deportation
or removal?
35.b.
Yes No
Overstayed a grant of voluntary departure from an
immigration judge or the Department of Homeland
Security (DHS)?
35.c.
Yes No
Departed the United States under a grant of voluntary
departure or voluntary return?
35.d.
Yes No
Page 5 of 15Form I-881 Edition 11/08/19
Part 4. Information About Your Employment
and Financial Status (continued)
7.c. City or Town
7.d. State 7.e. ZIP Code
7.f.
Postal Code
Street Number
and Name
7.a.
7.b. Flr.Apt. Ste.
7.g.
7.h. Country
Province
Address of Employer/Company
Earnings Per Week (U.S. dollars) $
Your Occupation9.
From (mm/dd/yyyy)10.a.
Dates of Employment
To (mm/dd/yyyy)10.b.
Financial Status
Provide information about your assets in the United States and other
countries, including those held jointly with your spouse (if you are
married) or with others. Do not include the value of clothing and
household necessities. If married, provide information about your
spouse's assets that he or she does not hold jointly with you. If you
need extra space to complete this section or to describe other assets
listed, use the space provided in Part 15. Additional Information.
Self (Including assets jointly owned with spouse or others)
Cash, Checking, or Savings Accounts (U.S. dollars)11.a.
$
Motor Vehicles (Minus any amount owed) (U.S. dollars)11.b.
$
Real Estate (Minus any amount owed) (U.S. dollars)11.c.
$
Other (U.S. dollars)11.d.
$
$
Total (U.S. dollars)11.e.
Spouse (if applicable)
Cash, Checking, or Savings Accounts (U.S. dollars)12.a.
$
Motor Vehicles (Minus any amount owed) (U.S. dollars)12.b.
$
Real Estate (Minus any amount owed) (U.S. dollars)12.c.
$
Other (U.S. dollars)12.d.
$
$
Total (U.S. dollars)12.e.
Have you filed a Federal income tax return while in the
United States?
13.a.
NoYes
From (mm/dd/yyyy)5.a.
Dates of Employment
To (mm/dd/yyyy)5.b.
Employer 2
Name of Employer or Company6.
Earnings Per Week (U.S. dollars)3. $
Your Occupation4.
If you answered "Yes," indicate the years you filed and
attach evidence that you filed the returns. If you did not file
a tax return during any particular years, explain why you did
not file. If you need extra space to complete this section,
use the space provided in Part 15. Additional Information.
13.b.
8.
Page 6 of 15Form I-881 Edition 11/08/19
Part 5. Information About Your Marital Status
and Spouse
Single, Never Married
Married
Divorced
Widowed
What is your current marital status?1.
Marriage Annulled Legally Separated
Information About Your Current Marriage
(including if you are legally separated)
If you are currently married, provide the following information
about your current spouse.
Current Spouse's Legal Name
2.b.
2.c.
2.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)3.
A-
Current Spouse's Date of Birth (mm/dd/yyyy)4.
Current Spouse's Date of Marriage (mm/dd/yyyy)5.
Current Spouse's Place of Birth
6.a. City or Town
State or Province
6.b.
Country
6.c.
Current Spouse's Place of Marriage
7.a. City or Town
State or Province
7.b.
Country
7.c.
Address Where Current Spouse Resides
8.c. City or Town
8.d. State 8.e. ZIP Code
8.f.
Postal Code
Street Number
and Name
8.a.
8.b. Flr.Apt. Ste.
8.g.
8.h. Country
Province
Current Spouse's Status
If your spouse presently resides in the United States, your
spouse's present status is:
9.
U.S. Citizen
Lawful Permanent Resident
Asylee
Asylum Applicant
Other (explain):
Current Spouse's Employment
Is your spouse employed? 10. Yes No
If your spouse is employed,
provide your spouse's name,
address of employment, and his or her salary.
Name of Employer/Company11.
12.c. City or Town
12.d. State 12.e. ZIP Code
12.f.
