Form I-566 Interangency Record of Individual Requesting Change/Adju

OMB No. 1615-0027; Expires 1/31/07

I-566, Interagency Record of Request - A, G, or
NATO Dependent Employment Authorization; Change/Adjust to/
from A, G or NATO; Extension of Stay for A-3, G-5 or NATO-7

Department of Homeland Security
U.S. Citizenship and Immigration Services

INSTRUCTIONS
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

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; or
3. You are an A-3, G-5 or NATO-7 and are applying for an
extension of stay.

Definitions

An A, G or NATO nonimmigrant requesting
adjustment to lawful permanent resident.

A # - Alien Registration Number assigned to an alien's
administrative file.

An A-3, G-5 or NATO-7 requesting an extension of
stay.

8 CFR - Title 8, Code of Federal Regulations.

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, change or adjustment
of status or extension of stay for A-3, G-5 or NATO-7. 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).

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, issued by DOS to
registered foreign government and international organization
personnel and their family members.
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, title 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.
Form I-566 Instructions (Rev. 06/29/06) N

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

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.

DS-2003, Notification of Appointment of Foreign Diplomatic
Officer and Career Consular Officer.
DS-2004, Notification of Appointment of Foreign
Government Employee.

USCIS Forms

Step 1. Reason for Filing Form I-566.
Dependent Employment Authorization

I-94, Arrival/Departure Record, issued to nonimmigrants upon
arrival in the United States.

Your request for employment authorization as an A, G or
NATO dependent may be based on either:

I-129, Petition for a Nonimmigrant Worker.

1. A formal, written bilateral agreement between the United
States and the country which employs the principal alien;

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

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 ages 21 and 23 years (or
between ages 21 and 25 under certain bilateral
agreements); or
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.

Form I-566 Instructions (Rev. 06/29/06) N Page 2

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.

Change to/from Nonimmigrant A, G or NATO
Status or Adjustment of Status
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 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;
If you are an A or G nonimmigrant, your Form I-508;
If you are an A or G 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.
Form I-566 Instructions (Rev. 06/29/06) N Page 3

Extension of Stay for A-3, G-5 or NATO-7
Complete Form I-566, Parts 1, 2, 3 (check appropriate box in
Number 3), 4 and 5. Attach the required supporting documents:

Your Form I-94 and Form I-539.
A statement by your employing official stating that he/she
intends to continue to employ you and describing the type
of work you will perform.

Step 2. Fill Out the Form I-566.
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 Pages 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, change/adjustment of
status or extension of stay.)

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.

Social Security # - Give your U.S. Social Security
number. If you do not have one, write "None".
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
issued by DOS to registered foreign government and
international organization personnel and their family
members. NATO visa holders and their family members
are not issued PID numbers.
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.
Name and Mailing Address of Diplomatic Mission,
International Organization, NATO/HQ SACT or
NATO Member State - Give organization name and the
address for the appropriate agency.
C/O (in care of) - Give the name of the agency contact
person who may be contacted for further information, if
necessary. NATO visa holders posted outside a NATO
Command should provide the point of contact at the
Sponsoring U.S. Command or National Component.
Daytime Phone Number (include area code) - Give a
phone number in the United States where the contact
person may be reached during the day.

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.

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.

Part 3 - Type of request.

Marital Status - Check the appropriate box. If you are
divorced or widowed, mark "Not Married."

Part 4 - Certification.

A # - This is your file number. If you do not have an A
number or do not know it, leave this blank.

Check and fill in any boxes that apply to your request.

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.
Form I-566 Instructions (Rev. 06/29/06) N Page 4

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 Form I-566 is to be submitted.

If You Are Requesting Employment Authorization
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 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.

If You Are Requesting a Change/Adjustment of
Status or Extension of Stay
Submit your request as follows:
Submit the following requests to your diplomatic
mission, international organization or NATO/HQ
SACT.
Change of nonimmigrant status to A, G or NATO
status or extension of stay for A-3, G-5 or NATO-7
nonimmigrant.
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.
Form I-566 Instructions (Rev. 06/29/06) N Page 5

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 and
your Permanent Resident Card (Form I-551) to the
USCIS office having jurisdiction. A Form I-407
will need be completed for you at the USCIS office.
Submit the following request directly to DOS/Visa
Office or USUN.
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).
Submit the following request directly to the USCIS
office having jurisdiction (see instructions on Form
I-485.)
Adjustment from A, G or NATO nonimmigrant to
immigrant.
NOTE: For such request, a DOS/USUN/NATO/
HQ SACT favorable endorsement is not required
prior to USCIS adjudication of the adjustment
application.
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.