Postal Code
Street Number
and Name
12.a.
12.b. Flr.Apt. Ste.
12.g.
12.h. Country
Province
Address of Employer/Company
Page 7 of 15Form I-881 Edition 11/08/19
Part 5. Information About Your Marital Status
and Spouse (continued)
Earnings per Week (U.S. dollars)13. $
From (mm/dd/yyyy)15.a.
To 15.b.
Information About Your Previous Marriage
(if applicable)
How many times have you been married?
If you were previously married, provide the following
information about your prior spouses.
If you have had more
than one previous marriage, use the space provided in Part 15.
Additional Information to provide the information below.
Prior Spouse's Legal Name
17.b.
17.c.
17.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Prior Spouse's Date of Birth (mm/dd/yyyy)18.
Date of Marriage to Prior Spouse (mm/dd/yyyy)19.
Date Marriage to Prior Spouse Ended (mm/dd/yyyy)20.
Place Where Marriage to Prior Spouse Ended
21.a City or Town
State or Province
21.b.
Country
21.c.
NoYes
23. Have you been ordered by any court or are you otherwise
under any legal obligation to provide child support and/or
spousal maintenance?
If you answered "Yes," use the space provided in Part 15.
Additional Information to explain what type of obligation you
have, to whom it is owed, and whether you are fulfilling that
obligation.
Part 6. Information About Your Children
Do you have children?1.a. Yes No
If you answered "No," then skip to Part 7.
How many children do you have?1.b.
List all your children below, regardless of their age, and provide
the requested information about each of them. If your child
currently resides with you, please type or print “with me” under
“current address.” If the child does not live with you, provide
his or her address and relationship to the person with whom he
or she lives. If you need extra space to complete this section,
use the space provided in Part 15. Additional Information.
Child 1
Child's Current Legal Name
2.b.
2.c.
2.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)3.
A-
Date of Birth (mm/dd/yyyy)4.
Country of Birth
5.
Immigration Status
6.
PRESENT
Your Spouse's Occupation14.
Manner in Which Marriage to Prior Spouse Was
Terminated or Ended
22.
Divorce
Death
Annulment
Other
Dates of Employment
16.
Page 8 of 15Form I-881 Edition 11/08/19
Child's Current Address
Part 6. Information About Your Children
(continued)
7.c. City or Town
7.d. State 7.e. ZIP Code
7.f.
Postal Code
Street Number
and Name
7.a.
7.b. Flr.Apt. Ste.
7.g.
7.h. Country
Province
Child's Current Legal Name
8.b.
8.c.
8.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)9.
A-
Date of Birth (mm/dd/yyyy)10.
Country of Birth
11.
Immigration Status
12.
Child's Current Address
13.c. City or Town
13.d. State 13.e. ZIP Code
13.f.
Postal Code
Street Number
and Name
13.a.
13.b. Flr.Apt. Ste.
13.g.
13.h. Country
Province
Child's Current Legal Name
14.b.
14.c.
14.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)15.
A-
Date of Birth (mm/dd/yyyy)16.
Country of Birth
17.
Immigration Status
18.
Child's Current Address
19.c. City or Town
19.d. State 19.e. ZIP Code
19.f.
Postal Code
Street Number
and Name
19.a.
19.b. Flr.Apt. Ste.
19.g.
19.h. Country
Province
Part 7. Information About Your Parents
Information About Your Parent 1
Parent 1's Legal Name
1.b.
1.c.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Parent 1's Name at Birth (if different than above)
2.b.
2.c.
2.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Child 2
Child 3
Page 9 of 15Form I-881 Edition 11/08/19
Part 7. Information About Your Parents
(continued)
A-Number (if any)3.
A-
Date of Birth (mm/dd/yyyy)4.
City or Town of Birth
5.
Country of Birth
6.
Immigration Status
7.
Country of Citizenship or Nationality
8.