Processing Information.
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.

Privacy Act Notice. USCIS will use the information on Form
I-566 to determine elegibility for the requested immigration
benefit. We may provide information on your request to other
government agencies.
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.
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.

Check List
If you filled out the Form I-566 by hand, did you:
Completely fill out the form;
Make 2 copies; and
Sign both copies?
If you filled out the Form I-566 electronically, did you:
Completely fill out the form; and
Make 2 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.
Form I-566 Instructions (Rev. 06/29/06) N Page 6

OMB No. 1615-0027; Expires 1/31/07

Department of Homeland Security

U.S. Citizenship and Immigration Services

I-566, Interagency Record of Request - A, G, or NATO Dependent Employment

Authorization; Change/Adjust to/from A, G or NATO; Extension of Stay for A-3, G-5 or NATO-7

START HERE - Please Type or Print in Black Ink.

Part 1. Information about you. ( The person seeking employment authorization, change/adjustment of status or extension of stay.)
1. Family Name

Given Name

Middle Name

2. Home Address - Street Number and Name

Apt.#
State

City

Zip Code

3. Date of Birth (mm/dd/yyyy) 4. Country of Birth

5. Country of Citizenship

6. Gender

Male
8. A # (if any)

7. Marital Status

Married

9. Social Security # (if any) 10. I-94 # (Arrival/Departure Document)

Not Married
12. Date of Last Entry into

11. DOS Personal

13. Current Immigration

the U.S. (mm/dd/yyyy)

Identification # (PID)

Female

Status

14. Relationship to Principal

(if applicable)

15. Name and Mailing Address of Diplomatic Mission, International Organization, NATO/HQ SACT, NATO Member State or

U.S. Sponsoring Command
C/O (in care of):

State

City

Zip Code

Daytime Phone # (with area code)

Part 2. Information about principal alien.
1. Family Name

Given Name

2. Home Address - Street Number and Name
3. Date Tour of Duty Expected to End (mm/dd/yyyy)

Middle Name
Apt.#

City

State

4. Job Title

Zip Code

5. Marital Status

Married
7. I-94 # (Arrival/Departure

6. Country of

Document)

Citizenship

8. Current

Immigration Status

Not Married

9. 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.

2.

3.

spouse.

b.

son or daughter, age:

, who:

is a full-time, post-secondary student.

is disabled.

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.
c.
Change to other nonimmigrant status from A, G or NATO - specifically to:
d.
Adjustment from A, G or NATO nonimmigrant to immigrant.
e.
A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
I am requesting an extension of stay as an:
A-3
G-5
NATO-7.

Part 4. Certification - Submit 2 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

Copy 1: USCIS

Date (mm/dd/yyyy)

Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE

Form I-566 (Rev. 06/29/06) N

Part 5.

Your personal information.

Your Name (family, given, middle)

Part 6.

Date of Birth (mm/dd/yyyy)

DOS Personal Identification # (PID)

For Official Use Only

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
With a numerical limit and this
numerical limit.
applicant is within the limit; and
As an applicant for status as a principal alien, I further
certify that he or she is being offered the position of:
Signature of Certifying Officer or Official

Based on principal alien's G-4 status
and was notified to the DOS on (date):

Printed Name

Official Seal

Name and Address of Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State
Duty/Title

Phone Number (include area code)

Date (mm/dd/yyyy)

Part 7. DOS, NATO/HQ SACT and/or USUN use only.
1. The Department of State, NATO/HQ SACT and/or USUN:
Recommends the request be granted.
Recommends the request be denied.
If the recommendation is for denial, provide a reason(s) for such recommendation:
2. Date (mm/dd/yyyy)

Phone Number (include area code)

3. Office:
Protocol

4. Signature 1

USUN

NATO/HQ SACT

Visa

Signature 2 (if required) or NATO Control # (if applicable)

Part 8. USCIS use only.
1. From:
Adjudicator's Identification #

USCIS Office

Office Phone Number (with area code)

A # / File #

2. To:
Protocol
USUN
NATO/HQ SACT
Visa Office (Subject filed under Section 13. Please advise USCIS of your findings.)
3. Request for Employment Authorization: Date of Decision (mm/dd/yyyy):
Valid to (mm/dd/yyyy):
Classification:
Granted
Denied
4. Adjustment or Change of Status:

Date of Decision (mm/dd/yyyy)

Granted
Denied
5. Request for Extension of Stay:

Date of Decision (mm/dd/yyyy):

Granted
Denied
6. DOS/NATO/HQ SACT/USUN/Visa Office Notified:
Yes
No
Copy 1: USCIS

Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE

If change of status granted, give new status:
Extension Granted To (mm/dd/yyyy):

Date of Notification (mm/dd/yyyy):
Form I-566 (Rev. 06/29/06) N Page 2

OMB No. 1615-0027; Expires 1/31/07

Department of Homeland Security

U.S. Citizenship and Immigration Services

I-566, Interagency Record of Request - A, G, or NATO Dependent Employment

Authorization; Change/Adjust to/from A, G or NATO; Extension of Stay for A-3, G-5 or NATO-7

START HERE - Please Type or Print in Black Ink.

Part 1. Information about you. ( The person seeking employment authorization, change/adjustment of status or extension of stay.)
1. Family Name

Given Name

Middle Name

2. Home Address - Street Number and Name

Apt.#
State

City

Zip Code

3. Date of Birth (mm/dd/yyyy) 4. Country of Birth

5. Country of Citizenship

6. Gender

Male
8. A # (if any)

7. Marital Status

Married

9. Social Security # (if any) 10. I-94 # (Arrival/Departure Document)

Not Married
12. Date of Last Entry into

11. DOS Personal

13. Current Immigration

the U.S. (mm/dd/yyyy)

Identification # (PID)

Female

Status

14. Relationship to Principal

(if applicable)

15. Name and Mailing Address of Diplomatic Mission, International Organization, NATO/HQ SACT, NATO Member State or

U.S. Sponsoring Command
C/O (in care of):

State

City

Zip Code

Daytime Phone # (with area code)

Part 2. Information about principal alien.
1. Family Name

Given Name

2. Home Address - Street Number and Name
3. Date Tour of Duty Expected to End (mm/dd/yyyy)

Middle Name
Apt.#

City

State

4. Job Title

Zip Code

5. Marital Status

Married
7. I-94 # (Arrival/Departure

6. Country of

Document)

Citizenship

8. Current

Immigration Status

Not Married

9. 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.

2.

3.

spouse.

b.

son or daughter, age:

, who:

is a full-time, post-secondary student.

is disabled.

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.
c.
Change to other nonimmigrant status from A, G or NATO - specifically to:
d.
Adjustment from A, G or NATO nonimmigrant to immigrant.
e.
A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
I am requesting an extension of stay as an:
A-3
G-5
NATO-7.

Part 4. Certification - Submit 2 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

Copy 1: USCIS

Date (mm/dd/yyyy)

Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE

Form I-566 (Rev. 06/29/06) N

Part 5.

Your personal information.

Your Name (family, given, middle)

Part 6.

Date of Birth (mm/dd/yyyy)

DOS Personal Identification # (PID)

For Official Use Only

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
With a numerical limit and this
numerical limit.
applicant is within the limit; and
As an applicant for status as a principal alien, I further
certify that he or she is being offered the position of:
Signature of Certifying Officer or Official

Based on principal alien's G-4 status
and was notified to the DOS on (date):

Printed Name

Official Seal

Name and Address of Diplomatic Mission, International Organization, NATO/HQ SACT or
NATO Member State
Duty/Title

Phone Number (include area code)

Date (mm/dd/yyyy)

Part 7. DOS, NATO/HQ SACT and/or USUN use only.
1. The Department of State, NATO/HQ SACT and/or USUN:
Recommends the request be granted.
Recommends the request be denied.
If the recommendation is for denial, provide a reason(s) for such recommendation:
2. Date (mm/dd/yyyy)

Phone Number (include area code)

3. Office:
Protocol

4. Signature 1

USUN

NATO/HQ SACT

Visa

Signature 2 (if required) or NATO Control # (if applicable)

Part 8. USCIS use only.
1. From:
Adjudicator's Identification #

USCIS Office

Office Phone Number (with area code)

A # / File #

2. To:
Protocol
USUN
NATO/HQ SACT
3. Request for Employment Authorization: Date of Decision (mm/dd/yyyy):

Valid to (mm/dd/yyyy):

Granted
Denied
4. Adjustment or Change of Status:

Date of Decision (mm/dd/yyyy)

If change of status granted, give new status:

Granted
Denied
5. Request for Extension of Stay:

Date of Decision (mm/dd/yyyy):

Granted
Denied
6. DOS/NATO/HQ SACT/USUN/Visa Office Notified:
Yes
No
Copy 1: USCIS

Copy 2: DOS/NATO/HQ SACT/USUN/VISA OFFICE

Classification:

Extension Granted To (mm/dd/yyyy):

Date of Notification (mm/dd/yyyy):
Form I-566 (Rev. 06/29/06) N Page 2