9.c. City or Town
9.d. State 9.e. ZIP Code
9.f.
Postal Code
Street Number
and Name
9.a.
9.b. Flr.Apt. Ste.
9.g.
9.h. Country
Province
Current Address
Estimated Total Assets (U.S. dollars)
Weekly Earnings (U.S. dollars)11.
Information About Your Parent 2
Parent 2's Legal Name
12.b.
12.c.
12.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
A-Number (if any)14.
A-
Date of Birth (mm/dd/yyyy)15.
City or Town of Birth
16.
Country of Birth
17.
Immigration Status
18.
Country of Citizenship or Nationality
19.
20.c. City or Town
20.d. State 20.e. ZIP Code
20.f.
Postal Code
Street Number
and Name
20.a.
20.b. Flr.Apt. Ste.
20.g.
20.h. Country
Province
Current Address
Estimated Total Assets (U.S. dollars)21.
Weekly Earnings (U.S. dollars)22.
Part 8. Biographic Information
1. Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
Parent 2's Name at Birth (if different than above)
13.b.
13.c.
13.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
2. Race (Select all applicable boxes)
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Height Feet Inches
3.
4. Weight Pounds
10.
Page 10 of 15Form I-881 Edition 11/08/19
Part 8. Biographic Information (continued)
5. Eye Color (Select only one box)
Black Blue Brown
Gray Green Hazel
Maroon Pink Unknown/Other
6. Hair Color (Select only one box)
Bald (No hair) Black Blond
Brown Gray Red
Sandy White
Unknown/Other
Part 9. Miscellaneous Information
Respond to the following questions. If you answer "Yes" to any
of the questions in Item Numbers 1. - 2.m., use the space
provided in Part 15. Additional Information to provide an
explanation.
Have you ever (either in the United States or in another
country) been arrested, summoned into court as a
defendant, convicted, fined, imprisoned, placed on
probation, or forfeited collateral for an act involving a
felony, misdemeanor, or breach of any public law or
ordinance (including, but not limited to, driving violations
involving alcohol)?
1.
Yes No
If you answered "Yes," your explanation must include a
brief description of each offense, including the name and
location of the offense, date of conviction, any penalty
imposed, any sentence imposed, and the time actually
served.
Trafficked a controlled substance, or knowingly assisted,
abetted, conspired, or colluded with others in any such
trafficking (not including a single offense of simple
possession of 30 grams or less of marijuana)?
2.g.
Yes No
Been a practicing polygamist?2.h.
Yes No
Been admitted into the United States as a crewman after
June 30, 1964?
2.i.
Yes No
Been admitted into the United States as an exchange
visitor or acquired such status after arriving in the U.S.?
2.j.
Yes No
Been inadmissible or deportable on security-related
grounds under the Immigration and Nationality Act (INA)
sections 212(a)(3) or 237(a)(4) (for cancellation
applicants), or under pre-IIRIRA INA section 241(a)(4)
(for suspension applicants)?
2.k.
Yes No
Ordered, incited, assisted, or otherwise participated in the
persecution of an individual on account of his or her race,
religion, nationality, membership in a particular social
group, or political opinion?
2.l.
Yes No
Been previously granted relief under INA sections 212(c)
(waiver for certain grounds of inadmissibility) or 244(a)
(suspension of deportation) or was your removal
cancelled under INA section 240A (cancellation of
removal)?
2.m.
Yes No
Have you EVER:
Been a habitual drunkard?2.a. Yes No
Derived income principally from illegal gambling?2.b.
Yes No
Given false testimony for the purpose of obtaining
immigration benefits?
2.c.
Yes No
Engaged in prostitution or unlawful commercialized vice? 2.d.
Yes No
Been involved in a serious criminal offense and asserted
immunity from prosecution?
2.e.
Yes No
Aided and/or abetted another person to enter the United
States illegally?
2.f.
Yes No
Part 10. Information About Hardship You and/
or Your Family Will Face If You Are Deported
or Removed from the United States
Your responses in this part should be about you and/or your
qualifying family members, except for your response to Item
Number 11. A qualifying family member is a parent, spouse,
or child who is a U.S. citizen (USC) or a lawful permanent
resident (LPR) of the United States. When providing responses
about a family member, provide the family member's name and
his or her relationship to you. Where required, provide an
explanation of your answer in the space provided in Part 15.
Additional Information and reference the Item Number for
which you are providing an explanation. Attach any documents
you have to support the responses you provide below. (See the
Instructions for types of documents that you may wish to
submit.)
Page 11 of 15Form I-881 Edition 11/08/19
If your children are American citizens or lawful
permanent residents, do your children speak, read, and
write English?
1.
Yes No
If your children are American citizens or lawful
permanent residents, do your children speak, read, and
write the native language of the country you would be
returned to if deported or removed?
2.
Yes No
Do you or any of your qualified family members suffer
from or have previously suffered from any illness, health
problem, or disability that requires or required medical
attention?
3.
Yes No
If you answered "Yes," provide information about the
health problem and whether you or your qualified family
member suffer or have suffered from it. Also include any
care you or the person receives in the United States that
would not be available in the country to which you would
be deported or removed.
If you are deported or removed from the United States,
would all qualified family members accompany you?
6.
Yes No Not applicable
If you answered "No," list which qualified family
members would not accompany you, why the qualified
family members would not accompany you, and how that
affects you and your family members.
Would you or your qualified family members experience
any emotional or psychological impact if you were
deported or removed from the United States?
7.
Yes No Not applicable
Would the current conditions in the country to which you
would be deported or removed cause you or your
qualified family members extreme hardship if you are
deported or removed?
8.
Yes No Not applicable
Do you currently have any other way, besides this
application, for suspension of deportation or special rule
cancellation of removal, to adjust status to that of lawful
permanent resident in the United States?
9.
Yes No Not applicable
If you belong to any civic, political, religious, community,
or social organization, association, foundation, club, or
similar group or participate in volunteer activities, would
separating from these community ties and activities affect
you if you are deported or removed from the United States?
10.
Yes No Not applicable
Is there any other types of hardship that you or your
family would face if you are deported or removed from
the United States? (Include any hardship to your children,
spouse, parents who are not American citizens or lawful
permanent residents, and to your brothers, sisters,
grandparents, or other extended family members.)
11.
Yes No Not applicable
Not applicable
Not applicable
Not applicable
NOTE: If you meet the eligibility requirements listed under
Part 2. Application Type and you complete this application,
you will be presumed to meet the extreme hardship requirement
unless the evidence in your case record establishes that neither
you nor your qualified relative are likely to experience extreme
hardship if you are deported or removed from the United States.
If you qualify for a presumption of extreme hardship, you do
not need to submit documents that support your answers below
regarding your claim to extreme hardship, but you need to
provide explanations to your answers below.
Part 10. Information About Hardship You and/
or Your Family Will Face If You Are Deported
or Removed from the United States (continued)
Would you be able to obtain employment in the country
to which you would be deported or removed?
4.
Yes No Not applicable
If you answered "Yes," explain the type of employment
you would be able to obtain. If you answered "No,"
explain why you would be unable to find employment.
If you or a qualified family member are currently
pursuing educational opportunities in the United States,
would you or the qualified family member continue to
pursue the educational opportunities if deported or
removed from the United States?
5.
Yes No Not applicable
If you answered "No," explain why not.
Page 12 of 15Form I-881 Edition 11/08/19
Part 11. Applicant's Statement, Contact
Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-881
Instructions before completing this section. You must file Form
I-881 while in the United States.
At my request, the preparer named in Part 13.,
2.
prepared this application for me based only upon
information I provided or authorized.
,
The interpreter named in Part 12. read to me every
question and instruction on this application and my
answer to every question in
1.b.
a language in which I am fluent, and I understood
everything.
,
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.
I can read and understand English, and I have read and
understand every question and instruction on this
application and my answer to every question.
Applicant's Statement
5. Applicant's Email Address (if any)
Applicant's Daytime Telephone Number3.
Applicant's Contact Information
Applicant's Mobile Telephone Number (if any)4.
Applicant's Certification
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information from
any and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
I certify, under penalty of perjury, that I provided or authorized
all of the information in my application, I understand all of the
information contained in, and submitted with, my application,
and that all of this information is complete, true, and correct.
1) I reviewed and provided or authorized all of the
information in my application;
2) I understood all of the information contained in, and
submitted with, my application; and
3) All of this information was complete, true, and correct at
the time of filing.
Applicant's Signature6.a.
6.b. Date of Signature (mm/dd/yyyy)
Applicant's Signature
NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
Part 12. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
Interpreter's Business or Organization Name (if any)2.
Provide the following information about the interpreter.
I understand that USCIS will require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, I will be required to sign an
oath reaffirming that:
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b.
Apt. Flr.Ste.
Page 13 of 15Form I-881 Edition 11/08/19
Part 12. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Daytime Telephone Number
6.
4.
Interpreter's Email Address (if any)
Interpreter's Contact Information
Interpreter's Mobile Telephone Number (if any) 5.
which is the same language specified in Part 11., Item
Number 1.b., and I have read to this applicant in the identified
language every question and instruction on this application and
his or her answer to every question. The applicant informed me
that he or she understands every instruction, question, and
answer on the application, including the Applicant's
Certification, and has verified the accuracy of every answer.
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and ,
Interpreter's Signature
Interpreter's Signature7.a.
7.b. Date of Signature (mm/dd/yyyy)
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code3.g.
Province
3.h. Country
Street Number
and Name
3.a.
3.b.
Apt. Flr.Ste.
Preparer's Contact Information
Preparer's Daytime Telephone Number
6.
4.
Preparer's Email Address (if any)
Preparer's Mobile Telephone Number (if any)5.
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
Preparer's Business or Organization Name (if any)2.
Part 13. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
Provide the following information about the preparer.
Page 14 of 15Form I-881 Edition 11/08/19
Preparer's Signature
Preparer's Signature 8.a.
8.b. Date of Signature (mm/dd/yyyy)
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this
application based only on information that the applicant
provided to me or authorized me to obtain or use.
Preparer's Certification
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
application.
Preparer's Statement
I am an attorney or accredited representative and my
representation of the applicant in this case
extends does not extend beyond the preparation
of this application.
I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.
7.a.
7.b.
Part 13. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Part 14. To Be Completed at Interview or
Hearing
You will be asked to complete Part 14. when you are before an
asylum officer or an immigration judge for examination.
1. I swear (affirm) that I know the contents of this application
that I am signing, including the attached documents and
supplements, are all true or not all true to the
best of my knowledge and that the corrections numbered
to
at my request.
were made by me or
Applicant's Signature
2.a.
Date of Signature (mm/dd/yyyy)
Print your name in your native alphabet.3.
Signed and sworn before me by the above-named
applicant on:
4.
Date (mm/dd/yyyy)
Asylum Officer or Immigration Judge's Signature5.a.
Date of Signature (mm/dd/yyyy)5.b.
2.b.
Page 15 of 15Form I-881 Edition 11/08/19
Part 15. Additional Information
3.d.
If you need extra space to provide any additional information
within this application, 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 application 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
2. A-Number (if any) ►
A-
6.a.
Page Number 6.b. Part Number 6.c. Item Number
6.d.
5.d.
5.a.
Page Number 5.b. Part Number 5.c. Item Number
7.a.
Page Number 7.b. Part Number 7.c. Item Number
7.d.
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Suspension Of Deportation Form I-881 (Visa Pro)

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Completed 18 July 2020

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